Mass administration of medication with a combination of ivermectin and azithromycin was effective at significantly reducing scabies and impetigo in villages in the Solomon Islands where the conditions are common.
In a paper published online ahead of print in The Lancet Infectious Diseases (Apr. 4, 2019), researchers describe a community intervention study which aimed to assess the efficacy of mass drug administration of ivermectin for scabies and impetigo, with co-administration of azithromycin for trachoma. Study co-author Dr. Michael Marks, an assistant professor at the London School of Health & Tropical Hygiene, U.K., said in a press release: “We know that treating individual cases of scabies is not effective, however, treatment of entire communities has been shown in small community-based trials to substantially reduce cases. Our study demonstrates this can be an effective approach when delivered at a larger scale.” All 26,000 residents of the Choiseul Province of the Solomon Islands were given one round of the two medications, together. Investigators compared the prevalence of scabies and impetigo in residents of 10 randomly selected villages in the province both before and after the treatment. The strategy resulted in a reduction in scabies cases to 2% from 19% (a 90% reduction), and in impetigo cases to approximately 6% from approximately 25% (a 75% reduction), in one year. This was the largest evaluation of ivermectin-based mass drug administration for the control of scabies, according to the study authors, and supports large-scale implementation of this strategy for control of scabies in locations where the condition is identified as a public health priority. A high number of scabies cases had been reported in Choiseul Province. As part of this study, some 1,399 people underwent skin examination in 2015, with 261 (one in five) having scabies and 347 having impetigo. One year later, 1,261 people were examined with only 29 identified as having scabies and 81 with impetigo. As well, nearly 6,000 fewer people presented to outpatient clinics, a drop of 36.1%, in the three months following the mass treatment. Presentations for skin sores, boils and abscesses also fell by 50.9%.