A Massive Scabies Outbreak in Makkah (Mecca) Region, Western Kingdom of Saudi Arabia 2018: Matched Case-Control Study

  • Vector-borne
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Background:
Muslims of different nationalities visit Makkah year-round to perform rituals in the Holy Mosque. The rituals involve close contact between pilgrims, and shared items, such as carpets for prayers. These are known risk factors for infectious skin diseases. In 2018, from March 25 - May 10, 4,423 cases of scabies were reported from Makkah region (baseline data regarding prevalence of scabies are not available for Makkah), leading to concerns about an outbreak that could spread globally. We sought to describe the scope of the outbreak and identify risk factors for infection.

Methods:
We conducted a matched case-control study with a 1:2 ratio. We defined cases as scabies clinically diagnosed by a dermatologist or family medicine consultant between April 11 - May 10, 2018, and used the Health Electronic Surveillance Network (HESN) for case finding. Controls were defined as scabies-free neighbors or students who shared schools and houses with cases. Data were collected through in-person interviews using a structured questionnaire.

Results:
We enrolled 270 cases and 596 controls. Most cases were male (57.4%), Burmese (51.8%), students (41.8%), and lived in a slum area (70%) within Makkah. Significant risk factors were contact with a confirmed case (OR=10, P value<0.001), male gender (OR=1.9, P value<0.01), Burmese nationality (OR=1.5, P value<0.003) and students (OR=1.4, P value<0.012). We found no statistically significant relationship between infection and visiting the holy mosque (OR=1.1, P value=0.7), contact with animals (OR=1.1, P value=0.7) or with institutional (e.g.: prisons) cases (OR=0.5, P value=0.6). We received no reports of scabies cases being internationally exported.

Conclusion:
Despite the proximity of the outbreak to the Holy Mosque, it was not associated with infection. Most cases occurred among Burmese students, who live in close communities. These communities should be specifically targeted for public health educational services to prevent future outbreaks.

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