A scabies outbreak in an inpatient rehabilitation setting

Published:October 13, 2022DOI:


      • Delayed diagnosis caused a scabies outbreak.
      • Use of steroids converted ordinary scabies to crusted scabies.
      • Effective nosocomial infection control without mass prophylaxis treatment.
      • Nurses and physical therapists are the most affected.



      Scabies is a skin infection transmitted by close person-to-person contact. Crusted scabies is a more severe type which is more contagious. Delayed diagnosis of scabies could lead to an outbreak.


      The outbreak occurred at a 435-bed academic medical center with 76 inpatient rehabilitation beds. The index patient was incarcerated and admitted to our hospital in February 2022. The patient developed crusted scabies after steroids treatment.


      The patient was treated with oral ivermectin (200 mcg/kg, maximum dose 15 mg) and topical permethrin 5%. All units were followed for 6 weeks since diagnosis of the index patient. A total of 46 healthcare workers (20 nurses and 26 physical therapists) were exposed. Twenty-nine presented symptoms and were treated with ivermectin and permethrin or only ivermectin. No physicians, other patients, or prison guards were affected. There was no secondary household transmission of those exposed healthcare workers.


      Scabies is highly contagious in high-risk patients. Early diagnosis and effective infection control are of vital importance.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Buehlmann M
        • Beltraminelli H
        • Strub C
        • et al.
        Scabies outbreak in an intensive care unit with 1,659 exposed individuals–key factors for controlling the outbreak.
        Infect Control Hosp Epidemiol. 2009; 30: 354-360
        • Vorou R
        • Remoudaki HD
        • Maltezou HC
        Nosocomial scabies.
        J Hosp Infect. 2007; 65: 9-14
      1. Epidemiology & Risk Factors. Scabies [cited 2022 30 June]; Available from:

        • Marotta M
        • Toni F
        • Dallolio L
        • et al.
        Management of a family outbreak of scabies with high risk of spread to other community and hospital facilities.
        Am J Infect Control. 2018; 46: 808-813
        • Ozdamar M
        • Turkoglu S
        A nosocomial scabies outbreak originating from immunocompromised transplant patients in Turkey: upholstery as a possible cause.
        Transpl Infect Dis. 2020; 22: e13284
        • Heukelbach J
        • Feldmeier H
        Lancet. 2006; 367: 1767-1774
        • Bouvresse S
        • Chosidow O
        Scabies in healthcare settings.
        Curr Opin Infect Dis. 2010; 23: 111-118
        • Berg JO
        • Alsbjørn B
        Crusted scabies in the burned patient.
        J Burn Care Res. 2011; 32: e97-100
        • Belvisi V
        • Orsi GB
        • Del Borgo C
        • et al.
        Large nosocomial outbreak associated with a Norwegian Scabies Index Case undergoing TNF-α inhibitor treatment: management and control.
        Infect Control Hosp Epidemiol. 2015; 36: 1358-1360
        • Ladbury G
        • Morroy G
        • van Hoeven-Dekkers S
        • et al.
        An outbreak of scabies in multiple linked healthcare settings in The Netherlands.
        Infect Control Hosp Epidemiol. 2012; 33: 1047-1050
        • Leistner R
        • Buchwald D
        • Beyer M
        • et al.
        Scabies outbreak among healthcare workers in a German acute care hospital.
        J Infect Prev. 2017; 18: 189-192
        • Khan A
        • O'Grady S
        • Muller MP
        Rapid control of a scabies outbreak at a tertiary care hospital without ward closure.
        Am J Infect Control. 2012; 40: 451-455
        • de Beer G
        • Miller MA
        • Tremblay L
        • et al.
        An outbreak of scabies in a long-term care facility: the role of misdiagnosis and the costs associated with control.
        Infect Control Hosp Epidemiol. 2006; 27: 517-518
        • van der Linden N
        • van Gool K
        • Gardner K
        • et al.
        A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions.
        PLoS Negl Trop Dis. 2019; 13e0007182
        • Romani L
        • Whitfeld MJ
        • Koroivueta J
        • et al.
        Mass drug administration for scabies control in a population with endemic disease.
        N Engl J Med. 2015; 373: 2305-2313
        • Romani L
        • Whitfeld MJ
        • Koroivueta
        • et al.
        Mass drug administration for scabies - 2 years of follow-up.
        N Engl J Med. 2019; 381: 186-187
        • Meinking TL
        • Taplin D
        • Hermida JL
        • et al.
        The treatment of scabies with ivermectin.
        N Engl J Med. 1995; 333: 26-30
        • Chosidow O
        N Engl J Med. 2006; 354: 1718-1727
        • Capobussi M
        • Sabatino G
        • Donadini A
        • et al.
        Control of scabies outbreaks in an Italian hospital: an information-centered management strategy.
        Am J Infect Control. 2014; 42: 316-320
        • Mounsey KE
        • Murray HC
        • King M
        • et al.
        Retrospective analysis of institutional scabies outbreaks from 1984 to 2013: lessons learned and moving forward.
        Epidemiol Infect. 2016; 144: 2462-2471
        • Morrison EJ
        • Middleton J
        • Lanza S
        • et al.
        Do we know how scabies outbreaks in residential and nursing care homes for the elderly should be managed? A systematic review of interventions using a novel approach to assess evidence quality.
        Epidemiol Infect. 2019; 147: e250
        • Obasanjo OO
        • Wu P
        • Conlon M
        • et al.
        An outbreak of scabies in a teaching hospital: lessons learned.
        Infect Control Hosp Epidemiol. 2001; 22: 13-18