Scabies epidemiology in health care centers for refugees and asylum seekers in Greece
Authors: Louka Christina , Logothetis Emmanouil , Engelman Daniel , Logotheti Eirini Samiotaki , Pournaras Spyros , Stienstra Ymkje 
Published: January 2022

Background

Scabies is a global health concern disproportionally affecting vulnerable population such as refugees and asylum seekers. Greece is a main geographical point of entry in Europe for refugees, but epidemiological data on scabies in this population is scarce. We aimed to evaluate the epidemiology of scabies, including trends over the study period.

Methodology/Principal findings

Data were collected from June, 2016 to July, 2020, using the surveillance system of the Greek National Public Health Organization. Staff at health centers for refugees/asylum seekers compiled daily reports on scabies and other infectious diseases. Observed proportional morbidity for scabies was calculated using consultations for scabies as a proportion of total consultations.

There were a total of 13118 scabies cases over the study period. Scabies was the third most frequently observed infectious disease in refugees/asylum seekers population after respiratory infections and gastroenteritis without blood in the stool. The scabies monthly observed proportional morbidity varied between 0.3% (August 2017) to 5.6% (January 2020). Several outbreaks were documented during the study period. An increasing number of cases was observed from October 2019 until the end of the study period, with a peak of 1663 cases in January 2020, related to an outbreak at one center. Spearman correlation test between the number of reported scabies cases and time confirmed an increasing trend (ρ=0.67).

Conclusions/Significance

Scabies is one of the most frequently reported infectious diseases by health care workers in refugee/asylum seekers centers in Greece. Consultations for scabies increased over time and there were several outbreaks. The current surveillance system effectively detects new cases in an early stage. Public health interventions, including mass drug administration, should be considered to reduce the burden of scabies in refugee/migrant populations.

Author summary

Scabies is a skin disease caused by ectoparasitic mite Sarcoptes scabiei var. hominis. A person infected by scabies manifests symptoms like itching and skin rash, while the most complicated forms of the infection can lead to bacterial infections and sepsis. Scabies is a global health concern and as of 2017, it is officially included in the portfolio of conditions prioritized by the Department of Neglected Tropical Diseases, according to the World Health Organization. Furthermore, scabies can disproportionally affect vulnerable population, such as refugees and asylum seekers. Greece is one of the main points of entry in Europe for refugees. However, the prevalence of scabies amongst refugees in Greece has not been thoroughly investigated. In this study, we utilized data weekly reported within the epidemiological surveillance in refugees/asylum seekers centers of the Greek National Public Health Organization, in order to obtain a clear overview of scabies epidemiology and identify any trends over time. Our findings confirmed the high prevalence of scabies among refugees and identified a clear trend of significant increase over time. Further public health interventions, like mass drug administration could help restrain the dissemination of the disease and lower its burden among refugees.