The United Kingdom is grappling with an unprecedented surge in scabies outbreaks, with cases doubling the seasonal average in November 2023 alone. While scabies is a common global affliction, the recent spike in the UK is raising concerns, and the root cause appears to be linked to treatment shortages.
Scabies is a skin infection caused by mites, ectoparasites that burrow under the skin and reproduce by laying eggs. Globally, there are approximately 450 million cases each year. Transmission occurs through close contact with an infected person or contact with contaminated bedding, clothes, or furniture. Symptoms, ranging from a subtle rash to severe itching, typically manifest one to six weeks after infection.
The Impact and Severity
In severe cases, known as crusted scabies, the rash becomes more pronounced, and the infection can lead to complications such as impetigo and even chronic kidney disease, especially in individuals with weakened immune systems. Scabies is prevalent in settings where people are in close contact for extended periods, such as schools, universities, prisons, and residential care homes.
The overcrowding factor exacerbates scabies outbreaks, making places like care homes particularly susceptible. Contact tracing is a crucial but resource-intensive measure to control outbreaks. Stigma surrounding the disease, often associated with uncleanliness, may deter individuals from seeking timely treatment.
Treatment Shortages Amplify Outbreaks
While scabies incidence may be higher in winter, the primary contributor to the recent surge in the UK is the shortage of key treatments. Since September 2023, both permethrin and malathion, commonly used to treat scabies, have faced supply issues, hindering the eradication of the mites. The shortage raises concerns about the continuous transmission of the infection among untreated individuals.
Ivermectin as a Viable Solution
In the face of treatment shortages, the UK Health Security Agency suggests considering ivermectin as an alternative. Although not licensed in the UK for scabies treatment, it is recommended by the World Health Organization for its effectiveness and safety. While initially in the spotlight during the COVID-19 pandemic, ivermectin has proven to be a valuable anti-parasitic drug with potential applications in managing scabies outbreaks.
To reduce the risk of scabies transmission, individuals with symptoms should promptly seek medical attention. Washing clothes and bedding at temperatures of 60°C or higher is recommended, and items that cannot be laundered should be sealed in plastic bags for at least four days. Early diagnosis and treatment are crucial to bringing scabies outbreaks under control.
As the UK faces an unusually high number of scabies outbreaks, treatment shortages emerge as a critical factor. The scarcity of essential medications like permethrin and malathion raises concerns about the prolonged suffering of infected individuals and the heightened risk of transmission. Exploring alternative treatments, such as ivermectin, could offer a solution to mitigate the impact of supply issues. Urgent measures, including increased medication supply and broader consideration of effective medicines, are necessary to curb the escalating scabies crisis in the United Kingdom.