The media is always reporting doom and gloom from around the world, but in this blog I want to share some wonderful news with you. Australian researchers have been awarded AU$10 million to lead a global program to wipe out scabies – the human parasite linked to severe skin infections, blood poisoning, kidney failure and heart disease.
The money comes from the Macquarie Group’s 50th anniversary philanthropic fund to address social need. The Macquarie Group is an Australian multinational independent investment bank and financial services company. It employs more than 14,000 staff in 25 countries and has around $495 billion in assets. All up it gave $50 million to five social needs projects.
World Scabies Elimination Program
The Murdoch Children’s Research Institute will use its $10 million to establish the first World Scabies Elimination Program.
Sarcoptes scabiei, the mite that causes scabies, is tiny, growing to less than half a millimetre. But these mites make hundreds of millions of people very unhappy. Named after the Latin ‘scabo’ (to itch), the mites burrows under the upper layer of the skin and cause ‘traumatic itching’ – an irritation so severe people cannot sleep and may scratch until they bleed.
Professor Andrew Steer, Infection and Immunity director at the Murdoch Children’s Research Institute (MCRI), has co-authored multiple papers on scabies control. He describes the contagious disorder as a ‘disease of inequity with the greatest impact on disadvantaged children’.
“It is widespread in low-income communities, including in Aboriginal communities and the South Pacific. The mites thrive in hot crowded conditions – schools, villages, refugee camps and prisons.”
Transmitted by skin-to-skin contact
The mites are transmitted by skin-to-skin contact with another infected individual. Most people with scabies carry small numbers of only ten mites (around six to 10), but some people become covered with thousands to millions of mites and develop a rare variant of the condition called ‘crusted scabies’.
“People with compromised immune systems are especially vulnerable to crusted scabies,” says Prof Steer. “It is a severely disabling and stigmatising condition and sometimes even fatal .”
The scratching caused by the scabies itch often results in the skin being breached leading in turn to bacterial skin infection (impetigo, also known as school sores), which can be further complicated by more severe skin infections and potentially diseases of internal organs such as rheumatic heart disease and chronic kidney disease. An estimated 455 million cases of scabies occur annually and around 200 million people are affected at any time.
Australia and the Pacific pioneer new treatment
Australian and Pacific researchers have conducted trials to show it is possible to dramatically cut community rates of scabies infestations with mass drug administration – whereby every person in an affected community takes medication, regardless of whether they have symptoms of scabies. In these trials, ral ivermectin is given to most people, while pregnant women and children under five years of age are given a skin cream treatment. Ivermectin, effective against many human parasites, is a World Health Organization ‘Essential Medicine’, meaning it’s accredited internationally as a highly effective and safe medication. Its creators received the 2015 Noble Prize for Medicine.
The world's first comparative trial of mass drug administration against scabies, was led by MCRI, the Fiji Ministry of Health and Medical Services and the Kirby Institute (University of New South Wales). Everyone on one remote Fijian island participated in the ivermectin-based mass drug administration, and compared to people on other islands, in 2013.
“A year later, the scabies infection rate in the ivermectin island was down from 32 per cent to 1.9 per cent – a 94 per cent decrease,” says lead researcher, Dr Lucia Romani from the Kirby Institute. The latest findings (two years after the treatment) put the infection rate still very low at 3.6 per cent – down 89 per cent on the original rate from just that single treatment in 2013.
Scabies mass drug administration for 135,000 now underway
Over the next two months, MCRI, the Fiji Ministry of Health and the Kirby Institute will coordinate a scabies mass drug administration of 135,000 people in Fiji’s Northern Division.
“The infection rate is high among children, who often pick up mites from their friends,” says Dr Mike Kama, scabies expert at the Fiji Ministry of Health. “Then they scratch all night, interrupting their sleep, and struggle to concentrate in class during the day. Often the scratching leads to impetigo and the children have to stay away until they clear up, so they miss out on more school.”
Dr Kama says the economic impact of scabies is severe, with infestations causing people to miss school and work.
“How can you put a dollar figure on the anguish scabies causes? It can disfigure. This and the itching hurts mental health. The mass drug administration in Northern Region will deliver countless benefits to the community.”
Treating multiple diseases simultaneously delivers value for money
Researchers have also managed to integrate scabies control with mass drug administration for other infectious diseases. In 2015, Australian and Pacific researchers ran mass drug co-administration for over 26,000 people in the province of Choiseul in the Solomon Islands, using ivermectin and azithromycin to targeted scabies and trachoma (an eye infection linked to blindness). A year later scabies infections were down 90 per cent, and impetigo had decreased by 74 per cent.
“There are massive efficiencies and cost-savings for health workers treating multiple diseases. The drugs are cheap, and major expense is getting out to people in remote settings, so if you can combine, you are effectively getting double the bang for their buck” says Prof Steer. “It’s also much better for communities to be served by an integrated approach.”
The Fiji Northern Division scabies mass drug administration is targeting three diseases: scabies, intestinal worms and lymphatic filariasis (which causes blockage of the lymphatic system and leads to irreversible fluid build up and swelling in extremities, especially the limbs and genitals).
Experts call for global control strategy
In a recent Lancet paper, Dr Daniel Engelman (from MCRI and UOM) and co-authors from around the world outlined actions needed to develop a global scabies control program.
Working with the International Alliance for the Control of Scabies, the World Health Organization and national Ministries of Health, Dr Engelman and colleagues identified recording the global patterns of scabies as a key challenge.
“Many countries have no data as there is no blood test or standardised way to diagnose scabies. It can be diagnosed by viewing skin scrapings under a microscope, but it is usually detected through examination of the skin.”
Dr Engelman believes infection rates are also influenced by changing climate and socio-political conditions.
“An outbreak began in 2015 in the Amhara region of Ethiopia following a severe drought and has affected more than one million people.”
More affordable and reliable treatments needed
The Lancet paper calls for more support for affordable and reliable treatments in affected countries, scaling-up effective interventions such as mass drug administration in close cooperation with health workers and impacted communities.
Dr Engelman endorses the Australian and Pacific research co-ordinating mass drug administrations with health workers in Fiji and the Solomon Islands.
“By working towards the elimination of scabies in the Pacific, Australia is supporting the health and wellbeing of its closest neighbours and contributing to the world fight against neglected tropical diseases.”
Fiji and the Solomon Islands are among the world’s most affected countries, and will also be pilot countries for the very new World Scabies Elimination Program. The entire populations of both countries, around 1.5 million people will be treated as part of this new program.
Just think what a big difference this program will make to people’s lives.
I wish the health workers of Australia and the Pacific all the best wiping out this terrible disease!
ABOUT PAT MESITI
Pat Mesiti is a best-selling author, coach and educator in the area of personal development. Having built some of Australia’s largest people-driven organisations, Pat understands the power of harnessing human potential. He has shared the stage with some of the world’s great business minds and has sold over millions of copies of his books and materials.