Round 4 survey responses.

<p>Round 4 survey responses.</p

Consensus criteria for the diagnosis of scabies: A Delphi study of international experts

<div><p>Background</p><p>Scabies was added to the WHO Neglected Tropical Diseases portfolio in 2017, and further understanding of the disease burden is now required. There are no uniformly accepted test methods or examination procedures for diagnosis, which limits the interpretation of research and epidemiological findings. The International Alliance for the Control of Scabies (IACS) designated harmonization of diagnostic procedures as a priority for the development of a global control strategy. Therefore, we aimed to develop consensus criteria for the diagnosis of scabies.</p><p>Methodology / Principal findings</p><p>We conducted an iterative, consensus (Delphi) study involving international experts in the diagnosis of scabies. Panel members were recruited through expression of interest and targeted invitation of experts. The Delphi study consisted of four rounds of anonymous surveys. Rounds 1 and 2 involved generation and ranking an extensive list of possible features. In Rounds 3 and 4, participants were presented results from previous rounds and indicated agreement with a series of draft criteria. Panel participants (n = 34, range per Round 28–30) were predominantly highly experienced clinicians, representing a range of clinical expertise and all inhabited continents. Based on initial rounds, a draft set of criteria were developed, incorporating three levels of diagnostic certainty–Confirmed Scabies, Clinical Scabies and Suspected Scabies. Consensus was reached in Round 4, with a very high level of agreement (> 89%) for all levels of criteria and subcategories. Adoption of the criteria was supported by 96% of panel members.</p><p>Conclusions / Significance</p><p>Consensus criteria for scabies diagnosis were established with very high agreement. The 2018 IACS Criteria for the Diagnosis of Scabies can be implemented for scabies research and mapping projects, and for surveillance after control interventions. Validation of the criteria is required.</p></div

Round 3 survey responses.

<p>Round 3 survey responses.</p

Risk factors for impetigo.

<p>Risk factors for impetigo.</p

Demographic characteristics.

<p>Demographic characteristics.</p

Scabies and Impetigo Prevalence and Risk Factors in Fiji: A National Survey

<div><p>Background</p><p>Scabies is recognised as a major public health problem in many countries, and is responsible for significant morbidity due to secondary bacterial infection of the skin causing impetigo, abscesses and cellulitis, that can in turn lead to serious systemic complications such as septicaemia, kidney disease and, potentially, rheumatic heart disease. Despite the apparent burden of disease in many countries, there have been few large-scale surveys of scabies prevalence or risk factors. We undertook a population-based survey in Fiji of scabies and impetigo to evaluate the magnitude of the problem and inform public health strategies.</p><p>Methodology/Principal Findings</p><p>A total of 75 communities, including villages and settlements in both urban and rural areas, were randomly selected from 305 communities across the four administrative divisions, and all residents in each location were invited to participate in skin examination by trained personnel. The study enrolled 10,887 participants. The prevalence of scabies was 23.6%, and when adjusted for age structure and geographic location based on census data, the estimated national prevalence was 18.5%. The prevalence was highest in children aged five to nine years (43.7%), followed by children aged less than five (36.5%), and there was also an indication of prevalence increasing again in older age. The prevalence of scabies was twice as high in iTaukei (indigenous) Fijians compared to Indo-Fijians. The prevalence of impetigo was 19.6%, with a peak in children aged five to nine years (34.2%). Scabies was very strongly associated with impetigo, with an estimated 93% population attributable risk.</p><p>Conclusions</p><p>As far as we are aware, this is the first national survey of scabies and impetigo ever conducted. We found that scabies occurs at high levels across all age groups, ethnicities, and geographical locations. Improved strategies are urgently needed to achieve control of scabies and its complications in endemic communities.</p></div

Classification of studies by region and World Bank Development Indicator in 2005.

<p>*Category has shifted rather than remaining stable within period from 1987–2013.</p><p><b>Source:</b> data.worldbank.org/data-catalog/world-development-indicators, accessed 12.11.2014.</p><p>Classification of studies by region and World Bank Development Indicator in 2005.</p

Estimates of children with impetigo by regions of the world with available data^*.

<p>*Studies from Australia, New Zealand and North America excluded as all these studies were conducted in small, impoverished populations within these countries that may not reflect the overall burden of impetigo for the childhood population.</p><p>Estimates of children with impetigo by regions of the world with available data^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136789#t003fn001" target="_blank">*</a>}.</p

Number of studies of impetigo prevalence by decade, country and region.

<p>* Two studies were published in 2010 and did not provide a year of data collection in the manuscript.</p><p>Number of studies of impetigo prevalence by decade, country and region.</p

Flowchart of systematic review according to the PRISMA statement.

<p>Flowchart of systematic review according to the PRISMA statement.</p