What is it? 

Scabies is a condition where tiny mites burrow under the skin and lay eggs. New mites hatch from the eggs and can spread to other parts of the skin, causing skin infestation. 

It can take 4-6 weeks for the skin to react, and scabies mites can live anywhere on the body.

What are the symptoms?

Intense itching of the skin, typically worse at night and after a hot bath or shower

Visible burrows on the skin, mainly between the fingers and skin creases such as armpits and genitals

A bumpy or pimple-like rash, which is often difficult to see

Small, clear, fluid-filled spots or lesions

Often the scabies rash does not show very much because the mites burrow into the skin

Even after effective treatment, the itch can persist for two to three weeks due to the body's immune system responding to the mites.

Crusted scabies (Norwegian Scabies) is a more severe type of scabies, where thousands to millions of mites infect an individual.

Aggressive detection, diagnosis, infection control, and treatment measures are needed to prevent and control the spread.

Transmission

Transmission usually occurs from one person to another via skin-to-skin contact. If a person has never had scabies, symptoms can take 4-8 weeks to develop. It is crucial to remember an infested person can spread scabies during this time even if they don't have symptoms.

Scabies transmission can also occur through skin contact with mattresses, clothes, linen, towels, and other infested items. 

The incubation period of scabies is 2-6 weeks for initial exposure. If someone has had scabies previously, symptoms usually appear much sooner, usually 1-4 days after exposure. 

On some people, mites can live as long as 1-2 months, but they will die within 48-72 hours when they aren't on a host.

Surveillance monitoring is to be continued for six weeks minimum due to the length of incubation time.

Diagnosis

Diagnosis of scabies is usually based on appearance, the location and distribution of the rash, and the presence of burrows. Typically fewer than 10-15 mites can be present on the entire body of an infested person. Still, residents with Norweigan Scabies might be infested with thousands of mites, which is why it's so contagious. The Doctor may request a skin scraping to diagnose in some cases.

Outbreak definition

An outbreak is two or more cases of scabies among residents or employees of a facility within 4-6 weeks.