Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States

BACKGROUND AND AIMS

Louse-borne Bartonella quintana infection and flea-borne murine typhus are two potentially serious vector-borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse- and flea-borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases.

METHODS AND RESULTS

Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared.

CONCLUSIONS

Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse- and flea-borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing.

The effectiveness of training mothers with regard to pediculosis preventive behavior among school students: A Protection Motivation Theory study

BACKGROUND OBJECTIVES

Lice infestation is considered as a reemerging problem as well as a health challenge. Based on Protection Motivation Theory, the present study was conducted to investigate the effectiveness of training mothers in regard to pediculosis preventive behavior among school students.

METHODS

In a critical trial, 180 mothers of primary school daughters were assessed in two study groups in the Iranian city of Qom in 2021. They received training intervention in a course of four ninety-minute sessions during four weeks. After six months, the post-test questionnaire and the checklist were completed by them. The data were gathered using a valid and reliable questionnaire. Finally, data analysis was performed using SPSS 20.

RESULTS

After the training intervention, a significant difference was observed within the intervention group in scores of the prevention motivation constructs (P<0.001). Besides, there was a significant difference between the mean scores of the preventive behavior of the mothers and daughters in the intervention group before the training intervention and six months after it (P<0.001). However, no significant difference was seen before and after the intervention in the control group (P>0.05). Additionally, no significant differences were observed between the intervention and control groups (P<0.001) in terms of comparing the mean score differences of all the constructs of protection motivation theory, the mothers' behavior and the daughters' behavior checklist.

INTERPRETATION CONCLUSION

The results indicate the effectiveness of training mothers based on Protection Motivation Theory in regard to pediculosis. Therefore, it seems that in developing training programs, utilizing this theory could prove useful to bring about changes in the individuals' behavior regarding the prevention of pediculosis.

Staying Ahead of Head Lice: Pediculosis Treatment Updates

Pediculosis (head lice) infections are one of the more sensitive issues that may involve the school nurse. In the 3- to 11-year-old age group in the United States, head lice infections are common and can elicit anxiety in students, parents, and school personnel. Head lice do not transmit any communicable diseases and therefore exclusion from school and "no nit" policies are not warranted. Treatment and management for head lice include a range of over-the-counter products and prescription topical and oral medications. Nonpharmacologic and alternative treatments do exist; however, many do not have established efficacy studies, and some can be costly. The school nurse plays an integral role in providing education related to treatment and environmental recommendations for families affected by head lice. Through this education, the nurse can also reduce the stigma and anxiety many feel around the subject of head lice infections.

New chemistries for the control of human head lice, Pediculus humanus capitis: A mini-review

Pediculus lice represent one of the longest and most prevalent parasitic infestations of humans. Head lice are an economic and social concern whereas body lice pose a more serious public health threat. Significant progress has been made in the study of human lice over the last 10 years, allowing for new approaches in their control. An in vitro rearing system has made it possible to maintain insecticide-susceptible and -resistant reference strains, which allowed an in depth study of pediculicide resistance, including its underlying molecular mechanisms and the detection and monitoring of resistance. The generation of inbreed strains facilitated the efficient sequencing, assembly and annotation of the genomes and transcriptomes of both lice. The use of functional genomics and reverse genetics elucidated the genetics involved in the evolution of resistance and the discovery of novel target sites for the development of new pediculicides. In this review, four new effective pediculicide products, each with different mode of action and unique chemistries, will be presented. They have been found to be safe and selective, and control resistant lice. As such, they meet the criteria necessary to be used in rotations as a sustainable resistance management strategy.

Infestations, Bites, and Insect Repellents

Infestations and arthropod bite reactions in children are common reasons for presentation to pediatric health care providers. Infestations in children include head lice, scabies, and other mites. Fleas and bed bugs are common causes of bite reactions in children, and papular urticaria is a chronic, recurrent eruption resulting from delayed hypersensitivity to a variety of insect bites. Both infestations and bite reactions may result in severe pruritus with associated sleep disturbance and can be a source of significant distress for patients and families. In this review, we discuss infestations and bite reactions affecting pediatric patients, along with the approach to treatment and prevention of these conditions. [Pediatr Ann. 2020;49(3):e124-e131.].

Is Allopreening a Stimulus-Driven Defense Against Ectoparasites?

Allopreening occurs when 1 bird preens another bird. The behavior is normally directed at the head and neck of the recipient, i.e., regions that the bird cannot self-preen. Studies of penguins, pigeons, and other groups of birds suggest that allopreening plays a role in the control of ectoparasites, such as ticks and feather lice. However, it is not known whether allopreening increases in response to increases in parasite load, or whether it is a programmed response that occurs independently of parasite load. We conducted a laboratory experiment using wild-caught rock pigeons (Columba livia) to test the relationship between ectoparasite load and allopreening rate. We added feather lice (Columbicola columbae) to captive pigeons and tested for changes in allopreening rates compared to control birds with no lice added. Allopreening rates did not change in response to the addition of lice. Interestingly, however, our data revealed a negative correlation between allopreening and self-preening rates.

A field study on the efficacy of ivermectin via subcutaneous route against chewing lice (Bovicola caprae) infestation in naturally infested goats

Caprine pediculosis is an ectoparasitic disease of great concern among goat farmers in India. It may be caused by either sucking lice or chewing lice; the latter one results in severe skin lesions, leading to production loss. This study evaluated the effectiveness of the macrocytic lactone drug, ivermectin, administered via subcutaneous injection, against chewing lice Bovicola (Damalinia) caprae infestation in naturally infested goats. The study was conducted on 20 goats with severe B. caprae infestation. Animals of group A (n = 10) were treated using a single dose of ivermectin (200 µg/kg body weight) subcutaneously and animals of group B (n = 10) underwent placebo therapy using normal saline. The animals were examined on days 0, 3, 7, 14, 21, 28, 42 and 56 for lice counts. There was 100% elimination of lice in all animals of group A and effective protection from re-infection remained at least for 21 days. Considerable improvement in haematological parameters was also observed by day 21. Based on this study, ivermectin injected via a subcutaneous route can be used effectively for the therapeutic and prophylactic management of chewing lice infestation in goats maintained under an extensive grazing system.

High level efficacy of lufenuron against sea lice (Lepeophtheirus salmonis) linked to rapid impact on moulting processes

Drug resistance in the salmon louse Lepeophtheirus salmonis is a global issue for Atlantic salmon aquaculture. Multiple resistance has been described across most available compound classes with the exception of the benzoylureas. To target this gap in effective management of L. salmonis and other species of sea lice (e.g. Caligus spp.), Elanco Animal Health is developing an in-feed treatment containing lufenuron (a benzoylurea) to be administered prior to seawater transfer of salmon smolts and to provide long-term protection of salmon against sea lice infestations. Benzoylureas disrupt chitin synthesis, formation, and deposition during all moulting events. However, the mechanism(s) of action are not yet fully understood and most research completed to date has focused on insects. We exposed the first parasitic stage of L. salmonis to 700 ppb lufenuron for three hours and observed over 90% reduction in survival to the chalimus II life stage on the host, as compared to vehicle controls. This agrees with a follow up in vivo administration study on the host, which showed >95% reduction by the chalimus I stage. Transcriptomic responses of salmon lice exposed to lufenuron included genes related to moulting, epithelial differentiation, solute transport, and general developmental processes. Global metabolite profiles also suggest that membrane stability and fluidity is impacted in treated lice. These molecular signals are likely the underpinnings of an abnormal moulting process and cuticle formation observed ultrastructurally using transmission electron microscopy. Treated nauplii-staged lice exhibited multiple abnormalities in the integument, suggesting that the coordinated assembly of the epi- and procuticle is impaired. In all cases, treatment with lufenuron had rapid impacts on L. salmonis development. We describe multiple experiments to characterize the efficacy of lufenuron on eggs, larvae, and parasitic stages of L. salmonis, and provide the most comprehensive assessment of the physiological responses of a marine arthropod to a benzoylurea chemical.

Effect of a health education program on reduction of pediculosis in school girls at Amphoe Muang, Khon Kaen Province, Thailand

BACKGROUND

Pediculosis caused by head lice (Pediculus humanus capitis) infestation is still an important health problem in schoolchildren, especially girls, worldwide, including in Thailand. Although pediculicidal agents effectively kill head lice, the re-infestation rate is still high. Thus, prevention is an important strategy for any sustainable control program. We aimed to develop and evaluate the efficacy of a health education program for increasing knowledge, changing attitudes and promoting preventive practices to reduce prevalence of pediculosis among school girls in Amphoe Muang, Khon Kaen, northeastern Thailand.

METHODOLOGY

Six schools were selected using multistage simple randomization and were allocated into intervention or control groups. A total of 267 girls was enrolled from these schools. A "knowledge, attitude and practice" (KAP) questionnaire, consent forms and health education materials were constructed and tested by experts and in one pilot school before the main investigation. Baseline prevalence of adult lice and nits was determined. The health education package was given only to the intervention group. The KAP questionnaire was re-evaluated at two months after intervention.

RESULTS

At baseline, the prevalence and intensity of head lice infestation, and the KAP scores did not differ significantly between the two groups. After re-evaluation at two months, the KAP score was significantly greater in the intervention group. A significant decrease of the infestation rate from 59% to 44% was observed in the intervention group, whereas infestation increased in the control group (from 56% to 65%). The incidence of new cases in the intervention group (6.14%) was lower than in the control group (12.62%).

CONCLUSION

These findings indicated that the newly-established health education package is an effective tool for increasing KAP and reducing head lice infestation in school girls. Efforts to combat pediculosis in schoolchildren elsewhere may consider including this, or a similar, health education package in their programs.

Efficacy of Peer Education for Adopting Preventive Behaviors against Head Lice Infestation in Female Elementary School Students: A Randomised Controlled Trial

Background

Pediculosis is a common parasitic infestation in students worldwide, including Iran. This condition is more prevalent in populous and deprived communities with poor personal hygiene. This study sought to assess the efficacy of peer education for adopting preventive behaviors against pediculosis in female elementary school students based on the Health Belief Model (HBM).

Methods

A total of 179 female fifth grade students were selected using multistage random sampling and were randomly allocated to control and intervention groups. A standard questionnaire was designed and administered to collect baseline information. An educational intervention was then designed based on the conducted needs assessment. The educational program consisted of three sessions, held by peers for the intervention group. The questionnaire was re-administered one month after the intervention. Independent and paired t-test, Pearson’s correlation coefficient, and regression analysis were applied as appropriate.

Results

The two groups had no significant differences in the scores of knowledge, HBM constructs, or behavior before the intervention. After the intervention, however, the mean scores of all parameters significantly improved in the intervention group.

Conclusion

Peer education based on HBM is an effective strategy to promote preventive behaviors against pediculosis in among fifth grade female elementary school students in Iran.

No-Nit Policies in Schools: Time for Change

No-nit policies that exist in many schools throughout the United States were established years ago based on fear and misinformation, rather than scientific evidence. Children who are found to have live lice are no more infectious on the day of diagnosis than they had been prior to the discovery. Transmission of head lice requires close personal contact, which is not common in the school setting. To date, no scientific literature exists to support the exclusion of children from school due to head lice infestation. Therefore, there is a need to develop updated school policies using research-based evidence to determine the best method of treating infestations while allowing children to remain in school.

Does allopreening control avian ectoparasites?

For birds, the first line of defence against ectoparasites is preening. The effectiveness of self-preening for ectoparasite control is well known. By contrast, the ectoparasite control function of allopreening-in which one birds preens another-has not been rigorously tested. We infested captive pigeons with identical numbers of parasitic lice, and then compared rates of allopreening to the abundance of lice on the birds over time. We documented a negative relationship between rates of allopreening and the number of lice on birds. Moreover, we found that allopreening was a better predictor of louse abundance than self-preening. Our data suggest that allopreening may be a more important means of ectoparasite defence than self-preening when birds live in groups. Our results have important implications for the evolution of social behaviour.

Effect of Environmental Conditions and Toxic Compounds on the Locomotor Activity of Pediculus humanus capitis (Phthiraptera: Pediculidae)

In this work, we evaluated the effect of environmental variables such as temperature, humidity, and light on the locomotor activity of Pediculus humanus capitis. In addition, we used selected conditions of temperature, humidity, and light to study the effects of cypermethrin and N,N-diethyl-3-methylbenzamide (DEET) on the locomotor activity of head lice. Head lice increased their locomotor activity in an arena at 30°C compared with activity at 20°C. When we tested the influence of the humidity level, the locomotor activity of head lice showed no significant differences related to humidity level, both at 30°C and 20°C. Concerning light influence, we observed that the higher the intensity of light, the slower the movement of head lice. We also demonstrated that sublethal doses of toxics may alter locomotor activity in adults of head lice. Sublethal doses of cypermethrin induced hyperactivated responses in adult head lice. Sublethal doses of DEET evocated hypoactivated responses in head lice. The observation of stereotyped behavior in head lice elicited by toxic compounds proved that measuring locomotor activity in an experimental set-up where environmental conditions are controlled would be appropriate to evaluate compounds of biological importance, such as molecules involved in the host-parasite interaction and intraspecific relationships.

In Vitro and In Vivo Evaluation of Infestation Deterrents Against Lice

The human head louse is a cosmopolitan ectoparasite and frequently infests many people, particularly school-age children. Due to widespread pyrethroid resistance and the lack of efficient resistance management, there has been a considerable interest in the protection of uninfested people and prevention of reinfestation by disrupting lice transfer. In this study, two nonclinical model systems (in vitro and in vivo) were used to determine the efficacy of the infestation deterrents, Elimax lotion and Elimax shampoo, against human head lice or poultry chewing lice, respectively. With in vitro assessments, female head lice exhibited significantly higher avoidance responses to hair tufts treated with either of the test formulations, which led to significantly higher ovipositional avoidance when compared with female lice on control hair tufts. Additionally, both formulations were determined to be competent infestation deterrents in a competitive avoidance test in the presence of a known attractant (head louse feces extract). In in vivo assessments using a previously validated poultry model, Elimax shampoo was determined to be an efficacious deterrent against poultry chewing lice within Menopon spp. and Menacanthus spp.

Behavioural adaptations of argulid parasites (Crustacea: Branchiura) to major challenges in their life cycle

Fish lice (Argulus spp.) are obligate ectoparasites, which contrary to most aquatic parasites, retain the ability to swim freely throughout the whole of their life. In fish farms, they can quickly increase in numbers and without effective control cause argulosis, which results in the reduced growth and survival of their fish hosts. The morphology of Argulus spp, including their sensory organs, is suitable for both parasitism and free-swimming. By spending a considerable amount of time away from their host, these parasites risk being excessively dispersed, which could endanger mating success. Here we present a review of recent studies on the behaviour of Argulus spp, especially the aggregative behaviour that mitigates the dilution of the parasite population. Aggregation of parasites, which is especially important during the period of reproduction, occurs on different scales and involves both the aggregation of the host and the aggregation of the parasites on the host. The main behavioural adaptations of Argulus spp, including searches for hosts and mates, host manipulation and host choice, are all focused on the fish. As these ectoparasites repeatedly change hosts and inflict skin damage, they can act as vectors for fish pathogens. The development of environmentally friendly measures for the control and prevention of argulosis needs to take into account the behaviour of the parasites.

Demystifying pediculosis: school nurses taking the lead

The treatment of Pediculosis capitis, or head lice, is fraught with misinformation, myths, and mismanagement. Common myths include the need to exclude children from school, the need to remove all visible nits ("no-nit" policies), the need for massive environmental cleaning, that head lice live for long periods of time, and that schools are a common location for lice transmission. Head lice are a common childhood nuisance, causing embarrassment and emotional trauma in both children and families. This article explores and challenges the commonly held beliefs about the identification, management, and treatment of Pediculosis by presenting current recommended evidence-based practice. It also challenges pediatric nurses, and school nurses in particular, in alignment with the National Association of School Nurses (NASN) Position Statement on Pediculosis Management in the School Setting, to act as change agents for reasonable and effective school policies and practices.

Headlice eradication as everyday engagement with science: An analysis of online parenting discussions

This paper focuses on the way in which people deploy scientific knowledge alongside other resources in everyday interactions. In the UK headlice are common amongst schoolchildren, and treatment is viewed as a parental responsibility. Choice between treatment options lies with individual parents, with official guidance giving no clear steer. In the face of this combination of responsibility and uncertainty, users of an online parenting forum justify their actions using a variety of resources, including claims to scientific knowledge of both headlice and the action of various treatments, but also drawing on the authority of having direct experience, trust in brand-named products and generalised suspicion of "chemical" treatments. These discussions occasion expression of knowledge as part of portraying oneself as a responsible parent, and thus while they do not necessarily represent public knowledge about science more generally, they do offer a useful site to explore what people do with science.

Socioeconomic status, family background and other key factors influence the management of head lice in Norway

How head lice infestations are managed by households is an important but generally neglected issue in head lice research. In the present study, we investigate actions taken against head lice by Norwegian households in association with socioeconomic status, family background, school-related variables and other key factors. Repeat questionnaires distributed to caretakers of the same elementary school children during a 2-year period enabled us to study both previous head lice management and any changes in this management through time. Households from 12 schools spanning the main socioeconomic variation found in Norway participated in the study. All students with active head lice infestation were treated in the four investigated periods. Most caretakers used a thorough head lice checking technique and informed others of own infestation. Checking frequency was low as most children were inspected less than monthly. The best determinant of increased checking frequency and thoroughness was personal experience with head lice. The increased awareness, however, seemed to be somewhat short-lived, as there was a decrease in checking frequency and thoroughness within 1 year after infestation. Personal experience with head lice also increased general knowledge related to the parasite. Parents born in developing countries checked their children for head lice more frequently, although less thoroughly, informed fewer contacts when infested, used pediculicides preventively more often and knew less about head lice than parents born in developed countries. Households with highly educated mothers had a lower checking frequency, but their knowledge and willingness to inform others was high. Single parents were more concerned about economic costs and kept children home from school longer while infested than other parents. As head lice management varied among socioeconomic groups and with parental background, differentiated advice should be considered in the control of head lice. The biannual focus on head lice during the 2 years of investigation increased checking thoroughness, while checking frequency remained unchanged. Based on the results, we suggest new head lice management guidelines for health authorities.

Wet combing for the eradication of head lice

Manual removal (using conditioner and comb or a wet comb) can be used in the treatment of head lice. Head lice infestation (Pediculosis humanus capitis) is a common problem. It is diagnosed by visualising the lice. As half of people infested with head lice will not scratch, all people in contact with a person affected with head lice should be manually checked for infestations. Wet combing is easily and safely performed at home, but persistence is needed. This article describes the process of head lice removal using a wet comb. It has NHMRC Level 2 evidence of efficacy and no serious adverse effects have been reported.

Efficacy of the treatments used for the control of Caligus rogercresseyi infecting Atlantic salmon, Salmo salar L., in a new fish-farming location in Region XI, Chile

Caligus rogercresseyi is the most important parasite affecting Atlantic salmon and rainbow trout farming in sea water in Chile. After the outbreaks of the infectious salmon anaemia recorded in Region X from 2007, the salmon industry has expanded southwards to Region XI, where 60% of Atlantic salmon in Chile is now produced. In parallel with the relocation of salmon production, sea lice infestation has also spread to Region XI, and today C. rogercresseyi is the most serious threat to the salmon-farming industry in this region. The results obtained through a year of monitoring between September 2007 and August 2008 on a farm located in the 'Las Guaitecas Archipelago' in Region XI (44°S; 74°W) showed that treatments with emamectin benzoate and deltamethrin did not give the expected control of Caligus. Failures of the treatments were associated with the loss of sensitivity recorded for C. rogercresseyi to emamectin benzoate in Region X. In addition, a major influence was the lack of delousing coordination measures with the neighbouring farms sharing the same area in that period.