Exclusion of ill children from child-care centers in Israel

The aim of the study was to examine criteria for ill children in child-care centers. A questionnaire on practices of exclusion/return of children according to specific signs and symptoms was mailed to the directors of care centers in central Israel. Thirty-six of the 60 questionnaires (60%) were returned by mail and the reminded were completed in personal visits to the CCCs achieving a response rate of 100%. About half (51.7%) used "common sense" and "personal feelings" to exclude children and to allow their return, and 29 (48.3%) used the guidelines of the Ministries of Education and Health or other authorities. The percentage of centers excluding children by signs/symptoms was as follows: high fever (>38 degrees C), 100%; low-grade fever, 76.7%; asthma exacerbation, 80.0%; heavy cough, 75.0%; eye discharge or conjunctivitis, 83.3%; diarrhea and vomiting more than twice per day, 100%; rash, 72.3%; otalgia, 46.7%; and infected skin lesion, 66.7%. Only four centers excluded children with head lice. Most centers required a physician's note on return of a child after high fever (76.7%), eye discharge or conjunctivitis (48.3%), and from 75 to 80%, respectively, for frequent vomiting and bloody or mucinous diarrhea. The results show that exclusion practices among child-care centers (CCCs) vary widely, suggesting the need for the establishment of a uniform exclusion and return policy in Israel, with distribution of clear, up-to-date guidelines on the prevention and control of communicable diseases to all day-care centers. In a simple way, this study identified attitudes concerning the exclusion/return of sick children in CCCs and was useful for the discussion of the related policy with CCCs responsible and national health and educational authorities.

Repellency of citronella for head lice: double-blind randomized trial of efficacy and safety

BACKGROUND

Head lice move easily from head to head. The lack of safe, effective repellents leads to reinfestation.

OBJECTIVES

To test the efficacy of a slow-release citronella formulation as a repellent against the head louse.

METHODS

During 4 months in 2003 a randomized, placebo-controlled double-blind clinical study was conducted in four elementary schools; 103 children were treated with the test formulation and 95 with a placebo.

RESULTS

A significant difference was observed during the second examination 2 months later, when 12.0% of the children treated with the test repellent and 50.5% of those treated with placebo were infested with lice. A significant difference was also observed at the third examination 2 months later, when 12.4% of the children treated with the test repellent and 33.7% treated with placebo were infested. Overall, there were significant differences between those treated with the repellent and those treated with the placebo (15.4% and 55.1% respectively, P < 0.0001). Side effects were observed in 4.4% of children who disliked the odor of the formulation, and an additional 1.0% who complained of a slight itching and burning sensation.

CONCLUSIONS

Use of an effective repellent could significantly lower the incidence of reinfestations, which would lower expenditure on lice control, including pediculicides, combs and products for nit removal, and the time spent on treatment and removal of the nits.

The prevalence of lice on sheep and control practices in South Australia

OBJECTIVE

To assess the prevalence of infestations of lice in sheep flocks and to survey control practices for lice in South Australia

DESIGN

A total of 201 managers of sheep flocks, 75 chosen randomly from the high rainfall zone (HR), 76 from the cereal sheep zone (CS) and 50 from the pastoral zone (PA), were surveyed by telephone interview.

PROCEDURE

Interviews were conducted between May 19 and May 25, 1999, according to a set questionnaire. Information was collected on presence of lice at last shearing, control practices for lice, factors important for gaining good effect from chemical treatments, sources of information on control practices and property details. Survey results were analysed by agricultural region.

RESULTS

The apparent state prevalence of flocks infested with lice was 21%, with 13% infested in the HR, 21% in the CS and 25% in the PA. Ninety one percent of managers claimed to take precautions to prevent the introduction of lice and 91% routinely checked their flocks for lice. Seventy eight percent treated their sheep for lice annually and 85% had treated within the last 12 months. Of those treating in the last year, 69% had used a backline application, 16% had used a shower dip and 17% had used plunge dipping. Only 4% of producers used a long wool treatment. Synthetic pyrethroid (SP) based products were used by 50% of producers who used backline treatments in the preceding 12 months, compared to 42% and 8% for insect growth regulator and organophosphorous (OP) based products, respectively. Only 34% of managers identified SP-based products as having potential resistance problems. Of those producers who used shower or plunge dips in the last 12 months, 75% used an OP based product. Rural newspapers and magazines were by far the most commonly noted source of information for the control of lice on sheep.

American Academy of Pediatrics guidelines for the prevention and treatment of head lice infestation

The American Academy of Pediatrics (AAP) established diagnosis and treatment guidelines for pediculosis in 2002. Ideally, diagnosis should be based on the observation of a live louse. The presence of nits is also used by many people to positively diagnose an infestation, although a nit located farther from the scalp than 1 cm is unlikely to be viable. Other material on the scalp may be mistaken for nits, leading to misdiagnosis. Because lice are not associated with serious medical problems, the primary consideration of the AAP regarding treatment is the safety of pediculicides and other products used to treat head lice. From a pediatrician's perspective, no significant risk is acceptable. Over-the-counter (OTC) pyrethroid products (pyrethrin and permethrin) are commonly used by parents to treat their children and are generally considered safe for most people. Pyrethroids are not completely ovicidal, however, so a second application is required. Misuse and overuse of these products have contributed to the development of resistance. Prescription products include permethrin 5%, lindane, and malathion 0.5%. Resistance to permethrin 5% and lindane has been documented. In addition, lindane is associated with serious adverse events and should be used with caution only in a select population. Malathion 0.5% is about 98% ovicidal, and no resistance has been reported. Malathion is highly effective, but AAP guidelines note that the product is flammable and serious adverse effects can occur with ingestion. Very few cases of ingestion have occurred, and no reported cases of flammability, but children being treated with malathion should be carefully supervised, and this pediculicide should not be used unless treatment with OTC products has failed. AAP guidelines also state that no-nit policies in schools are detrimental, causing lost time in the classroom, inappropriate allocation of the school nurse's time for lice screening, and a response to infestations that is out of proportion to their medical significance. Accurate diagnosis, safe treatment options, and a common-sense approach to managing infestations in schools are recommended.

Treating and managing head lice: the school nurse perspective

School nurses often are the first healthcare professionals to diagnose lice infestations in children. Although lice do not transmit disease, many schools send children home if they detect live head lice. It is the position of the National Association of School Nurses that children who have been treated for lice infestations should not be excluded from school because of the presence of residual nits. The primary goals of the school nurse in controlling infestations are to identify children with head lice and to break the cycle of reinfestation. Routine screening of children for head lice is often part of infestation management policies in school districts. A thorough screening of a child's head can take several minutes. If a school's policy is to screen all students, the total time for examination adds significantly to the school nurse's caseload. The use of the school nurse's time for universal screening must be measured against other responsibilities, including health problem management, medication management, health assessments, and vision and hearing screening. Once a child is identified as having lice, the school nurse can play a key role in working with the child's family to eradicate the infestation. Education about treatment options and environmental cleaning are topics the nurse can address with the family. The school nurse also can function as a case manager who coordinates various aspects of treatment for an affected child. Because infestations can be very upsetting to students and to their families, the nurse can provide support and reassurance to the family as the child is treated. Participation of school nurses in developing appropriate and consistent policies and procedures within the school district is vital to the overall management of infestations. Their efforts to control and reduce infestations are necessary for the overall health of the school population.

Effective treatment and control of biting lice, Felicola subrostratus (Nitzsch in Burmeister, 1838), on cats using fipronil formulations

The efficacy of 0.25% fipronil spray (Frontline Spray, Merial), 10% fipronil spot-on (Frontline Spot-on for Cats, Merial) and 10% fipronil/12% (S)-methoprene (Frontline Plus for Cats, Merial) against the biting louse Felicola subrostratus on cats was assessed and confirmed under laboratory conditions. A field study evaluated the efficacy of a single topical application of Frontline Spray, and spot-on against the parasite on cats. In the laboratory studies, animals were allocated based on pre-treatment louse counts to the treatment groups: (1) untreated control and (2) 10% fipronil spot-on in the exploratory study or (1) untreated control, (2) 0.25% fipronil spray, at 6 ml/kg; (3) 10% fipronil spot-on as per label and (4) 10% fipronil/12% (S)-methoprene as per label in the confirmation study. Cats in treatment groups 2-4 were treated twice topically on Days 0 and 28. No live F. subrostratus were found on cats treated with fipronil formulations at any post-treatment examination. The difference from controls was significant (P < 0.01) for each product at each examination. Based on whole body counts at Day 42, the efficacy of each product was determined to be 100%. In the field study, cats were allocated in strict order of presentation. Cats were randomly allocated to one of the three treatment groups: (1) propoxur collar (Bolfo, Bayer); (2) 0.25% fipronil spray, at 6 ml/kg and (3) 10% fipronil spot-on as per label. Cats were treated once topically on Day 0. Louse counts of cats treated with fipronil formulations were not different than those of cats receiving the propoxur collar. The efficacy was determined to be > 98% on Day 2 and 100% on Days 28 and 42 in all treatment groups. The results of these studies demonstrate that fipronil in topical formulations is effective for treatment and control of biting lice (F. subrostratus) infestations on cats.

Persistent activity of moxidectin long-acting injectable formulations against natural and experimentally enhanced populations of lice infesting cattle

A study was conducted under a common protocol in Wisconsin and Wyoming, USA, to evaluate therapeutic and persistent efficacy of two long-acting injectable formulations of moxidectin against lice populations infesting cattle. At each site, 30 beef calves were blocked into groups of three based on naturally acquired Linognathus vituli populations, then randomly assigned to treatments within blocks. Treatments, injected subcutaneously into the proximal third of the ear on Day 0, included saline, a long-acting oil-based formulation containing 10% moxidectin given at the rate of 1 mg moxidectin/kg body weight (M10/1.0), or a long-acting oil-based formulation containing 15% moxidectin given at the rate of 0.75 mg moxidectin/kg b.w. (M15/0.75). Species of sucking and chewing lice were quantified on nine predilection sites before treatment, then 28, 63, 98, 133 and 168 days after treatment. During intervals between lice counts after Day 28, study animals from the three treatment groups were commingled for 32 days with two lice-free sentinels plus four to six seeder calves with infestations of both sucking and chewing lice. Following each 32-day commingling interval, seeder and sentinel animals were removed, and principal animals were sorted into pens by treatment. Lice were quantified on sentinel animals on the day of removal, and lice were quantified on principal study animals 3 days after removal of sentinel and seeders. Moxidectin was generally not efficacious against Bovicola bovis in the injectable formulations tested, whereas Haematopinus eurysternus infestations were inadequate to judge product effectiveness. Based on geometric means, both M15/0.75 and M10/1.0 provided statistically significant therapeutic efficacy against existing infestations of L. vituli and Solenopotes capillatus (100% efficacy on Day 28), and provided persistent protection against reinfestation with L. vituli and S. capillatus (efficacy >97%) for at least 133 days following treatment.

Scabies and pediculosis

Although scabies and pediculosis are difficult and widespread problems, there are many effective treatments available. Dermatologists play a major role in educating the public in prevention and diagnosis. Although patients are more aware and well informed of the infections because of the Internet and other sources, practitioners are often the most important source of information and treatment in helping to eradicate this worldwide problem.

Human lice and their control

Current research on human louse biology has focused on the long-standing debate about speciation of head and body lice but using new tools of DNA and enzyme analysis. These studies have indicated that head and body lice from the same geographical zone may be more closely allied than insects inhabiting the same ecological niche in other regions. However, the majority of research over the past decade has involved clinical aspects including transmission, treatment, and the appearance and identification of resistant strains within populations of lice. Despite advances, there is a need for a better understanding of louse biology, as existing therapies fail and lice remain potential vectors of disease for millions of people.

Managing head lice in an era of increasing resistance to insecticides

Head lice are present in all age groups, however, the peak age for infestation is 7-8 years and the incidence varies throughout the year with higher incidence during the winter. Different insecticides have been used over the past 60 years to manage this condition. There is now strong evidence of insecticide resistance established in many countries to such an extent that some of these chemicals have become obsolete. Resistance to some pediculicides can vary from country to country and region to region within a country. The lack of a local monitoring system of resistance patterns means that parents and pupils are hampered in making an informed decision regarding how to treat head lice. One should no longer assume that treatment failure is due to poor treatment compliance or re-infestation. Clear treatment guidelines drawn up by healthcare professionals with an interest in head lice and taking into account regional/national resistance patterns should be implemented. These guidelines should combine chemical and non-chemical approaches to treatment and be coordinated and regularly reviewed by local public health departments. Drug companies should be made to provide up-to-date efficacy of their products.

The prevalence of pediculosis capitis in schoolchildren in Mersin, Turkey

BACKGROUND

Pediculosis capitis is an endemic parasitosis affecting many countries of the world. The aim of this study was to investigate the incidence of head lice infestation in Mersin, Turkey.

METHODS

A total of 5318 elementary schoolchildren, aged 8-16 years, were examined for the presence of Pediculus capitis. If any evidence of head lice was detected, such as live or dead eggs, or nits, the child was considered to be infected. The following details were recorded for each child: age, sex, family size, monthly income, number of siblings, parents' education, presence or absence of social security of the family, pet (cat or dog) ownership, and frequency of hair washing (per week). The chi-squared test and logistic regression analysis were performed to analyze the results.

RESULTS

Pediculosis capitis was detected in 360 (6.8%) children. The prevalence of infestation was significantly higher in girls (13.3%) than in boys (1.1%) (chi2 = 313.2, d.f. = 1, P = 0.000). Children aged 8-9 years exhibited a significantly lower prevalence rate than those aged 10-11 years and those aged 12 years and above. The following variables were found to be statistically significantly related to pediculosis capitis: sex, age, father's education level, and pet ownership (cat or dog).

CONCLUSIONS

Our results show that the prevalence of pediculosis capitis is not very high in Mersin, Turkey, and is observed in all schools regardless of the socio-economic and personal hygiene status of the children.

Relationship between lice infestation and leather damage in cattle

The relationship between lice infestation and leather damage was investigated in a trial involving 61 cattle, half of which were treated with ectoparasiticides for lice control either in their first or second year. Hides from the lice-free and lousy calves were removed manually at an abattoir, tanned and inspected for lice-related damage, commercially referred to as light spot and/or fleck. In both the first- and second-year animals there was a significant difference between the hides of the lousy and lice-free animals, confirming that the chewing louse Bovicola bovis is a cause of winter light spot. There was also a difference between the two groups in the levels of scratch damage. After the infested animals had been treated with fenvalerate and eprinomectin to kill all the lice, the damage to the hides had not been fully reversed 13 weeks later.

Head lice on pillows, and strategies to make a small risk even less

BACKGROUND

Due to a lack of evidence, controversy exists about the role of bedding in the transmission of head lice.

AIMS

To determine the proportion of the head lice population found on pillowcases of people with head lice, and to test strategies available to householders to kill head lice on pillowcases.

METHODS

To assess the incidence of head lice on pillowcases, people with active pediculosis had their head lice collected and counted and the pillowcase they had used the night before examined for head lice. To test strategies to kill head lice on pillowcases, live head lice were experimentally placed in miniature pillowcases, and the cases were subjected to a hot wash, a cold wash, hot dryer, and hanging out to dry on an outdoor clothes line.

RESULTS

Forty-eight people and their pillowcases were recruited from Townsville, Qld, Australia (dry tropics). One thousand, eight hundred and forty-five lice were collected from their heads to give an average and median intensity of infection of 38.4 and 21 lice, respectively. Two of the 48 pillowcases contained live lice, one nymph on each, 2 h and 9 h after the pillowcases had been removed from the bed. Another pillowcase contained a dehydrated nymph. The incidence of live lice on pillowcases was 4.2% per night and the proportion of the head louse population on the pillowcases was 0.11%. Heat (hot wash and hot clothes dryer) killed head lice experimentally placed in pillowcases. Cold wash and hanging pillowcases out to dry did not kill head lice.

CONCLUSIONS

Head lice transfer to pillowcases at night, but the incidence is low. Pillowcases pose a risk for re-infection with head lice, but the risk is low, and changing the pillowcase is a reasonably cost-efficient strategy to minimize this risk. Lice on pillowcases can be killed by heating the pillowcase by immersion in water at > 60 degrees C, by a hot wash, or by 15 min in a hot clothes dryer.