Scabies among Dutch higher education students: do cases notify their contacts and do contacts take adequate measures?

backgroundScabies incidence has rapidly increased in the Netherlands, particularly among higher education students. We hypothesized that effective control in this group is hindered by poor contact notification by indexes and limited treatment by contacts. We assessed this in a questionnaire study.

methodsAn online questionnaire was distributed to students, focusing on their adherence to notification (indexes), and treatment and hygiene recommendations (contacts), as well as their health seeking behaviour.

resultsOf the indexes (n = 308), 59% had experienced multiple scabies episodes and almost two-thirds had not been notified beforehand. Notably, 48% self-diagnosed their condition. Most indexes notified all regular (bed) partners and housemates, 53% also notified all casual bed partners. Contacts (n = 269) were usually notified by the index; in 57% of cases the notifier was a housemate. After notification, many contacts washed their bedding (85%), washed their clothes or put them in bags (81%); applied permethrin/benzoate cream (78%), avoided physical contact with others (74%); many also notified their own contacts (59%). The general practitioner was frequently contacted, especially by indexes, although experiences were often rated poorly owing to conflicting or incorrect information.

conclusionsThe high proportion of unnotified indexes suggests a notification gap. Especially casual bedpartners often remain unnotified, presenting a risk for onward transmission. Contacts generally took adequate measures, although premature notification of their contacts may lead to unnecessary treatment or 'notification fatigue.' Enhancing healthcare support and communication might help to improve notification and prophylactic treatment behaviours and may play a crucial role in breaking the chain of transmission.