Hi, 

Would colleagues be able to share any global guidance on IYCF, breastfeeding and care including infection control in scabies situation? Specific country guidance or documented practice is also welcome to learn from different settings.

We have guidance on treatment and technical guidance for IYCF/ IYCF-E  is what we are seeking. 

Thanks so much in advance. 

Hi Rose, 

Unicef has these tools for IYCF: https://www.unicef.org/documents/community-iycf-package

The scabies will need treatment: https://www.mayoclinic.org/diseases-conditions/scabies/diagnosis-treatment/drc-20377383

I've actually had scabies and it is awful, so good luck.

The American Academy of Dermatologists have these recommendations for managing that obviously need to be adapted to context (i.e. not sure there are many washing machines and dryers where you are dealing with this, but using hottest water possible to clean clothes or putting clothes in a plastic bag for a week seems manageable.): 

The mite that causes scabies is hardy. These tips can help you get rid of the mites.

  1. If you think you have scabies, don’t be embarrassed to see a dermatologist. Some people do not seek medical help because they feel this reflects poorly on them. This is not true. People who are very clean and neat can get scabies. People of all ages, races, and income levels get scabies.

  2. Everyone you had close contact with needs treatment. Scabies is very contagious. If you get treatment and people with whom you live or have close contact do not get treatment, you can get the mites again. People do not have to have signs and symptoms of scabies to have mites on their skin. Someone who has never had scabies may not have any symptoms for two to six weeks.

  3. If your dermatologist prescribes a medicine that you apply to your skin, be sure to take a bath or shower before you apply the medicine. You should then massage the medicine onto clean, dry skin. The medicine must remain on the skin for 8 to 14 hours. You will then wash off the medicine. For this reason, most people apply the medicine at bedtime and wash it off in the morning.

  4. Apply the medicine from your neck to your toes. This includes all skin between your neck and toes—the skin around your nails, the crease between your buttocks, and the skin between your toes. Infants, children, and the elderly often need to treat their scalp, temples, and forehead. You should never apply medicine to the nose, lips, eyelids, nor around the eyes or mouth.

  5. If you wash your hands after applying the medicine, be sure to reapply the medicine to your hands. Mites like to burrow in the hands, so it is important to treat the hands. Be sure to apply the medicine to the skin between your fingers.

  6. The day you start treatment, wash your clothes, bedding, towels, and washcloths. Mites can survive for a few days without human skin. If a mite survives, you can get scabies again. To prevent this, you must wash clothes, sheets, comforters, blankets, towels, and other items. Be sure to follow these instructions when washing:

    • Wash all items in a washing machine, using the hottest water possible.
    • After washing, dry everything in a dryer, using the hot setting.
    • If you cannot wash something in a washing machine and then dry it in a dryer, take it to a dry cleaner or seal it in plastic bag for at least one week.
    • Items that have not touched your skin for more than 1 week generally do not need washing. If you are not sure whether you wore clothing or used an item within the past week, be sure to wash and dry it.

    Wash and dry items the day you start treatment

    Washing clothes, bedding, and towels is necessary to get rid of the mites that cause scabies.

KEVIN PHELAN

Answered:

4 months ago

Hi there, here is an article from PLoS on the issue (the paper's title is on pregnancy, but it also addresses lactation). The paper is Open Access: Paper on Scabies and Lactation and Pregnancy. Text in this paper (quote):

Is lactation possible for scabies-infested pregnant women and is breastfeeding safe while using scabicide drugs?

In adults, scabies lesions are often clustered on the breasts and nipples. This situation raises the question of both the risk of mother-to-child transmission of scabies and scabicide drug absorption through breastfeeding. Scabies-infested lactating women should express their milk as long as they are not receiving an effective treatment, which allows for maintaining maternal breast milk feeding and limiting the risk of scabies transmission to the infant. For pregnant women, few data are available concerning the safety of scabicide drugs use during lactation. Excretion of permethrin and benzyl benzoate in breast milk after topical application has not yet been assessed, but permethrin residues in breast milk were evidenced after extensive exposure from agricultural use or malaria control in 1 study [20]. Regarding the very low absorption rate of permethrin after topical administration (2%), its rapid metabolism to inactive metabolites, and its safe application on infant skin, 5% permethrin cream is considered safe for nursing mothers and should be preferred over benzyl benzoate [21]. Yet, breastfeeding might be withheld during the 8 hours of permethrin topical application. Excretion of ivermectin in human breast milk was evaluated in 1 study of 4 lactating non-breastfeeding women after ivermectin intake at 150 μg/kg [22]. The authors indicated that a 1-month-old child would receive a dose of approximately 2.75 μg/kg (i.e., 1% of the maternal dose) on the day of the drug intake [22]. Also, from their 3 years of experience using ivermectin in onchocerciasis endemic areas, with lactating mothers constituting 5% to 10% of the population, no serious side effects were observed [22]. Both the American Academic of Pediatrics (https://www.aap.org) and the CRAT consider ivermectin compatible with breastfeeding.

Disclaimer:The findings and conclusions in this paper are those of the authors and do not necessarily represent my position. Mija

Anonymous

Answered:

4 months ago
Please login to post an answer:
Login