Prospective Surveillance of Primary Healthcare Presentations for Scabies and Bacterial Skin Infections in Fiji, 2018–2019

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  • 1 Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia;
  • 2 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia;
  • 3 Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia;
  • 4 Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Australia;
  • 5 College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji;
  • 6 Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia;
  • 7 Ministry of Health and Medical Services, Suva, Fiji;
  • 8 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia;
  • 9 Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia;
  • 10 School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia;
  • 11 Department of Dermatology, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
  • 12 School of Medicine, University of New South Wales, Sydney, New South Wales, Australia

Scabies, impetigo, and other skin and soft tissue infections (SSTIs) are highly prevalent in many tropical, low-middle income settings, but information regarding their burden of disease is scarce. We conducted a surveillance of presentations of scabies and SSTIs, including impetigo, abscesses, cellulitis, and severe SSTI, to primary health facilities in Fiji. We established a monthly reporting system over the course of 50 weeks (July 2018–June 2019) for scabies and SSTIs at all 42 public primary health facilities in the Northern Division of Fiji (population, ≈131,914). For each case, information was collected regarding demographics, diagnosis, and treatment. There were 13,736 individual primary healthcare presentations with scabies, SSTI, or both (108.3 presentations per 1000 person-years; 95% confidence interval [CI], 106.6–110 presentations). The incidence was higher for males than for females (incidence rate ratio [IRR], 1.15; 95% CI, 1.11–1.19). Children younger than 5 years had the highest incidence among all age groups (339.1 per 1000 person-years). The incidence was higher among the iTaukei (indigenous) population (159.9 per 1000 person-years) compared with Fijians of Indian descent (30.1 per 1000 person-years; IRR, 5.32; 95% CI, 5.03–5.61). Abscesses had the highest incidence (63.5 per 1,000 person-years), followed by scabies (28.7 per 1,000 person-years) and impetigo (21.6 per 1,000 person-years). Scabies and SSTIs impose a substantial burden in Fiji and represent a high incidence of primary health presentations in this population. The incidence in low-middle income settings is up to 10-times higher than that in high-income settings. New public health strategies and further research are needed to address these conditions.

    • Supplementary Materials

Author Notes

Address correspondence to Li Jun Thean, Murdoch Children’s Research Institute, Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia. E-mail:

Authors’ addresses: Li Jun Thean, Daniel Engelman, and Andrew C. Steer, Murdoch Children’s Research Institute and University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia, E-mails:,, and Lucia Romani, Handan Wand, and John Kaldor, Kirby Institute, University of New South Wales, Wallace Wurth Building, Kensington, New South Wales, Australia, E-mails:,, and Adam Jenney, Fiji National University and The Alfred Hospital, Melbourne, Victoria, E-mail: Jyotishna Mani and Jessica Paka, Murdoch Children’s Research Institute, Labasa, Fiji, E-mails: and Rachel Devi, Aalisha Sahukhan, Mike Kama, and Meciusela Tuicakau, Ministry of Health and Medical Services, Fiji, Dinem House, Suva, Fiji, E-mails:,, and Joseph Kado, Telethon Kids Institute, University of Western Australia and Ministry of Health and Medical Services Fiji, Northern Entrance, Perth Children’s Hospital, Nedlands, Western Australia, Australia, E-mail: Natalie Carvalho, University of Melbourne, Carlton, Victoria, Australia, E-mail: Margot Whitfeld, St. Vincent’s Hospital and School of Medicine, University of New South Wales, Darlinghurst, New South Wales, Australia, E-mail:

Financial support: Funding for this study was provided by the National Health and Medical Research Council (NHMRC) of Australia, awarded as a project grant (grant number: APP1127300) to Andrew Steer (principal investigator), Margot Whitfeld, Handan Wand, Mike Kama, Joseph Kado, Lucia Romani, and Natalie Carvalho. The NHMRC had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.