Scabies outbreak management in a vulnerable elderly population: Evidence from northeastern Iran

Infestation with Sarcoptes scabiei is a highly contagious, neglected tropical disease affecting vulnerable individuals in institutional settings. The present study described an outbreak at a 24-h elderly care facility in northeastern Iran with emphasis on clinical characteristics, management, and long-term consequences. From December 22, 2023, to February 21, 2024, 24 elderly participants and 13 participating staff members were screened after an index case was diagnosed with Norwegian scabies. The attack rate among residents was 16.7% (4/24; 95% CI 6.7-35.9%), while no staff members were laboratory-confirmed positive (0/13; 95% CI 0-22.8%). The latter diagnosis was performed for the elderly and staff based on the 2020 International Alliance for the Control of Scabies (IACS) criteria and confirmed by microscopic examination. Treatment included 5% permethrin cream and oral ivermectin, both repeated at one-week intervals, whereas unaffected individuals received permethrin prophylaxis. Environmental control strategies, including hot laundering, vacuuming, and isolation, were employed. Four cases were identified, including one of crusted scabies and three of ordinary scabies; all affected individuals were female. Complete recovery occurred within 8 to 19 days, with no new cases reported during the one-year follow-up. The outbreak was effectively managed by taking advantage of early diagnosis, combined therapy, prevention, and environmental measures. The current study highlighted the necessity of complex protocols in nursing homes and similar centers to control scabies in low-endemic areas.