Scabies - Update on outbreaks notified in Ireland in 2023
An increase in the number of scabies outbreaks was seen in Ireland in 2023, with 27 reported compared to 9 in 2022. Outbreaks have occurred in a variety of settings. Most were reported in congregate settings, including 10 in nursing homes and 8 in residential institutions. Four outbreaks occurred in private households. HPSC does not collate information on individual cases of scabies. An increase in cases has been noted in other European countries in recent years.
Scabies is a very common itchy skin condition caused by a tiny mite. It can spread from person to person through skin-to-skin contact, including during sexual contact. Once infected, it can take 3 to 6 weeks for symptoms to occur and can spread to others during this time. It usually presents with itching, which can affect the whole body, and can be worse at nighttime. An associated rash can be present in affected areas of skin; in particular it may be seen in skin folds, for example between fingers and toes. Less commonly a variant of scabies known as crusted scabies can occur which is highly contagious. This is more likely to affect elderly people or individuals with a poor immune system or mobility issues.
Scabies is not usually a serious condition, but it does require correct management to cure and prevent further spread. If you think you have scabies, seek advice from your GP or pharmacist. They can provide you with skin creams and information around additional measures required to treat and clear the infection.
Key messages for the public:
- Anyone of any age can get scabies as it spreads very easily between people with skin-to-skin contact for greater than 5 to 10 minutes, including during sexual contact. It is not caused by poor hygiene.
- It is usually not a serious condition but does require correct management to cure and prevent further spread. Normal washing or washing/showering with disinfectant does not prevent or treat scabies.
- If you think you have scabies, seek advice from your GP or pharmacist and follow the treatment and management recommendations promptly.
- Scabies is usually treated with creams applied directly to the skin in addition to other measures. To ensure successful treatment it is essential that you apply the prescribed cream correctly following the manufacturer’s instructions and leave it on for the recommended duration of time. A second application is required one week later to complete the treatment.
- If you have scabies, it is possible that other household members and sexual contacts may also have it, even if they do not have symptoms. It is therefore important that all close personal household members and sexual contacts are informed and follow the same treatment and management recommendations that you have been advised at the same time, in order to successfully manage the infection and prevent re-infection or further spread.
- Following the first application of treatment, all clothing, bedding and towels should be washed at a high temperature to destroy mites. Alternatively, items that cannot be washed can be sealed in a plastic bag for at least 3 days. These may include items which have been exposed to prolonged direct contact with the skin, for example shoes, coats, hats and soft toys.
- Adults and children can return to school, creche or work 24 hours after the first application of cream.
- Itching may continue following treatment. Your GP or pharmacist may recommend treatments to help relieve the itching. Seek further medical advice if there is no improvement after 4 weeks following correct application of treatment and completion of other recommended measures, or if there are signs of a skin infection (skin may be red, sore or hot).
- If you have genital scabies then tests for other sexually transmitted infections (STIs) are recommended. Free STI testing is available at HSE public STI clinics and through the HSE home testing service
- For further information and advice visit:
https://www2.hse.ie/conditions/scabies/
https://www.hpsc.ie/a-z/other/scabies/
Key messages for healthcare professionals:
- Although individual cases of scabies are not notifiable, any outbreaks should be notified to the relevant Public Health HSE region. Information on how to notify outbreaks is available on the HPSC website. Seek further advice from public health when managing difficult-to-control or recurrent outbreaks.
- Visit https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/skin-soft-tissue/scabies/ for up to date guidance on recommended treatments for scabies. Due to intermittent shortages of topical treatments, three different options for topical treatment are recommended.
- Seek specialist advice from dermatology when treating children under 2 months of age and when managing cases of crusted scabies.
- True resistant scabies is uncommon. If treatment failure is suspected following the use of topical treatment, ensure that the correct treatment application has been carried out by cases and their household and sexual contacts and that bedding and clothing was correctly handled. Seek advice from dermatology or microbiology if treatment-resistant scabies is suspected.
- If a patient presents with genital scabies, please arrange routine STI testing, including chlamydia, gonorrhoea, syphilis and HIV.