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10/22/15
1
HEAD LICE
Shujuan (Lucy) Li University of Arizona
How long can adult head lice survive when they are off the host?
A. No more than a minute B. More than 6 months C. No more than 48 hours,
usually much less
No#more#than#a#minute#
More#than#6#months#
No#more#than#48#hours,#usu...
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A. Yes B. No C. Not sure
Can head lice be transmi>ed from pets to humans?
Yes No
Not'sure
0% 0%0%
A. Yes B. No C. Not sure
Can head lice transmit infecAous disease?
Yes No
Not'sure
0% 0%0%
• Blood feeding ectoparasites associated with the scalp.
• Head lice can infest people of all ages.
• More commonly found in school age students and girls.
• Transfer can occur due to Ø Physical head-‐to-‐ head contact;
Ø Slumber parAes!
• Itching and sleeplessness. Scratching leads to secondary bacterial skin infecQon.
• US cost: One billion dollars annually. • Head lice: embarrassment; unnecessary days lost from school; pesQcide exposure; millions of dollars spent on remedies.
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1. Head lice are resistant to OTC pediculicides (Yoon 2015)
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100% Resistant 50-‐90% Resistant 1-‐49% Resistant Data not analyzed States not tested
1. In Arizona head lice are highly resistant to OTC pediculicides (Yoon 2015)
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1. Head Lice Facts
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• Pediculosis humanus capi0s
• Size of a sesame seed (2-‐3 mm long)
• Tan in color • Crawl rapidly across the scalp
• They do not and can not fly or jump
Female
Male
• Require human blood to grow, develop and lay eggs (nits).
• Cannot survive away from the scalp, and die within 2 days off the host .
• Cannot live within rugs, carpets, or school buses.
• Not a sign of uncleanliness.
• Head lice do not transmit disease causing pathogens.
• They are not found on animals or household pets.
• They are not transmi^ed from pets to humans. • Typically only 1% of students are affected,
20-‐40% is a misdiagnosis. • Schools are not good transiQon zones.
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Life Stages of Head Lice • Lice have three different life stages: egg (or nit); nymph; adult.
• Eggs that have died or hatched, remain firmly a^ached to the hair; but will never again produce another louse.
Lice eggs have curved walls and will pop when
squeezed
Dead eggs have collapsed sides
Hatched eggs have a flat top in profile
• Head lice can be found anywhere in the hair.
• Nits are easier to spot, at the nape of the neck or behind the ears, within ½ inch (or 1 cm) of the scalp.
• Eggs more than ½ inch (or 1 cm) away from the scalp are nearly always hatched and do not, by themselves indicate an acQve infestaQon.
• Lice feed by injecQng small amounts of saliva and taking Qny amounts of blood from the scalp every few hours. This saliva may create an itchy irritaQon.
• With a first case of head lice, itching may not develop for 4 to 6 weeks, because it takes Qme to develop a sensiQvity to louse saliva.
• If not treated, life cycle may repeat itself every 3 weeks.
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Transmission (Spread) of Head Lice • Head-‐to-‐head contact with an infested person and sleepovers are the BIG transfer risks.
• Only LIVING LICE can transfer from one person to another.
• The transmission from hats, combs, pillows, etc. is possible, but unlikely.
• Nits cannot be passed onto someone else.
• According to CDC, most transmissions occurs in the home environment (friends, sleep-‐overs, camps, etc.).
• Head lice are very communicable (spreads easily) in situaQons where people are in close contact with other people.
• Head lice are most common amongst school age children or young children a^ending child care services (1 in 10 children).
• Periodic inspecQons for early detecQon of adult lice are far easier than dealing with advanced infestaQons.
• During the early fall months (August to November) children should be inspected weekly by parents.
• Preven0on (home screening) is the best way to reduce the spread of lice infesta0on.
Checking for Head Lice • To confirm a case of head lice, you need to find live adult lice.
• Good lighQng is important when you are checking.
• Head lice move fast and are hard to see. They are usually found very close to the scalp, at the bo^om of the neck and behind the ears.
• To look for nits, part hair in small secQons, moving from one side of the head to the other. Check carefully, looking close to the scalp.
• Look for nits near the scalp. Eggs more than ½ inch away from the scalp are nearly always hatched or dead and do not, by themselves, indicate an acQve infestaQon or a need for treatment.
• If adults or lots of nits (more than 5 nits occurring in the area of a dime) are found, this is a call to acQon.
• Also check everyone in the household, including adults.
• While screening children, if you think you may have found nits or lice contact your team leader or school health nurse for addiQonal support.
• ConfidenQality! • Ensure sensiQvity surrounding the child’s feelings. Anyone can get lice and no one is immune (children or adults). Lack of cleanliness does not cause head lice (sQgma).
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Found lice?
Treatment is recommended only for individuals found with live lice
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• Finding nits alone is not a reason to treat, but nit removal is advisable.
• Never iniQate a head lice treatment unless there is a clear diagnosis with living adult or immature lice present.
• Use products or methods that are effecQve, and most importantly, safe.
Pediculicides • Chemical treatments
• Natural products – mayonnaise, petroleum jelly,
vinegar, olive oil, tea tree oil, or aromatherapy
• Alcohol – benzyl alcohol
• Never use gasoline or spray insecQcides to treat lice.
Treatment of Head Lice Alcohol based lice shampoo
• Resistant lice may need prescripQon treatment.
• Very effecQve prescripQon opQons include Ulesfia® (benzyl alcohol), and NatrobaTM (spinosad and benzyl alcohol).
• Benzyl alcohol (Ulesfia, 5% soluQon): non-‐neurotoxic, highly effecQve loQon.
• No resistance reported.
• Kills the live lice. • Not ovicidal (doesn’t kill eggs). • 2 treatments are necessary. Ø The second treatment is required to kill lice that
hatch a^er the first treatment has occurred. Typically the second treatment follows 7 -‐ 10 days a^er the first, depending on the product used.
• Consult your doctors before using it. • Follow label direcQons carefully.
Lice shampoos
• Contain insecQcides (Pyrethrins, Permethrin, Lindane, Malathion, etc).
• Widespread resistance to the most commonly used over-‐the-‐counter lice shampoos.
• Be cauQous when applying treatments. • DirecQons must be followed exactly. • Never apply treatments to children in the bath or
shower. • A second treatment may be
required in 10 to 14 days.
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• SuscepQble lice should die within 10 to 30 min aoer treatment.
• Resistance may be occurring. Switch to a different kind of product that does not rely on the same acQve ingredient.
AlternaAve treatments
• In addiQon to pediculicide treatments, people also commonly use approaches with other products such as petroleum jelly, mayonnaise, margarine, herbal oils, enzyme-‐based products and olive oil.
• No conclusive evidence that these treatments are effecQve, any Qme you wash the hair and scalp, you kill some head lice in the process.
• Kill lice mechanically: Hair drying and brushing. • Standard hair condiAoner is as effecAve.
• Suffocants – petroleum jelly, mayoonaise, olive oil, or Cetaphil Gentle Skin Cleanser
• Smother lice by prevenQng air exchange.
• They are massaged on the enQre surface of the hair and scalp, the head is then covered with a shower cap, and leo on for several hours.
• Diligent shampooing is necessary to remove the residue.
• Followed by nit combing.
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• DesiccaQon (heat treatment)
AirAllé™
Manual Removal
1. None of the pediculicides are 100% ovicidal. 2. Manual removal of nits (especially the ones within 1
cm of the scalp) aoer treatment with any product is recommended.
3. Special, fine-‐toothed “nit combs” are needed (LiceMeisterTM combs).
4. Nit removal aids are designed to loosen the a^achment of the nit to the hair shao.
• Combing and brushing wet hair damages lice. Hair drying injures adults and nymphs.
• Combing is criQcal to control head lice.
• Comb daily unQl no live lice are discovered (2 weeks).
• Recheck in 2-‐3 weeks aoer you think they are gone.
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Home disinfecAon
1. Wash items in hot soapy water and dry in a hot dryer for 15 minutes.
2. Launder and dry on a high heat, 130 degree F. 3. Store items in plasQc bags for 2 weeks. 4. Vacuum the surfaces where
heads may have rested (sofas, helmets, car seats, etc).
Check regularly
1. Daily head checks and nit removal unQl infestaQon is gone.
2. Followed by weekly head checks to detect re-‐infestaQon.
3. ConQnue weekly head checks of the whole family.
Managing Head Lice in Schools
• When parents of elementary school aged children are surveyed as to what childhood health issues concern them most, head lice usually rank higher than much more serious condiQons.
Managing Head Lice in Schools • School district policies on head lice vary throughout Arizona.
• Majority of students involved.
• 1% of students are usually infested.
• Some have “no nit policies”.
Why Ban the No-‐Nit Policy? – Not supported by research. – Not recommended by experts.
– Misdiagnosis of nits is common.
– Encourage use of potenQally dangerous pesQcides.
– Causes children to miss school needlessly.
– Costs school large
School Management Plan • Screening for nits is not an accurate way of predicQng which children will become infested.
• Children having 5 nits or more within 1 cm2 of the scalp are significantly more likely to develop an infestaQon, sQll only 1/3 of these higher-‐risk children convert.
• Approximately 18% of kids with nits alone, will convert to an acQve infestaQon.
• Generally, around 30% of school children with nits will have concomitant lice.
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Should classroom or school-‐wide screening be discouraged? • Providing informaQon to families on the diagnosis, treatment, and prevenQon of head lice is a good plan.
• Parents and the school nurses should be encouraged to check their children’s heads for lice if the child is symptomaQc.
• Parents need to be educated. This is not a hygiene issue.
• Children need to be educated about sharing hats, helmets, etc.
Classroom Management
1. No need to spray the classroom. Regular cleaning agents would work to control head lice.
2. Lice do not infest classrooms, carpets and chairs.
3. Space desks and chairs apart so that children are not siung shoulder-‐to-‐ shoulder.
4. Have children hang coats and hats separately.
5. Space children apart when standing or walking in lines.
6. During head lice outbreaks, minimize close contact games and sports, such as wrestling.
7. During outbreaks, minimize use of shared headgear and clothing. Always hand vacuum such headgear between users.
8. Provide head louse prevenQon educaQon to children, such as not sharing combs, brushes, hats, headbands, or clothing.
Please Remember • Only living lice transfer from person to person. • Head lice don’t fly or jump. • They don’t transmit infecQous disease. • Head lice can’t survive more than 48 hours away from the host.
• Head lice can’t live within rugs, carpets, or school buses.
• No need to exclude infested kids from school. • Work with parents! RouQne screening, early detecQon, accurate ID and thorough removal of lice and nits.
Which of the following statements are correct? (check all that apply)
A. Head lice cannot survive more than 48 hours away from the host
B. Head lice do not transmit disease causing pathogens
C. They are not transmi^ed from pets to humans
D. They are not found on pets
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References • h^p://cals.arizona.edu/apmc/docs/Head-‐Lice-‐vF.pdf • h^p://cals.arizona.edu/apmc/public-‐health-‐IPM#lice • Centers for Disease Control (2001). Fact sheet: treaQng head lice. Retrieved April 21, 2005
from: h^p://www.cdc.gov/ncidod/dpd/parasites/headlice/factsht_head_lice_treaQng.htm • The American Academy of Pediatrics and the NaQonal AssociaQon of School Nurses
(www.nasn.org/po siQons/nixree.htm) • NaQonal AssociaQon of school nurses (2004). PosiQon statement: pediculosis in the school
community. Retrieved October 20, 2004 from: h^p://www.nasn.org/posiQons/2004pediculosis.htm
• NaQonal Pediculosis AssociaQon [n.d]. The no nit policy: A healthy standard for children and their families. Retrieved April 21, 2005 from: h^p://www.headlice.org/downloads/nonitpolicy.htm
Acknowledgements
