Progress eliminating skin disease in northern Australia

One Disease is a non-profit organisation with a mission to eliminate crusted scabies as a public health concern in Australia by the end of 2022.

Crusted scabies develops from cases of untreated ordinary scabies in people who have compromised immune systems. Scabies is also known to underlie many skin infections in the Northern Territory (NT), which can lead to serious conditions such as sepsis, acute rheumatic fever, rheumatic heart disease and chronic kidney disease.

Crusted scabies is categorised into three grades – 1, 2 and 3 – in accordance with the scabies mite load present, with Grade 3 being the most severe and infectious.

Our approach to improving the health of people living in Northern Australia has been multifaceted and is built on partnerships with the NT Government and communities across Darwin (covering Darwin Urban, Top End West, Top End Central), East Arnhem Land, West Arnhem Land, Katherine and Central (including greater Alice Springs Region and Barkly).

The systems we have implemented include:

Surveillance

• Enhanced dataset of people who have had crusted scabies.
• Scabies prevalence surveys in community to determine when mass drug administrations for scabies should be undertaken.

Prevention

• Education using a range of methods to target individuals and communities including social media, online tools and materials.
• Education of health staff through training and skin health course modules.

Treatment

• Hospital bedside care pathway.
• Supporting hospital treatment completion.

Follow-up

• Electronic care plans.
• Increasing understanding on the importance of two doses of lyclear cream at 7-day intervals.
• Successful advocacy for ivermectin as a first-line treatment for Aboriginal and Torres Strait Islander people.
• Innovative work on the creation and maintenance of Scabies Free Zones within community.

This has led us to achieving remarkable progress against our goal of keeping the recurrence rate of NT crusted scabies clients at less than five per cent of the total cumulative cases identified, and we are now very close to eliminating crusted scabies as a public health concern. The 12-month average is 1.94 per cent and the current recurrence rate is 1.53 per cent.

During the final stage of One Disease’s work, the focus will be on reducing ordinary scabies. Resources such as the Skin Checks Across the North (SCAN) app – a skin self-assessment tool for Aboriginal and Torres Strait Islander people – and the Storytelling Tool – which provides culturally relevant illustrations and information – are readily available for use online or offline. These provide many opportunities for scabies education for health clinics and people in remote communities.

A full suite of our resources is available on the One Disease website, as well as on the Australian Indigenous HealthInfoNet, where the resources will continue to be available once we finish our work this year.