Scabies outbreaks have occurred among patients, visitors, and staff in institutions such as nursing homes, long-term care facilities, and hospitals. Such outbreaks frequently are the result of delayed diagnosis and treatment of crusted (Norwegian) scabies in debilitated, immunocompromised, institutionalized, or elderly persons. The characteristic itching and rash of scabies can be absent in such persons, leading to frequent misdiagnosis and delayed or inadequate treatment and continued transmission. Scabies often is not recognized until it begins to appear among staff and other patients at the institution.
Local and/or state health departments may be able to provide guidelines for preventing and controlling scabies outbreaks.