Scabies outbreaks in residential care: a three-year mixed-methods regional review in Ireland

Scabies outbreaks in residential care facilities (RCFs) are increasingly complex and difficult to control. We conducted a three-year mixed-methods review in one region in Ireland to describe outbreak epidemiology, identify factors associated with severity and duration, and explore operational barriers and enablers to effective management. A retrospective quantitative analysis included all outbreaks notified to Public Health between 2023 and 2025 (excluding facilities with <5 residents). Data on outbreak duration, resident caseload, treatment, timing of notification and treatment, and infection prevention and control (IPC) measures were analysed in SPSS. Qualitative data were collected via structured surveys and analysed using the Braun and Clarke framework. Thirty-eight outbreaks were identified (6 in 2023, 11 in 2024, 21 in 2025). Resident caseload increased over time (43, 113, 210; mean 7–10 cases per outbreak), with mean duration rising from 44 to 141 days. Delayed notification was associated with higher case numbers (r = 0.407, p = 0.019) and attack rates (r = 0.387, p = 0.038). Early ivermectin use was associated with faster outbreak resolution (HR 5.18, p = 0.035), while delayed use correlated with prolonged outbreaks (r = 0.668, p = 0.005). Most outbreaks required multiple treatment rounds, with varied regimens. Qualitative findings identified delayed diagnosis, limited access to clinicians and medications, coordination challenges, and IPC knowledge gaps as key barriers. Early detection, staff education, clear communication and coordinated treatment were critical enablers. Scabies outbreaks in RCFs are becoming more frequent, prolonged and complex. Earlier notification, timely treatment and coordinated management may reduce severity and duration. These findings from a regional Irish setting highlight challenges likely shared across comparable systems and support strengthened guidance, workforce education and preparedness to improve outbreak control across Europe.

Key messages

• Delayed diagnosis and notification drive larger, prolonged scabies outbreaks in residential care settings.

• Early ivermectin use and coordinated management are associated with faster outbreak control and may reduce scabies outbreak duration.