key: cord-0307648-xrbhwf15 authors: Louka, C.; Logothetis, E.; Engelman, D.; Samiotaki-Logotheti, E.; Pournaras, S.; Stienstra, Y. title: Scabies epidemiology in health care centers for refugees and asylum seekers in Greece date: 2022-01-10 journal: nan DOI: 10.1101/2022.01.10.22268996 sha: 26ccc27bfceb0e0032b40cb5c1424dea0504ef80 doc_id: 307648 cord_uid: xrbhwf15 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 ({rho}=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. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. Background. Scabies is a global health concern disproportionally affecting vulnerable 28 population such as refugees and asylum seekers. Greece is a main geographical point of entry 29 in Europe for refugees, but epidemiological data on scabies in this population is scarce. We 30 aimed to evaluate the epidemiology of scabies, including trends over the study period. 31 Methodology/Principal findings. Data were collected from June, 2016 to July, 2020, using the 32 surveillance system of the Greek National Public Health Organization. Staff at health centers 33 for refugees/asylum seekers compiled daily reports on scabies and other infectious diseases. 34 Observed proportional morbidity for scabies was calculated using consultations for scabies as 35 a proportion of total consultations. 36 There were a total of 13118 scabies cases over the study period. Scabies was the third most 37 frequently observed infectious disease in refugees/asylum seekers population after 38 respiratory infections and gastroenteritis without blood in the stool. The scabies monthly 39 observed proportional morbidity varied between 0.3% (August 2017) to 5.6% (January 2020). 40 Several outbreaks were documented during the study period. An increasing number of cases 41 was observed from October 2019 until the end of the study period, with a peak of 1663 cases 42 in January 2020, related to an outbreak at one center. Spearman correlation test between the 43 number of reported scabies cases and time confirmed an increasing trend (ρ=0.67). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. and asylum seekers. Greece is one of the main points of entry in Europe for refugees. 59 However, the prevalence of scabies amongst refugees in Greece has not been thoroughly 60 investigated. In this study, we utilized data weekly reported within the epidemiological is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. Scabies is a skin disease caused by infestation with ectoparasitic mite Sarcoptes scabiei var. 71 hominis. The main clinical manifestations include mild to severe itching and a skin rash 72 consisting of small papules, nodules and vesicles. Scabies can be further complicated, leading 73 to secondary bacterial skin infections, invasive bacterial infections, and sepsis [1] . 74 Scabies is a global health concern affecting an estimated 200 million people worldwide. It is 75 endemic in many low-and middle-income countries, particularly those with hot, tropical is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. Identification and assessment of refugees/asylum seekers 105 Refugees/asylum seekers may enter Greece by sea or land. As soon as practicable after arrival, 106 NPHO personnel conduct an initial, preliminary medical examination and identify those in 107 need of immediate medical assistance and/or hospital admission. Medically stable 108 refugees/asylum seekers complete registration and identification procedures and are 109 relocated to one of thirty-nine Regional Units is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. 246 We report a very high burden of scabies among the refugees/asylum seekers population in 247 Greece, with cases reported throughout the study period. Scabies was the third most frequent is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. to secondary bacterial infections. 256 The rapid turnover of populations in the refugees/asylum seekers centers predisposes to 257 reinfestations and outbreaks of scabies. A study from the Netherlands described mass drug is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. PoC can enable early interventions in order to reduce the burden of scabies and its 291 complications. As the incidence increases and living conditions complicate optimal treatment 292 of individual patients, mass drug administration may prove to be a necessary intervention to 293 reduce the burden of scabies in refugees/asylum seekers population. Acknowledgements 295 We would like to acknowledge all medical staff responsible for refugees/asylum seekers 296 health care at the Regional Units in Greece that contributed to the documentation and report . CC-BY 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 10, 2022. Scabies in the developing world--its 306 prevalence, complications, and management Migration and Migrants: Regional Dimensions and Developments Infectious disease outbreaks in centralized homes for asylum 313 seekers in Germany from Skin 316 diseases in Greek and immigrant children in Athens Health status of rescued 343 people by the NGO Open Arms Comprehensive 346 infectious disease screening in a cohort of unaccompanied refugee minors in Germany 347 from 2016 to 2017: A cross-sectional study Infectious disease profiles of Syrian and 350 Eritrean migrants presenting in Europe: A systematic review Asylum 353 seekers' perspectives on vaccination and screening policies after their arrival in Greece 354 and The Netherlands. PLoS One Efficacy of ivermectin mass-drug administration to control scabies in asylum seekers in 358 the Netherlands: A retrospective cohort study between The 361 public health control of scabies: priorities for research and action It is made available under a perpetuity.is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprintThe copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprintThe copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprintThe copyright holder for this this version posted January 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprintThe copyright holder for this this version posted January 10, 2022. ; https://doi.org/10.1101/2022.01.10.22268996 doi: medRxiv preprint