Pediculosis prevention and control strategies of community health and school nurses: a descriptive study

Head lice-induced anemia in a child and implications for oral health: Case report

Pediculosis capitis, colloquially referred to as head lice, engenders adverse social and economic consequences among children. While generally not considered a health hazard, chronic and severe head lice infestations have been linked to secondary iron-deficiency anemia. This case report documents a 7-year-old girl who presented for dental treatment with a history of social isolation and poor school attendance. Upon examination, the patient was found to have head lice and scabies infestations, resulting in secondary iron-deficiency anemia. The patient could return to full-time education after successful treatment for the head lice infestation administered by the dental team. This case underscores the need for treatment guidelines to manage children with diagnosed or suspected cases of head lice from a dental perspective. In instances of severe infestation, referral to a medical professional may be necessary for further management. This report highlights the importance of a multidisciplinary approach in managing head lice infestations and its implications on dental management.

Head Lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among caregivers of school-aged children and adolescents. Since the 2015 clinical report on head lice was published by the American Academy of Pediatrics, new medications have been approved, and an algorithm for management of affected patients is included. This revised clinical report clarifies current diagnosis and treatment protocols.

Head lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2010 clinical report on head lice was published by the American Academy of Pediatrics, newer medications have been approved for the treatment of head lice. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting.

Head lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2002 clinical report on head lice was published by the American Academy of Pediatrics, patterns of resistance to products available over-the-counter and by prescription have changed, and additional mechanical means of removing head lice have been explored. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting.

Fomite transmission in head lice

Control of various infestations requires an accurate understanding of transmission. After thousands of years of lice infestation, scientific documentation of indirect contact transmission has been substantiated. Lice can be transferred in the egg, instar, and adult stages. Lice have now been shown in the laboratory to be readily dislodged by air movements such as blow-drying one's hair, combing, and toweling. Moreover, passive transfer to adjoining fabric is also frequently observed. Louse transmission by fomites occurs more frequently than has been commonly believed. Close proximity suffices to increase the likeliness of a new infestation. Thus louse control measures should take account of fomite transmission and include screening of all individuals within an infested person's immediate circle of contact, laundering of everything within the infested individuals' bed or quarantining of such material for 10 days, thorough vacuuming of floors, carpets, upholstery, with a standard vacuum cleaner.

Head louse infestations: the "no nit" policy and its consequences

Health authorities in the USA, Canada and Australia recommend a "no nit" policy, i.e. the immediate dismissal of all children who have head lice, eggs and/or nits on their hair from school, camp or child-care settings. These children would be readmitted to the institution only when all head lice, eggs and nits have been removed. The "no nit" policy assumes that all nits seen when examining the scalp are viable and therefore the infested individual should be treated for lice, and all nits must be removed from the scalp. However, it has been repeatedly shown that only a small number of children who have nits on their scalp are also infested with living lice. Accordingly, in the USA alone 4-8 million children are treated unnecessarily for head lice annually, which amounts to 64% of all lice treatments. In addition, 12-24 million school days are lost annually. The annual economic loss owing to missed workdays by parents who have to stay home with their children adds US$4-8 billion to the country's economy. The policy also results in serious psychological problems for children and their parents. Therefore, the "no nit" policy should be abandoned and alternative ways of examination and treatment for head lice should be found.

Head lice prevalence in primary schools in Victoria, Australia

OBJECTIVES

To determine the prevalence of and assess risk factors associated with head lice infections (pediculosis) in children from government primary schools in Victoria, Australia.

METHODS

Between May and October 2001, children were selected by clustered random sampling of schools and classes, then examined for head lice using hair conditioner and a fine-toothed head lice comb. There were 1838 children screened from 16 primary schools. Risk factors evaluated included metropolitan or rural residence, school class, gender and hair length.

RESULTS

Thirteen percent of children (239/1838) had an active infection (95% CI, 10.9-15.1) and 3.3% (61/1838) had an inactive infection (95% CI, 2.0-4.6). Prevalence of active pediculosis varied between schools from 0 to 28%. Our screening identified no more than one case per class in the majority of classes screened (58.5%). Females were 2.2 times more likely to have active infection than males (95% CI [1.7,2.9]) and there was no significant difference for the other risk factors investigated.

CONCLUSIONS

Our study demonstrated the prevalence of head lice varied across Victoria and showed that risk factors commonly attributed to head lice infections did not hold true. Our findings support the premise that traditional ad hoc mass school-based screening may not be the best use of resources when controlling head lice. We suggest a more pragmatic community-based approach.

Towards the eradication of head lice: literature review and research agenda

Head lice infestation is a public health issue. In the effort to compile an evidence-base about the physiology, detection, treatment, effects and management strategies of head lice infestations we reviewed current literature. This literature signalled significant evidence gaps and these gaps provide incentives for further research. Our conclusions from the literature are that parents of children are responsible for head lice detection and treatment but have varying access to advice about how best to treat this condition. Concern is exacerbated by misconceptions surrounding the circumstances of infestation. Head lice are a low priority for health professionals in Australia, whereas parents and teachers believe the problem necessitates greater attention. It is important to provide a unified evidence-based approach to good information. It is timely for health care professionals to re-examine and prioritize this public health issue. They should research and work collaboratively towards the eradication of head lice.

Lice, nits, and school policy

BACKGROUND

The epidemiology of head lice infestation is poorly understood. Many schools treat all children with nits as though they are contagious. Children with nits but no lice are often removed from school until they are treated and all visible nits are removed.

OBJECTIVE

To investigate the probability that children with nits alone will become infested with lice.

DESIGNS

Prospective cohort study.

SETTING

Two metropolitan Atlanta elementary schools.

PARTICIPANTS

A total of 1729 children were screened for head lice. Twenty-eight children (1.6%) had lice, whereas 63 (3.6%) had nits without lice. Fifty of the 63 children (79%) with nits alone completed follow-up.

OUTCOME MEASURE

Conversion (ie, becoming infested with lice) within 14 days after initial screening.

RESULTS

Nine of 50 children (18.0%) followed for nits alone converted. Although children who converted did not have significantly more nits than did nonconverters, having nits near the scalp was a risk factor for conversion. Seven of 22 children (31.8%) with >/=5 nits within one fourth inch of the scalp converted, compared with 2 of 28 children (7.1%) with fewer (relative risk: 4.45; 95% confidence interval: 1.03-19.35). This risk remained statistically significant after separately stratifying for sex, recent treatment, and total number of nits.

CONCLUSIONS

Although having >/=5 nits within one fourth inch of the scalp was a risk factor for conversion, most children with nits alone did not become infested. Policies requiring exclusion from school and treatment for all children with nits alone are likely excessive. Instead, these children may benefit from repeated examination to exclude the presence of crawling lice.lice, pediculus, lice infestations, pediatrics, school.

Persistent head lice following multiple treatments: evidence for insecticide resistance in Pediculus humanus capitis

Viable head lice were found on the scalps of two family members following multiple topical insecticide treatments. The possibility of reinfestation had been reliably excluded. Persistent infestation could be diagnosed only after cutting the hair and combing repeatedly, which allowed visualization of juvenile (nymphal) and adult lice. Insecticide-resistant headlouse infestations are probably much more common than is generally realised and may persist unnoticed, so that more aggressive approaches will be needed to eradicate these ectoparasites from individuals and communities.

Pediculosis in a school population

This nonexperimental, retrospective study of elementary, middle school, and high school children (a) determined the prevalence of pediculosis, (b) identified populations susceptible to head lice infestation, and (c) examined the role of the school nurse in pediculosis management. The findings showed the highest prevalence of pediculosis was among younger school-age children, and girls were 3 times more likely to be infested than boys. Hispanic children had the highest rate of infestation, followed by Caucasian children. African American children showed a 15% infestation rate, a finding not supported by other studies. The role of the school nurse in pediculosis management was restricted by time and budgetary constraints. Findings of this study support the need for a standardized data collection system for pediculosis in all school districts.

Acanthosis Nigricans as an early clinical proxy marker of increased risk of type II diabetes

Diabetes affects 6% of the national population, yet approximately 50% of persons with diabetes remain undiagnosed and receive no treatment. In specific populations, Acanthosis Nigricans (AN) may serve as an early clinical proxy marker of increased risk of type II diabetes. The results of this pilot project to screen selected school age students in New Mexico for AN indicate that a large number of these students may be at increased risk for developing type II diabetes as young adults. The future burden of diabetes on individuals, families, communities, and health care systems may be greater than previously recognized.

The neglected saliva: medically important toxins in the saliva of human lice

Although there has been a great deal of research effort within the last two decades on identifying the active components of the saliva of blood-sucking ticks, mosquitoes, biting flies, fleas and bugs, essentially neglected have been the human lice. Despite initial reports in the early part of this century suggestive of vasodilatory, anticoagulant and immunosuppressive properties of the saliva, for the next 50 years there were no biochemical studies on the active principles. Very recently, anatomical and biochemical studies have begun to characterize the bioactive molecules in lice saliva. The louse stocks a salivary vasodilator in excess over what is needed for a single bite, and injects similar amounts at each successive bite. The vasodilator in lice saliva appears to have different pharmacological properties than peroxidative, oxidative and maxidilan types of vasodilators reported from other blood-sucking insects. Possible anticoagulant activities have also been characterized. This belated, but welcome, interest comes at a time of resurgence of lice-born disease in certain parts of Africa, and of resistance to chemical control in Europe and North America.

From eradication to resistance: five continuing concerns about pediculosis

A school nurse, serving in the capacity of infection control officer, is responsible for managing head lice infestations. The nurse's concerns on the student and parent levels include dispelling misconceptions about lice, screening, motivating correct treatment, and providing follow-up. The nurse's responsibility to the community as a whole also involves putting into practice policies that prevent the spread of infestations without promoting pediculicide resistance.