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Who is most at risk for scabies?

Scabies is a contagious skin infection caused by the human itch mite Sarcoptes scabiei. The microscopic scabies mites burrow into the upper layer of the skin and lay eggs. This causes an intense itchy rash to develop in areas where the mites have burrowed. Scabies is spread through direct, prolonged skin-to-skin contact with someone who has scabies. It can also be spread through contact with items such as clothing, bedding or towels used by someone with scabies. Certain groups are at higher risk of contracting scabies.

What is scabies?

Scabies is an infestation of the skin caused by the human itch mite Sarcoptes scabiei var. hominis. The microscopic mites burrow into the upper layer of the skin and lay eggs. This causes intense itching, which can be severe, especially at night. A rash composed of small, red bumps may develop in areas where the mites have burrowed. Common sites include the wrists, elbows, armpits, belt line, thighs, genital area, nipples, abdomen and lower buttocks. Scabies is highly contagious and spreads quickly through direct skin-to-skin contact or contact with infested items such as clothing, towels or bedding.

How do you get scabies?

Scabies mites are spread through prolonged, direct skin-to-skin contact with a person who has scabies. Contact must be sustained for at least 5-10 minutes. Brief, incidental contact does not usually spread infestation. Scabies can also spread through sexual contact. In addition, scabies mites can survive for 2-3 days away from human skin. They can be spread through shared clothing, towels, bedding or furniture. Crowded living conditions where close body and skin contact is frequent put people at increased risk of infestation and outbreaks. Good hygiene alone cannot prevent the spread of scabies if there is prolonged skin contact with an infested person or items.

Who is most at risk of scabies infestation?

While anyone can get scabies, certain populations are at higher risk:

  • Young children – Preschool and elementary school children often have close direct contact and have higher risk of transmission in childcare and classroom settings.
  • Elderly living in nursing homes – Outbreaks are common due to difficulty maintaining good hygiene and close living quarters.
  • People living in crowded conditions – Homeless shelters, group homes, prisons and refugee camps are prime environments for scabies outbreaks.
  • Healthcare workers – Prolonged direct contact with undiagnosed infested patients puts healthcare workers at risk.
  • Sexually active people – Scabies can spread through sexual contact and be mistaken for a sexually transmitted disease.
  • Immunocompromised people – Those with weakened immune systems due to disease or medication may be more susceptible to contracting scabies.
  • People living in tropical regions – Scabies infestation is more common in tropical climates of developing countries.

Why are young children more susceptible?

Young children are at greatest risk for several reasons:

  • Immature immune systems make them more vulnerable to infestation.
  • Close play contact and crowded classrooms facilitate mite transmission.
  • Children have difficulty adhering to treatment regimens, leading to persistent infestations.
  • Diagnosis is challenging in young children who cannot verbalize symptoms.
  • Children have lower standards of hygiene and personal care compared to adults.

Daycares and elementary schools frequently have scabies outbreaks that spread rapidly between children. Careful monitoring, screening and treatment is required to control transmission in childcare settings. Parents should be alert for symptoms like persistent nighttime itching to facilitate prompt diagnosis and treatment.

Why are elderly nursing home residents at high risk?

A number of factors put elderly nursing home residents at increased risk for scabies infestations:

  • Waning immune function due to aging and disease reduces resistance.
  • Cognitive decline makes proper hygiene and self-care difficult.
  • Weakened sensitivity of aged skin makes infestation less noticeable.
  • Close living quarters promotes rapid mite transmission.
  • Contact with healthcare workers can spread mites between patients.
  • Difficulty adhering to topical treatment due to physical limitations or dementia.

These factors make rapid containment of scabies challenging in long-term care facilities. Careful screening, treatment and environmental control measures are required to control infestation and limit transmission during outbreaks.

Why are homeless people vulnerable?

High rates of scabies infestation among homeless populations are linked to several risk factors:

  • Crowded living conditions in shelters promote mite transmission.
  • Poor access to healthcare delays diagnosis and treatment.
  • Inadequate hygiene and sanitation due to lack of facilities.
  • Warm climates provide favorable conditions for scabies mites.
  • Weakened immunity due to malnutrition, chronic diseases.
  • Difficulty implementing control measures like laundering clothes.
  • High rates of substance abuse or mental illness hinder self-care.

These barriers make scabies outbreaks common yet challenging to control in homeless populations. Targeted screening, access to treatment and sanitation/decontamination interventions can help reduce transmission and outbreaks in homeless shelters and encampments.

Why are people in institutions at higher risk?

Institutional environments like prisons, group homes, mental health facilities and refugee camps confine people in crowded, close-contact living conditions. This facilitates the rapid spread of scabies outbreaks. Additional risk factors in these settings include:

  • Difficulty isolating symptomatic individuals.
  • Inadequate access to healthcare and medications.
  • Poor adherence to treatment regimens.
  • Insufficient hygiene/sanitation due to limited facilities.
  • High rates of sexual activity in some facilities.
  • Rapid staff/population turnover hinders containment efforts.

Targeted control measures including screening, contact tracing, cohorting, enhanced hygiene and sanitation, and patient education are necessary to control scabies transmission in high-risk institutional environments.

Why are immunocompromised individuals at increased risk?

Those with weakened immune systems are more susceptible to scabies infestations for several reasons:

  • HIV, cancer, organ transplants and medications like steroids suppress the immune system.
  • Immune dysfunction reduces the body’s ability to mount an effective response.
  • Reduced immunity allows mites to more easily establish infection.
  • Higher mite burden due to impaired immune surveillance.
  • Atypical presentations make diagnosis more difficult.
  • Higher rate of treatment failures and persistent infections.

Immunocompromised patients require more aggressive diagnostic testing, treatment and follow-up care to clear infestations. Stronger topical or systemic therapies may be needed to compensate for decreased immune function.


While anyone can get scabies, certain populations are at higher risk. Young children, the elderly, those living in crowded conditions or institutions, the immunocompromised and those in tropical regions are most vulnerable to infestation and outbreaks. Awareness of risk factors guides targeted interventions including screening, treatment, containment and education programs to control scabies in high risk groups.