Scabies Outbreak in a Day-Care Center

Abstract

Scabies is a highly contagious condition characterized by cutaneous infestation with the human itch mite, Sarcoptes scabiei var. hominis. Although not a reportable disease, its prevalence has increased in the US since the mid-1970s.1-3 Worldwide, outbreaks have generally occurred in association with conditions of crowding, poor hygiene, or malnutrition.4,5 However, the current nationwide resurgence has affected persons from all socioeconomic levels without regard to age, sex, or personal hygiene.4,6 While scabies is primarily spread by intimate personal contact, skin-to-skin transmission can also occur after prolonged casual contact such as occurs in institutional settings, nursing homes, and day-care centers. Mites can survive for 2 to 3 days on inanimate surfaces, which permits transmission via fomites such as clothes, furniture, floors, and bed linens. Persons with chronic skin disorders are more likely to transmit the mite to others because their infestations may be more difficult to diagnose and treat. Exfoliation of skin flakes may enhance transmission. To our knowledge, there is no published account of a scabies outbreak in a day-care center. We describe an outbreak of scabies infestation in a hospital-affiliated child-care facility that ultimately involved the treatment of more than 600 people at a cost of more than $16 000 and took at least 4 months to eradicate. All of the childrens' parents were health-care workers at the nearby 1000-bed hospital, so there was potential for spread to patients and thus, a need for rapid control. Elimination of scabies within a day-care center may be particularly problematic unless a coordinated effort among staff, parents, and physicians can be established.