Impetigo

ObjectiveWe conducted a comprehensive, systematic review of the global childhood population prevalence of impetigo and the broader condition pyoderma.MethodsPubMed was systematically searched for impetigo or pyoderma studies published between January 1 1970 and September 30 2014. Two independent reviewers extracted data from each relevant article on the prevalence of impetigo.FindingsSixty-six articles relating to 89 studies met our inclusion criteria. Based on population surveillance, 82 studies included data on 145,028 children assessed for pyoderma or impetigo. Median childhood prevalence was 12·3% (IQR 4·2-19·4%). Fifty-eight (65%) studies were from low or low-middle income countries, where median childhood prevalences were 8·4% (IQR 4·2-16·1%) and 14·5% (IQR 8·3-20·9%), respectively. However, the highest burden was seen in underprivileged children from marginalised communities of high-income countries; median prevalence 19·4%, (IQR 3·9-43·3%).ConclusionBased on data from studies published since 2000 from low and low-middle income countries, we estimate the global population of children suffering from impetigo at any one time to be in excess of 162 million, predominantly in tropical, resource-poor contexts. Impetigo is an under-recognised disease and in conjunction with scabies, comprises a major childhood dermatological condition with potential lifelong consequences if untreated.

BackgroundImpetigo and scabies are endemic diseases in many tropical countries; however the epidemiology of these diseases is poorly understood in many areas, particularly in the Pacific.Methodology/principal findingsWe conducted three epidemiological studies in 2006 and 2007 to determine the burden of disease due to impetigo and scabies in children in Fiji using simple and easily reproducible methodology. Two studies were performed in primary school children (one study was a cross-sectional study and the other a prospective cohort study over ten months) and one study was performed in infants (cross-sectional). The prevalence of active impetigo was 25.6% (95% CI 24.1-27.1) in primary school children and 12.2% (95% CI 9.3-15.6) in infants. The prevalence of scabies was 18.5% (95% CI 17.2-19.8) in primary school children and 14.0% (95% CI 10.8-17.2) in infants. The incidence density of active impetigo, group A streptococcal (GAS) impetigo, Staphylococcus aureus impetigo and scabies was 122, 80, 64 and 51 cases per 100 child-years respectively. Impetigo was strongly associated with scabies infestation (odds ratio, OR, 2.4, 95% CI 1.6-3.7) and was more common in Indigenous Fijian children when compared with children of other ethnicities (OR 3.6, 95% CI 2.7-4.7). The majority of cases of active impetigo in the children in our study were caused by GAS. S. aureus was also a common cause (57.4% in school aged children and 69% in infants).Conclusions/significanceThese data suggest that the impetigo and scabies disease burden in children in Fiji has been underestimated, and possibly other tropical developing countries in the Pacific. These diseases are more than benign nuisance diseases and consideration needs to be given to expanded public health initiatives to improve their control.

BackgroundScabies is recognised as a major public health problem in many countries, and is responsible for significant morbidity due to secondary bacterial infection of the skin causing impetigo, abscesses and cellulitis, that can in turn lead to serious systemic complications such as septicaemia, kidney disease and, potentially, rheumatic heart disease. Despite the apparent burden of disease in many countries, there have been few large-scale surveys of scabies prevalence or risk factors. We undertook a population-based survey in Fiji of scabies and impetigo to evaluate the magnitude of the problem and inform public health strategies.Methodology/principal findingsA total of 75 communities, including villages and settlements in both urban and rural areas, were randomly selected from 305 communities across the four administrative divisions, and all residents in each location were invited to participate in skin examination by trained personnel. The study enrolled 10,887 participants. The prevalence of scabies was 23.6%, and when adjusted for age structure and geographic location based on census data, the estimated national prevalence was 18.5%. The prevalence was highest in children aged five to nine years (43.7%), followed by children aged less than five (36.5%), and there was also an indication of prevalence increasing again in older age. The prevalence of scabies was twice as high in iTaukei (indigenous) Fijians compared to Indo-Fijians. The prevalence of impetigo was 19.6%, with a peak in children aged five to nine years (34.2%). Scabies was very strongly associated with impetigo, with an estimated 93% population attributable risk.ConclusionsAs far as we are aware, this is the first national survey of scabies and impetigo ever conducted. We found that scabies occurs at high levels across all age groups, ethnicities, and geographical locations. Improved strategies are urgently needed to achieve control of scabies and its complications in endemic communities.

Pyoderma, commonly known as impetigo, is a bacterial skin infection causing pus formation, prevalent globally, especially in resource-poor areas. It affects both children and adults, including those with conditions like diabetes. Despite its significant impact and economic burden, research on its global epidemiology is limited. This study aims to address this gap by analyzing pyoderma trends from 1990 to 2019 using GBD data. The study aims to analyze global trends in pyoderma epidemiology from 1990 to 2019 using GBD data. Specifically, it investigates Age-Standardized Incidence Rate (ASIR), Mortality Rate (ASMR), and Disability-Adjusted Life Years Rate (ASDR) across 204 countries. Additionally, it provides insights into demographic and socioeconomic factors influencing pyoderma prevalence. Furthermore, it forecasts pyoderma's development trends for the next decade to inform public health strategies. Data were sourced from the GBD 2019 database, comprising various sources such as censuses, surveys, and registries. Estimates for pyoderma incidence, mortality, and DALYs, along with their 95% uncertainty intervals (UI), were retrieved. The Sociodemographic Index (SDI) was used to assess socioeconomic status, and statistical calculations were performed using the WHO Health Equity Assessment Toolkit and R software (v4.3.2). From 1990 to 2019, the Age-Standardized Incidence Rate (ASIR) and Age-Standardized Mortality Rate (ASMR) of impetigo increased, while the Age-Standardized Disability-Adjusted Life Years Rate (ASDR) declined. Significant global geographical heterogeneity persists, closely associated with the Sociodemographic Index (SDI). Children under 5 and the elderly are particularly at risk, with lower SDI nations bearing higher burdens. Population growth and aging contribute to this rise, with disparities in impetigo trends persisting among countries and regions with varying SDI levels, expected to continue until 2030. Pyoderma exhibits significant heterogeneity across age, gender, and geography, with pronounced disparities evident in underdeveloped regions or countries. Therefore, prioritizing policy formulation and implementing tailored prevention and treatment strategies for high-risk populations are imperative to alleviate the disease burden effectively. Such targeted approaches are crucial in addressing the global impact of pyoderma.