The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies

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Summary

Background

Scabies is a common parasitic skin condition that causes considerable morbidity globally. Clinical and epidemiological research for scabies has been limited by a lack of standardization of diagnostic methods.

Objectives

To develop consensus criteria for the diagnosis of common scabies that could be implemented in a variety of settings.

Methods

Consensus diagnostic criteria were developed through a Delphi study with international experts. Detailed recommendations were collected from the expert panel to define the criteria features and guide their implementation. These comments were then combined with a comprehensive review of the available literature and the opinion of an expanded group of international experts to develop detailed, evidence‐based definitions and diagnostic methods.

Results

The 2020 International Alliance for the Control of Scabies ( IACS) Consensus Criteria for the Diagnosis of Scabies include three levels of diagnostic certainty and eight subcategories. Confirmed scabies (level A) requires direct visualization of the mite or its products. Clinical scabies (level B) and suspected scabies (level C) rely on clinical assessment of signs and symptoms. Evidence‐based, consensus methods for microscopy, visualization and clinical symptoms and signs were developed, along with a media library.

Conclusions

The 2020 IACS Criteria represent a pragmatic yet robust set of diagnostic features and methods. The criteria may be implemented in a range of research, public health and clinical settings by selecting the appropriate diagnostic levels and subcategories. These criteria may provide greater consistency and standardization for scabies diagnosis. Validation studies, development of training materials and development of survey methods are now required.

What is already known about this topic?

The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical.
Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common.
These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies.

What does this study add?

International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts.
The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings.
Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.

Abstract

What is already known about this topic?

The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical.
Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common.
These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies.

What does this study add?

International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts.
The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings.
Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.

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Most cited references 81

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Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Yuan-Pang Wang, Maheswar Satpathy, Mathilde Touvier … (2018)

Summary Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer’s disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). Interpretation The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.

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Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Theo Vos, Christine Allen, Megha Arora … (2017)

Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Funding Bill & Melinda Gates Foundation.

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The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study

Anthony W. Solomon, Alexandre L Pavluck, Paul Courtright … (2015)

ABSTRACT Purpose: To complete the baseline trachoma map worldwide by conducting population-based surveys in an estimated 1238 suspected endemic districts of 34 countries. Methods: A series of national and sub-national projects owned, managed and staffed by ministries of health, conduct house-to-house cluster random sample surveys in evaluation units, which generally correspond to “health district” size: populations of 100,000–250,000 people. In each evaluation unit, we invite all residents aged 1 year and older from h households in each of c clusters to be examined for clinical signs of trachoma, where h is the number of households that can be seen by 1 team in 1 day, and the product h × c is calculated to facilitate recruitment of 1019 children aged 1–9 years. In addition to individual-level demographic and clinical data, household-level water, sanitation and hygiene data are entered into the purpose-built LINKS application on Android smartphones, transmitted to the Cloud, and cleaned, analyzed and ministry-of-health-approved via a secure web-based portal. The main outcome measures are the evaluation unit-level prevalence of follicular trachoma in children aged 1–9 years, prevalence of trachomatous trichiasis in adults aged 15 + years, percentage of households using safe methods for disposal of human feces, and percentage of households with proximate access to water for personal hygiene purposes. Results: In the first year of fieldwork, 347 field teams commenced work in 21 projects in 7 countries. Conclusion: With an approach that is innovative in design and scale, we aim to complete baseline mapping of trachoma throughout the world in 2015.

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Author and article information

Contributors

D. Engelman:

ORCID: https://orcid.org/0000-0002-4909-1287

Daniel.Engelman@rch.org.au

Journal

Journal ID (nlm-ta): Br J Dermatol

Journal ID (iso-abbrev): Br J Dermatol

Journal ID (doi): 10.1111/(ISSN)1365-2133

Journal ID (publisher-id): BJD

Title: The British Journal of Dermatology

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0007-0963

ISSN (Electronic): 1365-2133

Publication date (Electronic): 29 March 2020

Publication date (Print): November 2020

Volume: 183

Issue: 5 ( doiID: 10.1111/bjd.v183.5 )

Pages: 808-820

Affiliations

[ ¹ ] Tropical Diseases Murdoch Children's Research Institute Melbourne VIC Australia

[ ² ] Department of Paediatrics University of Melbourne Melbourne VIC Australia

[ ³ ] Melbourne Children's Global Health Melbourne VIC Australia

[ ⁴ ] Yoshizumi Dermatology Clinic Tokyo Japan

[ ⁵ ] Department of Dermatology Tokyo Women's Medical University Medical Center East Tokyo Japan

[ ⁶ ] Department of Dermatology King's College London London UK

[ ⁷ ] Dermatology Clinic University of Catania Catania Italy

[ ⁸ ] Children's National Medical Center and George Washington University Washington DC USA

[ ⁹ ] University of the Sunshine Coast Sunshine Coast QLD Australia

[ ¹⁰ ] Department of Paediatric Dermatology Hôpital Pellegrin‐Enfants CHU de Bordeaux Bordeaux France

[ ¹¹ ] Department of Dermatology AP‐HP Hôpital Henri Mondor Université Paris‐Est Créteil France

[ ¹² ] Dynamyc Research Group Faculty of Medicine Laboratory for Animal Health USC ANSES Créteil France

[ ¹³ ] Department of Infectious Diseases Perth Children's Hospital Perth WA Australia

[ ¹⁴ ] Wesfarmers Centre for Vaccines and Infectious Diseases Telethon Kids Institute University of Western Australia Perth WA Australia

[ ¹⁵ ] Menzies School of Health Research Darwin NT Australia

[ ¹⁶ ] Department of Dermatology University of California San Francisco San Francisco CA USA

[ ¹⁷ ] Department of Dermatology and Dermato‐Oncology Instituto Estatal de Cancerología ‘Dr Arturo Beltrán Ortega’ Faculty of Medicine Autonomous University of Guerrero Acapulco GRO Mexico

[ ¹⁸ ] Institute of Microbiology and Infection Immunology, Campus Benjamin Franklin Charité University Medicine Berlin Germany

[ ¹⁹ ] National Sanatorium Tama Zenshōen Tokyo Japan

[ ²⁰ ] Department of Dermatology Hôpital Pasteur Colmar France

[ ²¹ ] Department of Dermatology/AMPATH Indiana University Indianapolis IN USA

[ ²² ] Department of Dermatology Omdurman Friendship Hospital Khartoum State Sudan

[ ²³ ] Department of Dermatology Khartoum Dermatology and Venereology Teaching Hospital Khartoum State Sudan

[ ²⁴ ] Department of Dermatology West Hertfordshire Hospitals NHS Trust Watford General Hospital Watford UK

[ ²⁵ ] Department of Dermatology Eastern Virginia Medical School Norfolk VA USA

[ ²⁶ ] Department of Dermatology Venereology& Leprosy, Pramukh Swami Medical College Karamsad Gujarat India

[ ²⁷ ] Department of Pediatric Dermatology University of British Columbia Vancouver BC Canada

[ ²⁸ ] BC Children's Hospital Vancouver BC Canada

[ ²⁹ ] The Kirby Institute University of New South Wales Sydney NSW Australia

[ ³⁰ ] Royal Darwin Hospital Darwin NT Australia

[ ³¹ ] Department of Leprosy/Dermatology Tamavua Twomey Hospital Suva Fiji

[ ³² ] College of Medicine Nursing and Health Sciences Fiji National University Suva Fiji

[ ³³ ] London School of Hygiene and Tropical Medicine London UK

[ ³⁴ ] Hospital for Tropical Diseases and Department of Dermatology University College London Hospitals NHS Foundation Trust London UK

[ ³⁵ ] Department of Dermatology Medical College of Wisconsin Milwaukee WI USA

[ ³⁶ ] Department of Dermatology St Vincent's Hospital University of New South Wales Sydney NSW Australia

[ ³⁷ ] School of Tropical Medicine and Global Health Nagasaki University Nagasaki Japan

[ ³⁸ ] Department of Dermatology National Center for Global Health and Medicine Tokyo Japan

[ ³⁹ ] Chelsea and Westminster NHS Foundation Trust London UK

[ ⁴⁰ ] International Foundation for Dermatology London UK

Author notes

[*] [* ] Correspondence

Daniel Engelman.

Email: Daniel.Engelman@ 123456rch.org.au

Author information

D. Engelman https://orcid.org/0000-0002-4909-1287

O. Chosidow https://orcid.org/0000-0002-8400-4310

L.C. Fuller https://orcid.org/0000-0001-6561-8731

Article

Publisher ID: BJD18943

DOI: 10.1111/bjd.18943

PMC ID: 7687112

PubMed ID: 32034956

SO-VID: ab842d4b-0a00-4d23-9ae6-700271dc7e72

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date accepted : 07 February 2020

Page count

Figures: 4, Tables: 4, Pages: 13, Words: 8311

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cover-date November 2020

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ScienceOpen disciplines: Dermatology

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The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies

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Background

Objectives

Methods

Results

Conclusions

Abstract

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Most cited references 81

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

The Global Trachoma Mapping Project: Methodology of a 34-Country Population-Based Study

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Cited by 59

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