GD11 Scabies in the Mid-West of Ireland: trends and practices in primary care

Abstract Scabies has a substantial global disease burden, and the World Health Organization formally designated it as a neglected tropical disease in 2017. Although the prevalence is highest in the tropics, there have been increasing outbreaks of scabies reported throughout the UK and Ireland. Studies focused on the practices of general practitioners (GPs) have identified a rise in cases of scabies, with varying treatment approaches, and reinfection or treatment failure rates as high as 25%. The research was conducted with the support of a Humes Street Grant. In our dermatology department in the Mid-West of Ireland, a retrospective review of outpatient and inpatient consultations for scabies over a 3-year period was conducted, sampling 6 months (July to December) in each year. The number of consultations for review of patients with scabies increased by 625% from 2021 to 2023. We surveyed GPs and GP trainees about their experiences managing patients with scabies. Prior to review by dermatology, 59% of referred patients were reported to already be treated, while only 32% reported to have close contacts treated. We surveyed GPs and GP trainees in Ireland (n = 49), of whom 80% agreed or strongly agreed that cases of scabies are increasing in their practice. While the majority of GPs, at 63%, saw one to two cases of scabies in their practice per month, a considerable number of GPs (31%) reported a higher rate, with some seeing 10 or more cases per month. Regarding practices on treating close contacts, 82% of GPs would treat asymptomatic household members and 61% would treat sexual contacts; however, only 41% stated they would treat extended contacts who have skin-to-skin contact. Only nine GPs (18%) reported treating all three categories of contacts. GPs expressed concern about asymptomatic contacts not following treatment advice, citing significant reinfestation rates among larger families, young adults and college students. Additionally, special situations were raised involving patients having difficulty in effectively following decontamination advice due to complex living situations. This could be due to reasons of lower socioeconomic status or asylum seekers living in emergency accommodation. Significant medication supply issues lasting for months at a time were also highlighted for 5% permethrin and ivermectin. The 625% rise in dermatology consultations for scabies management, and the rise in the number of cases GPs report managing in the community, reflect the difficulties they are experiencing managing scabies. Difficulties with treatment failure and difficulty sourcing treatment options are concerns. We have developed a scabies educational care bundle disseminated to GPs in our hospital group’s catchment area and plan to assess the impact of this on referral to dermatology services for scabies management.