Investigation of a scabies outbreak in a kindergarten in Constance, Germany

  • L. Ariza
  • B. Walter
  • C. Worth
  • S. Brockmann
  • M.-L. Weber
  • H. FeldmeierEmail author


In industrialized countries, scabies occurs sporadically or in the form of protracted epidemics, typically in nursing homes for elderly people. Outbreaks of scabies in a kindergarten are very rare. The main goal of our study was to investigate an outbreak of scabies in a kindergarten and to identify risk factors for the infestation with the ectoparasitosis. We investigated an outbreak of scabies in a kindergarten in the City of Constance, southern Germany, with a particular pedagogical concept. Risk factors indicating a transmission of Sarcoptes mites through body contact or via fomites were assessed using questionnaires and by following the daily routine in the kindergarten. A total of 16 cases were identified. The attack rate was significantly higher in nursery teachers (risk ratio 42.1) compared to children (risk ratio 10.5). In all cases, scabies had developed rather recently, with minimal clinical manifestations. In nursery teachers, the probability of scabies was 4.4 times higher in those teachers who hugged children regularly. Children who preferably played with their own soft toys had a lower probability of developing scabies [risk ratio 0.14, 95 % confidence interval (CI) 0.05–0.42; p = 0.04]. It seems conceivable that the particular pedagogical concept of the kindergarten favored the spread of Sarcoptes mites. We were unable to show whether transmission had preferably occurred through body contact or via fomites.


Risk Ratio Index Case Scabies Body Contact Mass Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We express our gratitude to the city heath department and the employees of the public kindergarten in Constance, Germany. The data of this study are part of the medical thesis by B.W. L.A. received a postdoctoral scholarship from the German–Brazilian PROBRAL program jointly supported by the German Academic Exchange Service (DAAD, Germany) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Brazil).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Worth C, Heukelbach J, Fengler G, Walter B, Liesenfeld O, Hengge U, Feldmeier H (2012) Acute morbidity associated with scabies and other ectoparasitoses rapidly improves after treatment with ivermectin. Pediatr Dermatol 29:430–436. doi: 10.1111/j.1525-1470.2011.01680.x PubMedCrossRefGoogle Scholar
  2. 2.
    Jackson A, Heukelbach J, Filho AF, Júnior Ede B, Feldmeier H (2007) Clinical features and associated morbidity of scabies in a rural community in Alagoas, Brazil. Trop Med Int Health 12:493–502PubMedCrossRefGoogle Scholar
  3. 3.
    Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA (2006) Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis 6:769–779PubMedCrossRefGoogle Scholar
  4. 4.
    Sargent SJ, Martin JT (1994) Scabies outbreak in a day-care center. Pediatrics 94:1012–1013PubMedGoogle Scholar
  5. 5.
    Marshall R, Barkess-Jones L, Sivayoham S (1995) An outbreak of scabies in a school for children with learning disabilities. Commun Dis Rep CDR Rev 5:R90–R92PubMedGoogle Scholar
  6. 6.
    Danchaivijitr S, Suthipinittharm P, Srihapol N (1995) An outbreak of Norwegian scabies in a surgical ward. J Med Assoc Thai 78:S99–S101PubMedGoogle Scholar
  7. 7.
    Deabate MC, Calitri V, Licata C, Fidelio T, Rocchietti M, Pieri F, Gagliano P, Rabbia C, Dogliani M (2001) Scabies in a dialysis unit. Mystery and prejudice. Minerva Urol Nefrol 53:69–73PubMedGoogle Scholar
  8. 8.
    Mayer J, Wever S, Lurz C, Bröcker EB (2000) Scabies epidemic in a sheltered workshop—what should be done? Hautarzt 51:75–78PubMedCrossRefGoogle Scholar
  9. 9.
    Obasanjo OO, Wu P, Conlon M, Karanfil LV, Pryor P, Moler G, Anhalt G, Chaisson RE, Perl TM (2001) An outbreak of scabies in a teaching hospital: lessons learned. Infect Control Hosp Epidemiol 22:13–18PubMedCrossRefGoogle Scholar
  10. 10.
    Pruksachatkunakorn C, Wongthanee A, Kasiwat V (2003) Scabies in Thai orphanages. Pediatr Int 45:724–727PubMedCrossRefGoogle Scholar
  11. 11.
    Larrosa A, Cortés-Blanco M, Martínez S, Clerencia C, Urdániz LJ, Urbán J, García J (2003) Nosocomial outbreak of scabies in a hospital in Spain. Euro Surveill 8:199–203PubMedGoogle Scholar
  12. 12.
    Larrosa Montañés A, Cortés Blanco M, Clerencia Casorrán C, Martínez Cuenca S, Urdániz Sancho J, Urbán Sender J, Ariño Aldabo C, Güerri Mir L (2004) Outbreak of scabies at a home for the elderly in the province of Huesca. Rev Esp Salud Publica 78:107–114PubMedCrossRefGoogle Scholar
  13. 13.
    de Beer G, Miller MA, Tremblay L, Monette J (2006) An outbreak of scabies in a long-term care facility: the role of misdiagnosis and the costs associated with control. Infect Control Hosp Epidemiol 27:517–518PubMedCrossRefGoogle Scholar
  14. 14.
    Elgueta NA, Parada EY, Guzmán GW, Molina CP, González AP (2007) An outbreak of scabies in a tertiary-care hospital from a crusted scabies case. Rev Chilena Infectol 24:306–310Google Scholar
  15. 15.
    Koene RP, Tjioe M, Hoondert K, van de Vrie W, Olde Rikkert MG, Wulfen M, Voss A (2006) Scabies outbreak in a hospital and in 8 health-care institutions caused by an elderly patient with scabies crustosa. Ned Tijdschr Geneeskd 150:918–923PubMedGoogle Scholar
  16. 16.
    Ejidokun OO, Aruna OS, O’Neill B (2007) A scabies outbreak in a further education college in Gloucestershire. Epidemiol Infect 135:455–457PubMedCrossRefGoogle Scholar
  17. 17.
    Achtari Jeanneret L, Erard P, Gueissaz F, Malinverni R (2007) An outbreak of scabies: a forgotten parasitic disease still present in Switzerland. Swiss Med Wkly 137:695–699PubMedGoogle Scholar
  18. 18.
    Meyer EP, Heranney D, Foeglé J, Chamouard V, Hernandez C, Mechkour S, Passemard R, Berthel M, Kaltenbach G, Lipsker D, Christmann D, Lavigne T (2011) Management of a scabies epidemic in the Strasbourg teaching hospital, France. Med Mal Infect 41:92–96PubMedCrossRefGoogle Scholar
  19. 19.
    Terry BC, Kanjah F, Sahr F, Kortequee S, Dukulay I, Gbakima AA (2001) Sarcoptes scabiei infestation among children in a displacement camp in Sierra Leone. Public Health 115:208–211PubMedCrossRefGoogle Scholar
  20. 20.
    Feldmeier H (2011) Diagnosis of parasitic skin diseases. In: Maibach H, Gorouhi F (eds) Evidence-based dermatology, 2nd edn. People’s Medical Publishing House USA, Oak ParkGoogle Scholar
  21. 21.
    Walter B, Heukelbach J, Fengler G, Worth C, Hengge U, Feldmeier H (2011) Comparison of dermoscopy, skin scraping, and the adhesive tape test for the diagnosis of scabies in a resource-poor setting. Arch Dermatol 147:468–473PubMedCrossRefGoogle Scholar
  22. 22.
    Dupuy A, Dehen L, Bourrat E, Lacroix C, Benderdouche M, Dubertret L, Morel P, Feuilhade de Chauvin M, Petit A (2007) Accuracy of standard dermoscopy for diagnosing scabies. J Am Acad Dermatol 56:53–62PubMedCrossRefGoogle Scholar
  23. 23.
    Heukelbach J, Feldmeier H (2006) Scabies. Lancet 367:1767–1774PubMedCrossRefGoogle Scholar
  24. 24.
    Arlian LG, Runyan RA, Achar S, Estes SA (1984) Survival and infectivity of Sarcoptes scabiei var. canis and var. hominis. J Am Acad Dermatol 11:210–215PubMedCrossRefGoogle Scholar
  25. 25.
    Arlian LG, Estes SA, Vyszenski-Moher DL (1988) Prevalence of Sarcoptes scabiei in the homes and nursing homes of scabietic patients. J Am Acad Dermatol 19:806–811PubMedCrossRefGoogle Scholar
  26. 26.
    Pasternak J, Richtmann R, Ganme AP, Rodrigues EA, Silva FB, Hirata ML, Ciosak S (1994) Scabies epidemic: price and prejudice. Infect Control Hosp Epidemiol 15:540–542PubMedCrossRefGoogle Scholar
  27. 27.
    Tsutsumi M, Nishiura H, Kobayashi T (2005) Dementia-specific risks of scabies: retrospective epidemiologic analysis of an unveiled nosocomial outbreak in Japan from 1989–90. BMC Infect Dis 5:85PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • L. Ariza
    • 1
  • B. Walter
    • 2
  • C. Worth
    • 2
  • S. Brockmann
    • 3
    • 5
  • M.-L. Weber
    • 4
  • H. Feldmeier
    • 2
    Email author
  1. 1.Department of Community Health, School of MedicineFederal University of CearáFortalezaBrazil
  2. 2.Institute of Microbiology and HygieneCampus Benjamin Franklin, Charité University Medicine BerlinBerlinGermany
  3. 3.Landesgesundheitsamt Baden-WürttembergStuttgartGermany
  4. 4.Local Health DepartmentDistrict of ConstanceGermany
  5. 5.Local Health DepartmentDistrict of ReutlingenGermany

Personalised recommendations