Scabies outbreaks in Ireland – advice for the public and health and care professionals
There was an increase in the number of scabies outbreaks in Ireland in 2023, with 26 reported compared to nine in 2022. As of February 15th, 2024, an additional eight outbreaks have been notified in 2024. Outbreaks have occurred in a variety of settings. In 2023, most were reported in places where people are grouped together, including nine in nursing homes and eight in residential institutions. Three outbreaks were 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.
What is scabies?
Scabies is a very common itchy skin condition caused by a tiny mite. Anyone of any age can get scabies. It can spread easily from person to person through skin-to-skin contact, including during sexual contact. It is not caused by poor hygiene. Once infected, it can take three to six weeks for symptoms to occur and can spread to others during this time. It usually starts with itching, which can affect the whole body, and can be worse at nighttime. A rash can also be present in affected areas of skin; it may be seen in skin folds, for example between fingers and toes.
A less common variant of scabies is crusted scabies. It is highly contagious. Crusted scabies is more likely to affect elderly people or individuals with a poor immune system or mobility issues.
Is scabies a serious condition?
No, scabies is not usually a serious condition, but it does require correct management to cure and prevent further spread. Normal washing or washing/showering with disinfectant does not prevent or treat scabies.
What to do if you think you have scabies
Seek advice from your GP or pharmacist. They can provide you with skin creams and information on steps needed to treat and get rid of the infection.
How is scabies treated?
- 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 household members you have close personal contact with, 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 in a minimum 50 degrees Celsius wash cycle or put in a tumble dryer for 30 minutes at a minimum of 50 degrees Celsius to destroy mites. Alternatively, items can also be sealed in a plastic bag for four days. These may include items which have been exposed to prolonged direct contact with the skin, for example shoes, coats, hats, soft toys and removable covers of child car seats and buggies. Other items, such as mattresses and car seats, which have had prolonged direct contact with skin can be vacuumed.
- 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 four 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://www.hpsc.ie/a-z/other/scabies/
Advice for health and care 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.
- For further advice on Infection, Prevention and Control measures when managing cases of scabies please see the “Scabies Expert Advisory Group report of consensus on clinical, environmental, infection prevention and control, and contact tracing parameters for scabies”.
- Seek specialist advice from dermatology when treating children under two 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.