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• W2892992013 abstract "Duncan Mara criticises our study1Cassell JA Middleton J Nalabanda A et al.Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes.Lancet Infect Dis. 2018; 18: 894-902Summary Full Text Full Text PDF PubMed Scopus (68) Google Scholar for not investigating whether scabies transmission in UK care homes is caused by inadequate washing of residents, and remarks on the absence of discussion of a supposed “water-washed transmission route” of scabies in the wider literature. The sole reference Mara gives for this claimed transmission route is Drawers of Water: Domestic Water Use in East Africa,2White GF Bradley DJ White AU Drawers of water: domestic water use in East Africa. University of Chicago Press, Chicago1972Google Scholar in which scabies is classified as one of the “water-washed diseases”: “infections that decrease as a result of increasing the volume of available water”. However, its authors offer no citations or biological mechanism to substantiate this categorisation of scabies. Although one table states that an 80% reduction in scabies morbidity could be expected from water supply improvement, the authors themselves say this is “largely guesswork”. By contrast, multiple studies indicate that scabies prevalence is probably not influenced by personal washing,3Walton SF Currie BJ Problems in diagnosing scabies, a global disease in human and animal populations.Clin Microbiol Rev. 2007; 20: 268-279Crossref PubMed Scopus (274) Google Scholar, 4Mellanby K Scabies. E W Classet Ltd, Hampton1972: 49Google Scholar, 5Kouotou EA Nansseu JRN Sangare A et al.Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon.Australas J Dermatol. 2018; 59: e6-e10Crossref PubMed Scopus (7) Google Scholar including the observation that some coastal peoples with rigorous hygiene and access to water nevertheless have high prevalence of scabies.3Walton SF Currie BJ Problems in diagnosing scabies, a global disease in human and animal populations.Clin Microbiol Rev. 2007; 20: 268-279Crossref PubMed Scopus (274) Google Scholar In trials of the effect of bathing, intentionally infested individuals either had baths daily or none for up to 2 months. The rate of increase in number of egg-laying female mites did not differ between groups,4Mellanby K Scabies. E W Classet Ltd, Hampton1972: 49Google Scholar which is unsurprising since they live in burrows under the skin surface.3Walton SF Currie BJ Problems in diagnosing scabies, a global disease in human and animal populations.Clin Microbiol Rev. 2007; 20: 268-279Crossref PubMed Scopus (274) Google Scholar Vigorous use of a scrubbing brush sometimes removed them, but only when violent enough to draw blood4Mellanby K Scabies. E W Classet Ltd, Hampton1972: 49Google Scholar; more extreme than the “NHS-clean” requirements that Mara suggests could reduce transmission, or development of crusted scabies. This view might arise from a misconception that what is virucidal or bactericidal will be effective against mites. In experiments, hand-washing and alcohol handrubs have not reduced Sarcoptes scabiei number or viability.6Cinotti E Perrot JL Labeille B et al.Inefficacy of alcohol-based hand rub on mites in a patient with hyperkeratotic scabies.Clin Exper Dermatol. 2015; 40: 177-181Crossref PubMed Scopus (9) Google Scholar Mara criticises the term outbreak, suggesting that in care homes “the disease might be endemic”, and what is pertinent is what causes escalation to crusted scabies. However, crusted cases were only diagnosed in a minority of outbreaks, and S scabiei cannot live long off-host,3Walton SF Currie BJ Problems in diagnosing scabies, a global disease in human and animal populations.Clin Microbiol Rev. 2007; 20: 268-279Crossref PubMed Scopus (274) Google Scholar so could only be endemic in a home within residents or staff. Mara implies this is an undetected, normal state of affairs. This seems unlikely to us because contact rates would result in multiple cases, including among staff. Mara suggests using “ethically placed hidden cameras” to determine how often residents are bathed. We cannot imagine how to predict in which homes to place cameras before outbreaks. More importantly, care homes are homes, so it is unlikely such invasive data collection would be approved by a UK ethics committee. More scabies research is needed. Proposals should include biologically plausible justifications of mechanism, and methods that respect participant autonomy. Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomesClinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia. Full-Text PDF Open AccessScabies control: the forgotten role of personal hygieneIn 1972, David Bradley published his environmental classification of water-related diseases.1 The second of his four categories comprises the so-called water-washed diseases, which are diseases related to the quantity (ie, volume) of water, irrespective of its quality, used by an individual consumer. Thus, in water-scarce areas where water consumption is often less than 20 L per person per day in developing countries, these water-washed diseases comprise faeco-oral diseases (such as rotavirus and norovirus diarrhoea, campylobacteriosis, cryptosporidiosis, and ascariasis) and skin and eye diseases (such as scabies and trachoma). Full-Text PDF" @default.
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• W2892992013 title "Scabies control: the forgotten role of personal hygiene – Authors' reply" @default.
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