Control of scabies in endemic areas: Is mass drug administration the solution?

This study reports a comparative randomized trial, the Skin Health Intervention Fiji Trial (SHIFT), conducted in the island communities in Fiji in 2012. The authors aimed to determine the change in prevalence of scabies and impetigo from baseline after 12 months of treatment with three different regimens. Three island communities (2051 participants) in Fiji were randomly assigned to one of three treatment regimens: standard care with topical permethrin cream to affected patients and their contacts (803 patients), mass administration of topical permethrin cream 5% (532 participants) and mass administration of oral ivermectin (716 participants). Of the 716 participants in the community randomized to receive ivermectin, 93 had contraindications to the use of the drug (mainly, children below 5 years of age and pregnant and lactating mothers) all of whom received topical permethrin. There was a significant decline in the prevalence of scabies at the end of 12 months in all three communities. The relative reduction in the prevalence of scabies was 94% in the ivermectin group as compared with 62% in the permethrin group (p<0.001) and 49% (95% CI 37%–60%) in the standard care group (p<0.001). The difference between the permethrin and standard care groups was not significant. In addition, there was a reduction in the prevalence of impetigo by 67% in the ivermectin group compared with 54% in the permethrin group and 32% in the standard care group (p=0.05 for comparison with the ivermectin group). The difference between the permethrin and standard care groups was not significant for this outcome, either. Mild adverse events were noted in the permethrin and ivermectin groups (15.6% and 6.8%, respectively). Itching was the most common event (affecting 5.3% and 3.6% of participants in the ivermectin and permethrin groups, respectively), followed by headache (affecting 3.8% and 0.9%, respectively). The authors concluded that mass drug administration, particularly ivermectin, is efficacious for the control of scabies and impetigo.