Poster presentationsGD05 Managing scabies fomites: an analysis of current guidelines and recommendations
Authors: Kemi Fabusiwa, Rebecca McCarthy, Stephen Walker
Journal: British Journal of Dermatology (2024)

Abstract Scabies, a disease caused by the Sarcoptes scabiei var. hominis mite, is a significant global public health issue. It disproportionately affects the most vulnerable members of society, including the disenfranchized, the immunocompromised, and those living in resource-poor settings. With an estimated 200 million people affected worldwide, and treatment failure affecting up to 30% of cases, the role of fomites in scabies transmission is an area requiring further scrutiny. Traditionally, scabies transmission has been attributed to prolonged skin-to-skin contact. However, less discussed is the role of fomites, inanimate objects or materials capable of carrying infectious agents. With the escalating global burden of scabies, a comprehensive, unified approach to managing fomites in scabies-affected households and institutions is needed. To this end, we conducted an extensive review of online advice from 10 medical and public health organizations, collected in December 2023, regarding the management of scabies fomites. The guidelines covered varied aspects, including washing clothing, tumble drying, ironing, dry cleaning, isolating items, freezing items, and home fumigation. Our review revealed several areas of consensus. All organizations agreed on the use of high temperatures to destroy mites, with half specifying a target temperature of 50–60 °C, while the remainder used qualitative descriptors such as ‘hot’ or ‘high’. Isolation of nonwashable items in a plastic bag was also unanimously recommended, with suggested isolation periods ranging from 72 h to 1 week. However, the guidelines exhibited significant inconsistencies. There was considerable variation in the advice on which fomites required specific actions such as high-temperature washing or isolation. Moreover, guidance on dry cleaning methods and the handling of items that could not be washed, tumble dried, frozen or bag-sealed was inconsistent or lacking. Furthermore, potentially significant fomites such as children’s toys, furnishings, car seats and cushions were frequently overlooked. Large items, like mattresses, which may serve as significant vectors for scabies transmission but may not be easily replaced due to financial constraints, were also neglected. This comprehensive review highlights significant discrepancies and gaps in current fomite management guidelines, posing challenges for effective implementation of prevention and control measures, particularly during outbreaks. In conclusion, this review underscores the pressing need for a unified, evidence-based protocol for managing scabies fomites. Such a protocol would greatly enhance the global response to this pervasive disease and inform future public health interventions. Moreover, a harmonized approach to fomite management could be instrumental in reducing the global prevalence of scabies and its associated morbidity. We advocate for further research to evaluate the real-world effectiveness of these recommendations, taking into account resource availability, cost-effectiveness, feasibility, and impact on scabies transmission rates.