Mass Drug Administration for the Control of Scabies: A Systematic Review and Meta-analysis.

Background: Scabies is a neglected tropical disease of the skin that can lead to impetigo, serious secondary bacterial infections and immune-mediated diseases. Mass drug administration (MDA) has been reported in several studies to reduce the prevalence of scabies and impetigo. We aimed to assess the efficacy of MDA for scabies on scabies and impetigo.
Methods: We conducted a systematic review and meta-analysis of reports on the impact of MDA on scabies and impetigo. We included randomized control trials and observational evaluations reported from January 1970 to April 2021 and involving human participants. We searched PubMed, Ovid Medline, Embase, and Cochrane. We considered MDA as treatment intended for the whole population, regardless of individual infection status or symptoms. The main outcome assessed was the change in scabies and impetigo prevalence following MDA. This review is registered with PROSPERO (CRD42020169839).
Results: We identified 1110 records, of which 11 met inclusion criteria for the review and 9 were deemed suitable for meta-analysis for scabies and 4 for impetigo. Most studies were in small populations. There was a high degree of heterogeneity between studies (I2 value 96.19%). The overall relative reduction of the impact of MDA on scabies prevalence was 79%. The effect size was comparable for MDA based on ivermectin and permethrin. MDA for scabies also led to a reduction in impetigo prevalence with a relative reduction of 66%.
Conclusions: MDA for scabies is highly effective in reducing the prevalence of scabies and impetigo. Further research is needed to determine the durability of impact, and the effectiveness of MDA regimens in larger populations.
Competing Interests: Potential conflicts of interest. D. E. reports being Chair for International Alliance for the Control of Scabies, a not-for-profit association, unpaid role. M. H. reports payments to the institution outside of the submitted work from Bill and Melinda Gates Foundation, Coalition for Operational Research on Neglected Tropical Diseases, funded at The Task Force for Global Health primarily by the Bill and Melinda Gates Foundation, by UK aid from the British Government, and by the US Agency for International Development through its Neglected Tropical Diseases Program, and Australian Centre for the Control and Elimination of Neglected Tropical Diseases, National Health Medical Research Council Centre for Research Excellence; and Ackman Travelling Scholarship from the University of Melbourne paid to self. S. L. reports stipend paid to self for Postgraduate Health Research Scholarship—Royal Children’s Hospital Melbourne, Australia outside of the submitted work. A. C. S. reports being Co-Director of the Australian Strep A Vaccine Initiative, funding the Australian Government, Co-Direction of the Strep A Global Vaccine Consortium, funding by the Wellcome Trust, grants or contracts from the Australian Government Medical Research Fund, and Wellcome Trust outside of the submitted work; participation on a DSMB for studies on moxidectin for scabies—Medicine Development for Global Health (no payments); and President of the Lancefield Society (no payments). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America.)