Impact of an Ivermectin mass drug administration on scabies prevalence in a remote Australian Aboriginal community

Background: Scabies is endemic in many Aboriginal and Torres Strait Islander communities, with 69 of infants infected in the first year of life. We report the outcomes against scabies of two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community. Methods: Utilizing a before and after study design, we measured scabies prevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined disease acquisition and treatment failures. Scabies infestations were diagnosed clinically with additional laboratory investigations for crusted scabies. Non-pregnant participants weighing =15 kg were administered a single 200 ?g/kg ivermectin dose, repeated after 2?3 weeks if scabies was diagnosed, others followed a standard alternative algorithm. Principal Findings: We saw >1000 participants at each population census. Scabies prevalence fell from 4 at baseline to 1 at month 6. Prevalence rose to 9 at month 12 amongst the baseline cohort in association with an identified exposure to a presumptive crusted scabies case with a higher prevalence of 14 amongst new entries to the cohort. At month 18, scabies prevalence fell to 2 . Scabies acquisitions six months after each MDA were 1 and 2 whilst treatment failures were 6 and 5 respectively. Conclusion: Scabies prevalence reduced in the six months after each MDA with a low risk of acquisition (1?2 ). However, in a setting where living conditions are conducive to high scabies transmissibility, exposure to presumptive crusted scabies and population mobility, a sustained reduction in prevalence was not achieved. Clinical Trial Registration: Australian New Zealand Clinical Trial Register (ACTRN?12609000654257).