Is Scabies Contagious?
Yes, scabies is highly contagious and spreads primarily through direct, prolonged skin-to-skin contact with an infested person. 1, 2
Transmission Mechanisms
Direct transmission is the primary route:
- Scabies spreads when the Sarcoptes scabiei mite transfers from the skin of an infested person to an uninfected person through close personal contact 3, 4
- Both symptomatic patients and asymptomatic carriers can rapidly transmit the disease 2
- Sexual partners, household members, and close contacts are at highest risk 4
Indirect transmission is less common but possible:
- Contaminated bedding, clothing, or towels can harbor mites for limited periods 3
- Scabies mites survive on clothing for up to 4 days without skin contact but only 1-2 days at room temperature (21°C) 1
- In crusted (Norwegian) scabies, mites are dispersed within shed scales, enabling transmission from contaminated surfaces 3
Contagious Period and Isolation
Patients remain contagious until treated:
- Residents with scabies should remain in contact isolation until 24 hours after completion of their first treatment application 5
- After permethrin 5% cream application or oral ivermectin administration, the patient can be removed from isolation the following day 5
- Extended isolation is required for crusted scabies due to extremely high mite burden and infectivity 5
Contact Management Requirements
All close contacts must be treated simultaneously, even if asymptomatic:
- All persons with close personal, sexual, or household contact within the preceding month must be examined and treated simultaneously 1
- Failure to treat contacts simultaneously is the most common cause of treatment failure 1
- In institutional outbreaks, all residents, staff, and frequent visitors must be treated on the same day, regardless of symptoms 5
Special Considerations for High-Risk Settings
Institutional settings pose particular challenges:
- Scabies can cause major difficulties in healthcare institutions, particularly residential homes for the elderly 6
- Debilitated older adults are often heavily infested with high mite burdens 7
- Outbreaks in institutions should be referred to local health protection services 3
Environmental Decontamination
Fomite management reduces transmission risk:
- Machine wash and dry all bedding, clothing, and towels on hot cycles on the same day as treatment 5
- Items that cannot be laundered should be removed from body contact for at least 72 hours 1, 5
- Vacuum furniture and carpets; fumigation is unnecessary 5
Critical Pitfall to Avoid
Do not assume symptom resolution equals non-contagiousness: