An outbreak of scabies in a fishing community in Hoima District, Uganda, February - June, 2022.

Background: Scabies, an infectious parasitic disease, is endemic in most resource-poor tropical areas, including Uganda. On May 21, 2022, the Ugandan Ministry of Health was notified of > 1,000 cases of scabies in Hoima District. We investigated to assess the scope of the outbreak, identify associated factors, and recommend interventions.

Methods: We defined a suspected scabies case as the onset of an itchy pimple-like skin rash or crusting from January 2021 to July 2022 in a resident of Hoima District. We reviewed medical records, performed active community case-finding, and computed attack rates by age, sex, and village per 1,000 population. Using logistic regression, we compared exposures among 101 case persons and 99 unmatched controls living in Rwentale Landing Site in Hoima during June 2022.

Results: We line listed 2,236 suspected cases in Hoima District. Children aged 5-14 years were more affected (AR = 64/1,000) than persons aged ≥ 15 years (AR = 8/1,000) (p < 0.001). Males (AR = 27/1,000) were more affected than females (AR = 15/1,000) (p < 0.001). Of the 54 affected villages, Rwentale Village had the highest attack rate (AR = 233/1,000 population). Rwentale Village includes a fishing area known as Rwentale Landing Site where 1,119 (50%) cases in Hoima District were identified. At this landing site, cases began in April 2022 shortly after the end of the peak fishing and trading season. Being aged 5-14 years (AOR = 4.9, 95%CI: 2.0-12), being male (AOR = 2.4, 95%CI 1.1-5.1), living with another case (AOR = 3.1, 95%CI: 1.5-6.2), and sharing three or more personal care items (towel, beddings, clothes, or sponges) (AOR = 2.2, 95%CI: 1.1-4.6) were associated with scabies.

Conclusion: This scabies outbreak was likely initiated by person-to-person interactions during peak fishing and trading months at a landing site and propagated by close household interactions. Community sensitization on scabies, especially before fishing and trading seasons is recommended for prevention and early control of scabies in the region. Additionally, establishing a surveillance system for scabies, in high-risk areas such as fishing communities may facilitate timely detection and control of future outbreaks.