HEALTH PROTECTION AGENCY NORTH WEST
The prevention, identification and management of head lice infection in the
(Review Date: October 2010)
There are other national guidelines available
This is recommended for use in the North West.
Membership of the Group includes: Evdokia Dardamissis, Steve Gee, Ed Kaczmarski, Jeanette Kempster
Lorraine Lighton, Ken Mutton, Ruth Philp, Jeff Scott and Tracey Wood, on behalf of the North West Policy Group
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INDEX Page1 Introduction 3
2 Aims and Objectives 4
3 Information about Head Lice 4
4 Prevention and Detection 6
5 Parasiticidal Treatments 6
6 Treatment 8
7 Contact Tracing 10
8 Evaluating Treatment 11
9 Wet Combing (Bug Busting) 12
10 Alternative Remedies 12
11 Responsibilities of Parent/Carers 13
12 Role of School Nurse/School Health Visitor 14
13 Role of Health Visitor 15
14 Role of School 15
15 Role of General Practitioner 16
16 Role of Community Pharmacist 17
17 References/Bibliography 19
Appendix 1 21
Appendix 2 (Notes and Guidance for primary
Appendix 3 (Notes and Guidance for Head
Lice Detection 25
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This guidance has been developed to promote a co-ordinated approach to the control and effective management of head lice infection, and, to assist health professionals in reducing the anxiety that often surrounds this infection. Commitment between health professionals, schools, nurseries, parents/carers and the general public is of paramount importance in tackling the problem of head lice infection.
Head lice infection is a community problem and is not, as many people think,
restricted to children. Adults may become long-term carriers due to a de-sensitisation to head lice over time, and adults are also likely to have fewer lice so this can make an infection more difficult to identify. Consequently adults may be an ongoing source of head lice infection, and unknowingly infect children during prolonged head to head contact.
No data is routinely collected about the number of people with head lice
infection, but a number of local surveys in recent years have suggested no significant increase in the number of head lice infections. Nowadays most head lice infections are of only a few lice, whereas before effective treatments with insecticidal lotions became available, much heavier infections were seen.
The true prevalence of infection is probably lower than the public and
professional perception. Many supposed cases of head lice infection are not true infections, and are due to a variety of causes including psychogenic itch upon hearing of other cases (known as louse phobia), other causes of an itchy scalp (dermatitis etc.), and extinct infections with persistent itch or nits (empty egg cases). Consequently it is important that head lice infection is not diagnosed unless a living, moving louse is seen in the hair.
The main symptom from head lice is itching. Head lice infection does not constitute a serious public health problem. Head lice infection does generate considerable anxiety and distress among parents and within schools, which is often due to myths and to unjustified stigma. Inappropriate blame may be attached to schools or to individuals. Health professionals have an important role in reducing the anxiety surrounding head lice infection, and in changing false perceptions about the infection.
The problem must be tackled in the community. This requires the
involvement of all families within the community. Head lice will always be present in the community and in schools, and will probably never be eradicated. A sensible informed approach that reflects current evidence and national best practice will help to control the infection and, effectively manage the problem when it does occur.
Control of head lice is based on early detection of infection among
cases and close contacts, and effective treatment with an insecticidal lotion or liquid.
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e effective support concerning the detection and treatment of head lice.
lice infection, and to provide consistent information and advice to parents.
. Aims And Objectives
As with any other health-related problem detecting head lice is the responsibility of parents, although parents need to be provided with clear information and receiv
Health professionals need to adopt a co-ordinated approach to
The aims and objectives of this guidance are:
reducing the incidence and prevalence of head lice in the ommunity.
the detection, prevention, and treatment of ead lice to health professionals.
de aware of the importance of eir responsibilities in controlling head lice.
. Information about head lice
To assist in
To create accountability by identifying and clarifying the roles of the p
To promote a co-ordinated approach for the control of head lice infection by outlining the current information onh
To assist health professionals in providing factual and consistent information to members of the public whereby they are math
.1 What to look for 3
6 legged insect which is between the size of a pin-head nd a sesame seed.
is greyish brown in colour.
he adult louse lives for about one month.
n the scalp and cannot jump or fly and has difficulty walking on flat surfaces.
.2 Facts about head lice
A head louse is a tiny
Each leg ends with a claw, which grasps the hair, enabling swift movement close to the scalp. It does not walk o
blood, approximately 5 times per day. The biting is not painful
males in the ratio 4:1 and lay 6-8 eggs daily (not all eggs are viable).
it does ing off the hair is not
It feeds only on human
Females out number
Eggs are firmly glued to strands of hair close to the scalp, preferring temperature of 30 - 31C which is favourable to incubation. Therefore, not matter whether hair is short or long. Shav an
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The incubation period is 7 - 8 days and within 10 days of hatching, the louse
acceptable treatment for head lice infection.
Live eggs are skin coloured and very difficult to see.
becomes a mature adult and is able to mate.
Nits are empty egg cases. After a louse has hatched the empty egg case becomes white. If you have nits it does not always mean that you have a current head lice infection. Nits remain stuck to the hair and grow out as the
You only have head lice if you can find a living, moving louse (not a
hair grows, at a rate of about 1 cm per month.
nit). 3.3 Information on head lice infection
Lice will live on hair that is dirty or clean, short or long, adult or child. .
High standards of personal hygiene do not
Short hair may make it easier for them to get from one head to another
necessarily prevent head
thod of transmission (person to person spread) is walking from
head to head. The heads must touch for a duration of at least one minute or
through a population. It is much less infectious than some other common
Head lice infection is not highly contagious, taking time to
infections in children, such as chickenpox and impetigo.
Lice cann hop, jump, fly or be drowned. Should a louse be found on a
weak to hang on to the hair. Adult lice can live apart from humans for only a short period of time, therefore it is rare for infection to be caught in
Lice do not keep still and move very rapidly when disturbed
Most head louse infections are asymptomatic, but about one third of
For a first infection, it can take up to 8 weeks for itching to start, with
Sometimes the appearance of a rash at the back of the neck is the first indication of infection.
hat,collar, pillow, chair back etc it will either be a dead louse or a damaged louse that is too
e.g. when undertaking detection combing.
cases experience itching. The itching is due to sensitisation.
subsequent infections itching will occur sooner.
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4. Prevention and Detection
G ood hair care will not prevent head lice infection but it may help to identify head lice at an early stage and so help control the spread of the infection
When hair is washed, damaged lice will float on the surface of the water. Also, the presence of lice may be indicated by finding a black powderp