Abstract:
Background: Scabies occurs worldwide with a prevalence between 0.3 and 46.0%. In Ghana, even though a 5.1%
proportion of scabies was reported in a retrospective review of skin diseases at the Korle Bu Teaching Hospital, the
nationwide prevalence of scabies is unknown. Overall, its burden is higher in tropical regions. Scabies outbreaks
mostly occur among children, the elderly in nursing homes, and prison inmates. Even though primary scabies
hardly results in mortalities, the pain, itch, and systemic complications from secondary bacterial infections account
for about 1.5 million years lived with disabilities. We investigated a scabies outbreak among school children in
Ghana to determine its magnitude, stop the outbreak, and institute preventive measures to minimize risks of future
outbreaks.
Methods: The investigation was conducted between March 14 and May 17, 2017 among pupils of Presbyterian
Secondary Staff Basic School in Accra. We defined a case as a school child who on clinical examination, had an
intensely pruritic rash on at least one typical predilection site with or without a burrow, or positive skin scrapings
on microscopy. We screened and line listed cases, performed laboratory investigations on skin scrapings and
wound swaps, and conducted an environmental assessment. We performed descriptive statistics on data, and
calculated attack rate ratios (ARR) at 95% confidence level.
Results: Of 823 preschool children screened, 92 were cases. Median age of cases was 4 years (range 2–7 years) and
their modal age was 3 years. The overall attack rate was 11.2% (92/823). The sex specific attack rate was 11.5% for
males, and 10.8% for females (ARR: 0.93; CI: 0.67–1.28). Compared with the least affected class (crèche), the nursery
one class was worst affected (ARR: 5.14; CI: 3.44–7.50). On microscopy, all skin scrapings were negative for scabies.
Staphylococcus aureus and Streptococcus spp. were isolated from secondarily infected scabies lesions.
Conclusions: A scabies outbreak with a propagated source occurred among preschool children. The 3-year-old
pupils were most affected. It was controlled by mass treatment with benzyl benzoate and health education.
Classrooms and sleeping mats were disinfected. We recommended the decongestion of classrooms and
discouraged sharing of sleeping mats.
