Scabies, an ectoparasitic infestation caused by the mite Sarcoptes scabiei var. hominis, remains a global public health issue, disproportionately affecting vulnerable populations in crowded and resource-limited settings. Characterized by intense pruritus and a papular rash, scabies is primarily transmitted through direct, prolonged skin-to-skin contact. Its designation as a Neglected Tropical Disease (NTD) by the World Health Organization (WHO) underscores its significant, often under-recognized, impact on health and quality of life, particularly in tropical regions like the Caribbean.
This report provides a comprehensive analysis of scabies with a specific focus on Barbados. It examines the clinical and epidemiological characteristics of the disease, its global and regional burden, and delves into the recent scabies outbreak at the Geriatric Hospital in Barbados during May-June 2025. This outbreak highlighted several critical aspects of scabies management in institutional settings, including the susceptibility of elderly populations, challenges in medication procurement (specifically Permethrin 5% cream), and the difficulties posed by the disease's prolonged asymptomatic incubation period which facilitates silent transmission.
While the Chief Medical Officer of Barbados characterized scabies as not being a disease of major public health significance, the events at the Geriatric Hospital demonstrated its capacity to cause considerable discomfort, infect staff, and strain resources. The response by the Ministry of Health and Wellness involved activating infection prevention and control (IPC) protocols, engaging private dermatological expertise, and initiating treatment for affected individuals. However, the outbreak also exposed potential systemic vulnerabilities, such as in pharmaceutical supply chains and the need for consistently applied IPC measures in long-term care facilities.
Key recommendations arising from this analysis include the strengthening of scabies surveillance systems, particularly in high-risk institutional environments; enhancing IPC training and ensuring resource availability, including essential medications; developing targeted public awareness campaigns; and undertaking further research to ascertain the community prevalence and socio-economic impact of scabies in Barbados. Addressing these areas will not only improve the management of scabies but also contribute to overall health system resilience and preparedness for other infectious disease threats.
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