• Phyo Thu Zar Aung, Will Cuningham, Kerry Hwang, Ross M Andrews, Jonathan R Carapetis, Therese Kearns, Danielle Clucas, Jodie McVernon, Julie Ann Simpson, Tong Steven Y C SYC Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. , and Patricia Therese Campbell.
• Victorian Infectious Disease Reference Laboratory, The Royal Melbourne Hospital and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
• PLoS Negl Trop Dis. 2018 Jul 1; 12 (7): e0006668.

BackgroundSkin sores caused by Group A streptococcus (GAS) infection are a major public health problem in remote Aboriginal communities. Skin sores are often associated with scabies, which is evident in scabies intervention programs where a significant reduction of skin sores is seen after focusing solely on scabies control. Our study quantifies the strength of association between skin sores and scabies among Aboriginal children from the East Arnhem region in the Northern Territory.Methods And ResultsPre-existing datasets from three published studies, which were conducted as part of the East Arnhem Healthy Skin Project (EAHSP), were analysed. Aboriginal children were followed from birth up to 4.5 years of age. Self-controlled case series design was used to determine the risks, within individuals, of developing skin sores when infected with scabies versus when there was no scabies infection. Participants were 11.9 times more likely to develop skin sores when infected with scabies compared with times when no scabies infection was evident (Incidence Rate Ratio (IRR) 11.9; 95% CI 10.3-13.7; p<0.001), and this was similar across the five Aboriginal communities. Children had lower risk of developing skin sores at age ≤1 year compared to at age >1 year (IRR 0.8; 95% CI 0.7-0.9).ConclusionThe association between scabies and skin sores is highly significant and indicates a causal relationship. The public health importance of scabies in northern Australia is underappreciated and a concerted approach is required to recognise and eliminate scabies as an important precursor of skin sores.

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