Scabies Outbreak in Germany: Cases Rising & What You Need to Know

A disease with roots stretching back to biblical times and ancient Greece and Rome is experiencing a resurgence in Germany, with outbreaks reported in Lower Saxony and other regions. Scabies, also known as the seven-year itch, is a highly contagious skin condition characterized by intense itching, particularly at night. The increase in cases is particularly noticeable in communal settings.

Scabies is caused by the Sarcoptes scabiei mite, a microscopic arachnid. These mites burrow into the upper layer of the skin, where they live and lay eggs. The symptoms – burning sensations, intense itching, and a characteristic rash of small blisters and red nodules – don’t appear immediately. It takes approximately four to six weeks for the immune system to react to the mites, their eggs, and their waste products, triggering the inflammatory response that causes the itching and rash.

The mites commonly target specific areas of the body, including the spaces between fingers and toes, wrists, ankles, armpits, elbows, nipples, and genitals. In infants and young children, the rash can also appear on the head and face.

Over 380,000 Cases Diagnosed in 2018

While a comprehensive national reporting system for scabies doesn’t exist in Germany, data collected from outpatient billing records from statutory health insurance companies provides a clear picture of the increasing incidence. In 2018, over 380,000 patients received a diagnosis of scabies. This translates to an incidence rate of 525 diagnoses per 100,000 inhabitants annually. This data, analyzed by the Robert Koch Institute (RKI) in collaboration with the Central Institute for Statutory Health Insurance, reveals a nine-fold increase in scabies diagnoses since 2009.

The rise is particularly pronounced among adolescents and young adults, with diagnoses in this age group being more than eleven times higher in 2018 compared to 2009.

Increasing Hospitalizations

The number of patients requiring hospital treatment for scabies is also on the rise. Diagnoses in hospital settings have increased steadily since 2009 and have remained at a high level even during the COVID-19 pandemic. In 2023 alone, 7,094 hospital patients in Germany were diagnosed with scabies as the primary diagnosis. This trend mirrors observations in other European Union countries.

Who is at Risk?

Scabies is spread through prolonged, direct skin-to-skin contact. This makes close contacts – family members, intimate partners, and those in frequent physical contact – particularly vulnerable. Community settings, such as care homes and schools, also present a higher risk of transmission, affecting both residents and caregivers. The RKI notes that older adults, often managing multiple chronic health conditions, are an increasingly important population in the spread of scabies, especially within residential and nursing facilities.

It’s important to emphasize that scabies is not caused by poor personal hygiene. Bathing habits have no bearing on the risk of infection.

Treatment and Management

The primary goal of scabies treatment is to eliminate the mites, as well as their larvae and eggs. What we have is typically achieved with prescription creams or lotions specifically designed to kill the mites. Treatment also focuses on managing the symptoms, particularly the intense itching, and addressing any secondary skin infections that may develop due to scratching. Inflammatory responses are also addressed as part of a comprehensive therapeutic approach.

Outbreaks have been noted in asylum centres across Western Europe, which is unsurprising given that direct, prolonged skin-to-skin contact facilitates transmission. Supply chain issues impacting the availability of scabies creams in 2023 and 2024 in the UK contributed to a rise in cases, highlighting the importance of consistent access to treatment.

The increasing incidence of scabies underscores the need for increased awareness, prompt diagnosis, and effective treatment to control its spread, particularly within vulnerable populations and communal living environments. Further research is needed to fully understand the factors driving this resurgence and to develop strategies for prevention and management.