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Indirect Transmission of Head Lice via Inanimate Objects

Authors:
  • Daniel K. Inouye Asia-Pacific Center for Security Studies
  • Tropical Health Solutions Pty Ltd

Abstract

Whether people can become infected by head lice transferring from inanimate objects is a topic of controversy. This paper reviews the evidence available from experimental studies in controlled laboratory experiments and data from field studies. The weight of evidence appears to be against transmission from inanimate objects being significant, and the promotion of inanimate objects that play an epidemiologically important role in head lice dispersal is not supported by evidence. We conclude that the control of head lice should focus on the head, not on the environment. However, additional studies are needed to quantify transmission risk via inanimate objects and the probability that head lice eggs survive and hatch off-host.
72 The Open Dermatology Journal, 2010, 4, 72-76
1874-3722/10 2010 Bentham Open
Open Access
Indirect Transmission of Head Lice via Inanimate Objects
Deon V. Canyon
*
and Rick Speare
Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville QLD 4811, Australia
Abstract: Whether people can become infected by head lice transferring from inanimate objects is a topic of controversy.
This paper reviews the evidence available from experimental studies in controlled laboratory experiments and data from
field studies. The weight of evidence appears to be against transmission from inanimate objects being significant, and the
promotion of inanimate objects that play an epidemiologically important role in head lice dispersal is not supported by
evidence. We conclude that the control of head lice should focus on the head, not on the environment. However,
additional studies are needed to quantify transmission risk via inanimate objects and the probability that head lice eggs
survive and hatch off-host.
Keywords: Pediculosis, pediculus, transmission, fomites, inanimate objects.
INTRODUCTION
An assessment of transmission risks associated with the
spread of pediculosis is important because the prevalence of
Pediculus capitis, the head louse, has increased throughout
the 1900s [1]. In terms of an infectious disease, when
eradication is difficult or impossible, the next best option is
control. This means interrupting the transmission cycle to
limit the spread of disease agents [2].
Pediculosis is best managed by the individual or the carer
who must act quickly to address infestation and
transmission. Decreased pediculicide susceptibility and
reinfestation make this difficult. Since insecticide
susceptibility may vary substantially at a neighborhood level
[3], it is best dealt with by adjusting treatment regimes.
Reinfestation may involve direct transmission from other
people or indirect transmission from inanimate objects.
Direct reinfestation, involving head-to-head transmission, is
highly subject to social factors and is thus difficult to
resolve. Indirect transmission via inanimate objects would be
a more resolvable issue.
This paper focuses on head lice transmission via
inanimate objects. We review the body of knowledge in
support of and against this transmission mode. It should thus
be of practical use to policy developers and any person
dealing with a recurrent pediculosis.
SUPPORT
The transmission of head lice by way of inanimate
objects is not a clear-cut topic and there is difficulty in
estimating the importance of direct (person-to-person) vs
indirect (inanimate object-to-head) transmission. Since 10-
20% of the children in most primary schools in most
countries have head lice [1], a recommendation to change
head lice policy in schools and management practices in the
home can have significant economic implications. Several
head lice scholars have devoted their efforts to determine the
*Address correspondence to this author at the Anton Breinl Centre for
Public Health and Tropical Medicine, James Cook University, Townsville
QLD 4811, Australia; Tel: 0431907814; E-mail: deoncanyon@gmail.com
mechanisms involved in P. capitis transmission so that
control programs do not squander limited resources [4]. The
irony in this is that most head lice research is unfunded or
suffers limited funding because head lice do not vector
diseases and are simply considered to be an undesirable pest.
CONTROVERSY
Head lice mythology is strong in developed market
economies and there is an abundance of unconfirmed
suppositions that have inspired studies from different
countries [5-11]. Some of these studies are field-based and
employ epidemiological methods while others are
laboratory-based and involve experimentation under
controlled conditions. Other opinion-based publications
provide little in the way of evidence and yet they put forward
energetic arguments in support of strongly held views. These
scholars and many others speculate as to the principal mode
of transmission with varying conclusions because there is
still a lack of data, and evidence-based results from field and
laboratory sources are often contradictory. While
experimental researchers demonstrate that inanimate objects
are potentially important, the body of epidemiological
evidence concludes that direct transmission from head-to-
head is the primary mechanism.
For many years, the most active proponents of head lice
transmission via inanimate objects have been the
dermatologists Craig N Burkhart and Craig G Burkhart from
the USA, while the most active proponents of direct head
lice transmission have been Rick Speare, Petra Buettner and
Deon Canyon from James Cook University in Australia.
Both sides recognize that transmission from head-to-head
and from inanimate objects occurs, but they differ in their
belief in the extent to which each takes place. The former are
advocates of anecdotal and experimental evidence, but they
do not acknowledge most of the epidemiological and
experimental evidence base produced by the latter and term
it ‘dogma’ [2]. The latter recognize the former and are
careful to include their perspectives and evidence in
publications [12-15].
Indirect Transmission of Head Lice The Open Dermatology Journal, 2010, Volume 4 73
This article now endeavours to make a careful
assessment of evidence at hand because this is not a simple
academic argument, but one which affects people with
pediculosis and their families. The controversy manifests
itself in significant practical and economic outcomes for the
infected population. The advocates of inanimate objects state
that “louse control measures should ... include ... laundering
of everything within the infested individuals’ bed or
quarantining of such material for 10 days, thorough
vacuuming of floors, carpets, upholstery, with a standard
vacuum cleaner” [2]. Advocates of direct, head-to-head
transmission maintain that these measures are unnecessary,
overly burdensome and pose an economic barrier to the
effective management of head lice in all socio-economic
contexts. Clearly the first approach, that of controlling lice
on inanimate objects, is extremely time-consuming and
costly while the latter approach, that of focusing control
efforts on the head, is not.
EVIDENCE IN SUPPORT OF INANIMATE OBJECTS
Different modes of indirect head lice transmission were
proposed in 2000 by Burkhart and Burkhart who state that
inanimate objects can include [4]:
Dislodged lice on inanimate objects moving onto a
new host.
Dislodged hairs carrying lice to a new host.
Wind blowing lice from one location to a new host.
Static electricity from combing which expels lice into
the air and onto a new host.
In a recent review of fomite transmission by Burkhart
and Burkhart (2007), the only evidence-based results
provided in support of fomite transmission originated from
one experimental laboratory study [16]. This study
investigated fomite transmission in a number of ways.
Firstly, a vacuum cleaner was passed over lice positioned on
combs, towels or fabric to see if they could be dislodged.
This does not approximate any realistic situation so the
results are not very relevant to a realistic discussion.
Secondly, lice were placed on 15 strands of hair and were
subjected to a hair drier for a full minute. This also fails to
correlate with reality because people never blast a hair dryer
onto one spot on the scalp for a full minute. Thirdly, the lice
on the 15 strands of hair were combed. This is nothing new
since we know that combing is effective [15]. Fourthly, the
lice on the 15 strands of hair were stirred in water and were
gently towelled which resulted in transfer to the towel. This
experiment also does not replicate reality where lice have
access to a scalp and will run down a hair shaft onto the
scalp to escape from external interference. Fifthly, a band of
infested hair was placed onto a person’s wrist and covered
with dark cloth. After five minutes, 20% of lice had
transferred onto the cloth. Had this final experiment been
performed using a person’s head, it would have been
relevant. Any head lice researcher knows that lice will never
remain on an arm and will always seek to move upwards
until they reach the head. Thus this entire published study,
which forms the ‘evidence-base’ of the transmission via
inanimate objects theory is little more than a flawed
collection of ill-devised and counter-intuitive experiments.
EVIDENCE AGAINST INANIMATE OBJECTS – SUR-
VIVAL OFF-HOST
There are other factors to consider that relate to head-to-
inanimate object transmission and inanimate object-to-head
transmission. One factor of key importance is that
transmission of this nature is subject to the capacity of a
louse to survive off-host long enough to come into contact
with a new host and still have the strength to climb on board.
While body lice may live up to 10 days off a host at 15 °C, 5
days at 24 °C and 3 days at 30 °C [17], this is not true for
head lice which quickly perish from starvation when
removed from a host [6, 18]. Head lice only survive 9-11
hours at 25-37 °C in low humidity and 10-14 hours in higher
humidity, but can survive up to 44 hours at 15 °C in higher
humidity [6, 18]. Most head lice perish 40 hours post-blood
meal if they do not get another blood meal [19]. Thus the
advice from Burkhart and Burkhart to quarantine the living
quarters of infected people for 10 days [2] is not based on
current evidence.
How these survival data impact on transmission rates
from one substrate to another, whether living or inanimate,
have not yet been determined by experiment although death
after 2 days will stop any theoretical transmission far short of
a 10-day quarantine period. In addition, fully active lice
usually do not leave the head without any reason. Lice
leaving the head may be close to dying, and it can be
assumed that a high fraction of lice found off-head are not
capable of infesting a person or surviving for very long. Data
are required to confirm this assertion.
Whether or not head lice survival rates on inanimate
objects are low or not, it is possible that gravid females could
lay eggs that could later hatch and infest other hosts.
Questions arising from this are: Do head lice off the host lay
eggs on inanimate objects in nature? If yes, what are the
survival and hatch rates of these eggs? In vivo-reared lice
eggs take 8.4 days (range 6-11) to hatch with a hatch rate of
76% when they are exposed to a human host at night and are
placed in a 20°C rearing chamber during the day. However,
when eggs are exposed to a human for 8 hours each night
they take 15.2 days to hatch and only 58-59% hatch [16, 20].
While there are no available data for survival rates of eggs in
unfavorable off-host circumstances, one may assume that the
egg hatch rates off-host in nature is low due to dehydration.
However, additional experimental evidence is needed to
clarify this point.
EVIDENCE AGAINST INANIMATE OBJECTS –
FIELD STUDIES
There are very few well-researched, field studies on the
transmission of head lice via inanimate objects. One such
study, an epidemiological investigation on New York
schoolchildren, examined the sharing of lockers and wall
hooks for winter clothing and headwear as a risk factor for
pediculosis [5]. An association was found, however a
replication of this study in Pennsylvania schools found no
association [5].
Head lice researchers from the Anton Breinl Centre for
Public Health and Tropical Medicine (ABC) at James Cook
University in Townsville (Australia) conducted a series of
specifically designed field studies to investigate the truth
74 The Open Dermatology Journal, 2010, Volume 4 Canyon and Speare
behind commonly mentioned inanimate objects. Their major,
evidence-based, transmission-related findings related to three
studies on the presence of lice on school hats, school floors
and pillow slips of infested school children.
Articles of Clothing as Inanimate Objects
Hats have always been considered high-risk items. The
general public and even many head lice researchers are of
the opinion that hats and other apparel worn by infested
people harbour lice. For instance, it has been stated that
“Fomite transmission is common with Pediculosis capitis.
The source of transfer is often headwear, shared hats,
brushes, combs, earphones, bedding, upholstered furniture,
and rugs” [4]. The validity of this anecdotal assertion was
tested in a study in which over 1000 hats in four Australian
schools were investigated for lice [21]. No head lice were
found in all these hats and over 5500 head lice were captured
from the heads of surveyed students who were wearing the
very same hats. Thus, the results were 100% conclusive and
found that school hats do not sustain head lice transmission.
In another unpublished study conducted by the authors in a
different primary school, a further 1000 hats were examined
for lice and a single louse was identified on a hat belonging
to a student whose hair had just been treated one hour earlier.
It was assumed that this was a louse not killed by the
treatment and was exhibiting the flee response. These
empirical data demonstrate that the odds of head lice
transmission occurring via transmission by the hats of
children with pediculosis is sufficiently low to be considered
improbable and inconsequential.
In conclusion, the transmission of head lice via inanimate
objects including articles of personal clothing is in fact a
well-established myth. When considering why it is so
entrenched, one can only speculate that it originated from
older generations more familiar with body lice residing in
host clothing.
Floors and Floor Coverings as Inanimate Objects
Another common recommendation by many misinformed
companies, web sites and articles in the popular press is to
treat and clean rugs, carpeting or floors when pediculosis is
found. This recommendation is based on the unsubstantiated
belief that head lice are deposited on these surfaces with
some regularity and would survive in the environment of the
home or school long enough for people to become infested
from this environment. However, no data exist in the
scientific literature to support this.
Transmission of head lice from floors to people makes
little evolutionary or biological sense, and the lack of data to
quantify this potential route of transmission means that
recommendations have not been evidence-based. This idea
was put to the test by ABC researchers who carefully
vacuumed the floors of 118 primary school classrooms in
Australia and searched the contents for any signs of head lice
[22]. A median of only 1.6 g of vacuum debris was obtained
from each classroom prior to evening cleaning by school
janitors. No head lice, parts of head lice or head lice eggs
were found in any of this debris, but all samples contained
parts of insects or occasionally whole insects. Ants and parts
thereof were the most commonly identified insects found.
This was notable because 21% (466 out of 2,230 children)
who spent every school day in these 118 classrooms were
infested with lice. A rather staggering total of 14,033 lice
were captured from these 466 infested students and a mean
intensity of infestation of 30.1 lice per infested child was
calculated. Of the infested students, 58% had less than 10
lice, 35% had 10-99 lice, 8% had 100-499 lice, and one 4
year-old female preschooler had 1,623 lice. One hundred and
eight of the 118 classrooms (91.5%) had at least one student
with active pediculosis and an average of 130 lice per
infested classroom was calculated. Thus, the idea that lice
are inclined to drop of a person’s head onto the floor and that
subsequent transmission takes place from floors to people is
a fictitious myth that has been well and truly debunked. The
risk of acquiring head lice from the floors of school
classrooms is zero and there is no benefit in any control or
cleaning activities to remove head lice from floors.
Bedding as a Source of Head Lice
If head lice contaminate bedding, it would pose a
reinfection threat to people who have just been combed or
treated with pediculicides. It would also pose an infection
threat if other uninfested people were sharing the bed.
To resolve the question of whether or not bedding
becomes infested by head lice leaving their host, researchers
at the ABC investigated the proportion of head lice
populations found on pillow cases of people with head lice,
and tested strategies to kill head lice on pillow cases [20]. To
assess the occurrence of head lice on pillow cases, people
with active pediculosis had their head lice collected and
counted and the pillow case they had used the night before
examined for head lice. To test strategies to kill head lice on
pillow cases, live head lice were experimentally placed in
miniature pillow cases, and the cases subjected to a hot
wash, a cold wash, a hot clothes dryer, and hanging out to
dry on an outdoor clothes line in the sun.
In this study, 48 participants were recruited who were
harbouring 1,845 head lice. Of the 48 pillow cases
investigated, two cases had a single live nymph present and a
third had a single dehydrated nymph. Thus, the occurrence
of overnight live lice transference to pillow cases was 4.2%
and proportionately, 0.1% of the head lice population
actively transferred onto a fomite. The second part of the
study found that heat (hot wash and hot clothes dryer) killed
head lice experimentally placed in pillow cases while cold
wash and hanging pillow cases out to dry did not kill head
lice.
This low level of pillow case infestation provides further
good evidence that bedding is an incompetent passive vector
to the overall picture of transmission. Pillow cases do pose a
slight risk for transmission or reinfestation but that risk is
low enough to be considered unimportant compared to other
modes of transmission. While this mode of indirect
transmission is more important if bedding is shared,
changing and washing pillow cases in a situation where
multiple infected and uninfected people are cohabiting will
have minimal impact on transmission since such a small
proportion of the head lice population transfers to bedding,
and bedding is a hostile environment for head lice. The point
is for those advising on the control of head lice to look at the
effectiveness of recommendations. Hence, this paper
commented “Pillowcases pose a risk for re-infection with
Indirect Transmission of Head Lice The Open Dermatology Journal, 2010, Volume 4 75
head lice, but the risk is low, and changing pillowcases is a
reasonable cost-efficient strategy to mimimize this risk.
Unfortunately, this was the only ABC field study cited by
Burkhart and Burkhart who claimed that it provided
evidence in support of “...the transfer of lice to numerous
objects including hats, upholstery, headphones, and
pillowcases...” [2].
It is entirely plausible that that head lice transmission
occurs via inanimate objects to a significant extent in certain
circumstances, but little more than anecdotal evidence exists
to confirm this [23]. For instance, one of the authors (DVC)
was once travelling in remote Aboriginal communities in
northern Australia and happened one night to sleep in a
‘men’s house’ with five other men. The author slept on the
left of the group with his head approximately two feet away
from the next person’s head and at no time was his head in
contact with the next person’s head. Nevertheless, the author
found himself infested the following day. No other head-to-
head contact can be recalled before or after this event, which
could have resulted in transmission. Head lice transmission
may thus take place over inanimate objects between people
who share bedding if the distance is small. But, the
magnitude of this needs to be confirmed through appropriate
scientific study. Other studies have found that family size,
overcrowding and sleeping in the same bed can promote
transmission [24-28].
Brushes as Sources of Head Lice
Three epidemiologic studies have demonstrated that there
is no association between head lice presence and the sharing
of combs and brushes, and one found an association [10, 29,
30]. In the latter study, which took place in Canada, no lice
were found on the brushes of 10 children with active
pediculosis [30]. The body of evidence thus suggests that
this mode of transmission is possible, but most likely of little
consequence compared to other modes.
RECOMMENDATIONS FOR FUTURE RESEARCH
As discussed, advice abounds on what to wash and clean
if you have a head lice infestation, but the evidence for these
assertions is anecdotal or based on flawed laboratory studies.
Very little, if any, in the way of supporting field evidence is
presented to back up these assertions. At the heart of the
matter are a number of questions about healthy active head
lice:
How often do healthy head lice become naturally
dislodged from their host?
What do head lice do when they find themselves off-
host?
Do head lice on inanimate objects constitute a
significant transmission problem?
Do head lice actively leave their hosts to wait on
inanimate objects for a chance occurrence with
another host?
Do head lice intentionally traverse inanimate objects
to cross from one host to another in response to
olfactory stimuli emanating from potential hosts?
Do female head lice lay eggs when they are off-host?
Do these eggs survive and hatch?
A comprehensive awareness of the biology and ecology
of P. capitis and the epidemiology of pediculosis leads to the
conclusion that transmission via inanimate objects may
occur, but it is unimportant compared to direct person-to-
person transmission. The emergence of data on transmission
factors over the past decade has definitively enabled
evidence-based head lice researchers to state that direct
person-to-person transmission is the major route. However,
transmission is a product of several inter-related variables,
and physical factors pale into insignificance when compared
to social and behavioural factors. The real problem is not
how head lice transmission occurs, but why it is occurring.
Reinfestation is thus is of greater importance, and future
studies should endeavour to reveal the reasons behind it.
CONCLUSIONS
The control of head lice should focus on the head, not on
the environment. Head lice scholars should focus on how to
limit reinfestation rather than providing erroneous control
advice. Schools and other institutions wishing to be
proactive should invest their resources into educational
approaches if they wish to render their mass treatment
campaigns more effective. The promotion of inanimate
objects that play an epidemiologically important role in head
lice dispersal is unsupported by the evidence-base, and any
further support of this mode of transmission needs to be
accompanied by new conclusive evidence from well-
designed laboratory and field studies.
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Received: April 5, 2010 Revised: May 18, 2010 Accepted: May 18, 2010
© Canyon and Speare; Licensee Bentham Open.
This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/
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... In terms of infection epidemiology, however, all that is relevant is how long they remain infectious. It may be assumed that, as a result of dehydration, head lice not in contact with heads are unable to produce saliva, feed on blood, and hence transmit infection (21). Although there are no data about the survival rate of eggs laid off-host, it is unlikely that nymphs can hatch from dehydrated eggs (21). ...
... It may be assumed that, as a result of dehydration, head lice not in contact with heads are unable to produce saliva, feed on blood, and hence transmit infection (21). Although there are no data about the survival rate of eggs laid off-host, it is unlikely that nymphs can hatch from dehydrated eggs (21). Recommendations for 10-day quarantine of rooms used by people in whom head lice have been found (e9) thus have no rational basis. ...
... Transmission via objects is a rare exception and is epidemiologically irrelevant (e13). This is however a contentious issue, with proponents on both sides (for: [e9]; against: [21]). Although the "pro" side adduces evidence from in vitro studies that do not match conditions in nature, such as transmission through the use of a hair dryer or combing or toweling hair, and egg lay on synthetic textiles among other things (19), the "contra" side has large quantities of data from clinical field studies to draw on. ...
Article
Background: Conflicting information about the proper treatment of head lice has given rise to uncertainty among patients and treating personnel. For example, the reported efficacy of permethrin fell from 97% in the 1990s to 30% in 2010. Methods: Review of the literature based on a selective search of PubMed. Results: In Germany, outbreaks of head lice mainly occur among 5- to 13-year-olds returning to school after the summer vacation. Nymphs hatch from eggs after an average of 8 days and become sexually mature lice over the ensuing 9 days. The main route of transmission is direct head-to-head contact; transmission via inanimate objects is of no relevance. Symptoms arise 4–6 weeks after an initial infestation; many affected persons have no symptoms at all. Wet combing is the most sensitive method of establishing the diagnosis and monitoring treatment. Resistance to neurotoxic pediculocidal drugs is increasing around the world. Dimethicones are the treatment of choice, with 97% efficacy. Outbreaks must be managed with the synchronous treatment of all infested persons to break the chain of infestation. If the agent used is not ovicidal, the treatment must be repeated in 8–10 days and sometimes in a further 7 days as well. Conclusion: Outbreaks of head lice can be successfully terminated by synchronous treatment with ovicidal dimethicones.
... Kutu rambut meninggalkan kepala mungkin dekat dengan kematian, dan dapat diasumsikan bahwa sebagian besar kutu yang ditemukan terlepas dari kepala tidak akan mampu menginfeksi seseorang atau bertahan untuk waktu yang lama. Namun, masih diperlukan data untuk mengkonfirmasi pernyataan ini (14). (2011), berbagi topi antara anak-anak sekolah menunjukkan proporsi infestasi yang lebih rendah dibandingkan dengan mereka yang tidak berbagi, dari hasil uji statistik nilai p-value = 0.309 (14). ...
... Namun, masih diperlukan data untuk mengkonfirmasi pernyataan ini (14). (2011), berbagi topi antara anak-anak sekolah menunjukkan proporsi infestasi yang lebih rendah dibandingkan dengan mereka yang tidak berbagi, dari hasil uji statistik nilai p-value = 0.309 (14). Sebuah studi yang dilakukan, di mana lebih dari 1000 topi di empat sekolah di Australia di selidiki untuk kejadian kutu kepala (13). ...
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ABSTRAKPediculosis capitis adalah infestasi yang disebabkan oleh pediculus humanus var. capitis dan merupakan masalah kesehatan anak-anak yang tinggal di asrama. Sampai saat ini penelitian tentang hal yang menyebabkan kutu kepala masih terbatas. Tujuan penelitian untuk mengetahui faktor-faktor yang berhubungan dengan kejadian pediculosis capitis pada anak-anak yang tinggal di asrama. Metode penelitian ini menggunakan studi kasus kontrol, pada siswi SMP pondok pesantren dan dilakukan tanggal 09 Desember 2015. Responden dibagi dalam 2 kelompok yaitu kelompok kasus (n=48) dan kelompok kontrol (n=48). Pemeriksaan kutu kepala dilakukan menggunakan sisir bergigi rapat dan respon pasien dicatat dalam lembar checklist. Hasil penelitian tidak terdapat hubungan antara faktor-faktor risiko yaitu panjang rambut (p=0,321), frekuensi mencuci rambut dalam seminggu (p=0,117), berbagi sisir (p=0,301), berbagi handuk (p=1,000), berbagi penutup kepala (kerudung) (p=0,323), kebiasaan tidur atau penggunaan tempat tidur bersama (p=0,784), dan frekuensi mengganti sprei tempat tidur sekali seminggu (p=0,268), dengan kejadian pediculosis capitis. kesimpulan pada penelitian tidak terdapat hubungan antara faktor-faktor dengan kejadian pediculosis capitis, hal ini mungkin disebabkan oleh faktor lain yaitu kepadatan hunian.Kata-kata kunci: pediculosis capitis, kutu kepala, faktor risiko.ABSTRACTPediculosis capitis is an infestation caused by pediculus humanus var. capitis and it is one of health problem on children who lived in a dormitory. Unfortunately, recent research about things caused head louse is still limited. The objective was to determine the factors which had correlation with pediculosis capitis incident in children who lived in dormitory. The method of this research used case control study, performed to girl students in SMP Pondok Pesantren on 09 December 2015. Respondents were divided into 2 groups, case group (n=48) and control group (n=48). The examination of head louse was performed using tight-brush comb and patient’s response has written in checklist paper. The result there was no correlation between hair long (p=0,321), frequency of hair washing in a week (p=0,117), shared comb (p=0,301), shared towel (p=1,000), shared head cover (jilbab) (p=0,323), sleep habit or shared bed (p=0,784), and frequency of changing bed cover once a week (p=0,268), with pediculosis capitis incident. It can be concluded this study there was no correlation between factors with pediculosis capitis incidence, this happened maybe because of other factor like occupancy density.Keywords: pediculosis capitis, head louse, risk factor.
... Transmission of head lice can occur through direct physical contact, especially head-to-head contact and also via inanimate objects, also known as fomites (Burkhart and Burkhart 2007). However, evidence has shown that fomites play a minor role in head lice transmission (Takano-Lee et al. 2005, Canyon andSpeare 2010). For this reason, it is very important to understand the details of the head-to-head transmission process. ...
... This does not necessarily contradict the finding of Canyon et al. (2002) that only a small fraction of lice was able to move between hairs in in vitro bioassays, since in a real environment the frequency and duration of head to head contacts should also be taken into account. Additionally, it is probably yet another evidence that fomites do not play a significant role in the spreading of pediculosis (Canyon and Speare 2010). ...
Article
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Head lice infest millions of school-age children every year, both in developed and developing countries. However, little is known about the number of lice transferred among children during school activities, because direct methods to study this are almost impossible to implement. This issue has been addressed following an indirect method, which consist in collecting data of real infestation from several children groups and using a mathematical model of lice colonies to infer how the infestation observed might have evolved. By determining the events that would most likely lead to infestations as those observed, we find that severe infestations are most likely initiated by a relatively large number of lice transferred at the same moment or within relatively short time spans. In turn, analysis of the data obtained from screenings of the same groups of children a few days apart shows evidence of such transmission events. Interestingly, only children with severe infestations could harbor the lice necessary for this type of transmission. Thus, they play the same role as ‘superspreaders’ in epidemiology. As part of our experimental study it is also shown that a simple procedure of combing can be very effective to remove all mobile lice, and thus could be used as an effective preventive measure against those severe infestations that are responsible for the spread of pediculosis.
... Semakin besar waktu yang digunakan maka semakin besar pula tingkat mortalitas kutu kepala. Dengan demikian perlakuan 2 dan 3 dengan waktu perlakuan 15 menit mampu membunuh kutu kepala dengan tingkat mortalitas paling tinggi (Canyon & Speare, 2010) Hasil penelitian menunjukkan bahwa jumlah kematian kutu kepala meningkat seiring dengan peningkatan waktu yang digunakan. Perbedaan yang bermakna pada setiap pengulangan perlakuan yang dilakukan sebanyak 3 kali yaitu pengulangan pertama 5 menit, pengulangan ke dua 10 menit dan pengulangan ke tiga 15 menit. ...
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Head lice infestation with pediculosis capitis is a serious problem that is not well- respected in Indonesia. Most Indonesians tend to let pediculosis capitis multiply on their heads. This head lice infestation causes problems with a lack of focus due to head lice activity. The most effective eradication of head lice is by using chemical pediculosides. Soursop leaves contain many secondary metabolites which have potential as bioinsecticides which can be used as pediculosides (head lice eradication). This study aims to determine the effect of soursop leaf extract on the mortality rate of pediculosis capitis. This study used a Quasy Experiment Time Series Design using a purposive sampling technique. The hypothesis test uses the One Way Annova statistical test with a significance level of α <0.05. The study showed that 56 pediculosis capitis tails were divided into 4 treatments and 3 repetitions, namely not given soursop leaf extract (K0), given soursop leaf extract with a trial time of 5 minutes (P1), given soursop leaf extract with a trial time of 10 minutes (P2). was given soursop leaf extract with a trial time of 15 minutes (P3). The results showed that the percentage of pediculosis capitis mortality from the soursop leaf extract treatment, it was known that the highest mortality was in the P2 and P3 treatments of the soursop leaf extract. While the lowest number of deaths occurred in the K0 treatment without using soursop leaf extract at all 0%. The above results show that the number of head lice deaths increases with increasing time used. Based on the research above, soursop leaf extract by direct spraying method on head lice with 5, 10, 15minute observations had an effect on head lice mortality. The higher the observation time studied, the higher the head lice mortality rate. The results show that the mortality rate is higher the longer the time given. ABSTRAK Infestasi kutu kepala pediculosis capitis merupakan masalah serius yang tidak ditanggapi dengan baik di Indonesia. Kebanyakan orang Indonesia cenderung membiarkan pediculosis capitis berkembangbiak dikepala mereka. Infestasi kutu kepala ini menyebabkan masalah kurang fokusnya pikiran karena aktifitas kutu kepala. Pemberantasan kutu kepala paling efektif dengan menggunakan pedikulosida kimiawi. Daun sirsak mempunyai banyak kandungan senyawa metabolit sekunder yang berpotensi sebagai bioinsektisida yang dapat digunakan sebagai pedikulosida (pemberantas kutu kepala). Penelitian ini bertujuan untuk mengetahui pengaruh ekstrak daun sirsak terhadap tingkat mortalitas pediculosis capitis. Penelitian ini menggunakan desain Quasy Eksperimen Time Series Design dengan menggunakan Teknik purposive sampling. Uji hipotesis menggunakan uji statistic Kruskal-Wallis dengan tingkat kemaknaan α < 0,05. Penelitian menunjukkan 56 ekor pediculosis capitis dibagi menjadi 4 perlakuan dan 3 kali pengulangan yaitu tidak diberi ekstrak daun sirsak (K0), diberi ekstrak daun sirsak dengan waktu uji coba 5 menit (P1), diberi ekstrak daun sirsak dengan waktu uji coba 10 menit (P2), diberi ekstrak daun sirsak dengan waktu uji coba 15 menit (P3). Hasil penelitian menunjukkan bahwa presentase mortalitas pediculosis capitis dari perlakuan ekstrak daun sirsak, diketahui bahwa kematian tertinggi terdapat pada perlakuan P2 dan P3 ekstrak daun sirsak. Sedangkan jumlah kematian terendah terjadi pada perlakuan K0 dengan tidak menggunakan ekstrak daun sirsak sama sekali 0%. Hasil diatas menunjukkan bahwa jumlah kematian kutu kepala meningkat seiring dengan peningkatan waktu yang digunakan. Berdasarkan penelitian diatas bahwa ekstrak daun sirsak dengan metode penyemprotan langsung pada kutu kepala dengan pengamatan 5,10,15 menit memeberikan pengaruh terhadap mortalitas kutu kepala. Semakin tinggi waktu pengamatan yang diteliti maka semakin tinggi pula tingkat mortalitas kutu kepala. Hasil menunjukan bahwa tingkat mortalitas semakin tinggi apabila waktu yang diberikan semakin lama.
... The chance is exceptionally remote that a live head louse or egg, displaced onto an inanimate object, would succeed in infesting another person. [54][55][56] The "no-nit" policy ...
Article
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Head louse infestations continue to be a concern of public health in most countries, including the most developed ones. The present recommendations are intended to inform and stress the role and impact of the different authorities, institutions, industry, and the public in the control of head lice in order to reduce the prevalence of this parasite. We encourage health authorities to pursue more effective methods to correctly identify such infestations, and evaluate existing and new pediculicides, medical devices, louse repellents, and louse- and nit-removal remedies. Pediculicides and medical devices must have verifiable claims in the instructions for use and should be tested periodically to document current levels of resistance by lice to the active ingredients and to the formulated products. Where the prevalence of lice is claimed to be epidemic, children should be periodically evaluated objectively to document the actual level of prevalence. Continuing education for health providers and the general population promises to correct misinformation regarding the biology, prevention, and management of lice. Parents should regularly inspect their children for head lice and treat as necessary. Health authorities are encouraged to eliminate policies and practices that rely upon school exclusion as a means to reduce incidence and prevalence, e.g., the 'no-nit' policy which lacks scientific justification, and are counterproductive to the health and welfare of children.
... The chance is exceptionally remote that a live head louse or egg, displaced onto an inanimate object, would succeed in infesting another person. [54][55][56] The "no-nit" policy ...
Article
Full-text available
Head louse infestations continue to be a concern of public health in most countries, including the most developed ones. The present recommendations are intended to inform and stress the role and impact of the different authorities, institutions, industry, and the public in the control of head lice in order to reduce the prevalence of this parasite. We encourage health authorities to pursue more effective methods to correctly identify such infestations, and evaluate existing and new pediculicides, medical devices, louse repellents, and louse‐ and nit‐removal remedies. Pediculicides and medical devices must have verifiable claims in the instructions for use and should be tested periodically to document current levels of resistance by lice to the active ingredients and to the formulated products. Where the prevalence of lice is claimed to be epidemic, children should be periodically evaluated objectively to document the actual level of prevalence. Continuing education for health providers and the general population promises to correct misinformation regarding the biology, prevention, and management of lice. Parents should regularly inspect their children for head lice and treat as necessary. Health authorities are encouraged to eliminate policies and practices that rely upon school exclusion as a means to reduce incidence and prevalence, e.g., the ‘no‐nit’ policy which lacks scientific justification, and are counterproductive to the health and welfare of children.
Article
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Infestasi kutu kepala (pediculosis capitis) merupakan suatu masalah kesehatan umum yang ditemukan di seluruh dunia. Tujuan studi ini adalah untuk mengetahui gambaran salah satu faktor risiko yaitu perilaku kebersihan diri yang terkait pada seseorang dengan infestasi kutu kepala. Diharapkan hasil studi ini dapat menambah informasi mengenai perilaku kebersihan diri yang mempengaruhi infestasi sehingga dapat mempermudah pencegahan dan mengurangi angka kejadian infestasi kutu kepala. Studi deskriptif dengan desain cross sectional yang dilakukan pada 152 santriwati di Pondok Pesantren Anshor Al- Sunnah, Riau dengan infestasi kutu kepala. Sampel diambil dengan metode purposive sampling. Data diambil melalui inspeksi kepala dan rambut serta pengisian kuesioner perilaku kebersihan diri terkait infestasi kutu kepala. Pengolahan data dilakukan dengan menggunakan SPSS v.17. Mayoritas santriwati yang mengalami infestasi kutu kepala memiliki perilaku kebersihan diri yang baik (88,2%). Kontak erat dengan penderita merupakan cara transmisi kutu kepala yang utama sehingga diperlukan pengobatan sekaligus pada santriwati yang mengalami infestasi kutu kepala untuk menghentikan transmisi kutu kepala.
Article
Colonization with head lice is a mostly harmless parasitosis of humans. Nevertheless, being infested with head lice is of great social importance. Uncertainties with respect to appropriate action and treatment, a broad market of predominantly prescription-free therapeutic agents and infection control regulations often lead to a considerable family burden, high costs and absenteeism in day care centers, schools and at work.A critical review of current recommendations for action from international professional societies and infection control authorities demonstrates that not all of the information listed there consistently relies on scientific or epidemiological findings. There are significant differences between these recommendations, not least in the selection of the medications to be used against head lice. While the use of drugs is primarily limited by national approval restrictions, non-medical products are subject to significantly lower legal hurdles with respect to approval and their therapeutic use. This also influences the results of studies on the effectiveness of these substances.The Committee for Infectious Diseases and Vaccinations of the German Academy for Pediatrics and Adolescent Medicine took this overall situation as an opportunity to comprehensively examine the literature on the control of head lice infestations and to compile the documented evidence and plausibly documented findings. Information on the biology, epidemiology and spreading dynamics of head lice should enable the medical profession and other advisors, such as pedagogical and pharmaceutical specialists to provide the best possible advice to those who are affected and those who are afraid of being affected.With this statement we would like to give an overview of an evidence-based treatment of this parasitosis. We hope that a stronger focus on effective approaches while avoiding ineffective recommendations will ultimately result in better control of this health burden and its consequences in the sense of a secondary preventive approach.
Chapter
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The therapy of pediculosis remains a common problem in pediatric clinical practice. As resistance to commonly used chemical pediculicides, such as permethrin, is constantly increasing, there is a need for the development of new compounds that are effective in causing mortality in adult lice and their eggs. Natural products have been used in traditional medicine for thousands of years and recently have been of increasing interest, since the costs are usually lower and they are considered less toxic by the public. Here we present a review on plant compounds used for the treatment of head lice. An overview is given on published evidence on the use of natural product pediculicides and ovicides in clinical trials and in vitro studies. We conclude that several plant products offer promise for new compounds to treat head lice infestation. However, the number of clinical studies is very limited, and there is an urgent need to increase research assessing the effectiveness and safety of promising compounds. Over the counter natural products should be supported by in vitro data and by adequately designed comparative trials that evaluate cure rates and safety.
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Head lice are cosmopolitan and endemic. While they are not responsible for the spread of any disease, they are the cause of considerable social distress. They can infest anybody and do not discriminate between class or cleanliness. Head lice are transmitted primarily by direct contact. The only satisfactory method to clear an infestation is by chemical treatment. The most effective pediculicides to date are those which contain permethrin (Nix) or malathion (Prioderm). Compliance with product instructions eliminates the need for nit removal after treatment. Treatment of inanimate objects and the environment should be discouraged. To obtain effective control of head lice, the whole community needs to be involved. Parents must be encouraged to screen themselves and their children regularly in the home, and to treat themselves only when necessary.
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The aim was to determine the influence of the socioeconomic status of the family and the hygienic practices in the home on the prevalence of head lice infestation in children. The study was carried out by analyzing the answers to a standardized epidemiological questionnaire given to parents of school children aged 4-17 in Bet Shemesh, a medium-sized urban town 25 km from Jerusalem. Of 3,000 questionnaires distributed, 958 (31.9%) were completed and returned. The majority of the children (72.4%) had been previously infested with lice. Half of them had other family members, mainly brothers and sisters, who had been infested in the past with lice. In 97.5% of the families the mother was responsible for examining the children for lice, and for carrying out treatment when infestation was present. An association was found between presence of lice infestation and mother's education, age of child, and frequency of shampooing, combing, and examination for lice. There was no association between infestation rates and mother's country of origin, crowding in the home, and the sharing of combs, brushes, hats, scarves, towels, and clothes. There is evidence that the incidence of lice infestation depends on the hygienic practices in the home rather than on the socioeconomic status of the family or sharing of personal articles among family members.
Article
Insecticide susceptibility of a 1995 Townsville Aedes aegypti ( L) population was investigated in the laboratory according to World Health Organization guidelines. Using baseline data from two Townsville populations (1955 and 1989), larval bioassays detected significant increases in susceptibility to synthetic pyrethroids and malathion, and significant reductions in susceptibility to most organophosphates and propoxur. Adult bioassays detected significant resistance to bendiocarb and DDT. Comparison of larval data with the international reference ROCK strain showed substantial resistance to have developed to malathion and fenthion. Further analysis revealed the presence of distinct substrains in the baseline 1989 population. which displayed varying levels of temephos susceptibility. We concluded that susceptibility investigations should assess mosquito populations collected from many sites within an area rather than taking a single population from one site, and that the 1989 Ae. aegypti colony would be unsuitable for use as a susceptible reference population.
Article
In the following account of the biology of Pediculus humanus, I have sought to bring together all that could be gathered from the publications of the many authors who have occupied themselves more or less with these insects, adding here and there my own observations2. I have sought throughout to give credit where it is due and have not withheld criticism where it appeared necessary.
Article
Most of the infestations, though light, must have been established at least for some weeks.(Received November 21 1941)
Article
Insecticide susceptibility of a 1995 Townsville Aedes aegypti (L.) population was investigated in the laboratory according to World Health Organization guidelines. Using baseline data from two Townsville populations (1955 and 1989), larval bioassays detected significant increases in susceptibility to synthetic pyrethroids and malathion, and significant reductions in susceptibility to most organophosphates and propoxur. Adult bioassays detected significant resistance to bendiocarb and DDT. Comparison of larval data with the international reference ROCK strain showed substantial resistance to have developed to malathion and fenthion. Further analysis revealed the presence of distinct substrains in the baseline 1989 population, which displayed varying levels of temephos susceptibility. We concluded that susceptibility investigations should assess mosquito populations collected from many sites within an area rather than taking a single population from one site, and that the 1989 Ae. aegypti colony would be unsuitable for use as a susceptible reference population.
Article
Infestation of the head louse Pediculus humanus var capitis DeGeer (Phthiraptera: Pediculidae) is an important public health problem in Australia, with up to a third of children infested in some primary schools. Insecticide resistance and inadequate attention to the application instructions of topical pediculicides are common reasons for treatment failure. This study evaluated six popular Australian over-the-counter products against head lice, primarily comprised of different botanical extracts, and compared them with permethrin 1% (Quellada) and a non-treatment control in order to assess their in vitro efficacy. We also assessed commonly used criteria for evaluating pediculicide efficacy in vitro. All tested products failed to demonstrate high levels of efficacy with the exception of Tea Tree Gel((R)), which outperformed 1% permethrin. Permethrin had a high level of efficacy, but using stringent criteria 18% of lice were not dead at 3 h, indicating some resistance to Quellada. Commonly used less stringent criteria were shown to overestimate mortality of head lice as a result of the protective phenomenon of stasis or sham death observed in exposed lice that may recover after some time. Using two different levels of stringency resulted in different rankings of efficacy for most products, with the exception of the first ranked product, Tea Tree Gel. Rankings of efficacy also varied over time, even within the different assessment criteria. Government regulatory agencies should require standard in vitro tests using stringent mortality criteria, with an observation period of >or= 6 h, to determine the efficacy of new pediculicides, and only products that cause a minimum mortality rate (e.g. 80%) in head lice collected from the target population should be licensed for sale.
Article
An outbreak of head lice infestation (pediculosis) occurred in elementary school children in Barrow County, Georgia, in January 1974. An investigation was initiated to define the magnitude of the outbreak, determine factors that contribute to transmission, and disseminate information on control. All elementary school children in the county were examined for head lice and answered a questionnaire. Fifty-three (3%) of 1,783 white pupils were infested, but none of the 500 black pupils was infested. Distribution of infestation in the white pupils was influenced by grade, bed-sharing, socioeconomic status, infestation of other family members, crowding in the home, and family size; distribution was not influenced by hair length or the sex of the pupil. Recommendations for control based on the results of the investigation included procedures for identifying and processing cases, distributing free pediculicides, continuing surveillance, educating school personnel and parents on how to control the parasite.