Scabies among Dutch higher education students: do cases notify their contacts and do contacts take adequate measures?

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Wilma A. Stolk, Marloes D. Stradmeijer, Hélène A.C.M. Voeten, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7452814/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Mar, 2026 Read the published version in Parasites & Vectors → Version 1 posted 9 You are reading this latest preprint version Abstract Background Scabies incidence has rapidly increased in the Netherlands, particularly among higher education students. We hypothesized that effective control in this group is hindered by poor contact notification by indexes and limited treatment by contacts. We assessed this in a questionnaire study. Methods An online questionnaire was distributed to students, focusing on their adherence to notification (indexes), and treatment and hygiene recommendations (contacts), as well as their health seeking behaviour. Results Of the indexes (n=334), 57% had experienced multiple scabies episodes and over two-thirds had not been notified beforehand. Notably, 47% self-diagnosed their condition. Most indexes notified all regular (bed) partners and housemates, 55% also notified all casual bed partners. Contacts (n=287) were usually notified by the index, in 46% of cases the notifier was a housemate. After notification, contacts avoided physical contact with others (73%), applied permethrin (78%), washed bedding and clothing preventively (84%), or put their clothing in bags (81%); 59% also notified their own contacts. The general practitioner was frequently contacted, especially by indexes, although experiences were often rated poorly due to conflicting or incorrect information. Conclusion The high proportion of unnotified indexes suggests a notification gap. Especially casual bedpartners often remain unnotified, presenting a risk for onward transmission. Contacts generally took adequate measures, although premature notification of their contacts may lead to unnecessary treatment or ‘notification fatigue’. Enhancing health care support and communication might help to improve notification and prophylactic treatment behaviours and may play a crucial role in breaking the chain of transmission. scabies young adults students contact notification preventive treatment behaviour questionnaire Figures Figure 1 Figure 2 Background Scabies is a contagious skin condition, caused by the scabies mite Sarcoptes scabiei (var. hominis ) and associated with intense itching, especially at night. The infestation is directly transmitted through prolonged skin-to-skin contact, although indirect transmission can also occur via fomites (e.g. via shared mattrasses, bed linen, clothing, chairs/couches). Scabies can be treated with permethrin or benzyl benzoate cream (effective against all mite stages) or oral ivermectin (effective against mites, but not eggs) [ 1 ]. A second treatment after 7–14 days is recommended to kill newly hatched mites [ 1 ]. To prevent re-infestation, potentially infected household members and other close contacts should be treated simultaneously with the index and environmental decontamination measures should be applied (e.g., washing of clothing, bed linen, towels and vacuum cleaning of carpet, couch) [ 1 ]. The many steps involved make scabies treatment cumbersome and failure-prone [ 2 , 3 ]. The scabies incidence in the Netherlands has risen sharply in the past decade, with more general practitioner (GP) consultations [ 4 ], scabicide dispensations [ 4 ] and institutional outbreaks (e.g., in nursing homes or day care centres). This resulted in increased pressure on GPs [ 4 ], dermatologists and public health services. Similar increases are seen in other European countries [ 5 ]. The increase in scabies incidence is not fully understood. Potential contributing factors include increased importation (e.g. through tourism / refugees), changes in social behaviour, and altered living conditions [ 5 ]. Reduced mite susceptibility to treatment may also contribute [ 1 , 6 ], but is difficult to separate this from other causes of treatment failure such as suboptimal treatment application or incomplete contact treatment [ 7 ]. GP data show that the incidence is particularly high among older adolescents and young adults [ 4 ], and especially also among higher education students (referred to as ‘students’ hereafter) [ 8 ]. Indeed, scabies has become a common problem among students with frequent outbreaks in student houses (e.g., [ 9 , 10 , 11 ]). Students constitute a specific risk group for scabies due to their extensive contact networks, shared housing facilities, and behavioural factors (e.g. sharing of bedding, clothes). Therefore, specific attention to students is needed in the prevention and control of scabies in the Netherlands. Scabies management practices need to be strengthened to stop the epidemic. National guidelines for scabies treatment stress the importance of treating potentially infected contacts on the same day and time as the index [ 12 , 13 ], but this is often difficult in practice. It requires indexes to notify all their contacts (e.g., housemates, sexual partners, guests, other contacts), who must then follow the recommended hygiene and treatment guidelines. Failure to treat all contacts has been associated with increased treatment failure [ 2 ]. Research on contact notification for sexually transmitted diseases and Covid-19 shows this is often challenging, due to societal dynamics, disease characteristics, or stigma [ 14 , 15 ]. We hypothesize that poor contact treatment also hinders scabies control among students, but the extent of this is unclear. To inform interventions for scabies control, we assessed whether students with scabies notify all their contacts (housemates, sexual contacts, guests, others), and whether notified students take adequate measures. Health seeking behaviour and reasons for non-compliance with recommended measures were also evaluated. Elsewhere, we report on psychosocial determinants of the students’ behaviours; good understanding of this can help to improve health education and, ultimately, treatment outcomes [ 16 , 17 ]. Methods Study design This study comprised an online cross-sectional questionnaire among Dutch higher vocational education (in Dutch: Hoger Beroepsonderwijs (HBO)) and university students, specifically targeted at students who had experienced scabies or had been in contact with someone with scabies in the past year. Study population and recruitment Our study population consists of students in the Netherlands aged 18–30 years. In study year 2022–2023, respectively 417,000 and 337,0000 students were enrolled in Dutch HBO institutions and universities in the Netherlands [ 18 ]. About 39% of HBO students and 71% of university student live away from their parents, e.g. in a rented private room in a student house or student flat, often sharing facilities like kitchen, bathroom, toilet, and living room with 1 or more other students/persons. We focussed our recruitment on university cities Rotterdam and Leiden, although students nationwide could participate. We advertised the study via educational institutions, flyers, posters, student GPs, municipal health services (GGDs), local and national student associations, snowballing methods, and post mailings to known student housing complexes. Students were provided with a link to the questionnaire or were directed to the online questionnaire by scanning a QR code. The online questionnaire was open for responses from May to June 2023. Questionnaire On the online questionnaire’s opening page, we provided clear, non-technical information about the study’s purpose, key characteristics (voluntary participation, anonymous data collection, 10–15 minutes survey completion time), and eligibility criteria (students aged 18–30 years with scabies experience / scabies contact in the past year). We provided a weblink and email address for more detailed information. To encourage participation and reduce selection bias, we offered a chance to win one of five €50-gift vouchers. We then asked for digital informed consent. Participants providing informed consent were led to the main questionnaire. The introductory section asked about demographics. We then asked whether participants had had scabies in the past year (indexes) or had been in contact with someone with scabies (contacts). Students without such experience were included as reference group and for them the questionnaire ended here. Participants continued with either the 'index' or 'contact' questionnaire, depending on their experience. If participants had experiences both as index and contact, they would get the index questionnaire, unless their most recent experience was one as contact in which case they received the contact questionnaire. The index questionnaire focussed on the participant’s most recent scabies episode, with questions about diagnosis, symptoms, and treatment. We also asked about the number and type of contacts during the infectious period, the extent to which the participant notified these contacts, and reasons for incomplete contact notification. Next, we provided the respondent with information about the contact-definition as used in the Netherlands for determining treatment groups and asked whether the index had notified all contacts according to this definition. We paraphrased the guideline definition [ 19 ] as follows: “People with whom you have had prolonged (> 15 minutes) or frequent skin contact since 1 to 2 weeks after becoming infected. This often comes down to family contacts, housemates, friends and guests staying overnight. This also applies if you did not have any symptoms of scabies during that period, such as itching, rash, etc. Examples of skin contact are holding hands, sitting next to each other, or sharing a bed (bed partners, lovers, guests staying overnight). Via intensive use of each other's clothing, towels and bedding or, for example, a shared sofa in the communal living room, the scabies mite can also be transmitted.” The contact questionnaire focused on the most recent contact notification event, with questions about relationship to the notifier, actions taken after receiving the notification (e.g. including simultaneous treatment, hygienic measures such as washing clothes and bedding [ 19 ]), compliance with recommended measures, and reasons for incomplete compliance. Both questionnaires also contained questions about their health care seeking behaviour, including questions on which health care providers were contacted. After completing all relevant questions, respondents were asked if they wanted to participate in the raffle for the €50-gift voucher. The Survalyzer application [ 20 ] was used to develop and publish the questionnaire and to collect responses. We used closed questions with pre-programmed answer options where possible. The questionnaire was pretested by target audience members for clarity and completion time estimation. Data cleaning and statistical methods Data were analysed in SPSS version 28. Respondent not meeting the inclusion criteria (e.g. those aged > = 30 years, reporting not to be studying at higher education institution, or missing information on his/her student status) were removed from the database before the analysis. Background variables and behavioural patterns (contact notification vs. compliance with measures) were studied by calculating frequency distributions and means; significance of differences was tested with chi-square tests and ANOVA. Figures were created using the ggplot package of R version 4.3.1 [ 21 ]. Results General information The introductory questionnaire was completed by 807 consenting students, and 787 of them met the inclusion criteria. Of these respondents, 334 completed the index questionnaire and 287 the contact questionnaire, while 166 only completed the introductory part as they had no experience with scabies. Table 1 gives a description of respondent characteristics. About half of the respondents came from Rotterdam and Leiden, where we focussed our recruitment. In comparison to the reference group, contacts and indexes were slightly older, were more often male, university student, member of a study or student association, and residing in student housing, and had more housemates. Scabies experience was often quite recent: respectively, 22% and 47% of indexes had scabies at the moment of the survey and or in the 3 months preceding the survey, and 13% and 65% of contacts received the last notification in the last week and last 3 months preceding the survey. About 40% of our contacts had also experienced scabies themselves and about 70% of the indexes had ever received a contact notification for scabies. Table 1 Characteristics of study participants Indexes (n = 334) Contacts (n = 287) Reference group (neither contact nor index) (n = 166) Total (n = 787) Count (%) Count (%) Count (%) Count (%) p value Study city Rotterdam a 94 (28.1%) 72 (25.1%) 83 (50.3%) 249 (31.7%) < 0.001, chi-square Leiden 80 (24.0% 81 (28.2%) 9 (5.5%) 170 (21.6%) Utrecht 74 (22.2%) 62 (21.6%) 1 (0.6%) 137 (17.4%) Other b 86 (25.7%) 72 (25.1%) 72 (43.6%) 230 (29.3%) Missing 0 (0.0%) 0 (0.0%) 1 (0.6%) 1 (0.1) Age Mean in years (range) 21.8 (18–28) 21.6 (18–28) 21.3 (18–28) 21.6 0.045, ANOVA Missing 64 (19.2%) 77 (26.8%) 34 (20.5%) 175 (22.2%) Gender Female 215 (64.4%) 201 (70.0%) 125 (75.3%) 541 (68.7%) 0.033, chi-square c Male 118 (35.3%) 81 (28.2%) 41 (24.7%) 240 (30.5%) Other/unknown 1 (0.3%) 5 (1.7%) 0 (0.0%) 6 (0.8%) Type of education University education 264 (79.0%) 250 (87.1%) 94 (56.6%) 608 (77.3%) < 0.001, chi-square Higher vocational education 70 (21.0%) 37 (12.9%) 72 (43.4%) 179 (22.7%) Living situation Living with parents / caretakers 22 (6.6%) 14 (4.9%) 75 (45.2%) 111 (14.1%) < 0.001, chi-square Living in a student house or a student housing complex d 280 (83.8%) 255 (88.9%) 56 (33.7%) 591 (75.1%) Living in independent home (rented or owned) with or without partner) 30 (9.0%) 15 (5.2%) 31 (18.7%) 76 (9.7%) Other 2 (0.6%) 3 (1.0%) 4 (2.4%) 9 (1.1%) Number of housemates 0 9 (2.7%) 7 (2.4%) 12 (7.2%) 28 (3.6%) < 0.001, chi-square 1 32 (9.6%) 23 (8.0%) 34 (20.5%) 89 (11.3%) 2 64 (19.2%) 46 (16.1%) 39 (23.5%) 149 (19.0%) 3 44 (13.2%) 34 (11.9%) 43 (25.9%) 121 (15.4%) 4 46 (13.8%) 33 (11.5%) 21 (12.7%) 100 (12.7%) 5 27 (8.1%) 23 (8.0%) 6 (3.6%) 56 (7.1%) > 5 112 (33.5%) 120 (42.0%) 11 (6.6%) 243 (30.9%) Missing 0 (0.0%) 1 (0.3%) 0 (0.0%) 1 (0.1%) Membership of student associations Member of both study and student association 76 (22.8%) 80 (27.9%) 15 (9.0%) 171 (21.7%) < 0.001, chi-square Member of general student association 165 (49.4%) 133 (46.3%) 16 (9.6%) 314 (39.9%) Member of study association 48 (14.4%) 43 (15.0%) 47 (28.3%) 138 (17.5%) Not a member of study or general student association 45 (13.5%) 31 (10.8%) 88 (53.0%) 164 (20.8%) How many persons do you know who have had scabies during the past year? I don't know anyone who has had scabies 3 (0.9%) 1 (0.3%) 61 (36.7%) 65 (8.3%) 10–20 persons 77 (23.1%) 62 (21.6%) 4 (2.4%) 143 (18.2%) > 20 person 82 (24.6%) 68 (23.7%) 2 (1.2%) 152 (19.3%) When was the last time you had scabies yourself? I currently have scabies 74 (22.2%) 0 (0.0%) 74 (9.4%) 1 to 4 weeks ago 81 (24.3%) 2 (0.7%) 83 (10.5%) 1 to 3 months ago 75 (22.5%) 28 (9.8%) 103 (13.1%) 4 to 6 months ago 51 (15.3%) 26 (9.1%) 77 (9.8%) 7 to 12 months ago 28 (8.4%) 31 (10.8%) 59 (7.5%) > 12 months ago 25 (7.5%) 26 (9.1%) 51 (6.5%) I’ve never had scabies 0 (0.0%) 174 (60.6%) 166 (100%) 340 (43.2%) When was the last time you received a contact notification for scabies? Last week 21 (6.3%) 38 (13.2%) 59 (7.5%) 1 to 4 weeks ago 37 (11.1%) 92 (32.1%) 129 (16.4%) 1 to 3 months ago 76 (22.8%) 95 (33.1%) 171 (21.7%) 4 to 6 months ago 43 (12.9%) 32 (11.1%) 75 (9.5%) 7 to 12 months ago 26 (7.8%) 16 (5.6%) 42 (5.3%) > 12 months ago 29 (8.7%) 14 (4.9%) 43 (5.5%) I have never had a contact notification for scabies 102 (30.5%) 0 (0.0%) 166 (100%) 268 (34.1%) a The Rotterdam-subpopulation contained more respondents without any scabies experience (reference group), due to wider advertisement of the study. b Other respondents studied in Amsterdam (n = 55), Den Haag (n = 42), Delft (n = 36), Eindhoven (n = 27), Groningen (n = 18), Maastricht (n = 13), Nijmegen (n = 12), Enschede (n = 11), Wageningen (n = 2), and other (n = 14); 35/42 respondents from The Hague were controls. c Chi-square, calculated ignoring the few individuals with other or unknown sex. d Typically sharing kitchen and bathroom; sometimes also shared living room. [Table 1, included at the end of this document] Indexes Table 2 shows the main characteristics of the indexes (n = 333; one index was removed because of too many missing values). Almost 60% of the indexes had experienced multiple scabies episodes, and 20% even had four or more episodes. Almost two-thirds of the indexes were not notified before their last episode and half of them self-diagnosed the infection. Most indexes (85%) reported significant suffering from scabies, and in half of the cases, it took three months or more to clear the infestation. Table 2 Students with scabies: characteristics of the last scabies episode (n = 333) Count % How many times have you had scabies in your life so far, including the last episode? Once 141 42.3% Twice 76 22.8% Three times 48 14.4% Four times or more 68 20.4% Were you notified beforehand that you could have contracted scabies, and by whom? Yes, by the source of my infestation 102 30.6% Yes, by someone else 17 5.1% No, I was not notified beforehand 212 63.7% Other (persistent or recurrent infection) 2 0.6% Who diagnosed the scabies? General practitioner 122 36.6% Dermatologist 50 15.0% Municipal health service (GGD) a 4 1.2% Self-diagnosis 157 47.1% To what extent have you suffered from scabies-related complaints such as itching and rash? I did not suffer at all 4 1.2% I suffered a bit 43 12.9% I suffered quite a bit 77 23.1% I suffered much 103 30.9% I suffered very much 106 31.8% How long did it take for you to be completely cured of scabies? Less than 4 weeks 54 16.2% 1–2 months 113 33.9% 3 months or more 165 49.5% Missing 1 0.3% Approximately, how many contacts did/do you have, approximately, whom you might have infected with scabies? 0 21 6.3% 1–5 199 59.8% 6–10 67 20.1% More than 10 46 13.8% Type of contacts, who may have been exposed to the infection by the index case (percentage of all indexes, including those with 0 contacts, n = 333) (Bed) partner(s) 256 76.9% Household members, other than family 229 68.8% Friends, who are not household members 138 41.4% Family members 127 38.1% Acquaintances from general student association 65 19.5% People visiting my household members or family 31 9.3% Acquaintances from study association 15 4.5% Acquaintances from sport club 5 1.5% Other 3 0.9% Have you notified these contacts (possibly anonymously) about possible infection with scabies? (percentage of indexes, reporting to have had at least 1 contact, n = 312) No, I did not notify any of my contacts 11 3.5% b Yes, I notified some of my contacts 58 18.6% b Yes, I notified about half of my contacts 17 5.4% b Yes, I notified most of my contacts 101 32.4% b Yes, I notified all my contacts 125 40.1% b According to the presented guideline definition of contacts, have you notified all your possible contacts? (percentage of all indexes, n = 333) c According to this definition, I notified: Not any of my contacts 12 3.6% Some of my contacts 37 11.1% About half of my contacts 20 6.0% Most of my contacts 99 29.7% All of my contacts 164 49.2% Missing 1 0.3% Which health care providers did you consult about your scabies infestation? (multiple answers possible) Did not contact any health care provider 34 10.2% Contacted the following health care provider - General practitioner 296 88.9% - Dermatologist 77 23.1% - Municipal Health Service (GGD) 50 15.0% - Any of the above 299 89.8% a These 4 cases where diagnosed by municipal health services with a scabies-clinic, in Leiden, Amsterdam, or Utrecht. b Percentage is calculated among persons reporting to have been in contact with at least 1 person who they could have infected (n = 312). c See methods section for the guideline definition. [Table 2 , included at the end of this document] About one-third of the indexes reported having 6 or more contacts, most commonly bed partners, household members, friends, and family (Table 2 ). Forty percent notified all their contacts, while 22% notified none or only some. The extent to which contacts are notified varied (Fig. 1 ): most indexes notified all or most of their regular bedpartners and housemates, and about 74% of indexes also notified all their family members. However, only 55% of the indexes notified all their casual bedpartners with 22% notifying none. Friends, visitors and fellow members of study / student associations and sport clubs were notified less often. Gender subgroups showed no significant differences. Common reasons reported for not notifying all these contacts included: low likelihood of having passed on the infection (n = 109/184, 59.2%), fear (n = 53, 28.5%), uncertainty about who should be notified (n = 51/184, 27.7%), or lack of contact information (n = 12, 6.5%). Other reasons mentioned in free text fields included a long diagnostic delay (contacts’ risk was deemed negligible, if they had not contracted it during the prolonged period of diagnostic uncertainty), notification being unnecessary in view of rapid action, or postponing notification until after completing treatment. One person indicated to have had too many (indirect) contacts, including via fomites (e.g. coat rack), making it impossible to notify everyone. When we presented the indexes afterwards with the definition of who should be notified according to the Dutch national guidelines, the proportion of respondents indicating to have notified all their contacts increased from 40–49%, and the proportion of respondents indicating to have reported none or only few of their contacts declined from 22–15% (Table 2 ). Ten percent of indexes had not consulted any health care provider, while 89%, 23% and 15% had consulted a GP, dermatologist or the municipal health service (Table 2 ). Respectively 40%, 16% and 30% of respondents were not satisfied with their contact with these health care providers. Frequently cited reasons for dissatisfaction were no or late diagnosis, or receiving conflicting, not enough or incorrect information/advice. Contacts Table 3 shows the main characteristics of the contacts (n = 282; 5 contacts were removed because of too many missing values or because information from the contact questionnaire revealed that they did not receive a contact notification). Nearly half (45%) of contacts had received 3 or more notifications in the past year and 10% even 6 or more. Most notifications (86%) came directly from the person with scabies. The notifier was often a housemate (58%), friend (27%), or someone from a study or student association (17%), and less often a regular or casual bedpartner (13% or 10%). Three-quarters of contacts had no scabies-related complaints when notified. Two-thirds of the contacts sought advice, usually from the internet, people who’ve had scabies, or other social contacts; fewer consulted a GP or dermatologist. Table 3 Students who were notified for scabies: characteristics of the latest notification and measures taken (n = 282) Question Answer category Count % How often have you been notified in the past 12 months about possible infestation with scabies? 1 or 2 times 155 55.0% 3 to 5 times 100 35.5% 6 + times 27 9.6% By whom were you notified? By the potential source 241 85.5% By someone else 41 14.5% What was your relationship to the person who notified you? (multiple answers were possible) A housemate 164 58.2% A family member 8 2.8% A friend 75 26.6% A casual bedpartner 29 10.3% A regular bedpartner 36 12.8% Someone from the study or general student association 47 16.7% Other 7 2.5% Invalid answer 1 0.4% Did you have scabies-related complaints, such as itching and rash, when you received the notification? No complaints 208 73.8% Some complaints 55 19.5% A moderate amount of complaints 7 2.5% Many complaints 6 2.1% Very many complaints 6 2.1% Who did you ask for advice? (multiple answers possible, number and percentage indicating to have asked the given source for advice) The person who notified me about the potential infestation with scabies 76 27.0% General practitioner 74 26.2% Dermatologist 12 4.3% Someone who has had scabies 109 38.7% Guideline website of the Dutch Institute for Public Health and the Environment 104 36.9% One of my social contacts 106 37.6% Other 4 1.4% Did not seek advice 95 33.7% Which action did you take after receiving the notification? (multiple answers possible, number and percentage indicating to have taken the given measures) Avoided physical contact with others 205 72.7% Went to the general practitioner/medical specialist to check whether I also have scabies 54 19.1% Started applying medicinal ointment against scabies (permethrin or benzyl benzoate). 222 78.7% Took ivermectin tables against scabies 56 19.9% Started washing my clothes preventively and/or putting them in garbage bags 228 80.9% Started washing my bedding as a preventative measure 239 84.8% Notified other people about possible infestation with scabies 165 58.5% Looking back on how you acted after you received a contact notification: did you take the right measures according to the guidelines from the RIVM? No, I have not followed any of these measures 29 10.3% Yes, I have partially followed these measures 26 9.2% Yes, I have largely followed these measures 46 16.3% Yes, I have fully/exactly followed these measures 181 64.2% Which of the following healthcare providers or health authorities have you contacted (by phone, directly, or by email) regarding your scabies contact alert? (multiple answers possible) Did not contact any health care provider 141 50.0% Contacted the following health care provider - General practitioner 131 46.5% - Dermatologist 25 8.9% - Municipal Health Service (GGD) 24 8.5% - Any of the above 141 50.0% [Table 3 , included at the end of this document] Some students (n = 17, 6%) did not take any measures after notification (Fig. 2). All others took one or more measures, frequently including washing of bedding, washing of clothes or putting them in sealed plastic bags for at least 3 days, topical treatment with permethrin or benzyl benzoate cream, and avoiding physical contact with others. Slightly fewer but still many respondents notified others about their possible scabies infestation. Only few went to their GP or took ivermectin tablets. Other measures taken included avoiding sitting on upholstered sofas and chairs, washing (or put in sealed bags) their pillows and stuffed animals, and cleaning their rooms. When we presented the contacts afterwards with an overview of recommended measures for contacts according to the guidelines of the Dutch Institute for Public Health and the Environment (RIVM), 64% of students indicated to have applied all recommended measures, and 10% indicated that they did not apply any of the recommended measures (Table 3 ). Main reasons for not or only partially applying the recommended measures were low perceived risk of infestation (63%) and absence of scabies-related symptoms (51%). Other reasons included high costs (23%), being unfamiliar with the guidelines or finding them unclear (17%), too much work (14%), and unavailability of medication (5.6%). Half of the contacts (n = 141, 50%) reported to have contacted a GP, dermatologists and/or municipal health service (Table 3 ). While satisfaction with health care provider contacts was slightly higher than for indexes, the reasons for dissatisfaction were similar. Discussion Scabies is common among Dutch students, as illustrated by our findings that most respondents knew multiple people who have had scabies, that many indexes had suffered multiple scabies episodes, that many contacts had received multiple contact notifications, and that many contacts also had suffered from scabies themselves. We found that contact notification by indexes and subsequent actions taken by contacts are not always fully in line with Dutch recommendations, which may hamper effective control. The information received from health care providers was often not rated very positive. About 20% of indexes notified only half or even fewer of the contacts recommended by Dutch guidelines. This may not be too problematic, if at least all high-risk contacts are notified. However, while most indexes notified all their housemates and regular sexual partners (all at high risk), casual bedpartners (also at high risk) were often not notified. Failure to notify all bed partners is a recognized known issue for sexually transmitted diseases [ 22 ]. It is associated with a risk of onward transmission [ 23 ], especially with one-off partners who tend to have larger, non-exclusive sexual networks [ 24 ]. For other less-notified contact types (e.g., members of a study or student association, members of a sport club) the intensity of contact and associated risk of contracting scabies from the index will often be low. Notifying them will then not be required according to the guidelines. Two-thirds of the indexes were not notified before their latest scabies episode, which seems at odds with the relatively high contact notification rates reported by indexes, at least for high-risk groups. Various factors could explain this discrepancy. Firstly, unnotified indexes may have belonged to less frequently notified contact groups that can play a considerable role in transmission (e.g. casual bed partners). Secondly, transmission may occur indirectly via fomites (e.g. bedding, clothing, upholstered furniture) [ 25 ], blurring the link between source and contact and making contact notification difficult or inapplicable. Students belief strongly in these indirect transmission routes [ 17 ], although the relative importance of fomite transmission remains debated. Thirdly, transmission may have happened long before the index was diagnosed due to diagnostic delays, hindering timely notification by indexes. Finally, due to self-selection our respondent group may be biased towards students who are more motivated to follow treatment steps and notify contacts, with less interested students potentially less likely to participate or notify. About 80% of notified contacts took preventive measures, including applying scabicidal cream (permethrin), washing bedding, and washing clothes or sealing them in plastic bags for at least 3 days. Some also avoided physical contact with others, which was recently added to the national guideline. Additionally, some contacts also informed others about their possible infestation. Notification is only recommended if a contact has scabies-related complaints [ 26 ], as premature notification might cause unnecessary concern and could potentially lead to overtreatment and treatment-fatigue. The willingness to take extra precautions illustrates the students’ strong motivation to prevent establishment and onward transmission. Our data were not detailed enough to assess whether the response was appropriate given the intensity of the contact with the initial index case. Some students delay taking the recommended measures (treatment, hygiene) and instead adopt a "watchful waiting" strategy, acting only if symptoms appear. This approach may be appropriate for contacts with minimal exposure to the index case, especially since many students felt their risk of scabies was low. However, few students remarked that scabies occurs so frequently in their house or social network, that applying all measures at every notification is not practical. In such situations, mapping the broader transmission network and considering group treatment may be more efficient. Some scientists therefore suggested mass treatment as a strategy to stop the epidemic among students [ 27 ]. Contact tracing can be an effective public health tool for controlling infectious diseases [ 28 ]. It is also important for scabies, where failure to treat close contacts can lead to reinfection and treatment failure in the index case [ 6 ]. The Dutch scabies treatment guidelines recommend treating all household members and other close contacts [ 19 ]. This guideline may not be directly applicable to student houses with many housemates, where the transmission risk depends on the extent to which spaces are shared (e.g., living room, kitchen, bathroom, toilet or coat rack). This is not accounted for in national guidelines, forcing students to make their own judgement. Our study has several limitations. Firstly, it is difficult to reliably assess respondent behaviours retrospectively via a questionnaire. We relied on self-reported behaviours about scabies experiences from up to 1 year ago, making the data susceptible to recall and possibly social desirability bias. Reported behaviour frequencies therefore should be interpreted cautiously. Moreover, our questionnaire was long (up to 15 minutes) and fairly complex, with questions pertaining to the respondents’ behaviours, but also to the socio-psychological factors influencing these behaviours [ 16 ]. For students who have had multiple experiences, both as index and as contact, it may have been difficult to always maintain the focus on the last event. Indeed, in open questions we sometimes noticed that contacts had answered a question from the perspective of an index. Valuable additional information will come from in-depth interviews with 15 indexes and 15 contacts, which will be reported elsewhere [ 17 ]. Secondly, our study provides limited insight into whether the respondents’ behaviour was adequate and timely. For instance, the appropriateness of indexes’ notification behaviour and contacts’ responses after receiving a notification is hard to judge without information on the intensity of contact. For example, when a contact received a notification from a housemate (one of many) with whom he/she has had little contact and has not shared facilities, a watchful waiting approach may be preferred over immediate treatment. We also could not assess if measures were taken correctly or on time. Treatment guidelines recommend simultaneous treatment for indexes and contacts [ 19 ], but this was not addressed in our questionnaire. Further insights will come from the in-depth interviews [ 17 ]. Thirdly, we specifically asked students with scabies experience to respond. This entails a risk of selection bias, with students who take the scabies problem more seriously being more likely to respond. We aimed to minimize this effect by advertising the study widely among all students and raffling gift vouchers among respondents as incentive. Our study suggests that contact notification among students is not optimal, with many never-notified indexes and both over- and under-notification of contacts. To improve the notification behaviour and subsequent actions by contacts, indexes need better information on who should be notified, and contacts need better information on what measures should be taken depending on the type and intensity of contact. This information should consider the specific living conditions of Dutch students and the transmission risk associated with direct and indirect contact. Extra effort may be needed to motivate students to always notify all contacts, including casual bed partners. Our follow-up study on psychosocial-determinants of notification-behaviours may provide important additional information to help design interventions to improve these behaviours [ 16 ]. Besides improved contact notification, individual-level disease management needs strengthening. About 90% of the indexes and half of the contacts had consulted a health care provider, usually their GP, but many were dissatisfied with scabies-related consultations due to late diagnoses and insufficient or incorrect information. There is room for improvement, e.g. through additional training for GPs. Scabies is often misdiagnosed as eczema or allergic dermatitis [ 29 ], so raising awareness of its growing incidence and training GPs to recognize key symptoms is essential. To further reduce diagnostic delays, promoting the use of dermatoscopes and molecular techniques could be considered [ 30 ]. Disease management at primary care should also be improved as treatment failure is common and is often associated with incomplete treatment compliance [ 31 ]. GPs and other health care professionals should be trained to assist patients with contact identification and to educate patients and their contacts about the many steps involved in treatment and the disinfestation of possible fomites [ 32 ]). Important steps in this direction have been taken since our field work, including the development of an e-learning on scabies for GPs [ 33 ], revisions of national and GP-guidelines for scabies management [ 34 , 35 ], and the online publication of step-by-step treatment instructions for ivermectin and permethrin [ 12 , 13 ]. It is uncertain to what extent improvements of notification behaviour and improvement of measures taken by contacts will help to stop the ongoing epidemic among students. If reinfection rates remain high, targeted mass drug administration (offering treatment to all members of a high-risk target population, without individual diagnosis) could be considered as an alternative strategy [ 36 ]. A screen-and-treat approach (involving screening of the target population for clinical manifestations of scabies and offering treatment to those with clinical signs of scabies) could also be considered, but is likely less cost-effective as it requires additional resources for the screening and asymptomatic carriers would not be treated [ 36 ]. Conclusions The high proportion of unnotified indexes suggests a notification gap. Our data show that indexes notify most of their contacts, although there can be under-notification (e.g. casual sex partners are frequently missed) and over-notification. Notified contacts often take the recommended measures, although some prefer a watchful waiting strategy. Useful additional information will come from the in-depth interviews that were held with several of our indexes and contacts. Our research provides guidance for education aimed at improving notification and treatment of contacts. Declarations Ethics approval and consent to participate Since participants were not subjected to procedures or were not required to follow rules of behaviour, ethical approval was waived by the Medical Ethics Review Committee at Erasmus MC, University Medical Centre Rotterdam (MEC-2023-0259). This study complies with the requirements of the General Data Protection Regulation (GDPR). All data were stored anonymously. All study participants provided electronic informed consent to participate. Consent for publication Not applicable Availability of data and materials The dataset created and analysed during the current study is available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This study was supported by the research fund of the Dutch National Institute for Public Health and Environment (RIVM) for local Public Health Services. Authors’ contributions WS, HV, and FM conceptualized the study. Methods were developed by FM, HV, WS, with input from other authors. FM drafted a first version of the questionnaire, which was reviewed and edited by all other authors. FM developed the online version of the questionnaire. Recruitment was done by MS, IL-vD, and DdZ-S in Leiden, and by WS, HV and FM in Rotterdam. Formal data analysis was carried out by WS. Interpretation was done by all authors, with MS, IL-vD, and DdZ-S specifically commenting on implications for public health practice. WS wrote the initial draft manuscript. All authors reviewed and edited several draft versions of the manuscript. All authors read and approved the final manuscript. HV carried out project administration and general supervision. Acknowledgements We would like to express our sincere gratitude to the respondents for their participation in this study. We also thank the educational institutions and student organizations for their cooperation and support throughout the research process. Special thanks go to Lieneke Glas and Iris Bonnema for their invaluable assistance with participant recruitment. The authors acknowledge the research infrastructure provided by the Dutch Collaborative Academic practice for Public health Infectious diseases (CAPI). References Sunderkotter C, Wohlrab J, Hamm H. Scabies: Epidemiology, Diagnosis, and Treatment. Dtsch Arztebl Int. 2021;118 41:695-704; doi: 10.3238/arztebl.m2021.0296. Mbuagbaw L, Sadeghirad B, Morgan RL, Mertz D, Motaghi S, Ghadimi M, et al. Failure of scabies treatment: a systematic review and meta-analysis. Br J Dermatol. 2023; doi: 10.1093/bjd/ljad308. Aussy A, Houivet E, Hebert V, Colas-Cailleux H, Laaengh N, Richard C, et al. Risk factors for treatment failure in scabies: a cohort study. Br J Dermatol. 2019;180 4:888-93; doi: 10.1111/bjd.17348. van Deursen B, Hooiveld M, Marks S, Snijdewind I, van den Kerkhof H, Wintermans B, et al. Increasing incidence of reported scabies infestations in the Netherlands, 2011-2021. PLoS One. 2022;17 6:e0268865; doi: 10.1371/journal.pone.0268865. Azdajic MD, Beslic I, Gasic A, Ferara N, Pedic L, Lugovic-Mihic L. Increased Scabies Incidence at the Beginning of the 21st Century: What Do Reports from Europe and the World Show? Life (Basel). 2022;12 10; doi: 10.3390/life12101598. Riebenbauer K, Purkhauser K, Walochnik J, Urban N, Weber PB, Stamm T, et al. Detection of a knockdown mutation in the voltage-sensitive sodium channel associated with permethrin tolerance in Sarcoptes scabiei var. hominis mites. J Eur Acad Dermatol Venereol. 2023; doi: 10.1111/jdv.19288. Veraldi S, Schianchi R, Silvio M, Aromolo IF. Pseudoresistance to permethrin in scabies. J Infect Dev Ctries. 2023;17 5:713-5; doi: 10.3855/jidc.17750. Dijkman B, Fanoy E, Hooiveld M, Braks M, Meiberg A, Pattipeilohy J, et al: Scabies: a rising problem in the student population?https://www.rivm.nl/sites/default/files/2018-11/20_Dijkman_%20scabies%20studenten_definitief.pdf (2018). Accessed 02 Aug 2024. An outbreak of scabies hits students in Groningen. 2023. https://northerntimes.nl/an-outbreak-of-scabies-hits-students-in-groningen/. Accessed 12 July 2025. Hesselink I: Scabies outbreak among Utrecht students: ‘The itch kept me awake for nights’.https://dub.uu.nl/en/depth/scabies-outbreak-among-utrecht-students-itch-kept-me-awake-nights (2022). Accessed 24 Aug 2025. Groningse studentenverenigingen gaan tijdens actieweek de strijd aan met schurft.https://www.nu.nl/binnenland/6243495/groningse-studentenverenigingen-gaan-tijdens-actieweek-de-strijd-aan-met-schurft.html?referrer=https%3A%2F%2Fwww.google.com%2F (2022). Accessed 24 Aug 2025. Rijksinstituut voor Volksgezondheid en Milieu: Step-by-step instructions for treating scabies with permethrin cream.https://www.rivm.nl/en/en/documenten/step-by-step-instructions-for-treating-scabies-with-permethrin-cream (2023). Accessed 24 Aug 2025. Rijksinstituut voor Volksgezondheid en Milieu: Step-by-step instructions for treating scabies with Ivermectin tablets.https://www.rivm.nl/en/en/documenten/step-by-step-instructions-for-treating-scabies-with-ivermectin-tablets (2023). Accessed 24 Aug 2025. Hansman E, Klausner JD. Approach to Managing Sex Partners of People with Sexually Transmitted Infections. Infect Dis Clin North Am. 2023;37 2:405-26; doi: 10.1016/j.idc.2023.02.003. El-Sadr WM, Platt J, Bernitz M, Reyes M. Contact Tracing: Barriers and Facilitators. Am J Public Health. 2022;112 7:1025-33; doi: 10.2105/AJPH.2022.306842. Mevissen FEF, De Zwart D, Stolk WA, Stradmeijer M, van Disseldorp I, Voeten HACM. WHØ you gonna call? Factors influencing contact notification for scabies among students in the Netherlands. submitted Somra SB, Voeten HACM, Lewis - van Disseldorp I, Mevissen FEF. Socio psychological determinants of scabies contact notification among Dutch students: a qualitative study. PLoS Negl Trop Dis. In press. Landelijke monitor studentenhuisvesting 2023.https://studentenhuisvesting.incijfers.nl/mosaic/lms/ (2023). Accessed 24 Aug 2025. Rijksinstituut voor Volksgezondheid en Milieu / Landelijke Coördinatie Infectieziektebestrijding (RIVM/LCI): LCI Guidelines for treating scabies [in Dutch].https://lci.rivm.nl/richtlijnen/scabies (2023). Accessed 24 Aug 2025. Survalyzer: Survalyzer [computer software]. . 2023. R Core Team: R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2023. van Aar F, van Weert Y, Spijker R, Gotz H, Op de Coul E, Partner Notification G. Partner notification among men who have sex with men and heterosexuals with STI/HIV: different outcomes and challenges. Int J STD AIDS. 2015;26 8:565-73; doi: 10.1177/0956462414547398. Althaus CL, Turner KM, Mercer CH, Auguste P, Roberts TE, Bell G, et al. Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling. Health Technol Assess. 2014;18 2:1-100, vii-viii; doi: 10.3310/hta18020. Estcourt CS, Flowers P, Cassell JA, Pothoulaki M, Vojt G, Mapp F, et al. Going beyond 'regular and casual': development of a classification of sexual partner types to enhance partner notification for STIs. Sex Transm Infect. 2022;98 2:108-14; doi: 10.1136/sextrans-2020-054846. Burkhart CG, Burkhart CN, Burkhart KM. An epidemiologic and therapeutic reassessment of scabies. Cutis. 2000;65 4:233-40. Rijksinstituut voor Volksgezondheid en Milieu: Schurft aanpakken? Behandel samen en precies!https://rivm.nl/documenten/folder-schurft-aanpakken-behandel-samen-en-precies (2023). Accessed 24 Aug 2025. ter Steege L: ‘Meldplicht niet de oplossing voor schurftbestrijding’.https://www.medischcontact.nl/actueel/laatste-nieuws/nieuwsartikel/meldplicht-niet-de-oplossing-voor-schurftbestrijding (2022). Accessed 24 Aug 2025. Hossain AD, Jarolimova J, Elnaiem A, Huang CX, Richterman A, Ivers LC. Effectiveness of contact tracing in the control of infectious diseases: a systematic review. Lancet Public Health. 2022;7 3:e259-e73; doi: 10.1016/S2468-2667(22)00001-9. Lugovic-Mihic L, Delas Azdajic M, Beslic I. Scabies Cases Misdiagnosed and Treated as Allergic Diseases: Itch as Alarm. Acta Clin Croat. 2022;61 2:349-53; doi: 10.20471/acc.2022.61.02.22. Thean LJ, Engelman D, Kaldor J, Steer AC. Scabies: New Opportunities for Management and Population Control. Pediatr Infect Dis J. 2019;38 2:211-3; doi: 10.1097/INF.0000000000002211. Azzolina V, Schauer F, Pilz JF, Zink A, Eyerich K, Pilz AC. Scabies Management Outcomes: Identification of Risk Factors for Treatment Success or Failure. Dermatol Pract Concept. 2025;15 2; doi: 10.5826/dpc.1502a5077. World Health Organization: WHO informal consultation on a framework for scabies control, World Health Organization Regional Office for the Western Pacific, 19-21 February 2019: meeting report. Geneva: World Health Organization; 2020. Nederlands Huisartsen Genootschap (NHG): NHG E-learning Scabiës.https://www.nhg.org/product/scabies/ (2025). Accessed 24 Aug 2025. Rijksinstituut voor Volksgezondheid en Milieu / Landelijke Coördinatie Infectieziektebestrijding (RIVM/LCI): LCI Guidelines for treating scabies [in Dutch].https://lci.rivm.nl/richtlijnen/scabies (2024). Accessed 24 Aug 2025. Nederlands Huisartsen Genootschap (NHG): NHG-Behandelrichtlijn Scabiës [NHG treatment guideline scabies].https://richtlijnen.nhg.org/behandelrichtlijnen/scabies (2025). Accessed 24 Aug 2025. Engelman D, Marks M, Steer AC, Beshah A, Biswas G, Chosidow O, et al. A framework for scabies control. PLoS Negl Trop Dis. 2021;15 9:e0009661; doi: 10.1371/journal.pntd.0009661. Additional Declarations No competing interests reported. Supplementary Files Graphicalabstract.png GA Cite Share Download PDF Status: Published Journal Publication published 16 Mar, 2026 Read the published version in Parasites & Vectors → Version 1 posted Editorial decision: Revision requested 19 Oct, 2025 Reviews received at journal 17 Oct, 2025 Reviews received at journal 29 Sep, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviewers agreed at journal 13 Sep, 2025 Reviewers invited by journal 02 Sep, 2025 Editor assigned by journal 29 Aug, 2025 Submission checks completed at journal 29 Aug, 2025 First submitted to journal 25 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7452814","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":505202501,"identity":"61d77058-4c7e-4038-976b-a2d6f9120e19","order_by":0,"name":"Wilma A. Stolk","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYNCCggQ5ZC7jAQLqGRsYDBKMUYSI0pLYQLQWgwPszx98MEhL75c+/PjTzba6aP4G3gMEtPAYNs4wyMmd2ZdmJp3bdjh3xgG+BLxazA7wMDbzGFTkbjjDYMac23YgdwMDjwEBLewPQVrS7c+wf/6c21ZHjBYGQ6CWnAQDHh4DoMOYCWuxP8xjOHOGQZrhjDM8ZdI554B+OUxAi2R7+4MPHyqS5fl72Dd/zimry+1v7zF8gE8LAzMRIqNgFIyCUTAKSAUA4NhKn7OBr6IAAAAASUVORK5CYII=","orcid":"","institution":"Public Health Service (GGD) of Rotterdam-Rijnmond","correspondingAuthor":true,"prefix":"","firstName":"Wilma","middleName":"A.","lastName":"Stolk","suffix":""},{"id":505202502,"identity":"0a1c6396-7345-4f57-b4cd-881624e9ab18","order_by":1,"name":"Marloes D. 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Lewis-van","lastName":"Disseldorp","suffix":""},{"id":505202505,"identity":"aacc8854-acf1-478b-a4d6-3723b6d3c04d","order_by":4,"name":"Diane Zwart-Slats","email":"","orcid":"","institution":"Public Health Service (GGD) Hecht Hollands Midden","correspondingAuthor":false,"prefix":"","firstName":"Diane","middleName":"","lastName":"Zwart-Slats","suffix":""},{"id":505202506,"identity":"9550dc2a-4175-423e-8d2e-dd6f5adcbd8f","order_by":5,"name":"Fraukje E.F. Mevissen","email":"","orcid":"","institution":"Public Health Service (GGD) of Rotterdam-Rijnmond","correspondingAuthor":false,"prefix":"","firstName":"Fraukje","middleName":"E.F.","lastName":"Mevissen","suffix":""}],"badges":[],"createdAt":"2025-08-25 10:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7452814/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7452814/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13071-026-07301-8","type":"published","date":"2026-03-16T15:58:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90320069,"identity":"7d9bfcb7-78b3-4dbf-aa8c-172a51d2b1ef","added_by":"auto","created_at":"2025-09-01 10:42:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":240113,"visible":true,"origin":"","legend":"\u003cp\u003eTo what extent did students with scabies notify their contacts, by type of contact. Respondentsanswered this question based on their own definition of contacts, i.e. before being presented the contact definition from the Dutch treatment guidelines.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7452814/v1/11f1e4dbd863ab1e2c3ba90c.png"},{"id":90320067,"identity":"1dae9fd8-8ca8-49ae-9057-98b2f559e2b8","added_by":"auto","created_at":"2025-09-01 10:42:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":165607,"visible":true,"origin":"","legend":"\u003cp\u003eContacts’ responses after receiving their latest contact notification: a) number of actions taken, b) which actions were taken in relation to the number of actions taken.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7452814/v1/02ca2199b5e6eaaa7d021c1d.png"},{"id":105223743,"identity":"0c3f9ad5-35ff-45b6-811d-ab7b2b3b6e7a","added_by":"auto","created_at":"2026-03-23 16:09:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1752588,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7452814/v1/f9223689-6532-4d25-8f47-fd8ec6abf686.pdf"},{"id":90320804,"identity":"ee10f21c-0260-4d7c-a833-6671a818337d","added_by":"auto","created_at":"2025-09-01 10:50:46","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":279806,"visible":true,"origin":"","legend":"\u003cp\u003eGA\u003c/p\u003e","description":"","filename":"Graphicalabstract.png","url":"https://assets-eu.researchsquare.com/files/rs-7452814/v1/de92a8d49e6ff8f62cdf498f.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Scabies among Dutch higher education students: do cases notify their contacts and do contacts take adequate measures?","fulltext":[{"header":"Background","content":"\u003cp\u003eScabies is a contagious skin condition, caused by the scabies mite \u003cem\u003eSarcoptes scabiei\u003c/em\u003e (var. \u003cem\u003ehominis\u003c/em\u003e) and associated with intense itching, especially at night. The infestation is directly transmitted through prolonged skin-to-skin contact, although indirect transmission can also occur via fomites (e.g. via shared mattrasses, bed linen, clothing, chairs/couches). Scabies can be treated with permethrin or benzyl benzoate cream (effective against all mite stages) or oral ivermectin (effective against mites, but not eggs) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A second treatment after 7\u0026ndash;14 days is recommended to kill newly hatched mites [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. To prevent re-infestation, potentially infected household members and other close contacts should be treated simultaneously with the index and environmental decontamination measures should be applied (e.g., washing of clothing, bed linen, towels and vacuum cleaning of carpet, couch) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The many steps involved make scabies treatment cumbersome and failure-prone [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe scabies incidence in the Netherlands has risen sharply in the past decade, with more general practitioner (GP) consultations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], scabicide dispensations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and institutional outbreaks (e.g., in nursing homes or day care centres). This resulted in increased pressure on GPs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], dermatologists and public health services. Similar increases are seen in other European countries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The increase in scabies incidence is not fully understood. Potential contributing factors include increased importation (e.g. through tourism / refugees), changes in social behaviour, and altered living conditions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Reduced mite susceptibility to treatment may also contribute [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], but is difficult to separate this from other causes of treatment failure such as suboptimal treatment application or incomplete contact treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGP data show that the incidence is particularly high among older adolescents and young adults [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and especially also among higher education students (referred to as \u0026lsquo;students\u0026rsquo; hereafter) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Indeed, scabies has become a common problem among students with frequent outbreaks in student houses (e.g., [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]). Students constitute a specific risk group for scabies due to their extensive contact networks, shared housing facilities, and behavioural factors (e.g. sharing of bedding, clothes). Therefore, specific attention to students is needed in the prevention and control of scabies in the Netherlands.\u003c/p\u003e\u003cp\u003eScabies management practices need to be strengthened to stop the epidemic. National guidelines for scabies treatment stress the importance of treating potentially infected contacts on the same day and time as the index [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], but this is often difficult in practice. It requires indexes to notify all their contacts (e.g., housemates, sexual partners, guests, other contacts), who must then follow the recommended hygiene and treatment guidelines. Failure to treat all contacts has been associated with increased treatment failure [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Research on contact notification for sexually transmitted diseases and Covid-19 shows this is often challenging, due to societal dynamics, disease characteristics, or stigma [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We hypothesize that poor contact treatment also hinders scabies control among students, but the extent of this is unclear.\u003c/p\u003e\u003cp\u003eTo inform interventions for scabies control, we assessed whether students with scabies notify all their contacts (housemates, sexual contacts, guests, others), and whether notified students take adequate measures. Health seeking behaviour and reasons for non-compliance with recommended measures were also evaluated. Elsewhere, we report on psychosocial determinants of the students\u0026rsquo; behaviours; good understanding of this can help to improve health education and, ultimately, treatment outcomes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThis study comprised an online cross-sectional questionnaire among Dutch higher vocational education (in Dutch: Hoger Beroepsonderwijs (HBO)) and university students, specifically targeted at students who had experienced scabies or had been in contact with someone with scabies in the past year.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population and recruitment\u003c/h3\u003e\n\u003cp\u003eOur study population consists of students in the Netherlands aged 18\u0026ndash;30 years. In study year 2022\u0026ndash;2023, respectively 417,000 and 337,0000 students were enrolled in Dutch HBO institutions and universities in the Netherlands [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. About 39% of HBO students and 71% of university student live away from their parents, e.g. in a rented private room in a student house or student flat, often sharing facilities like kitchen, bathroom, toilet, and living room with 1 or more other students/persons.\u003c/p\u003e\u003cp\u003eWe focussed our recruitment on university cities Rotterdam and Leiden, although students nationwide could participate. We advertised the study via educational institutions, flyers, posters, student GPs, municipal health services (GGDs), local and national student associations, snowballing methods, and post mailings to known student housing complexes. Students were provided with a link to the questionnaire or were directed to the online questionnaire by scanning a QR code. The online questionnaire was open for responses from May to June 2023.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eOn the online questionnaire\u0026rsquo;s opening page, we provided clear, non-technical information about the study\u0026rsquo;s purpose, key characteristics (voluntary participation, anonymous data collection, 10\u0026ndash;15 minutes survey completion time), and eligibility criteria (students aged 18\u0026ndash;30 years with scabies experience / scabies contact in the past year). We provided a weblink and email address for more detailed information. To encourage participation and reduce selection bias, we offered a chance to win one of five \u0026euro;50-gift vouchers. We then asked for digital informed consent.\u003c/p\u003e\u003cp\u003e Participants providing informed consent were led to the main questionnaire. The introductory section asked about demographics. We then asked whether participants had had scabies in the past year (indexes) or had been in contact with someone with scabies (contacts). Students without such experience were included as reference group and for them the questionnaire ended here. Participants continued with either the 'index' or 'contact' questionnaire, depending on their experience. If participants had experiences both as index and contact, they would get the index questionnaire, unless their most recent experience was one as contact in which case they received the contact questionnaire.\u003c/p\u003e\u003cp\u003eThe index questionnaire focussed on the participant\u0026rsquo;s most recent scabies episode, with questions about diagnosis, symptoms, and treatment. We also asked about the number and type of contacts during the infectious period, the extent to which the participant notified these contacts, and reasons for incomplete contact notification. Next, we provided the respondent with information about the contact-definition as used in the Netherlands for determining treatment groups and asked whether the index had notified all contacts according to this definition. We paraphrased the guideline definition [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] as follows: \u0026ldquo;People with whom you have had prolonged (\u0026gt;\u0026thinsp;15 minutes) or frequent skin contact since 1 to 2 weeks after becoming infected. This often comes down to family contacts, housemates, friends and guests staying overnight. This also applies if you did not have any symptoms of scabies during that period, such as itching, rash, etc. Examples of skin contact are holding hands, sitting next to each other, or sharing a bed (bed partners, lovers, guests staying overnight). Via intensive use of each other's clothing, towels and bedding or, for example, a shared sofa in the communal living room, the scabies mite can also be transmitted.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThe contact questionnaire focused on the most recent contact notification event, with questions about relationship to the notifier, actions taken after receiving the notification (e.g. including simultaneous treatment, hygienic measures such as washing clothes and bedding [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]), compliance with recommended measures, and reasons for incomplete compliance.\u003c/p\u003e\u003cp\u003eBoth questionnaires also contained questions about their health care seeking behaviour, including questions on which health care providers were contacted. After completing all relevant questions, respondents were asked if they wanted to participate in the raffle for the \u0026euro;50-gift voucher. The Survalyzer application [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] was used to develop and publish the questionnaire and to collect responses. We used closed questions with pre-programmed answer options where possible. The questionnaire was pretested by target audience members for clarity and completion time estimation.\u003c/p\u003e\n\u003ch3\u003eData cleaning and statistical methods\u003c/h3\u003e\n\u003cp\u003eData were analysed in SPSS version 28. Respondent not meeting the inclusion criteria (e.g. those aged\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30 years, reporting not to be studying at higher education institution, or missing information on his/her student status) were removed from the database before the analysis. Background variables and behavioural patterns (contact notification vs. compliance with measures) were studied by calculating frequency distributions and means; significance of differences was tested with chi-square tests and ANOVA. Figures were created using the ggplot package of R version 4.3.1 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eGeneral information\u003c/h2\u003e\u003cp\u003eThe introductory questionnaire was completed by 807 consenting students, and 787 of them met the inclusion criteria. Of these respondents, 334 completed the index questionnaire and 287 the contact questionnaire, while 166 only completed the introductory part as they had no experience with scabies.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e gives a description of respondent characteristics. About half of the respondents came from Rotterdam and Leiden, where we focussed our recruitment. In comparison to the reference group, contacts and indexes were slightly older, were more often male, university student, member of a study or student association, and residing in student housing, and had more housemates. Scabies experience was often quite recent: respectively, 22% and 47% of indexes had scabies at the moment of the survey and or in the 3 months preceding the survey, and 13% and 65% of contacts received the last notification in the last week and last 3 months preceding the survey. About 40% of our contacts had also experienced scabies themselves and about 70% of the indexes had ever received a contact notification for scabies.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIndexes (n\u0026thinsp;=\u0026thinsp;334)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eContacts (n\u0026thinsp;=\u0026thinsp;287)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference group (neither contact nor index) (n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;787)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCount (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCount (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCount (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCount (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy city\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRotterdam\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94 (28.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72 (25.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83 (50.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e249 (31.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001, chi-square\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeiden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80 (24.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81 (28.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (5.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e170 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUtrecht\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e137 (17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86 (25.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72 (25.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (43.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e230 (29.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean in years (range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.8 (18\u0026ndash;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.6 (18\u0026ndash;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.3 (18\u0026ndash;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e21.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.045, ANOVA\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77 (26.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (20.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e175 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e215 (64.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e201 (70.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e125 (75.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e541 (68.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.033, chi-square\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118 (35.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81 (28.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e41 (24.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e240 (30.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther/unknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5 (1.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6 (0.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eType of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e264 (79.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e250 (87.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e94 (56.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e608 (77.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001, chi-square\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigher vocational education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70 (21.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (43.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e179 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLiving situation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiving with parents / caretakers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22 (6.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75 (45.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e111 (14.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001, chi-square\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiving in a student house or a student housing complex\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e280 (83.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e255 (88.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56 (33.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e591 (75.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiving in independent home (rented or owned) with or without partner)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30 (9.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (18.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e76 (9.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (0.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9 (1.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eNumber of housemates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (2.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (7.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001, chi-square\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (20.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e89 (11.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39 (23.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e149 (19.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34 (11.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43 (25.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e121 (15.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46 (13.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33 (11.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (12.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e100 (12.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (8.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e56 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e112 (33.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e120 (42.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (6.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e243 (30.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1 (0.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eMembership of student associations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMember of both study and student association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76 (22.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e80 (27.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (9.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e171 (21.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001, chi-square\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMember of general student association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e165 (49.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e133 (46.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e314 (39.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMember of study association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (14.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47 (28.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e138 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot a member of study or general student association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e88 (53.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e164 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eHow many persons do you know who have had scabies during the past year?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI don't know anyone who has had scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (0.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e61 (36.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e65 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001, chi-square\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 person\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (3.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (20.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e61 (7.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;5 persons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79 (23.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73 (25.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56 (33.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e208 (26.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10 persons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80 (24.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69 (24.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e158 (20.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u0026ndash;20 persons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e143 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20 person\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82 (24.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68 (23.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e152 (19.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eWhen was the last time you had scabies yourself?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI currently have scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e74 (9.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 to 4 weeks ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81 (24.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e83 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 to 3 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28 (9.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e103 (13.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 to 6 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51 (15.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e77 (9.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 to 12 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28 (8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e59 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;12 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26 (9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e51 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI\u0026rsquo;ve never had scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e174 (60.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e166 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e340 (43.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eWhen was the last time you received a contact notification for scabies?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLast week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e59 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 to 4 weeks ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92 (32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e129 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 to 3 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76 (22.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e95 (33.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e171 (21.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 to 6 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32 (11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e75 (9.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 to 12 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26 (7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e42 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;12 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e43 (5.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI have never had a contact notification for scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e102 (30.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e166 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e268 (34.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e The Rotterdam-subpopulation contained more respondents without any scabies experience (reference group), due to wider advertisement of the study.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003e Other respondents studied in Amsterdam (n\u0026thinsp;=\u0026thinsp;55), Den Haag (n\u0026thinsp;=\u0026thinsp;42), Delft (n\u0026thinsp;=\u0026thinsp;36), Eindhoven (n\u0026thinsp;=\u0026thinsp;27), Groningen (n\u0026thinsp;=\u0026thinsp;18), Maastricht (n\u0026thinsp;=\u0026thinsp;13), Nijmegen (n\u0026thinsp;=\u0026thinsp;12), Enschede (n\u0026thinsp;=\u0026thinsp;11), Wageningen (n\u0026thinsp;=\u0026thinsp;2), and other (n\u0026thinsp;=\u0026thinsp;14); 35/42 respondents from The Hague were controls.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ec\u003c/sup\u003e Chi-square, calculated ignoring the few individuals with other or unknown sex.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ed\u003c/sup\u003e Typically sharing kitchen and bathroom; sometimes also shared living room.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e[Table 1, included at the end of this document]\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eIndexes\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the main characteristics of the indexes (n\u0026thinsp;=\u0026thinsp;333; one index was removed because of too many missing values). Almost 60% of the indexes had experienced multiple scabies episodes, and 20% even had four or more episodes. Almost two-thirds of the indexes were not notified before their last episode and half of them self-diagnosed the infection. Most indexes (85%) reported significant suffering from scabies, and in half of the cases, it took three months or more to clear the infestation.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudents with scabies: characteristics of the last scabies episode (n\u0026thinsp;=\u0026thinsp;333)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eHow many times have you had scabies in your life so far, including the last episode?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThree times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFour times or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eWere you notified beforehand that you could have contracted scabies, and by whom?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, by the source of my infestation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, by someone else\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo, I was not notified beforehand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther (persistent or recurrent infection)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eWho diagnosed the scabies?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDermatologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMunicipal health service (GGD) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eTo what extent have you suffered from scabies-related complaints such as itching and rash?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI did not suffer at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI suffered a bit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI suffered quite a bit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI suffered much\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eI suffered very much\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eHow long did it take for you to be completely cured of scabies?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 4 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 months or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eApproximately, how many contacts did/do you have, approximately, whom you might have infected with scabies?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore than 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003eType of contacts, who may have been exposed to the infection by the index case (percentage of all indexes, including those with 0 contacts, n\u0026thinsp;=\u0026thinsp;333)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(Bed) partner(s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousehold members, other than family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFriends, who are not household members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFamily members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcquaintances from general student association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeople visiting my household members or family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcquaintances from study association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcquaintances from sport club\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eHave you notified these contacts (possibly anonymously) about possible infection with scabies? (percentage of indexes, reporting to have had at least 1 contact, n\u0026thinsp;=\u0026thinsp;312)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo, I did not notify any of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.5% \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, I notified some of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.6% \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, I notified about half of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.4% \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, I notified most of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.4% \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, I notified all my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.1% \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eAccording to the presented guideline definition of contacts, have you notified all your possible contacts? (percentage of all indexes, n\u0026thinsp;=\u0026thinsp;333) \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccording to this definition, I notified:\u003c/p\u003e\u003cp\u003eNot any of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSome of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbout half of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMost of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll of my contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eWhich health care providers did you consult about your scabies infestation? (multiple answers possible)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDid not contact any health care provider\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContacted the following health care provider\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- General practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Dermatologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Municipal Health Service (GGD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Any of the above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003e These 4 cases where diagnosed by municipal health services with a scabies-clinic, in Leiden, Amsterdam, or Utrecht.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eb\u003c/sup\u003e Percentage is calculated among persons reporting to have been in contact with at least 1 person who they could have infected (n\u0026thinsp;=\u0026thinsp;312).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ec\u003c/sup\u003e See methods section for the guideline definition.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, included at the end of this document]\u003c/h2\u003e\u003cp\u003eAbout one-third of the indexes reported having 6 or more contacts, most commonly bed partners, household members, friends, and family (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Forty percent notified all their contacts, while 22% notified none or only some. The extent to which contacts are notified varied (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): most indexes notified all or most of their regular bedpartners and housemates, and about 74% of indexes also notified all their family members. However, only 55% of the indexes notified all their casual bedpartners with 22% notifying none. Friends, visitors and fellow members of study / student associations and sport clubs were notified less often. Gender subgroups showed no significant differences. Common reasons reported for not notifying all these contacts included: low likelihood of having passed on the infection (n\u0026thinsp;=\u0026thinsp;109/184, 59.2%), fear (n\u0026thinsp;=\u0026thinsp;53, 28.5%), uncertainty about who should be notified (n\u0026thinsp;=\u0026thinsp;51/184, 27.7%), or lack of contact information (n\u0026thinsp;=\u0026thinsp;12, 6.5%). Other reasons mentioned in free text fields included a long diagnostic delay (contacts\u0026rsquo; risk was deemed negligible, if they had not contracted it during the prolonged period of diagnostic uncertainty), notification being unnecessary in view of rapid action, or postponing notification until after completing treatment. One person indicated to have had too many (indirect) contacts, including via fomites (e.g. coat rack), making it impossible to notify everyone.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eWhen we presented the indexes afterwards with the definition of who should be notified according to the Dutch national guidelines, the proportion of respondents indicating to have notified all their contacts increased from 40\u0026ndash;49%, and the proportion of respondents indicating to have reported none or only few of their contacts declined from 22\u0026ndash;15% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTen percent of indexes had not consulted any health care provider, while 89%, 23% and 15% had consulted a GP, dermatologist or the municipal health service (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Respectively 40%, 16% and 30% of respondents were not satisfied with their contact with these health care providers. Frequently cited reasons for dissatisfaction were no or late diagnosis, or receiving conflicting, not enough or incorrect information/advice.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eContacts\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the main characteristics of the contacts (n\u0026thinsp;=\u0026thinsp;282; 5 contacts were removed because of too many missing values or because information from the contact questionnaire revealed that they did not receive a contact notification). Nearly half (45%) of contacts had received 3 or more notifications in the past year and 10% even 6 or more. Most notifications (86%) came directly from the person with scabies. The notifier was often a housemate (58%), friend (27%), or someone from a study or student association (17%), and less often a regular or casual bedpartner (13% or 10%). Three-quarters of contacts had no scabies-related complaints when notified. Two-thirds of the contacts sought advice, usually from the internet, people who\u0026rsquo;ve had scabies, or other social contacts; fewer consulted a GP or dermatologist.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudents who were notified for scabies: characteristics of the latest notification and measures taken (n\u0026thinsp;=\u0026thinsp;282)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnswer category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHow often have you been notified in the past 12 months about possible infestation with scabies?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 or 2 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 to 5 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026thinsp;+\u0026thinsp;times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBy whom were you notified?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBy the potential source\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e85.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBy someone else\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eWhat was your relationship to the person who notified you? (multiple answers were possible)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA housemate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA family member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA friend\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA casual bedpartner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA regular bedpartner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSomeone from the study or general student association\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInvalid answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eDid you have scabies-related complaints, such as itching and rash, when you received the notification?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo complaints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSome complaints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA moderate amount of complaints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMany complaints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery many complaints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eWho did you ask for advice? (multiple answers possible, number and percentage indicating to have asked the given source for advice)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe person who notified me about the potential infestation with scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDermatologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSomeone who has had scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGuideline website of the Dutch Institute for Public Health and the Environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne of my social contacts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDid not seek advice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eWhich action did you take after receiving the notification? (multiple answers possible, number and percentage indicating to have taken the given measures)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAvoided physical contact with others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWent to the general practitioner/medical specialist to check whether I also have scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStarted applying medicinal ointment against scabies (permethrin or benzyl benzoate).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e78.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTook ivermectin tables against scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStarted washing my clothes preventively and/or putting them in garbage bags\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e80.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStarted washing my bedding as a preventative measure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e84.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNotified other people about possible infestation with scabies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLooking back on how you acted after you received a contact notification: did you take the right measures according to the guidelines from the RIVM?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo, I have not followed any of these measures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, I have partially followed these measures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, I have largely followed these measures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, I have fully/exactly followed these measures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e64.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eWhich of the following healthcare providers or health authorities have you contacted (by phone, directly, or by email) regarding your scabies contact alert? (multiple answers possible)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDid not contact any health care provider\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContacted the following health care provider\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- General practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Dermatologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Municipal Health Service (GGD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e- Any of the above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, included at the end of this document]\u003c/h2\u003e\u003cp\u003eSome students (n\u0026thinsp;=\u0026thinsp;17, 6%) did not take any measures after notification (Fig.\u0026nbsp;2). All others took one or more measures, frequently including washing of bedding, washing of clothes or putting them in sealed plastic bags for at least 3 days, topical treatment with permethrin or benzyl benzoate cream, and avoiding physical contact with others. Slightly fewer but still many respondents notified others about their possible scabies infestation. Only few went to their GP or took ivermectin tablets. Other measures taken included avoiding sitting on upholstered sofas and chairs, washing (or put in sealed bags) their pillows and stuffed animals, and cleaning their rooms.\u003c/p\u003e\u003cp\u003eWhen we presented the contacts afterwards with an overview of recommended measures for contacts according to the guidelines of the Dutch Institute for Public Health and the Environment (RIVM), 64% of students indicated to have applied all recommended measures, and 10% indicated that they did not apply any of the recommended measures (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Main reasons for not or only partially applying the recommended measures were low perceived risk of infestation (63%) and absence of scabies-related symptoms (51%). Other reasons included high costs (23%), being unfamiliar with the guidelines or finding them unclear (17%), too much work (14%), and unavailability of medication (5.6%).\u003c/p\u003e\u003cp\u003eHalf of the contacts (n\u0026thinsp;=\u0026thinsp;141, 50%) reported to have contacted a GP, dermatologists and/or municipal health service (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). While satisfaction with health care provider contacts was slightly higher than for indexes, the reasons for dissatisfaction were similar.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eScabies is common among Dutch students, as illustrated by our findings that most respondents knew multiple people who have had scabies, that many indexes had suffered multiple scabies episodes, that many contacts had received multiple contact notifications, and that many contacts also had suffered from scabies themselves. We found that contact notification by indexes and subsequent actions taken by contacts are not always fully in line with Dutch recommendations, which may hamper effective control. The information received from health care providers was often not rated very positive.\u003c/p\u003e\u003cp\u003e About 20% of indexes notified only half or even fewer of the contacts recommended by Dutch guidelines. This may not be too problematic, if at least all high-risk contacts are notified. However, while most indexes notified all their housemates and regular sexual partners (all at high risk), casual bedpartners (also at high risk) were often not notified. Failure to notify all bed partners is a recognized known issue for sexually transmitted diseases [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It is associated with a risk of onward transmission [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], especially with one-off partners who tend to have larger, non-exclusive sexual networks [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. For other less-notified contact types (e.g., members of a study or student association, members of a sport club) the intensity of contact and associated risk of contracting scabies from the index will often be low. Notifying them will then not be required according to the guidelines.\u003c/p\u003e\u003cp\u003eTwo-thirds of the indexes were not notified before their latest scabies episode, which seems at odds with the relatively high contact notification rates reported by indexes, at least for high-risk groups. Various factors could explain this discrepancy. Firstly, unnotified indexes may have belonged to less frequently notified contact groups that can play a considerable role in transmission (e.g. casual bed partners). Secondly, transmission may occur indirectly via fomites (e.g. bedding, clothing, upholstered furniture) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], blurring the link between source and contact and making contact notification difficult or inapplicable. Students belief strongly in these indirect transmission routes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], although the relative importance of fomite transmission remains debated. Thirdly, transmission may have happened long before the index was diagnosed due to diagnostic delays, hindering timely notification by indexes. Finally, due to self-selection our respondent group may be biased towards students who are more motivated to follow treatment steps and notify contacts, with less interested students potentially less likely to participate or notify.\u003c/p\u003e\u003cp\u003eAbout 80% of notified contacts took preventive measures, including applying scabicidal cream (permethrin), washing bedding, and washing clothes or sealing them in plastic bags for at least 3 days. Some also avoided physical contact with others, which was recently added to the national guideline. Additionally, some contacts also informed others about their possible infestation. Notification is only recommended if a contact has scabies-related complaints [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], as premature notification might cause unnecessary concern and could potentially lead to overtreatment and treatment-fatigue. The willingness to take extra precautions illustrates the students\u0026rsquo; strong motivation to prevent establishment and onward transmission. Our data were not detailed enough to assess whether the response was appropriate given the intensity of the contact with the initial index case.\u003c/p\u003e\u003cp\u003eSome students delay taking the recommended measures (treatment, hygiene) and instead adopt a \"watchful waiting\" strategy, acting only if symptoms appear. This approach may be appropriate for contacts with minimal exposure to the index case, especially since many students felt their risk of scabies was low. However, few students remarked that scabies occurs so frequently in their house or social network, that applying all measures at every notification is not practical. In such situations, mapping the broader transmission network and considering group treatment may be more efficient. Some scientists therefore suggested mass treatment as a strategy to stop the epidemic among students [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eContact tracing can be an effective public health tool for controlling infectious diseases [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It is also important for scabies, where failure to treat close contacts can lead to reinfection and treatment failure in the index case [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The Dutch scabies treatment guidelines recommend treating all household members and other close contacts [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This guideline may not be directly applicable to student houses with many housemates, where the transmission risk depends on the extent to which spaces are shared (e.g., living room, kitchen, bathroom, toilet or coat rack). This is not accounted for in national guidelines, forcing students to make their own judgement.\u003c/p\u003e\u003cp\u003eOur study has several limitations. Firstly, it is difficult to reliably assess respondent behaviours retrospectively via a questionnaire. We relied on self-reported behaviours about scabies experiences from up to 1 year ago, making the data susceptible to recall and possibly social desirability bias. Reported behaviour frequencies therefore should be interpreted cautiously. Moreover, our questionnaire was long (up to 15 minutes) and fairly complex, with questions pertaining to the respondents\u0026rsquo; behaviours, but also to the socio-psychological factors influencing these behaviours [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For students who have had multiple experiences, both as index and as contact, it may have been difficult to always maintain the focus on the last event. Indeed, in open questions we sometimes noticed that contacts had answered a question from the perspective of an index. Valuable additional information will come from in-depth interviews with 15 indexes and 15 contacts, which will be reported elsewhere [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSecondly, our study provides limited insight into whether the respondents\u0026rsquo; behaviour was adequate and timely. For instance, the appropriateness of indexes\u0026rsquo; notification behaviour and contacts\u0026rsquo; responses after receiving a notification is hard to judge without information on the intensity of contact. For example, when a contact received a notification from a housemate (one of many) with whom he/she has had little contact and has not shared facilities, a watchful waiting approach may be preferred over immediate treatment. We also could not assess if measures were taken correctly or on time. Treatment guidelines recommend simultaneous treatment for indexes and contacts [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], but this was not addressed in our questionnaire. Further insights will come from the in-depth interviews [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThirdly, we specifically asked students with scabies experience to respond. This entails a risk of selection bias, with students who take the scabies problem more seriously being more likely to respond. We aimed to minimize this effect by advertising the study widely among all students and raffling gift vouchers among respondents as incentive.\u003c/p\u003e\u003cp\u003eOur study suggests that contact notification among students is not optimal, with many never-notified indexes and both over- and under-notification of contacts. To improve the notification behaviour and subsequent actions by contacts, indexes need better information on who should be notified, and contacts need better information on what measures should be taken depending on the type and intensity of contact. This information should consider the specific living conditions of Dutch students and the transmission risk associated with direct and indirect contact. Extra effort may be needed to motivate students to always notify all contacts, including casual bed partners. Our follow-up study on psychosocial-determinants of notification-behaviours may provide important additional information to help design interventions to improve these behaviours [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBesides improved contact notification, individual-level disease management needs strengthening. About 90% of the indexes and half of the contacts had consulted a health care provider, usually their GP, but many were dissatisfied with scabies-related consultations due to late diagnoses and insufficient or incorrect information. There is room for improvement, e.g. through additional training for GPs. Scabies is often misdiagnosed as eczema or allergic dermatitis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], so raising awareness of its growing incidence and training GPs to recognize key symptoms is essential. To further reduce diagnostic delays, promoting the use of dermatoscopes and molecular techniques could be considered [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Disease management at primary care should also be improved as treatment failure is common and is often associated with incomplete treatment compliance [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. GPs and other health care professionals should be trained to assist patients with contact identification and to educate patients and their contacts about the many steps involved in treatment and the disinfestation of possible fomites [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]). Important steps in this direction have been taken since our field work, including the development of an e-learning on scabies for GPs [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], revisions of national and GP-guidelines for scabies management [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and the online publication of step-by-step treatment instructions for ivermectin and permethrin [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is uncertain to what extent improvements of notification behaviour and improvement of measures taken by contacts will help to stop the ongoing epidemic among students. If reinfection rates remain high, targeted mass drug administration (offering treatment to all members of a high-risk target population, without individual diagnosis) could be considered as an alternative strategy [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. A screen-and-treat approach (involving screening of the target population for clinical manifestations of scabies and offering treatment to those with clinical signs of scabies) could also be considered, but is likely less cost-effective as it requires additional resources for the screening and asymptomatic carriers would not be treated [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe high proportion of unnotified indexes suggests a notification gap. Our data show that indexes notify most of their contacts, although there can be under-notification (e.g. casual sex partners are frequently missed) and over-notification. Notified contacts often take the recommended measures, although some prefer a watchful waiting strategy. Useful additional information will come from the in-depth interviews that were held with several of our indexes and contacts. Our research provides guidance for education aimed at improving notification and treatment of contacts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eSince participants were not subjected to procedures or were not required to follow rules of behaviour, ethical approval was waived by the Medical Ethics Review Committee at Erasmus MC, University Medical Centre Rotterdam (MEC-2023-0259). This study complies with the requirements of the General Data Protection Regulation (GDPR). All data were stored anonymously. All study participants provided electronic informed consent to participate.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe dataset created and analysed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was supported by the research fund of the Dutch National Institute for Public Health and Environment (RIVM) for local Public Health Services.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthors’ contributions\u003c/h2\u003e\n\u003cp\u003eWS, HV, and FM conceptualized the study. Methods were developed by FM, HV, WS, with input from other authors. FM drafted a first version of the questionnaire, which was reviewed and edited by all other authors. FM developed the online version of the questionnaire. Recruitment was done by MS, IL-vD, and DdZ-S in Leiden, and by WS, HV and FM in Rotterdam. Formal data analysis was carried out by WS. Interpretation was done by all authors, with MS, IL-vD, and DdZ-S specifically commenting on implications for public health practice. WS wrote the initial draft manuscript. All authors reviewed and edited several draft versions of the manuscript. All authors read and approved the final manuscript. HV carried out project administration and general supervision.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to the respondents for their participation in this study. We also thank the educational institutions and student organizations for their cooperation and support throughout the research process. Special thanks go to Lieneke Glas and Iris Bonnema for their invaluable assistance with participant recruitment. The authors acknowledge the research infrastructure provided by the Dutch Collaborative Academic practice for Public health Infectious diseases (CAPI).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSunderkotter C, Wohlrab J, Hamm H. Scabies: Epidemiology, Diagnosis, and Treatment. Dtsch Arztebl Int.\u003cem\u003e \u003c/em\u003e2021;118 41:695-704; doi: 10.3238/arztebl.m2021.0296.\u003c/li\u003e\n\u003cli\u003eMbuagbaw L, Sadeghirad B, Morgan RL, Mertz D, Motaghi S, Ghadimi M, et al. Failure of scabies treatment: a systematic review and meta-analysis. Br J Dermatol.\u003cem\u003e \u003c/em\u003e2023; doi: 10.1093/bjd/ljad308.\u003c/li\u003e\n\u003cli\u003eAussy A, Houivet E, Hebert V, Colas-Cailleux H, Laaengh N, Richard C, et al. Risk factors for treatment failure in scabies: a cohort study. Br J Dermatol.\u003cem\u003e \u003c/em\u003e2019;180 4:888-93; doi: 10.1111/bjd.17348.\u003c/li\u003e\n\u003cli\u003evan Deursen B, Hooiveld M, Marks S, Snijdewind I, van den Kerkhof H, Wintermans B, et al. Increasing incidence of reported scabies infestations in the Netherlands, 2011-2021. PLoS One.\u003cem\u003e \u003c/em\u003e2022;17 6:e0268865; doi: 10.1371/journal.pone.0268865.\u003c/li\u003e\n\u003cli\u003eAzdajic MD, Beslic I, Gasic A, Ferara N, Pedic L, Lugovic-Mihic L. Increased Scabies Incidence at the Beginning of the 21st Century: What Do Reports from Europe and the World Show? Life (Basel).\u003cem\u003e \u003c/em\u003e2022;12 10; doi: 10.3390/life12101598.\u003c/li\u003e\n\u003cli\u003eRiebenbauer K, Purkhauser K, Walochnik J, Urban N, Weber PB, Stamm T, et al. Detection of a knockdown mutation in the voltage-sensitive sodium channel associated with permethrin tolerance in Sarcoptes scabiei var. hominis mites. J Eur Acad Dermatol Venereol.\u003cem\u003e \u003c/em\u003e2023; doi: 10.1111/jdv.19288.\u003c/li\u003e\n\u003cli\u003eVeraldi S, Schianchi R, Silvio M, Aromolo IF. Pseudoresistance to permethrin in scabies. J Infect Dev Ctries.\u003cem\u003e \u003c/em\u003e2023;17 5:713-5; doi: 10.3855/jidc.17750.\u003c/li\u003e\n\u003cli\u003eDijkman B, Fanoy E, Hooiveld M, Braks M, Meiberg A, Pattipeilohy J, et al: Scabies: a rising problem in the student population?https://www.rivm.nl/sites/default/files/2018-11/20_Dijkman_%20scabies%20studenten_definitief.pdf (2018). Accessed 02 Aug 2024.\u003c/li\u003e\n\u003cli\u003eAn outbreak of scabies hits students in Groningen. 2023. https://northerntimes.nl/an-outbreak-of-scabies-hits-students-in-groningen/. 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Factors influencing contact notification for scabies among students in the Netherlands. submitted\u003c/li\u003e\n\u003cli\u003eSomra SB, Voeten HACM, Lewis - van Disseldorp I, Mevissen FEF. Socio psychological determinants of scabies contact notification among Dutch students: a qualitative study. PLoS Negl Trop Dis.\u003cem\u003e \u003c/em\u003eIn press.\u003c/li\u003e\n\u003cli\u003eLandelijke monitor studentenhuisvesting 2023.https://studentenhuisvesting.incijfers.nl/mosaic/lms/ (2023). Accessed 24 Aug 2025.\u003c/li\u003e\n\u003cli\u003eRijksinstituut voor Volksgezondheid en Milieu / Landelijke Co\u0026ouml;rdinatie Infectieziektebestrijding (RIVM/LCI): LCI Guidelines for treating scabies [in Dutch].https://lci.rivm.nl/richtlijnen/scabies (2023). Accessed 24 Aug 2025.\u003c/li\u003e\n\u003cli\u003eSurvalyzer: Survalyzer [computer software]. . 2023.\u003c/li\u003e\n\u003cli\u003eR Core Team: R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2023.\u003c/li\u003e\n\u003cli\u003evan Aar F, van Weert Y, Spijker R, Gotz H, Op de Coul E, Partner Notification G. Partner notification among men who have sex with men and heterosexuals with STI/HIV: different outcomes and challenges. Int J STD AIDS.\u003cem\u003e \u003c/em\u003e2015;26 8:565-73; doi: 10.1177/0956462414547398.\u003c/li\u003e\n\u003cli\u003eAlthaus CL, Turner KM, Mercer CH, Auguste P, Roberts TE, Bell G, et al. Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling. Health Technol Assess.\u003cem\u003e \u003c/em\u003e2014;18 2:1-100, vii-viii; doi: 10.3310/hta18020.\u003c/li\u003e\n\u003cli\u003eEstcourt CS, Flowers P, Cassell JA, Pothoulaki M, Vojt G, Mapp F, et al. Going beyond \u0026apos;regular and casual\u0026apos;: development of a classification of sexual partner types to enhance partner notification for STIs. Sex Transm Infect.\u003cem\u003e \u003c/em\u003e2022;98 2:108-14; doi: 10.1136/sextrans-2020-054846.\u003c/li\u003e\n\u003cli\u003eBurkhart CG, Burkhart CN, Burkhart KM. An epidemiologic and therapeutic reassessment of scabies. Cutis.\u003cem\u003e \u003c/em\u003e2000;65 4:233-40.\u003c/li\u003e\n\u003cli\u003eRijksinstituut voor Volksgezondheid en Milieu: Schurft aanpakken? Behandel samen en precies!https://rivm.nl/documenten/folder-schurft-aanpakken-behandel-samen-en-precies (2023). Accessed 24 Aug 2025.\u003c/li\u003e\n\u003cli\u003eter Steege L: \u0026lsquo;Meldplicht niet de oplossing voor schurftbestrijding\u0026rsquo;.https://www.medischcontact.nl/actueel/laatste-nieuws/nieuwsartikel/meldplicht-niet-de-oplossing-voor-schurftbestrijding (2022). Accessed 24 Aug 2025.\u003c/li\u003e\n\u003cli\u003eHossain AD, Jarolimova J, Elnaiem A, Huang CX, Richterman A, Ivers LC. Effectiveness of contact tracing in the control of infectious diseases: a systematic review. Lancet Public Health.\u003cem\u003e \u003c/em\u003e2022;7 3:e259-e73; doi: 10.1016/S2468-2667(22)00001-9.\u003c/li\u003e\n\u003cli\u003eLugovic-Mihic L, Delas Azdajic M, Beslic I. Scabies Cases Misdiagnosed and Treated as Allergic Diseases: Itch as Alarm. Acta Clin Croat.\u003cem\u003e \u003c/em\u003e2022;61 2:349-53; doi: 10.20471/acc.2022.61.02.22.\u003c/li\u003e\n\u003cli\u003eThean LJ, Engelman D, Kaldor J, Steer AC. Scabies: New Opportunities for Management and Population Control. Pediatr Infect Dis J.\u003cem\u003e \u003c/em\u003e2019;38 2:211-3; doi: 10.1097/INF.0000000000002211.\u003c/li\u003e\n\u003cli\u003eAzzolina V, Schauer F, Pilz JF, Zink A, Eyerich K, Pilz AC. Scabies Management Outcomes: Identification of Risk Factors for Treatment Success or Failure. Dermatol Pract Concept.\u003cem\u003e \u003c/em\u003e2025;15 2; doi: 10.5826/dpc.1502a5077.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization: WHO informal consultation on a framework for scabies control, World Health Organization Regional Office for the Western Pacific, 19-21 February 2019: meeting report. Geneva: World Health Organization; 2020.\u003c/li\u003e\n\u003cli\u003eNederlands Huisartsen Genootschap (NHG): NHG E-learning Scabi\u0026euml;s.https://www.nhg.org/product/scabies/ (2025). Accessed 24 Aug 2025.\u003c/li\u003e\n\u003cli\u003eRijksinstituut voor Volksgezondheid en Milieu / Landelijke Co\u0026ouml;rdinatie Infectieziektebestrijding (RIVM/LCI): LCI Guidelines for treating scabies [in Dutch].https://lci.rivm.nl/richtlijnen/scabies (2024). Accessed 24 Aug 2025.\u003c/li\u003e\n\u003cli\u003eNederlands Huisartsen Genootschap (NHG): NHG-Behandelrichtlijn Scabi\u0026euml;s [NHG treatment guideline scabies].https://richtlijnen.nhg.org/behandelrichtlijnen/scabies (2025). Accessed 24 Aug 2025.\u003c/li\u003e\n\u003cli\u003eEngelman D, Marks M, Steer AC, Beshah A, Biswas G, Chosidow O, et al. A framework for scabies control. PLoS Negl Trop Dis.\u003cem\u003e \u003c/em\u003e2021;15 9:e0009661; doi: 10.1371/journal.pntd.0009661.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"parasites-and-vectors","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"parv","sideBox":"Learn more about [Parasites \u0026 Vectors](http://parasitesandvectors.biomedcentral.com/)","snPcode":"13071","submissionUrl":"https://submission.nature.com/new-submission/13071/3","title":"Parasites \u0026 Vectors","twitterHandle":"@bugbittentweets","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"scabies, young adults, students, contact notification, preventive treatment, behaviour, questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-7452814/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7452814/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScabies incidence has rapidly increased in the Netherlands, particularly among higher education students. We hypothesized that effective control in this group is hindered by poor contact notification by indexes and limited treatment by contacts. We assessed this in a questionnaire study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn online questionnaire was distributed to students, focusing on their adherence to notification (indexes), and treatment and hygiene recommendations (contacts), as well as their health seeking behaviour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the indexes (n=334), 57% had experienced multiple scabies episodes and over two-thirds had not been notified beforehand. Notably, 47% self-diagnosed their condition. Most indexes notified all regular (bed) partners and housemates, 55% also notified all casual bed partners. Contacts (n=287) were usually notified by the index, in 46% of cases the notifier was a housemate. After notification, contacts avoided physical contact with others (73%), applied permethrin (78%), washed bedding and clothing preventively (84%), or put their clothing in bags (81%); 59% also notified their own contacts. The general practitioner was frequently contacted, especially by indexes, although experiences were often rated poorly due to conflicting or incorrect information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe high proportion of unnotified indexes suggests a notification gap. Especially casual bedpartners often remain unnotified, presenting a risk for onward transmission. Contacts generally took adequate measures, although premature notification of their contacts may lead to unnecessary treatment or ‘notification fatigue’. Enhancing health care support and communication might help to improve notification and prophylactic treatment behaviours and may play a crucial role in breaking the chain of transmission.\u003c/p\u003e","manuscriptTitle":"Scabies among Dutch higher education students: do cases notify their contacts and do contacts take adequate measures?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 10:42:41","doi":"10.21203/rs.3.rs-7452814/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-19T16:06:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-17T08:01:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-29T12:55:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203458566019122234503950542802572587450","date":"2025-09-24T07:27:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62438588547609859675403775206392387491","date":"2025-09-13T14:29:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T03:33:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-29T07:50:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-29T04:10:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Parasites \u0026 Vectors","date":"2025-08-25T10:31:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"parasites-and-vectors","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"parv","sideBox":"Learn more about [Parasites \u0026 Vectors](http://parasitesandvectors.biomedcentral.com/)","snPcode":"13071","submissionUrl":"https://submission.nature.com/new-submission/13071/3","title":"Parasites \u0026 Vectors","twitterHandle":"@bugbittentweets","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b51cf60-d163-45b8-9cbc-6c52f6400f6e","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:06:18+00:00","versionOfRecord":{"articleIdentity":"rs-7452814","link":"https://doi.org/10.1186/s13071-026-07301-8","journal":{"identity":"parasites-and-vectors","isVorOnly":false,"title":"Parasites \u0026 Vectors"},"publishedOn":"2026-03-16 15:58:47","publishedOnDateReadable":"March 16th, 2026"},"versionCreatedAt":"2025-09-01 10:42:41","video":"","vorDoi":"10.1186/s13071-026-07301-8","vorDoiUrl":"https://doi.org/10.1186/s13071-026-07301-8","workflowStages":[]},"version":"v1","identity":"rs-7452814","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7452814","identity":"rs-7452814","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}