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Mass Drug Administration for Scabies Control in a Population with Endemic Disease

Romani, Lucia, Whitfeld, Margot J., Koroivueta, Josefa, Kama, Mike, Wand, Handan, Tikoduadua, Lisi, Tuicakau, Meciusela, Koroi, Aminiasi, Andrews, Ross M., Kaldor, John M. and Steer, Andrew C. (2015). Mass Drug Administration for Scabies Control in a Population with Endemic Disease. New England Journal of Medicine,373(24):2305-2313.

Document type: Journal Article
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IRMA ID 10444xPUB24
Title Mass Drug Administration for Scabies Control in a Population with Endemic Disease
Author Romani, Lucia
Whitfeld, Margot J.
Koroivueta, Josefa
Kama, Mike
Wand, Handan
Tikoduadua, Lisi
Tuicakau, Meciusela
Koroi, Aminiasi
Andrews, Ross M.
Kaldor, John M.
Steer, Andrew C.
Journal Name New England Journal of Medicine
Publication Date 2015
Volume Number 373
Issue Number 24
ISSN 0028-4793   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84949454497
Start Page 2305
End Page 2313
Total Pages 9
Place of Publication United States
Publisher Massachusetts Medical Society
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Scabies is an underrecognized cause of illness in many developing countries. It is associated with impetigo, which can lead to serious systemic complications. We conducted a trial of mass drug administration for scabies control in Fiji.

Methods
We randomly assigned three island communities to one of three different interventions for scabies control: standard care involving the administration of permethrin to affected persons and their contacts (standard-care group), mass administration of permethrin (permethrin group), or mass administration of ivermectin (ivermectin group). The primary outcome was the change in the prevalence of scabies and of impetigo from baseline to 12 months.

Results
A total of 2051 participants were enrolled; 803 were in the standard-care group, 532 in the permethrin group, and 716 in the ivermectin group. From baseline to 12 months, the prevalence of scabies declined significantly in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 36.6% to 18.8% in the standard-care group (relative reduction in prevalence, 49%; 95% confidence interval [CI], 37 to 60), from 41.7% to 15.8% in the permethrin group (relative reduction, 62%; 95% CI, 49 to 75), and from 32.1% to 1.9% in the ivermectin group (relative reduction, 94%; 95% CI, 83 to 100). The prevalence of impetigo also declined in all groups, with the greatest reduction seen in the ivermectin group. The prevalence declined from 21.4% to 14.6% in the standard-care group (relative reduction, 32%; 95% CI, 14 to 50), from 24.6% to 11.4% in the permethrin group (relative reduction, 54%; 95% CI, 35 to 73), and from 24.6% to 8.0% in the ivermectin group (relative reduction, 67%; 95% CI, 52 to 83). Adverse events were mild and were reported more frequently in the ivermectin group than in the permethrin group (15.6% vs. 6.8%).

Conclusions
Mass drug administration, particularly the administration of ivermectin, was efficacious for the control of scabies and impetigo. (Funded by the Australian National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12613000474752.)
DOI http://dx.doi.org/10.1056/NEJMoa1500987   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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