IAS Gyan

Daily News Analysis

SCABIES

2nd November, 2023 Health

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Context: Malawi is experiencing a scabies outbreak, with 4,152 cases reported in the past week, highlighting the highly contagious nature of the disease transmitted through skin-to-skin contact and causing intense skin irritation and discomfort.

Details

  • The outbreak comes just months after a cholera outbreak in Malawi, which killed over 1,800 people and affected a total of 58,982 people in August.
  • Hospitals in Malawi are struggling to cope with the influx of scabies cases, and there is a shortage of medicine to treat the disease.
  • Health experts believe the outbreak may be linked to the climate crisis, as the current heatwave, high humidity, and water shortages in Malawi make people more vulnerable to disease outbreaks.
    • WaterAid Malawi reports that a significant portion of the country's population, about one in three people, lacks access to clean water, and poor sanitation.
    • The Intergovernmental Panel on Climate Change's sixth assessment report suggests that climate risks are manifesting faster than previously anticipated, and about 3.6 billion people live in areas highly affected by climate change.
    • Low-income countries and small island developing states, despite contributing minimally to global emissions, experience the most severe health impacts of climate change, with a death rate from extreme weather events in vulnerable regions 15 times higher than in less vulnerable ones.
  • Public health experts in Malawi stress the need for more efforts to address the impact of the climate crisis on health and to take climate change negotiations seriously.

Malawi

‚óŹMalawi is a landlocked country in southeastern Africa. It is bordered by Tanzania to the north, Zambia to the west, Mozambique to the south and east, and Lake Malawi to the east.

‚óŹIt is known for its diverse landscape, which includes mountains, plateaus, valleys, and lakes.

‚óŹIt is heavily dependent on agriculture, which accounts for about 30% of GDP. Malawi is also a major producer of tobacco, tea, and sugar.

‚óŹMalawi is one of the countries most vulnerable to the impacts of climate change. The country is already experiencing more extreme weather events, such as droughts, floods, and cyclones. These events are having a devastating impact on agriculture, food security, and health.

‚óŹThe scabies outbreak that is currently happening in Malawi is a clear example of how the climate crisis is impacting human health. The heatwave, high humidity, and water shortages across the country are making people more vulnerable to disease outbreaks.

Scabies

  • Scabies is a parasitic infestation caused by tiny mites that burrow into the skin, leading to itching, a rash, and potential complications.

Causes and Transmission

‚óŹScabies is caused by infestation with the Sarcoptes scabies mite. These mites burrow into the top layer of the skin, where they lay eggs and cause an allergic reaction, leading to intense itching and a rash.

‚óŹScabies is highly contagious and spreads through close skin-to-skin contact. It can also spread through infected personal items such as clothing and bedding. Individuals with crusted scabies are particularly infectious.

Global Burden

‚óŹScabies is prevalent worldwide but is particularly common in low-income tropical areas. It affects over 200 million people at any given time and more than 400 million people cumulatively every year.

‚óŹChildren and older people in resource-poor areas are at higher risk. Prevalence among children in these settings can vary from 5% to 50%.

Complications

‚óŹScabies can lead to various complications, including skin sores and serious conditions such as kidney disease, heart disease, and septicaemia (bloodstream infection).

Symptoms

‚óŹCommon Symptoms typically include severe itching, especially at night, linear burrows, and papules on the skin. Infants and small children might develop a more widespread rash, including on palms, soles of feet, ankles, and scalp.

Crusted Scabies

‚óŹCrusted scabies is a severe and highly infectious form of scabies. It involves a large number of mites (thousands or millions) and can cause dry, scaly areas on the skin. Interestingly, it might not cause itching in affected individuals.

‚óŹCrusted scabies can easily spread and cause secondary infections. It is life-threatening and requires intense treatment with both topical and oral medications.

Diagnosis and Clinical Features

‚óŹScabies is diagnosed based on clinical recognition of typical features.

‚óŹVisual imaging techniques and microscopy of skin scrapings can support the diagnosis but are not always necessary, especially in highly endemic areas.

‚óŹPatients typically present with severe itch, linear burrows, and papules around finger webs, wrists, upper and lower limbs, and belt area.

‚óŹIn infants and small children, the rash might be more widespread, including involvement of palms, soles of feet, ankles, and sometimes the scalp.

Treatment

‚óŹCommon topical treatments include 5% permethrin cream, 0.5% malathion in aqueous base, 10–25% benzyl benzoate emulsion, and 5–10% sulphur ointment.

‚óŹIvermectin taken orally is also highly effective but should not be taken by pregnant women or children weighing less than 15 kg.

‚óŹTreatments do not kill the parasite's eggs, so treatment needs to be repeated to kill newly hatched mites.

‚óŹAll household members should be treated to prevent the spread, even if they don't show symptoms.

Prevention and Disease Control

‚óŹPrevention involves avoiding skin-to-skin contact with infected individuals, washing and drying infested bedding and clothing in hot water, and cleaning living spaces thoroughly after treatment.

‚óŹMass Drug Administration (MDA) strategies are used in areas with high prevalence (10% or greater) to control scabies. Ivermectin and topical agents like permethrin 5% cream are administered. Ongoing research is exploring the effectiveness of one dose of treatment for MDA.

WHO Response and Global Targets

‚óŹScabies is recognized as a Neglected Tropical Disease (NTD) by the WHO. WHO's 2030 global targets include incorporating scabies management into universal health coverage and conducting MDA interventions in endemic areas (prevalence of 10% or greater).

‚óŹWHO collaborates with member states and partners to develop control strategies and outbreak response plans. Research efforts are ongoing to refine guidelines and strategies, especially in low-prevalence areas.

Challenges and Outbreaks

‚óŹOutbreaks can occur in closed institutional settings and open community settings, with refugee or internally displaced person camps being particularly high risk due to overcrowding.

‚óŹOutbreaks can be difficult to control, and general principles include surveillance, early confirmation of outbreaks, and involvement of public health experts.

Conclusion

  • Scabies is a widespread and challenging health issue, especially in resource-poor tropical areas. Its control involves prompt and comprehensive treatment, preventive measures, and ongoing research efforts to refine strategies and guidelines. WHO plays a crucial role in global efforts to manage and control scabies, especially in high-prevalence regions.

Must Read Articles:

Neglected Tropical Diseases: https://www.iasgyan.in/blogs/neglected-tropical-diseases

PRACTICE QUESTION

Q. How does climate change influence the occurrence and distribution of disease outbreaks, and what are some specific examples of diseases that have been impacted by changes in climate patterns?