Notifiable diseases

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Notifiable diseases can spread in society, but it is not essential to get information on the personal identity of the people with the disease. Treating physicians and health clinics must submit data on notifiable diseases to the Chief Epidemiologist without personal identity.

Maintaining a register on communicable diseases makes it possible to monitor their spread and development in society and, as needed, inform the public and healthcare practitioners and provide recommendations. Action should be considered if there is an unexpected increase in cases.

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Adenoviruses are the most common cause of conjunctivitis and, in addition, can cause infections with symptoms from, for example, airway, gastrointestinal, and central nervous system (CNS) pathways. Adenovirus infections are ongoing throughout the year, and a temporary increase in community cases is often observed. Outbreaks due to adenoviruses are also well known, especially with close contact between several individuals. The primary examples are children's summer camps and military and training camps.

At least 51 human adenovirus serotypes have been described, divided into six subtypes from A-F. Many serotypes are associated with certain infections and depend on the patient's age; therefore, some serotypes are more common in children than in adults or vice versa. Infection with a particular serotype protects against future infections with the same serotype.

Primary adenovirus infections and serotype linkage

Epidemic keratoconjunctivitis is associated with serotypes 8, 19, and 37.
Pharyngoconjunctival fever is associated with serotypes 3 and 7.
Upper and lower respiratory infections with cold symptoms, sore throats, cough, and fever are associated with serotypes 1, 2, and 4 in children and 3, 4, and 7 in adults.
Diarrhea is associated with serotypes 2, 3, 5, 40, and 41.
Cystitis is associated with serotypes 7, 11, and 21.
Central nervous system infections are related to serotypes 2, 6, 7, and 12.

Transmission

The most common modes of transmission are:

With hands.
Direct contact with infected fluids from an individual's eye.
Indirect contact with infected fluids through contaminated surfaces, instruments, or fluids.

Initial infection among factory workers can often be traced back to fluids used for eyewash after minor eye accidents; such infections occur with fingers, instruments, or other contaminated objects. Similar outbreaks have also appeared in ophthalmological wards and clinics, and infection among staff can perpetuate the outbreak. Infections occur commonly within families, especially when children are in the home. Even if it is minimal, an injury to the eye can increase the risk of infection.

Incubation period: The period from infection to onset of symptoms is usually 4 to 12 days but may be longer.
The period during which an infected individual is infectious: An infected individual may be contagious from shortly before symptoms appear up to 14 days from the start of symptoms.
Diagnosis: Adenovirus diagnosis is made at the National University Hospital of Iceland virus laboratory, usually with a diagnosis of the virus's genetic material. It is also possible to culture the virus and measure antibodies.

Prevention and control of possible or confirmed infection.

The infected person:

Carriers should be instructed to wash their hands frequently and avoid contact with the eye.
Disposable paper towels should be used. If this is not possible, the infected person shall keep his/her towel until the paper towels have been provided.
Infectious persons must not share eye medications, drop-ons, cosmetics, or other eye contact materials.

Healthcare/ophthalmological center infection

Patients and healthcare professionals with a possible infection should avoid contact with other patients.
Workers shall wash their hands before and after any contact with any patient. Gloves should be worn if contamination is suspected, and hands should be thoroughly wiped with disposable paper towels after washing hands.
Repeated devices used for eye examination must be carefully cleaned and sterilised (by an approved procedure) after use.
Any eye medications or drops that have come in contact with the eyelids or mucous membranes must be discarded after use.
Preventive measures must be taken if the epidemic persists, including the reception of potentially infected patients in special reception rooms.
All surroundings of the infected person must be cleaned thoroughly with soap and water and disinfected by mild surface chlorine, which is contaminated with ocular or nasal fluids.
In outbreaks, the transmission route must be traced back to the source of the contaminated eye medicines or wash-out fluids, and appropriate measures must be taken to prevent further spread.

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Borrelia burgdorferi bacteria cause the disease borreliosis or Lyme disease in humans. The bacteria are transmitted to humans by bites of a tick (Ixodes ricinus in Europe, Ixodes scapularis, and pacificus in the United States) when it feeds on blood.

The optimal conditions for the tick are wooded areas and the wildlife there, which provides the tick with blood. Over the last thirty years, this disease has spread significantly, linked to the increased spread of woodlands and wild mammals, climate change, and increased outdoor activities by people with more free time.

In the United States, Lyme disease is most common in New England, the Midwest, California, and Oregon. In Europe, the disease is most common in Germany, Austria, Slovenia, Sweden, Finland, and the Baltic countries. The disease is also present locally in Russia, China, and Japan. The disease has been increasingly introduced to the British Isles in recent years.

Ixodes ricinus

According to information from the Icelandic Institute of Natural History, the tick was first found in Iceland on a migratory bird in 1967. It has been found from time to time, especially in recent years, and the Institute believes it is in all likelihood endemic, as its distribution area has shifted northwards with a warming climate. Since the tick travels with migratory birds, it has likely been introduced to Iceland from time to time for centuries but has yet to take root here. No one, however, is known to have been infected with Lyme disease in Iceland.

Life conditions of ticks in Iceland are poorly researched, but unsteady weather conditions and limited woodland habitats have been linked to the risk of its establishing roots in Iceland. This may change if the weather is warming and woodland is growing in Iceland. A woodpecker, an arthropod, is a vector that transmits the virus from mammals to birds. It may concern humans because it can carry bacteria (Borrelia burgdorferi) and viruses that cause encephalitis (see section TBE). It stays in vegetation, especially on the forest floor, and clings to the blood donor.

There are three life stages of the mite. After hatching from an egg, it becomes a six-legged larva, which remains dormant over the winter. In spring, the larvae crawl upwards along the vegetation and are subject to an opportunity to reach a host to suck blood. If all is successful, the mite is switched to an eight-legged juvenile in late summer, who will again be dormant during the winter.

In spring, it adopts the same mode and changes into an adult mite after a successful blood meal, hibernates another winter, and repeats the game in spring. The male then dies, but the female lays eggs before accompanying her partner. Adult mites are 0.5 to 11.1 cm long, while juveniles are much smaller.

An adult mite is distended after a blood meal, reaching the size of a coffee bean.

Symptoms

After a bite leading to infection, erythema migrans that spread into a circle can form. It can take 3–30 days for the erythema to spread.

Soon, fatigue, fever, chills, and headaches can begin, and muscle and joint pain may last for weeks. A widespread infection occurs when the bacteria spread through the body and settle in the skin, central nervous system, heart, or joints. This may happen in the weeks after infection if treatment is not given. However, your infection usually clears up after a few weeks to a month of treatment. In some cases, the infection causes persistent joint inflammation. Uncommon complications include memory loss, fatigue, and heart rhythm problems that remain even after the bacteria has been eliminated.

Diagnosis

Diagnosis is usually made by a blood test for antibodies, sometimes in the spinal fluid (the intrathecal fluid). The antibodies are often only found a few weeks after infection. However, the bacteria can sometimes be found in skin samples from erythema. It was also likely that due to the unclear symptoms of other diseases, the disease may be overdiagnosed in many cases.

Treatment

Antibiotics are given for Lyme disease. Generally, doxycycline, penicillin, amoxicillin, or cephalosporin are given for 2-4 weeks, depending on the severity of the disease. If the infection does not respond well to antibiotic treatment, anti-inflammatory treatment must sometimes be administered.

Preventive measures

It is sensible to gather information on whether ticks are in the area where the animals stay.
Learn what a tick looks like.
If there is a tick in the area, you should be equipped with a pointed pin tweezer.
Wear clothing that covers the body well, such as long trousers and a long-sleeved T-shirt or shirt, especially if you go through woods or scrubland. Use light-coloured clothes so that mites are more easily seen.
Use a chironomid fertiliser.
When you come from a spare area, you must examine your body carefully to see if a mite has bitten itself firmly on the skin.
If the tick has been firmly sucked to feed on blood, care should be taken when removing the tick. This is best done by pinpointing the mite's mouthparts and lifting it straight up from the skin. Rotating the wound shall be avoided. This prevents tick contents from spiking into the wound, or part of it remains.
It is generally considered that infection may only be prevented after the mite has been retained for a day in the skin.

Puffin lice, Ixodes uriae

Another type of tick is the so-called puffin lice (Ixodes uriae). The lice are found in seabirds in Iceland. It has been shown that they contain bacteria from the genus Borrelia. It has not been demonstrated that puffin hunters have been infected with Borrelia even though puffin lice have bitten them.

Notifiable diseases

Lyme disease is a notifiable disease. Notifiable diseases are diseases that can spread in society but which do not have practical significance. The Chief Epidemiologist gets non-personal information about these diseases from treating physicians and health clinics.

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Head lice are a tiny insect that has adapted to man and lives a parasitic life in the hair of a human on its head and feeding on sucking blood from its scalp. It is considered to bear no diseases and, therefore, harmless to the host. All can be infected, but confirmed infection is most common in children 3–12 years old. Head lice infection is not considered a witness to uncleanliness.

Those diagnosed with head lice or guardians must respond to the infection immediately, using the recommended methods, to prevent the spread to others.
Since 1999, head lice have been a notifiable disease, and health centres and school nurses collect information on lice infections and send them to the Chief Epidemiologist once a month. The public is asked to report lice infection to their clinic.

Head lice on Youtube

The life cycle
Adult head lice are 2–3 millimetres in size (similar to sesame seeds), greyish white or light brown. Its life cycle begins in an egg called a nit. In six to ten days, a tiny nymph hatches from the nit, which in 9-12 days develops into an adult male or female louse. Within 24 hours from copulation, which takes place once, the female louse begins to lay and attach nits to hair and can lay up to ten eggs per day.

The lice have six legs and specially designed claws to get around in their hair and can crawl 6–30 cm per minute. Lice cannot fly, jump or swim. The lifespan of female and male head lice is up to 30 days, but if they fall from the hair to the surroundings further away from the warm, moist, and bloody scalp, they will wash up and die in 15–20 hours.

Nit - the eggs of lice
The louse's eggs are called nits and can lay up to ten eggs daily. The louse 'sticks' them to head hair using a particular substance it produces, about 1cm from the scalp, but for them to hatch, the temperature must be about 22°C.

The nit is 0.8 mm long, can be seen with the human eye, and can look like dandruff, but unlike dandruff, it is stuck in the hair. Once hatched, empty egg capsules remain in the hair, and it may be difficult to see if they are full or empty, but if they are far from the scalp, they are likely to be empty, or the lice in them are dead. Nits are most commonly found in the hair above the ears and at the hairline at the back of the head.

The presence of nit in the hair does not necessarily indicate the presence of lice.

Ways of transmission
Lice can spread between heads if there is direct hair-to-hair contact long enough for them to crawl between, but they cannot jump, fly or swim.

Head lice dropped into an environment will immediately become damaged and weak and, therefore, cannot crawl on another head and settle there. Consequently, transmission via clothing and intra-cellular components is considered highly unlikely. However, it cannot be excluded that combs, brushes, hats, and the like, used by more than one person within a short period, may be possible transmission sources.

Symptoms of infection
Two in three people infected with head lice have no symptoms. One in three people gets itching. Itching is an allergy that develops over time (from a few weeks to three months) against the louse's saliva. It spits on the scalp when it sucks blood. It can become severe, and skin redness and swelling can occur when the person scratches. In some cases, ulcers that can become infected with bacteria can occur.

Analysis

Looking for lice in the head hair with a careful examination is best done with a comb with a piece of lumber over a white surface or mirror and good light.
Many people find it more convenient to comb wet hair, which contains hair conditioner, while others find it more comfortable to comb their hair dry.
If a louse is found, even just one, it is a sign that the person has head lice and requires treatment. The treatment can consist of combing (once daily for 14 days) or treatment with anti-lute preparations.
Nit looks like a bottle in a hurry, but unlike a bottle, it is attached to the hair and is preferred to be found above the ears and at the hairline at the back of the neck.

The lice comb
It is important to use a good lice comb. The gap between the rails must not be more than 0–3 mm. It is best to use combs with rigid rails.

Combing in search of head lice in wet hair

Wash hair using the normal method, rinse, and apply normal hair conditioner which is kept in the hair and the hair is wet.
Comb out all tangles - hair is still wet.
Divide the hair up into smaller areas to facilitate the examination of all the hair.
Switch from comb/brush to a lice comb and have a white sheet or a mirror under it to make it easier to see if lice fall from the hair.
Pull the comb from the scalp to the ends of the hair and repeat until the hair has been thoroughly combed.
After each combing, check if lice have entered the comb and wipe with a tissue before the next combing.
Nit of the lice, which resembles dandruff, is often found above the ears and at the hairline at the back of the neck. Nit is not a clear sign of infection, especially if it is far from the scalp, as the lice in it are probably dead.
After combing the hair, rinse out the conditioner.
Comb again to see if any lice have remained.
If lice are found during combing, the conditioner should be washed and the hair dried before treatment with lice medicine is started.
Clean the comb with warm, soapy water and dry it.

Treatment of head lice

To detect head lice in the hair, comb the hair with a good louse comb.
Only those who have live lice in their hair should be treated with lice medicine.

Head lice removal with 'natural' chemicals

Research has shown that herbal extracts and various old house advice (such as putting udder ointments or vaseline in the hair, mayonnaise, olive oil, vegetable oil, etc.) do not kill head lice, although some benefits have been found with tea tree oil.
The use of aromatics in the fight against head lice cannot be recommended and is likely to do no good - no studies support the use of such chemicals.
Never put flammable and toxic substances in your hair, such as gasoline or kerosene, or substances intended for use on animals.
If the treatment is not successful, it is most likely that it was not carried out properly, such as that the correct material was not used, that not enough material was used, that the material was not kept in the hair long enough or that there will be re-infection from infected persons in the environment such as family members or close friends.

Cleaning the environment
There is no need for special environmental cleaning to control head lice infestation. Head lice in the environment have little potential when they are not in the warmth of scalp hair and have access to human blood. They die within 15–20 hours, within a day.

If it is considered necessary, for example where there is a shared comb or brush, it is correct to wash such utensils with hot soapy water or pour hot water over them and let them stand for a few minutes.

Symptoms

Norovirus can affect people of all ages. Common symptoms include vomiting and/or diarrhea, often accompanied by abdominal pain, body aches, headaches, and sometimes a mild fever. The illness typically lasts one to two days and resolves without treatment. However, young children and the elderly are more vulnerable to dehydration due to vomiting and diarrhea.

Transmission

Norovirus is highly contagious. The primary risk of infection comes from contact with infected individuals experiencing symptoms, but the virus can also spread just before symptoms appear and for several days after recovery. The virus can survive on surfaces like doorknobs for extended periods, making indirect environmental transmission possible.

There are multiple ways the virus can spread:

Direct contact: from person to person, through physical touch or droplet transmission.
Airborne: during vomiting, the virus may become airborne, increasing the risk of transmission.
Contaminated food and water: Food can become contaminated during production, packaging, serving, or sharing. A well-known route is through raw oysters contaminated by norovirus-infected water.

Diagnosis

Norovirus is most commonly detected by analyzing the virus's genetic material using a PCR test on a stool sample from an infected person. The virus can also be identified through rectal swabs or vomit samples.

Treatment

Antibiotics will not help treat norovirus, as it is a viral infection. Over-the-counter pain relievers like paracetamol can help alleviate symptoms, especially if accompanied by body aches or headaches. It is crucial to stay hydrated during the illness. In rare cases, hospitalization may be required for intravenous fluids to treat severe dehydration.

Complications

Norovirus infection can lead to more severe symptoms in individuals with pre-existing health conditions.

Prevention

People with norovirus are contagious during their illness, and most stop being infectious two to three days after symptoms subside. However, in some cases, individuals can remain contagious for up to 10 days after recovery.

Currently, there is no vaccine for norovirus.

Preventing infection primarily involves practicing good hand hygiene, which is the most effective measure.

When cleaning up after someone with norovirus, it is important to be cautious, as vomiting and diarrhea are highly contagious.

Surfaces in the infected person's environment should be thoroughly cleaned with soap and water, followed by disinfection (e.g., using a chlorine-based solution). Laundry, such as clothes, bedding, and towels, should be washed at high temperatures. Those with norovirus symptoms should avoid preparing or serving food for others and refrain from sharing food.

It is important to thoroughly cook shellfish and wash fruits and vegetables before consumption.

In healthcare settings, infected individuals should be isolated during their illness and for at least two days after symptoms have cleared. Healthcare workers should remain at home for at least two days after recovery before returning to work.

The Chief Epidemiologist has published a brochure outlining how to reduce the spread of norovirus. This brochure, available as a printable trifold, explains the symptoms and offers guidance on preventing infection.

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Pinworm is a tiny, white roundworm that is a common infection in people of all ages, but most common in children and institutions where many children gather, e.g., in kindergartens and schools, and with the relatives of those who become infected. It is considered one of the few endemic parasites in humans in Iceland that has been here since settlement. Keeping pinworms under control requires strict hygiene and medication. Pinworm infection is a registrable disease, which means that The Chief Epidemiologist collects information about its incidence without personally identifying those who become infected.

Risk factors and epidemiology

The people most likely to get pinworm infections are children under 18, their caregivers, and people who stay in institutions. Man is its only host. Pets, e.g. dogs and cats, cannot be infected.

Life cycle

After the eggs are swallowed, they hatch in the small intestine, mature into adults, and then migrate to the large intestine. This developmental cycle takes one month, but the total lifespan of the nymph is estimated to be two months. In appearance, the stem is a white, small, and delicate pinworm. An adult female is 8–13 mm long and 0.5 mm thick. An adult male is 2–5 mm long and 0.2 mm thick. After mating, the males die, while the females move down into the colon and anus. There they surface, usually during sleep at night, and lay large numbers of eggs in the area around the anus. After that, they die. The eggs are oblong, translucent with a thick shell with a flat side, and cannot be seen with the human eye. Each egg contains a larva that can be infective for 4–6 hours after hatching. In some cases, eggs hatch in the area around the anus and the larvae then crawl through the anus, up the colon, and into the small intestine, where they mature before returning to the colon. During shedding, the anus becomes irritated and itchy, and the infected person starts scratching and can thus get eggs on the fingers and spread them into the environment by contact.

Transmission

Infection occurs when nymph eggs enter the digestive tract after entering the mouth and being swallowed. Self-infection and maintenance of infection occurs when eggs enter the mouth through hands that have scratched the reoccur or acquire eggs through contact with other contaminated areas. The eggs can be transferred to underwear, bedding, doorknobs, toys, and the environment and are easily transmitted between family members and playmates through contact. In some cases, individual eggs can be airborne and thus enter the respiratory tract and mouth and, from there, into the digestive tract by swallowing. How long nits are contagious depends on the temperature and humidity of the environment. In a damp and cold environment, the larvae can live for up to 2-3 weeks in the eggs, but they die much sooner in hot and dry air. Studies have shown that 90% of nymph egg larvae are dead after two days at room temperature.

Symptoms of infection

Pinworm infection is often asymptomatic (one in three), but itching around the anus is the main symptom. The itching worsens at night and can cause sleep disturbances. If the infected person scratches a lot, the skin can become red, sore, and infected with bacteria. If the pinworm infection is severe, i.e., with many worms, it can manifest in loss of appetite, abdominal pain and vomiting. Other symptoms that may occur are irritability, restlessness, teeth grinding, sleep disturbances, and decreased appetite.

Diagnose

When a pinworm infection is suspected, there are three ways to diagnose the infection:

In the case of a child, parents can examine the area around the anus for 2–3 hours after the child is asleep, e.g. by shining a flashlight on the area or examining the anus early in the morning before the child wakes up. Worms can often be seen near the anus, and sometimes they can be seen on the stool. However, the eggs cannot be seen with your own eyes.
Another diagnostic method is to press an adhesive tape on the skin near the anus immediately after waking up to capture eggs and then examine the tape under a microscope. If the person is infected, you can see eggs on the table. The tape test should be repeated three mornings in a row, as soon as the person wakes up and before washing because the number of worms and eggs in the rectum can vary between days.
The third method of diagnosis would be to take scrapings from the nails of infected people and examine them under a microscope in search of eggs.

A stool sample does not help diagnose a pinworm infection because few worms and eggs are in the stool. There is no way to diagnose pinworm infection with a blood test.

Treatment

Drug therapy is needed to control ringworm, and two drugs are registered in this country, Vermox and Vanquin. Both drugs are available as tablets or oral solutions and are sold in pharmacies without a prescription, except if Vermox needs to be given to children under the age of two or to pregnant women, it must be done in consultation with a doctor. Vanquin has not been available in Iceland for a long time (written in Dec. 2023). The medicine must be taken in two doses, i.e. first one dose and then another dose approx. 2 weeks later.

Vermox (mebendazole) blocks the worms' metabolism, causing the worms to die. Vermox also inhibits the development of worm eggs and is a broad-spectrum drug that works against more types of worms than roundworms, but is used in different doses. Dosages for the treatment of ringworm are the same for children and adults, 100 mg (1 tablet or 5 ml of oral solution (20 mg/ml)) as a single dose. The treatment should be repeated after approx. 2 weeks to prevent re-infection. It is recommended that everyone in the same family receive treatment at the same time to prevent the spread of the infection. The treatment can be repeated at 2-3 week intervals if it is not successful in the first attempt. Since there is little experience with the use of the medicine in children under 2 years of age and the effect of the medicine on pregnant women is not sufficiently well known, they are not advised to use the medicine without medical advice. The drug may cause temporary abdominal pain and allergic reactions have been described.

Vanquin (pyruvine embonate) has not been available for a long time in Iceland (Dec. 2023). Vanquin has a specialized action against shingles. The medicine kills both the gnat and its larvae and thus prevents the creation of infectious eggs. The drug does not affect the eggs that are already present, and this is important to keep in mind during treatment, because reinfection is common because live eggs continue to be passed out of the body in the stool for up to 2 weeks after administration of the drug. Due to the tick's life cycle, it is recommended that all family members and close playmates be treated at the same time and that everyone repeat the treatment 2–3 weeks later to prevent further transmission. The dosage of the medicine is based on 1 tablet or 5 ml of oral solution per 10 kg of body weight. An adult person takes a maximum of 8 tablets and they should all be taken in one dose. The active ingredient in Vanquin is a strong dye and colors stools red. The color easily sticks to clothes and furniture if the oral solution is spilled or thrown up. The tablets should be swallowed but not chewed as they can stain the teeth and mouth. Side effects of the drug are mainly nausea and occasionally vomiting, and then more so after taking the oral solution. Stomach pain and diarrhea are known side effects. Allergic reactions are rare.

Repeated infections should be treated like the first ones i.e. take one dose of the medicine and repeat the treatment for approx. two weeks ago. In households where more than one member of the household is infected and infections even reoccur, it is recommended that all family members be treated at the same time. The same applies to children's playmates. If nail infections manifest themselves in schools and kindergartens, the children's guardians must be notified. There are no fixed rules on how to respond to such situations, but it is desirable that a health center in the immediate vicinity of the school attend to such matters, give advice and keep track of actions.

Actions to reduce the spread of pinworm infection and re-infection
Hand washing with soap and water, drying with a clean towel after using the toilet, changing diapers, and handling food are the most effective ways to prevent pinworm transmission and further transmission. Teaching children to wash their hands and ensure they do it is essential.

Other necessary measures to control infection:

Bathe in the morning because it reduces the chance of spreading eggs from the anus. A shower is better than a bath in a tub because bath water can be contaminated with eggs.
Clean underwear daily and frequently change pyjamas and sheets. Do not shake the rope; wash it directly in the washing machine at ≥ 40°C. Preferably dry in a dryer.
Do not scratch the skin near the anus.
Keep your nails short and clean. Do not bite your nails.
Good general hygiene in the environment.
After each chemotherapy treatment, underwear, pyjamas, and bedclothes must be changed.

Sources

Skírnisson K. About the skunk and its biology. Læknablaðð, 1998;84: 208–2013
Pinworm infection. Centers for Disease Control and Prevention (CDC)
Drug information from the Special Drug Register.

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What are pubic lice?

Pubic lice (Phthirus pubis) is an insect mainly found in the hairs around the genitals. It can also be in the armpit, sternum, eyebrow, and eyelashes. Pubic lice are rare on the scalp.

How do pubic lice spread?

Pubic lice are transmitted through close contact and by towels, bedding, and clothes.

What are the symptoms of pubic lice?

In most cases, pubic lice cause severe local itching.

Is it possible to get treatment for pubic lice?

Lice creme may be purchased without a prescription in pharmacies. It is applied to all hairy locations except the scalp. Follow the instructions in the packet strictly. The sexual partner and family members must also be treated so that infection does not occur again. Bed linen and clothes should be washed in the usual way.

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What are Scabies?

Scabies is a parasite that lives in human skin. This is a common skin disease that can be transmitted through sexual contact.

How does the mite infect?

Scabies are transmitted by close contact but also in other ways, such as sleeping in the bed of an infected person where the sheets have not been changed or the same towels are used. It is doubtful that infection can occur even if an infected person greets you with a handshake, but if you hold hands for a long time and the skin is hot and clammy, the mite will come to the surface and can become infected. Infection on toilet seats is extremely unlikely. The ant can live for two to three days outside the body. It takes four to six weeks from infection until symptoms appear if the person has never had scabies, but if they have had scabies before, symptoms may appear after a few days.

What are the symptoms?

Scabies causes rashes and itching. The rash tends to appear in those parts of the body where the mite is most at home: between the fingers, on the wrists, in the waist, on the back, and around the genitals. It is highly unusual for scabies to come to the face. The itching is often worse at night under a warm blanket.

Can scabies be treated?

The treatment involves smearing the whole body (except the face and scalp) with a fertiliser that kills the scabies. The fertiliser can be bought without a prescription in drugstores, and instructions are included in the package.

An infected partner and family members must be treated simultaneously to prevent re-infection. Bedding and clothes are washed in the usual way. The itching may continue for several weeks after the treatment ends, even if the mite is gone.

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Scarlet fever is a disease caused by the bacterium Streptococcus pyogenes. The bacterium is commonly called simply streptococci or group A streptococci (GAS). The most common manifestation of such infections is strep throat. Streptococci are transmitted by droplet infection, e.g. when coughing or sneezing and also during close contact with infected people (droplet and contact infection).

Scarlet fever is most common in children and adolescents under 18 and sometimes accompanies a sore throat.

The gestation period of the disease, i.e. the time that elapses from when a person is infected until they start to develop symptoms, is often 2–5 days. It can take several hours to 1–2 days from the onset of illness to the appearance of the rash.

Symptoms
The main symptoms are sore throat, rash, fever, weakness, headache, and sometimes earache and vomiting.

Rashes associated with scarlet fever are often characterised by considerable redness of the face, with paler skin around the mouth and rashes around the genitals, the chest, the nape, and the groin. The rash is often reddish raised dots on the chest and stomach that are slightly rough to the touch, like fine sandpaper. Later, the rash can spread over the body and become more extensive. The tongue often becomes very red, and the characteristic rash on the tongue is the so-called "strawberry tongue". It is common for the skin to peel in the palms of the hands and under the soles of the feet 1-2 weeks after the disease begins.

Diagnosis
Diagnosis is often based on symptoms, but the disease can resemble certain viral infections, e.g. adenovirus infections. Therefore, confirming the diagnosis with at least one family member is desirable if several have similar symptoms. It is often done by taking a throat swab for a rapid test at a doctor and health institution. Sometimes, culture is taken from the throat with a throat swab.

Treatment
Treating scarlet fever with antibiotics (usually penicillin) is essential. GAS can cause serious infections, so a doctor should be contacted immediately if the patient's condition worsens, even if treatment has been started. It is essential to take the antibiotics according to the doctor's instructions, both in dose and duration of therapy.