Assessment of the Prevalence of Head Lice Infestation and Parents' Attitudes Towards Its Management: A School-based Epidemiological Study in Istanbul, Türkiye

OBJECTIVE: Head lice infestation (HLI), caused by Pediculus humanus capitis, is an important public health problem worldwide, especially in primary school children. The aim of this study is to investigate HLI level, related factors, and families' knowledge levels and attitudes about HLI in two primary schools in a relatively low socio-economic region in Istanbul. METHODS: A questionnaire on HLI was developed initially and delivered to all children and parents in the school. A total of 340 primary school students, aged between 6-12, were enrolled in the study after the consent of their parents. Their hair were examined for HLI with special combs at their schools, and free anti-lice shampoos were given to parents of positive children. A total of 951 completed questionnaires were received and evaluated with chi-square test using the SPSS® 17.0 program, and the differences of p<0.05 were considered significant. RESULTS: Number of boys in the study was slightly higher than the girls (176 vs. 164). HLI was detected in 32 (9.4%) of 340 children; seven had live adult lice on their hair while 25 had only the nits. HLI was obviously more common in girls (16.4%), compared to boys (2.8%). Analysis of 951 questionnaires revealed a statistically significant difference between HLI and infrequent bathing (p<0.05). The differences between HLI and the education levels of parents, income, the number of siblings and in contact with animals were not found to be significant (p>0.05). CONCLUSION: HLI is still a common health problem, especially in girls in primary schools. Parents are aware of the relationship between the hygiene and prevention against HLI, but low socio-economic resources seem to be important determinants. Regular combing and training activities in primary schools, in coordination with the local authorities and parents are no doubt useful in reducing the incidence of HLI among the children.

DOES PREENING BEHAVIOR REDUCE THE PREVALENCE OF AVIAN FEATHER LICE (PHTHIRAPTERA: ISCHNOCERA)?

Animals defend themselves against parasites in many ways. Defenses, such as physiological immune responses, are capable of clearing some infections. External parasites that do not feed on blood, however, are not controlled by the physiological immune system. Instead, ectoparasites like feather-feeding lice (Phthiraptera: Ischnocera) are primarily controlled by behavioral defenses such as preening. Here we test the hypothesis that birds able to preen are capable of clearing infestations of feather lice. We experimentally manipulated preening ability in a captive population of rock pigeons (Columba livia) that were infested with identical numbers of feather lice (Columbicola columbae or Campanulotes compar or both). We then monitored the feather louse infestations for 42 wk. Birds with impaired preening remained infested throughout the experiment; in contrast, the prevalence of lice on birds that could preen normally decreased by 50%. These data indicate that it is indeed possible for birds to clear themselves of feather lice, and perhaps other ectoparasites, by preening. We note, however, that captive birds spend more time preening than wild birds, and that they are less likely to be reinfested than wild birds. Thus, additional studies are necessary to determine under what circumstances wild birds can clear themselves of ectoparasites by preening.

Effect of Education and Regular Examination on the Prevalence of Head Louse Infestations in Adana

Objective: The current study provides training to parents and teachers about pediculosis in schools in three villages in Adana to measure their knowledge level by conducting surveys and to determine the prevalence of pediculosis in these foci. Methods: Pre- and post-questionnaires including 30 questions about pediculosis were handed to parents and teachers. The answers were analyzed with the Pearson correlation analysis. Overall, 418 school pupils s were examined for lice. The results of the head louse control were analyzed by the chi-square test and t-test. Results: We observed that the level of awareness increased in parents and teachers. Additionally, the gender of both teachers and parents was determined as the most important factor in increasing this awareness. Because of interventions for the control of head and lice, the prevalence of pediculosis decreased from 15.22% to 1.71%. Conclusion: It is very important that parents and teachers are aware of the health problems related to pediculosis, while regular combing of school children may be essential for the control of this common infestation.

Prevalence of Pediculus humanus capitis and associated risk factors among elementary school-aged girls in Paveh, West Iran.

INTRODUCTION: Head lice infestation is considered as a common dermatological health problem worldwide. This study was aimed to determine the pediculosis prevalence and associated risk factors among school-aged girls enrolled in public elementary schools of the city of Pave, Kermanshah province, West Iran. The study findings will provide an evidence base, upon which a multifaceted intervention against pediculosis can be formulated and implemented. METHODOLOGY: In this cross-sectional study, 361 elementary school-aged girls were recruited from October to December 2018 at the beginning of the school year. Diagnosis was made by visual inspection. A structured questionnaire was utilized to collect data about past history of infestation and associated factors. RESULTS: A total of 26/361 (7.2%; 95% CI: 4.50-9.90) suffered from pediculosis. Pediculosis was associated with the history of previous infestation (OR: 6.12; 95% CI: 2.68-13.99; p < 0.001), low frequency of bathing (OR: 7.90; 95% CI: 3.36-18.60; p < 0.001), low frequency of hair combing (OR: 3.64; 95% CI: 1.56-8.50; p = 0.004), screening of the student's hair by parents at home (OR: 0.39; 95% CI: 0.19-0.78; p < 0.001) and with the absence of screening by the school health officer in the schools (OR: 7.16; 95% CI: 2.91-17.61; p < 0.001). CONCLUSIONS: Synchronized efforts to enhance public knowledge, periodic examination of school-aged children for pediculosis, and proper treatment of infested patients are needed to control the disease in the Iranian elementary schools. The applied strategies in low and middle income countries is suggested to be focused mainly on low cost family-based and school-based initiatives for maximum effectiveness.

Decreases in scabies and lice cases among the pediatric and adult populations during COVID-19.

The influence of the nationwide lockdown orders during the COVID-19 pandemic on the transmission of scabies and lice remains unknown. We conducted a cross-sectional study utilizing UNC patient registry i2b2 to investigate monthly cases and prescriptions for scabies and lice in adult and pediatric patients in North Carolina. There were significant decreases in the cases and prescriptions for scabies and lice in the pediatric and adult populations. These results provide early insights on how COVID-19 pandemic lockdown orders affected the prevalence of these two conditions and suggest that physical distancing measures reduce transmission of these parasitic conditions.

Impact of a health educational interventional program on reducing the head lice infestation among pupils in an elementary school of a sub-tropical region: a quasi-experimental study.

BACKGROUND: Pediculosis is an important social challenge that can be caused by human head louse, Pediculus humanus capitis. This infestation is cosmopolitan, especially in countries with low hygiene and sanitation. Regular health education classes for students and their parents are required to reduce this infestation in schools and families. This study aimed to evaluate the impact of a health education intervention program on reducing head lice among pupils of an elementary school. METHODS: In a quasi-experimental study, a total of 880 elementary school girls were screened for pediculosis in (2017-2018). The prevalence of pediculosis follow-up continued monthly until the end of the school year after a two months educational intervention course. Visual inspection was applied for initial diagnosis of infection. The suspected cases were confirmed by wood lamp and potassium hydroxide (KOH) microscopic examination. Also eight questions about diagnostic, epidemiology, treatment and prevention were answered in a questionnaire by 50 volunteer parents before and after the training intervention course, to evaluate their general knowledge and measure the effectiveness of learning. All data were statistically analyzed using SPSS software (version 20.0, SPSS, Inc., Chicago, IL, USA). McNemar's test was also applied to investigate the prevalence rate before and after the intervention. A p -value of less than 0.05 was considered as statistically significant. RESULTS: At the beginning of study, pre-intervention prevalence of pediculosis among pupils was 8.4% (49/594). The mean age in all pupils was 9.86 ± 1.83 years old and the most infestation was shown in fourth-grade students with 10 years old. Analysis of statistics demonstrated a significant difference between having infestation and the number of members in the families. Post-intervention phase led to a decreased prevalence of pediculosis in pupils to 3% (8/594) (p-value < 0.05). Based on statistical analysis of questions before and after the training in the questionnaire, a significant increase of parental knowledge was observed on the prevention program of pediculosis (p-value < 0.001). CONCLUSION: The prevalence of pediculosis was significantly reduced following the educational interventions in the school. The applied interventions may be implemented in other residual centers to get rid of this important infestation.

Pediculosis knowledge among schoolchildren parents and its relation with head lice prevalence.

Pediculosis mainly affects school-age children worldwide. The aim of this study was to identify and analyze the knowledge of the parents and guardians of children in elementary schools in Niterói, Brazil, regarding pediculosis. Questionnaires were applied to 237 guardians of children at five 1-5 grade municipal schools. The responses were analyzed and correlated with positivity to louse infestation, detected by scalp aspiration. 73.8% of the respondents reported that their child had already been infested with lice. 32.9% presented correct responses about transmission. Incorrect responses were attributed to the air/wind, blood type and the fact that lice jump and fly. 40.1% of the respondents erroneously correlated control over the parasitosis with hygiene. A majority of the participants (58.6%) responded that pediculosis is harmful to health, while a small proportion (20.7%) considered it to be a disease. The prevalence of pediculosis was 19.8% among schoolchildren. Female sex, pruritus on the head and indifference regarding infestation were shown to be risk factors for pediculosis. The lack of perception of pediculosis as a disease may lead to naturalization of this parasitosis. Incorrect responses may add difficulty to implementation of preventive and curative approaches, which highlights the importance of dissemination of correct information about 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.

Explaining the Determinants of Pediculosis Control and Prevention: A Qualitative Study in Southern Iran.

In many regions of the world, human head lice infestations caused by Pediculus capitis are a major health concern among school-aged children. This study was carried out to explain variables influencing pediculosis prevention and control from the perspective of parents and teachers of female elementary school pupils, as well as healthcare practitioners in Bandar Abbas, Iran. Participants in this qualitative study included 23 participants, including parents and teachers of primary school girls, as well as healthcare practitioners. Purposive sampling was employed and sustained until data saturation was reached. Data was acquired through in-depth interviews and evaluated using content analysis in the form of constant comparison. To assess the quality of the outcomes, Lincoln and Guba's criteria were used. The data were extracted into 2 primary categories, including challenges and facilitators to controlling pediculosis, each with several subcategories as follows: 1) economic-political aspects; 2) family factors; 3) social-cultural elements; 4) personal and mental issues; 5) geographical position of the investigated region; 6) school and education factors; and 7) factors related to medications and therapy. There were 2 types of facilitators: 1) informative factors and 2) social-cultural variables. According to the findings, pediculosis prevention, control, and treatment necessitate multifaceted and multi-level intervention. Some solutions must be addressed at the personal-psychological, familial, political-economic, geographical, and informational levels, as well as school-related concerns, social stigma elimination, and evaluation of cultural components of the issue at the social level.

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.

Head lice were also affected by COVID-19: a decrease on Pediculosis infestation during lockdown in Buenos Aires.

Pediculosis is a worldwide disease affecting school-aged children produced by the presence of the head louse, Pediculus humanus capitis De Geer, an obligate ectoparasite on the human scalp feeding exclusively on blood. Transmission occurs primarily through direct physical head-to-head contact. In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic. COVID-19 is caused by SARS-CoV-2, a variant of the coronavirus. Therefore, on March 18, 2020, the Argentinean government established mandatory isolation for an indefinite period. This obligatory isolation interrupted regular classes avoiding direct contact between children, thus affecting the dispersal route of individuals and the evolution of head louse populations. In this study, we evaluated through an online survey how confinement affected the prevalence of lice during lockdown compared to the situation prior to confinement. The survey allowed to discriminate the different control strategies, the number of treatments, and the amount of insects recorded by parents. Data of 1118 children obtained from 627 surveys were analyzed. As the main result, it was observed that prevalence of lice decreased significantly from before (69.6%) to during (43.9%) COVID-19 lockdown. Moreover, head lice infestation was more effectively controlled in households with up to 2 children in comparison to households with 3 or more children. This is the first study that analyzed the prevalence of head lice during COVID-19 pandemic. In addition, this work demonstrated the impact of social distance in the population dynamics of head lice and how it could affect the control strategies in the future.

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.].

Use of afoxolaner for the treatment of lice (Goniodes pavonis) in different genera (Chrysolophus spp, Lophura spp, Phasianus spp, and Syrmaticus spp) and species of pheasants and West Mexican Chachalacas (Ortalis poliocephala).

Lice are ectoparasites capable of affecting birds, and can result in direct and indirect damage to their host. Afoxolaner is an isoxazoline that has been shown to be effective against these ectoparasites without known adverse effects. The objective of this research was to evaluate the effect of afoxolaner on lice in pheasants and plain chachalacas. A total of 29 pheasants of different genera and species (Chrysolophus pictus, C. amherstiae, Lophura swinghoii, L. nycthemera, Phasianus colchicus, and Syrmaticus reevesii) and 18 West Mexican Chachalacas (Ortalis poliocephala) naturally infested with Goniodes pavonis were used. The birds were allocated to one of two groups: group 1 treated with 2.50 mg/kg of afoxolaner, and group 2 given no treatment. Ectoparasites were collected using the adhesive tape technique and identified. Afoxolaner was administered later as a single dose to group 1, and the clinical assessment to detect ectoparasites was repeated 28 days post-treatment. On day 28 post-treatment, group 1 was found to be negative for the presence of lice. The body weights were compared at the beginning and end of the clinical assessment in both groups and a significant difference in weight of treated birds was found. The mean body weight decreased by 0.017 g in control group, whereas it increased by 0.016 g in treated group. Oral administration of afoxolaner is an effective option for the treatment of Goniodes pavonis infestations in zoo birds.

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.

Impact of infectious exposures and outbreaks on nurse and infection preventionist workload.

BACKGROUND: Staff nurse and infection preventionist (IP) workload increases in response to exposures and outbreaks. Understanding the time burden associated with responding to specific pathogens may improve resource allocation. The purpose of this study was to evaluate workload increases reported by nurses and IPs in response to common exposures and outbreaks. METHODS: Surveys were distributed to nurses in a New York hospital network and to IPs who attended the 2018 Association for Professionals in Infection Control and Epidemiology annual conference or to IPs who were members of local Association for Professionals in Infection Control and Epidemiology chapters. Respondents were asked to rate their daily workload increase and to rank their most time-consuming activities in response to exposure and outbreak scenarios. RESULTS: A total of 150 nurses and 228 IPs responded. Among the nurses, >60-minute workload increases were reported for Clostridium difficile (76%), lice or scabies (46%), and influenza (45%). Among the IPs, >60-minute increases were reported for mumps or measles (66%), tuberculosis (64%), and C difficile (50%). Among the nurses, isolation precautions, patient and family education, and staffing changes were the most frequently reported time-consuming activities. Among the IPs, chart review, exposure list compiling, and preventive measures for exposures were the most frequently reported time-consuming activities. CONCLUSIONS: Organisms that are easier to treat and more difficult to spread, such as scabies or lice, can contribute substantially to nursing workload. Notably, three-quarters of the nurses and one-half of the IPs reported that C difficile adds >1 hour to their daily workload.

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.

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.

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.