TY - JOUR
T1 - Scabies and risk of skin sores in remote Australian Aboriginal communities
T2 - A self-controlled case series study
AU - Aung, Phyo Thu Zar
AU - Cuningham, Will
AU - Hwang, Kerry
AU - Andrews, Ross M.
AU - Carapetis, Jonathan
AU - Kearns, Therese
AU - Clucas, Danielle
AU - McVernon, Jodie
AU - Simpson, Julie Ann
AU - Tong, Steven
AU - Campbell, Patricia Therese
N1 - Funding Information:
The project is partly supported by the National Health and Medical Research Council (NHMRC) grant #1098319. JMV is supported by an NHMRC Principal Research Fellowship (#1117140); ST is supported by a NHMRC Career Development Fellowship (#1145033); and JAS is supported by a NHMRC Senior Research Fellowship (#1104975). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would like to thank the Menzies School for Health Research and related project staff for providing the data from the EAHSP, staff at the primary health care centres and the members of the five remote indigenous communities for their participation. We acknowledge our partners in this work: Northern Territory Remote Health, Aboriginal Medical Services Alliance Northern Territory, Northern Territory Centre for Disease Control, One Disease and Miwatj Health, NHMRC HOT NORTH initiative, and the Lowitja Institute and the Cooperative Research Centre for Aboriginal Health who lent significant support to the EAHSP. We also thank Professor Bart Currie and Dr Erin McMeniman for their work on the original data collection and for their helpful comments.
Publisher Copyright:
© 2018 Aung et al. http://creativecommons.org/licenses/by/4.0/.
PY - 2018/7/25
Y1 - 2018/7/25
N2 - Background: Skin sores caused by Group A streptococcus (GAS) infection are a major public health problem in remote Aboriginal communities. Skin sores are often associated with scabies, which is evident in scabies intervention programs where a significant reduction of skin sores is seen after focusing solely on scabies control. Our study quantifies the strength of association between skin sores and scabies among Aboriginal children from the East Arnhem region in the Northern Territory. Methods and results: Pre-existing datasets from three published studies, which were conducted as part of the East Arnhem Healthy Skin Project (EAHSP), were analysed. Aboriginal children were followed from birth up to 4.5 years of age. Self-controlled case series design was used to determine the risks, within individuals, of developing skin sores when infected with scabies versus when there was no scabies infection. Participants were 11.9 times more likely to develop skin sores when infected with scabies compared with times when no scabies infection was evident (Incidence Rate Ratio (IRR) 11.9; 95% CI 10.3–13.7; p<0.001), and this was similar across the five Aboriginal communities. Children had lower risk of developing skin sores at age ≤1 year compared to at age >1 year (IRR 0.8; 95% CI 0.7–0.9). Conclusion: The association between scabies and skin sores is highly significant and indicates a causal relationship. The public health importance of scabies in northern Australia is underappreciated and a concerted approach is required to recognise and eliminate scabies as an important precursor of skin sores.
AB - Background: Skin sores caused by Group A streptococcus (GAS) infection are a major public health problem in remote Aboriginal communities. Skin sores are often associated with scabies, which is evident in scabies intervention programs where a significant reduction of skin sores is seen after focusing solely on scabies control. Our study quantifies the strength of association between skin sores and scabies among Aboriginal children from the East Arnhem region in the Northern Territory. Methods and results: Pre-existing datasets from three published studies, which were conducted as part of the East Arnhem Healthy Skin Project (EAHSP), were analysed. Aboriginal children were followed from birth up to 4.5 years of age. Self-controlled case series design was used to determine the risks, within individuals, of developing skin sores when infected with scabies versus when there was no scabies infection. Participants were 11.9 times more likely to develop skin sores when infected with scabies compared with times when no scabies infection was evident (Incidence Rate Ratio (IRR) 11.9; 95% CI 10.3–13.7; p<0.001), and this was similar across the five Aboriginal communities. Children had lower risk of developing skin sores at age ≤1 year compared to at age >1 year (IRR 0.8; 95% CI 0.7–0.9). Conclusion: The association between scabies and skin sores is highly significant and indicates a causal relationship. The public health importance of scabies in northern Australia is underappreciated and a concerted approach is required to recognise and eliminate scabies as an important precursor of skin sores.
UR - http://www.scopus.com/inward/record.url?scp=85051288525&partnerID=8YFLogxK
U2 - 10.1371/journal.pntd.0006668
DO - 10.1371/journal.pntd.0006668
M3 - Article
C2 - 30044780
AN - SCOPUS:85051288525
SN - 1935-2727
VL - 12
JO - PLoS Neglected Tropical Diseases
JF - PLoS Neglected Tropical Diseases
IS - 7
M1 - e0006668
ER -
