After the cases of Cavagnolo primary school and of Isaac Newton high school in Chivassowhere suspicions of scabies were reported with the infection of two pupils, we asked the ASL To 4 for information on the measures to be taken to avoid contagion.
He replied to us Dr. Piergiorgio Bertucciinfectious disease doctor Service of Hygiene and Public Health (SISP) of the local health company To4.
Doctor Bertucci, what are the initial symptoms of scabies and how can you recognize it?
Human scabies is a parasitic skin disease caused by a mite (Sarcoptes scabiei variant hominis) whose presence is indicated by the presence of papules, vesicles or small linear burrows. It is characterized by intense itching, especially at night. Itching is the “key” symptom and can be present even in the absence of particular skin signs.
How does scabies spread in schools and how easy is it to transmit it?
Scabies caused by the mite Sarcoptes scabiei var. hominis affects only humans. The transmission of parasites occurs by direct skin-to-skin contact or indirect: transmission through linen and sheets occurs if these effects have recently been contaminated by an infested person. The mite, if it is not in contact with the skin, does not live more than 3-4 days.
What prevention measures can parents and teachers take to limit the spread of scabies?
Primary prevention consists of health education on the modes of transmission in order to prevent infestation.
When the infestation is present:
- With respect to the affected person: remove the student from school attendance until the day following the start of the specific treatment: in practice, the person with scabies must be placed in contact isolation if possible until the day following the start of the treatment.
- With regards to cohabitants and contacts one should:
– Look for other cases of infestation.
– Treat family members and contacts for preventive purposes tightsymptomatic or not. Each case must be treated following the instructions of the doctor or specialist (dermatologist, hygienist, infectious disease specialist). The medicine for the treatment of scabies must be prescribed by such professionals.
It is essential that treatments are conducted in a coordinated manner ensuring the precise execution of each prescription.
Doctor Piergiorgio Bertucci, infectious disease doctor at ASL To 4
Can scabies cause serious complications or is it always manageable with standard treatments?
Complications can occur especially in immunosuppressed subjects; in particular, bacterial superinfections can occur especially following scratching injuries. This is unlikely to happen if the treatment instructions are followed.
How is scabies treated and how long does it take for complete recovery?
Given that the treatment must be prescribed by the doctor, it is generally prescribed with both topical drugs (ointments/creams) and systemic drugs (drugs taken orally), but naturally the therapeutic management can vary depending on the person concerned and the clinical presentation , more or less important.
A rigorous execution of the treatment and a strict control of the same are necessary: 7-10 days after the treatment, it is necessary to carry out a new control visit of the identified cases and the identification of any secondary cases, also to verify the need for a second treatment, often necessary to eliminate any new larvae, considering that anti-scabies drugs do not have good ovicidal activity (they do not kill the mite eggs).
It is essential that treatments are conducted in a coordinated manner ensuring the precise execution of each prescription.
Are there at-risk groups who could develop more severe forms of scabies?
Certainly there are categories at greater risk, first and foremost, immunosuppressed people (for example, due to illnesses or certain immunosuppressive pharmacological treatments, such as some types of chemotherapy). Obviously, those who, for one reason or another, do not access the appropriate treatments could (but it is not certain) develop more advanced forms.
How can schools manage confirmed cases of scabies and what measures should be taken to contain an outbreak?
The affected individual should refrain from attending school until the day following the start of treatment.
It is advisable to carry out a check-up visit to pupils and teaching staff of the same class (as well as obviously to close contacts) and carry out specific treatment of the cases found as well as evaluate the preventive treatment of those who have had close contact with the affected person.
In the environment, mites usually do not survive longer than 48-72 hours and die rapidly if exposed to a temperature of 50°C for 10 minutes. Normal cleaning and disinfection of school environments is usually sufficient to guarantee the limitation of indirect infections.
Can scabies be diagnosed quickly? Are specific tests necessary to confirm the diagnosis?
The most important element for scabies to be diagnosed quickly is to raise suspicion: in case of intense itching (especially at night, but not only) it is advisable to have the symptomatic person checked.
Often a pimple-like (papular) rash may be present. The most affected areas are the wrist, the creases between the fingers, the elbow, the armpit, the nipple, the penis, the groin, the waist, the periumbilical area, the waist line and the buttocks. The rash may also include tiny blisters and scales. Scratching the rashes can cause irritation; these lesions sometimes become infected by bacteria. Therefore, the diagnosis of scabies is mainly based on the signs and symptoms (clinical observation of any skin lesions and – as the main symptom – the reported itching).
What should parents do if their children suspect scabies?
Parents should notify the family doctor or pediatrician to check their patients and prescribe the appropriate treatment (including preventative treatment, for family contacts). Obviously they should pay attention to contact with the lesions or in any case with the skin of those for whom there is certainty or strong suspicion of scabies and in close contact with the affected person.
CHow is the hygiene of objects and spaces frequented by infected people managed?
Standard cleaning and disinfection of environments is generally sufficient, except in cases where there are very severe manifestations of the disease (“Norwegian” scabies, for example, a very important form which however mostly affects immunosuppressed subjects). Especially in the case of severe scabies (crusted or Norwegian scabies) it is recommended to carefully vacuum furniture and carpets in the rooms used by these people, or to use steam jet equipment (which are however useful at home, where, at unlike, for example, school environments, furniture – armchairs or sofas – and any carpets may not be easily washable).
Obviously, avoid exchanging clothes between different people or reusing the same clothes after carrying out the treatment, without first having subjected them to suitable washing.
Washing sheets and clothing carefully is very important: sheets and clothing of affected people should be washed at temperatures above 60°C; items that cannot be washed at high temperatures should be closed in nylon bags for at least three days up to a week.
Can scabies leave long-term effects or scars on the skin?
Skin lesions may remain in the case of severe forms of scabies (crusted or norwegian), but above all in the case of secondary skin infections, if not adequately treated, but the lesions practically always heal after a variable amount of time. No other long-term effects are known although the psychological impact can cause “phantom” symptoms (feeling of itching even weeks after recovery) and a feeling of discomfort.
