Strategies for managing contact cases depending on the organization of child custody
according to their characteristics (age, mode of care, in the intra- and extra-family home) of a newborn, infant, child under 5 years old

Back to decision-making tree Print last updated on 10/06/2024

Strategies depend on the characteristics (age, childcare mode, within and outside the family) of a newborn, infant, or child under 5 years old.

Childcare Facility: Risk Factors and Organization

Risk factors for the spread of the epidemic (defined by 2 linked cases) include:

• Significant diagnostic delay
• Clinical form of the index case (profuse and/or hyperkeratotic scabies)
• Number of suspected and confirmed cases
• Sharing of nap beds, changing table
• Lack of coordination in managing the epidemic by a dedicated person

Management of scabies clusters in a facility for children under 5:

During scabies clusters in a facility for children, special attention should be given to children under 5, who are more susceptible to infection.

Identifying a coordinator for epidemic management is necessary. In France, the Regional Health Agency (ARS) has the authority to identify the coordinator based on the type of childcare facility.

The treatment of asymptomatic contact subjects is similar to that proposed in this recommendation for confirmed cases. However, for clustered cases in a community, treating contact cases with ivermectin is preferable to improve adherence.

Management Based on Affected Circles

The different primary, secondary, or tertiary circles are defined based on the type of contact (frequency, duration, quality):

• 1st circle: People with close and prolonged skin-to-skin contact with an infected person.
• 2nd circle: Staff and residents of the living or childcare facility, school in regular contact with an infected person.
• 3rd circle: People who occasionally visit the childcare facility.

Management in a childcare facility for children under 5:

• If only one case of classic scabies is identified: treat only the 1st circle.
• In the presence of 2 cases of classic scabies: treatment of the 2nd circle is indicated based on the facility's characteristics and the type of contact between individuals (bed sharing, dormitories). Treatment of the 3rd circle is not indicated.
• In case of hyperkeratotic scabies: treatment of the first and second circles is indicated. Treatment of the third circle is discussed based on the facility's characteristics. The index case is managed in a hospital setting.
• In all circumstances, follow-up for 6 to 12 weeks is necessary.

➜ Associated measures