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Introduction
Scabies is an important health concern in hospitals and care facilities. There is no standardized report about Scabies, and occurrence rates vary in the recent literature from 0.271 to 46% (1). Although there is less information about mortality, deaths frequently occur due to secondary sepsis (2). There are numerous medical staff who have not experienced scabies, and there are previous reports that have misdiagnosed it as eczema and senile dermal pruritus, leading to an outbreak because of its highly contagious nature (3–6). Scabies is relatively common in tropical areas and in developing countries because of poor hygiene practices, and war and poverty can be causes of large epidemics (7). However, sometimes epidemics occur in medical institutions in elderly and immune-suppressed patients, even in developed countries. In a previous report, bedridden, living in a nursing home, a higher clinical severity status before admission and a catheter inserted are identified as being significant risk factors for acquiring scabies infection (8). Delayed diagnosis of Norwegian scabies, which is highly infectious, has occurred (9). Ivermectin is used worldwide in oral or injection form . Topical application of 5% permethrin cream is also popular and the combination of an effective topical treatment and oral ivermectin seems to be most successful (10). The present study describes an outbreak of Norwegian scabies at Toho University School of Medicine, Omori Hospital (Tokyo, Japan). This study demonstrates the need for medical staff education so that the infection can be detected early, and the need of an early referral procedure to a medical specialist.
Materials and methods
The present epidemiologic study was performed between June 2014 and October 2014 in a diabetic and collagen disease ward at the Toho University School of Medicine, Omori Hospital. Written informed consent was obtained from all patients. The clinical features of scabies patients and a report on a follow-up survey that was conducted by the infection control committee were respectively reviewed. The follow-up survey included the following four steps: i) Contact patients admitted onto the same ward as that of a confirmed case; ii) telephone interviews with all family members of the confirmed cases; iii) instructions to consult a dermatologist from the hospital in person or by telephone for those who have symptoms; and iv) consult a dermatologist...