What parents in Australia know and do about head lice

INTRODUCTION

Although parents in developed market economies regard head lice infections (pediculosis) as a significant problem, health departments generally rate pediculosis as a low priority health issue, encouraging parents to manage and control it. But how well equipped and willing are parents to manage the infections? There do not appear to be any studies in the literature addressing these issues. This article presents the results of a survey conducted in Australia that aimed to answer these questions.

METHODS

A cross-sectional survey of parents of primary school aged children in Victoria (Vic) and north Queensland (NQ) was conducted using a self-administered questionnaire. The study investigated the knowledge, attitudes and practices of parents regarding head lice infections.

RESULTS

Only 7.1% of 1338 who completed the questionnaire answered all 10 knowledge questions correctly and more than one-third failed to answer half correctly. There was a weak negative correlation between parents' knowledge and the prevalence of active pediculosis in the school. Almost all parents wanted the responsibility for treating pediculosis and more than three-quarters saw it as a health concern. A higher proportion of parents in NQ used preventative strategies (67% vs 41%). Most parents spent less than AU$50 per year on treatments. Alarmingly, however, the proportion of children missing school as a result of pediculosis was 24.4% and 30.3% in Vic and NQ, respectively. In Vic there was a positive correlation (r = 0.39) between missing school in the previous 12 months and prevalence of pediculosis in the school.

CONCLUSIONS

This appears to be the most comprehensive study of parental knowledge, beliefs, and practices regarding head lice infections. Although parents wanted responsibility for the management of pediculosis, deficiencies in their knowledge indicate they may be inadequately equipped to do so. Given the high proportion of children in both states who have missed school as a result of head lice, it is recommended that health departments in Australia should work to ensure that consistent and accurate messages about pediculosis are disseminated, and that relevant legislation is amended to prevent children being excluded from school.

[Lice, fleas and other beasts]

Bedbugs, lice, fleas and mites are blood-sucking ectoparasites whose bites cause allergic skin reactions. Diagnosis of bites is based on the morphology of the skin eruptions and the pattern of involved skin areas. Confirmation of the diagnosis often requires detection of the causal parasite. The main reservoir for ectoparasites (e.g., bedbugs, fleas, lice and scabies mites) are humans, but animals are also known to harbor ectoparasites (e.g., certain fleas and mites). Fleas, body lice and certain mite larvae in the tropics can transmit infectious diseases, but bedbugs, headlice, pubic lice and scabies mites cannot. Therapy is primarily directed against itching and bacterial superinfections. Pediculosis and scabies are additionally treated with t0pical insecticides. In order to kill freshly hatched larvae, topical treatmentmust be repeated after one week. In the case of pediculosis, people who have come into contact with symptomatic individuals also need to be treated, whereas with scabies, all contact persons must undergo treatment in order toprevent further transmission. Topicalinsecticides, in combination with anti-itch treatment, is usually sufficientto immediately relieve the symptoms and promote permanent healing of the skin lesions.

International guidelines for effective control of head louse infestations

Head louse infestations are increasing or remain high in most countries. In order to reduce the proportion of children infested with head lice and slow down the emergence of strains of lice resistant to pediculicides, more active involvement of health and educational authorities, as well as parents, is of paramount importance. We suggest that health authorities should introduce more efficient methods for evaluating pediculicides and more stringent regulations for adoption of new anti-louse products. Baseline studies are also essential for new pediculicides. Children should be properly screened, especially in problematic areas. The media should be used to educate parents on louse control. Health providers need to be aware of which anti-louse remedies are demonstrably effective and be capable of assisting families with louse control. Academic institutions should conduct baseline and efficacy studies on pediculicides and other treatment modalities, as well as research on the biology and epidemiology of lice. Parents should regularly inspect their children, treat as necessary, and try to avoid creating stigmas and emotional problems for the child. The pharmaceutical industry should aim to introduce pediculicides based on new chemical compounds, especially natural products. Companies should develop effective and safe repellents and nit removal remedies. General recommendations are given on how to diagnose and treat louse infestations with chemicals, biological agents, and louse combs and how to protect children from infestations. The no-nit policy, based on the persistence of empty egg cases, is not justified and does more harm than good; therefore, we recommend that it be immediately halted.

A comparison of botanical and synthetic substances commonly used to prevent head lice (Pediculus humanus var. capitis) infestation

BACKGROUND

Pediculosis, caused by head lice (Pediculidae: Pediculus humanus var. capitis), is experiencing a global resurgence, with the prevalence in primary schools averaging as high as 40% in some areas regardless of socioeconomic factors. Control efforts using chemical treatments are becoming increasingly ineffective, with insecticide resistance recorded in several countries. Prevention using repellents and oils would be useful if they limited transmission. Many commercially available substances reputedly have effective repellent qualities, but remain untested.

METHODS

This study tested the preventative efficacy of N,N-diethyl-3-methylbenzamide (DEET) against several commercially available botanicals to clarify their value as transmission inhibitors, irritants, repellents, and antifeedants.

RESULTS

The transfer of head lice to treated hairs was limited by the slippery nature of the oils rather than their repellent qualities. Irritancy was not important because lice proceeded despite being highly irritated, except in the case of coconut. Tea tree and peppermint caused the most repellence, and tea tree and lavender prevented some blood feeding on treated skin. Comparatively, tea tree oil was most efficacious, with DEET ranking equal second overall with coconut, peppermint, and a botanical mixture.

CONCLUSIONS

Neither DEET nor any of the botanicals tested showed sufficient preventative efficacy to be endorsed.

Lice infestation and lice control remedies in the Ukraine

A permanent decrease was seen in the prevalence of lice infestation among population of the Ukraine from 1990-2004. The prevalence of lice infestation among children under 14 years of age was 6-27 times more than that in adults. The highest figures were among children 7-14 years old. During all of the observation period there were changing tendencies relative to the groups. The greatest number of cases of infection with lice were noted in the months when the control inspections of children in education institutions were performed.

Control of head lice: past, present and future

Pediculosis capitis is common among children. Rapid and accurate detection is an underlying principle of effective control and the use of a fine-tooth comb in wet, conditioned hair is most sensitive. However, none of the available treatments are fully effective. Of the current pediculicides available over the counter in the UK, those based on malathion are more effective than pyrethroids. Carbaryl is likely to be the most effective insecticide but is only available on prescription. Wet combing with conditioner has proven to be as effective as some over-the-counter lotions for unsupervised use in the home. There are several promising candidates for new insecticidal actives that are likely to be highly effective for a new generation of pediculicides, as well as a variety of unconventional novel treatments.

[The frequency of intestinal parasites and head lice among students of the Akşemsettin Primary School for Deaf Students]

Parasitic infections especially affect those children in critical phases of growing and development. They can lead to malnutrition, malabsorption, mental and social adaptation problems, and critical illnesses that hinder productivity. This is an important health problem in Turkey, and intestinal parasites are quite frequently found in boarding school and care centers for children. The aim of this study was to discover and treat the parasitological agents found in the students of the Primary School for Deaf Students. A total of 117 fecal specimens and material from the perianal region (using the cellophane tape method) were collected from deaf students and examined during 2003-2004 school season. Also the students were scanned for adult head lice and their eggs. As a result, 53 (45.3%) children with intestinal parasites and 6 (5.1%) with head lice were detected in the study. The patients were treated and informed about means of protection. The same children were examined again after six months: Only 24 (20.5%) children had intestinal parasites and 2 (1.7%), head lice. Thus, the decrease in parasitic infections was found to be significant (qui-square test in dependent samples P < 0.05). Therefore it was concluded that the schools should be scanned for intestinal parasites and head lice, and both treatment and training in the subject should be given the necessary importance.

[Treatment of Linognathus vituli and Bovicola bovis infestations of calves with cypermethrin]

This study has been conducted to determine the efficacy level of cypermethrin on the 14 calves that were naturally infested by Linognathus vituli and Bovicola bovis. A 10% solution of cypermethrin was diluted to 0.1% and applied to infested animals twice. All L. vituli were found to be dead after the fourth day of the first application and the second day of the second application. After the first day of application, all of the B. bovis were found dead at the end of each treatment. This study confirmed the protective efficacy of cypermethrin against L. vituli and B. bovis showing that infestation is prevented for a period of about 24-35 days following administration of cypermethrin at this dose.

Control of the cattle louse Bovicola bovis with the fungal pathogen Metarhizium anisopliae

The effects of the entomopathogenic fungus Metarhizium anisopliae (Metschnikoff) were evaluated against the common louse parasite of cattle, Bovicola bovis (Piaget) (Trichodectidae: Ischnocera). Two different concentrations and formulations of conidial suspensions were applied to contained populations of adult female lice. In vitro, lice immersed in suspensions of M. anisopliae formulated in 0.03% Tween 80 developed infections; at the highest concentration (1x10(8)conidia ml-1) a mean of 71% (+/-11.52%, 95% C.I.) of lice became infected. Lice exposed to the Tween 80 only in vitro, showed high levels of survival and zero infection. In vivo, fungal conidia were applied to louse populations contained in 7 cm diameter circular arenas glued to the backs of Holstein cattle, maintained in controlled climate conditions. Conidia were formulated in either Tween 80 or silicone oil. The treatment with M. anisopliae resulted in high levels of infection and there was no overall difference between the two formulations in the number of infections observed. At the highest concentration (1x10(8)conidia ml-1) a mean of 73% (+/-15.57%, 95% C.I.) lice became infected. It is concluded that the strategic seasonal use of a fungal pathogen on cattle, applied in early winter, may be of value in suppressing the winter increase in abundance, preventing the population increasing to clinically significant levels.

Ectoparasites of Cattle and Small Ruminants

Arthropod ectoparasites are the most ubiquitous life forms affecting ruminant animals and commonly affect the daily activity and health status of ruminants. This article describes the phenology of several important ectoparasites of livestock and small ruminants, and delineates some general control and management strategies for protecting domestic ruminants.

Therapeutic and persistent efficacy of spinosad applied as a pour-on or a topical spray against natural infestations of chewing and sucking lice on cattle

Studies were conducted in Wisconsin and Illinois, USA, to assess and compare the therapeutic and persistent efficacy of spinosad when applied as either a pour-on or topical spray and compared with cyfluthrin pour-on and coumaphos topical spray for controlling natural infestations of chewing (Bovicola bovis) and sucking (Linognathus vituli, Solenopotes capillatus and Haematopinus eurysternus) lice on cattle. Thirty-five animals at each trial site were blocked according to pre-treatment lice counts and randomly allocated to one of five treatment groups: single treatments of spinosad (25 g/L), diluted with water to 0.04% active ingredient and applied as a whole-body topical spray; spinosad (25 g/L) applied as a neat pour-on at 2 mg/kg body weight; Co-Ral Emulsifiable Livestock Insecticide (5.8% coumaphos), diluted to 0.03% active ingredient and applied as a whole-body topical spray; CyLence Pour-on Insecticide (1% cyfluthrin), applied as a neat pour-on at the manufacturer's recommended use rate for lice; and untreated control. Both spinosad treatments and cyfluthrin provided > or =96% control of B. bovis for up to 7 weeks, whereas the efficacy of coumaphos dropped to <90% after week 5 at one site. Spinosad spray had the best therapeutic and residual control of all treatments against L. vituli, > or =98% for at least 5 weeks at both sites, compared with 3 weeks for coumaphos at one site. Spinosad and coumaphos sprays provided 100% control of S. capillatus for at least 8 weeks compared with > or =97% control for spinosad and cyfluthrin pour-on treatments over the same interval. While H. eurysternus burden was low and limited to one study site, all four treatments provided 100% control for at least 6 weeks. These studies showed that topically applied spinosad provided a high degree of therapeutic and residual control against both sucking and chewing lice.

Fumigant and repellent properties of essential oils and component compounds against permethrin-resistant Pediculus humanus capitis (Anoplura: Pediculidae) from Argentina

The repeated use of permethrin and other insecticides for the control of head lice, Pediculus humanus capitis De Geer (Anoplura: Pediculidae), during past decades has resulted in the development of marked levels of resistance. Thus, new alternative insecticides are needed for the control of head lice. We studied the fumigant and repellent properties of essential oils from 16 native and exotic plants in Argentina, and 21 chemical components against permethrin-resistant head lice from Argentina. With a direct vapor-exposure bioassay, the most effective oil was from the native Myrcianthes cisplatensis Cambess (Myrtaceae) with a time to 50% knockdown (KT50) of 1.3 min, followed by exotic species, Eucalyptus cinerea F.V. Muell., Eucalyptus viminalis Labill., and Eucalyptus saligna Smith. with KT50 values of 12.0, 14.9, and 17.4 min, respectively. The most effective components were 1,8-cineole and anisole, with KT50 values of 11.1 and 12.7 min, respectively. Regression analysis of KT50 values and vapor pressures and water-partition coefficients for the essential oil components revealed that the most effective fumigants were among the more volatile components. Repellency assays indicated that the essential oil from Mentha pulegium L. and its benzyl alcohol component were the most effective repellents, having repellency indices of 75.5 and 57.8%, respectively. Thus, some Argentinean plants contain essential oils and components that function as fumigants or as repellents and thereby show potential for development of new control products for head lice.

[Questionnaire survey of different groups of the population for pediculosis]

A sociological study of the level of hygienic knowledge in different groups of the population (pupils of general educational schools, students of secondary specialized and higher educational establishments, teachers of general educational schools, parents of the pupils of these schools, employees, workers, and unemployed adults), performed, by using the questionnaires for individual survey has revealed the inadequate awareness of the medical significance of lice, the conditions for the appearance and maintenance of pediculosis, the basic rules of the prevention and treatment ofpediculosis among young persons and the fair level of adults' knowledge on the above problems, which should be used in organizing and doing sanitary educational work among different groups of the population in order to enhance its effectiveness.

World Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.) guidelines for evaluating the efficacy of ectoparasiticides against biting lice, sucking lice and sheep keds on ruminants

These guidelines have been prepared to assist in the design, implementation and interpretation of studies for the assessment of the efficacy of ectoparasiticides against biting and sucking lice and sheep keds on ruminants. Information is provided on the selection of animals, dose determination, dose confirmation and field studies, record keeping and result interpretation. These guidelines advocate the use of pen facilities for dose determination and dose confirmation studies for defining therapeutic and persistent efficacy. These guidelines are also intended to assist investigators on how to conduct specific experiments, to provide specific information for registration authorities involved in the decision making process, to assist in the approval and registration of new ectoparasiticides, and to facilitate the world-wide adoption of standard procedures.

Efficacy of Machine Laundering to Eradicate Head Lice: Recommendations to Decontaminate Washable Clothes, Linens, and Fomites

The efficacy of machine laundering to eradicate head lice should be determined. Viable lice and nits were machine laundered using 3 washing programs (with water temperatures of 40 degrees C, 50 degrees C, and 60 degrees C), with and without detergent, and the results were compared with results for control lice and nits. A drying program was also used. Either washing done with a water temperature of at least 50 degrees C or drying is necessary to kill head lice and nits.

Impact of the duration of control of cattle lice with eprinomectin on leather quality

The relationship between lice infestation in calves during their first winter and damage to the leather produced was investigated in a trial involving 500 calves, 100 of which were treated with a pour-on endectocide during the first winter. All the calves received routine lice treatment in the second winter and were reared to slaughter weight. The hides were removed at the abattoir, tanned, inspected for lice-related damage, and graded according to their suitability for the production of high quality leather. The untreated group developed natural infestations of the chewing louse (Bovicola bovis) during the first winter but none was observed in the second winter. Hides from cattle infested with lice in their first winter had higher levels of lice damage than hides from those treated with eprinomectin, at both the chrome-tanned and dried dyed-crust stages of leather production.

Prevalence of pediculosis capitis and determination of risk factors in primary-school children in Kerman

This descriptive, analytical study was carried out in 2003 to determine the prevalence of pediculosis capitis and some risk factors among primary-school pupils in Kerman. We selected 1200 pupils (53% girls) from 50 primary schools by multistage, systematic random sampling. Their hair was examined for head louse infestation: 45 (3.8%) were infected with lice, 43 (95.5%) girls and 2 (4.5%) boys. The highest rate of infestation was in 9-year-olds. There was a significant relationship between head louse infestation and sex (P < 0.0001), age (P < 0.05), parents' education (P < 0.0001), father's job (P < 0.01), family size (P < 0.01), length of hair (P < 0.0001) and having separate bathing facilities in the house (P < 0.0001).

Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom

OBJECTIVE

To compare the effectiveness of the Bug Buster kit with a single treatment of over the counter pediculicides for eliminating head lice.

DESIGN

Single blind, multicentre, randomised, comparative clinical study.

SETTING

Four counties in England and one county in Scotland.

PARTICIPANTS

133 young people aged 2-15 years with head louse infestation: 56 were allocated to the Bug Buster kit and 70 to pediculicide treatment.

INTERVENTIONS

Home use of proprietary pediculicides (organophosphate or pyrethroid) or the Bug Buster kit.

MAIN OUTCOME MEASURE

Presence of head lice 2-4 days after end of treatment: day 5 for the pediculicides and day 15 for the Bug Buster kit.

RESULTS

The cure rate using the Bug Buster kit was significantly greater than that for the pediculicides (57% v 13%; relative risk 4.4, 95% confidence interval 2.3 to 8.5). Number needed to treat for the Bug Buster kit compared with the pediculicides was 2.26.

CONCLUSION

The Bug Buster kit was the most effective over the counter treatment for head louse infestation in the community when compared with pediculicides.