3/27/2017. Head Lice. Learning Objectives. Disclosures

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Nigel Holt
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1 Head Lice Andi L. Shane, MD, MPH, MSc Associate Professor and Interim Division Director, Division of Pediatric Infectious Disease Marcus Professor of Hospital Epidemiology and Infection Control Learning Objectives At the conclusion of this session, participants will be able to: 1. Explain the epidemiology of human Pediculosis capitis (lice) infestations in children in the U.S. 2. Articulate the options for treatment of the child with lice infestation. 3. Describe the control measures that are recommended to prevent transmission of lice infestations including the recommendation against no nit policies in schools. 2 Disclosures ALS has received support from the NIH and the Gerber Foundation paid directly to Emory. She has also received support for travel from the International Scientific Society of Prebiotics and Probiotics paid directly to her. 3 1

Learning Objectives http://islandlife808.com/wp-content/uploads/2011/11/headlice.

2 Learning Objectives Overview of Head Lice (1) Pediculus humanus capitis Commensal with humans for years 1990s: direct and indirect costs $350 million - $1 billion (consumer costs, lost wages, school system expenses. Head lice do not transmit infections and are not a health risk Head lice are not an indication of personal hygiene and not associated with hair length Head lice infestations result in unnecessary exclusion and stigma 5 Overview of Head Lice (2) Pediculus humanus capitis School nurses may be the first point of evaluation Important to correctly recognize and diagnose Recommend management / treatment with pediculicides Treat children with living lice only Ensure product is safe and efficacious May need to refer to child s pediatrician 6 2

The Louse Life Cycle Pediculus humanus capitis http://www.headlicetreatmentworld.com/wpcontent/uploads/2011/05/nits_and_lice_life_cycle1.

near the scalp 7 Transmission Lice do not hop or jump; only crawl Transmission by direct contact Indirect contact by personal items much less likely

Identification of eggs (egg cases = nits), nymphs, or adults with observation Lice avoid light and crawl quickly Eggs may be located at nape of neck

3 The Louse Life Cycle Pediculus humanus capitis Pruritus from sensitization to saliva develops from 4-6 weeks Survive < 1 day away from scalp Eggs cannot hatch at temperatures lower than those near the scalp 7 Transmission Lice do not hop or jump; only crawl Transmission by direct contact Indirect contact by personal items much less likely to occur Lice on inanimate objects are usually dead Control: reduce lice on head and decrease opportunity for direct contact 8 Diagnosis Identification of eggs (egg cases = nits), nymphs, or adults with observation Lice avoid light and crawl quickly Eggs may be located at nape of neck or behind ears; firmly affixed to hair shaft Viable lice are rarely > 1 cm from scalp om/- Z_4ii1mT_es/VFiBIsF Ba5I/AAAAAAAAk2w/ Zl7qSgC91E4/s1600/q.jpg 9 3

Treatment Options http://pediatrics.aappublications.org/content/pediatrics/early/2015/04/21/ peds.2015-0746.full.

4 Treatment Options peds full.pdf 10 Treatment Logistics Rinse topical pediculicides from the hair over a sink to limit skin exposure Itching or burning of the scalp may persist for days after treatment Topical corticosteroids and oral antihistamines may relieve symptoms 11 Pediculicide Resistance No pediculicide is 100% ovicidal resistance reported regionally Treatment failures may be due to misdiagnosis, lack of adherence, inadequate treatment, reinfestation, lack of ovicidal activity, resistance When resistance documented, can use benzyl alcohol 5% if > 6 months or malathion 0.5% if > 24 months or manual removal 12 4

Alternative Treatments - Oils Essential oils (yiang yiang oil, Andiroba oil, Quassia vinegar, melaleuca oil [tea tree oil], lavender oil May result in contact sensitization Safety and efficacy not

5 Alternative Treatments - Oils Essential oils (yiang yiang oil, Andiroba oil, Quassia vinegar, melaleuca oil [tea tree oil], lavender oil May result in contact sensitization Safety and efficacy not regulated by FDA 13 Alternative Treatments Occlusive Agents Petrolatum shampoo, mayonnaise, butter or margarine, or olive oil designed to suffocate lice only anecdotal Uncontrolled, nonrandomized study 96% cure rate with a facial cleanser applied to hair, dried with hair dryer, left on overnight, rinsed off in the morning repeated once weekly x 3 weeks Other hair rinses that dissolve exoskeleton of louse dehydration louse 14 Alternative Treatments Dessication 15 5

Alternative Treatments Manual Removal Safest treatment avoids chemical treatment Advocated for parent-child bonding May require

children should be treated promptly to reduce opportunities for transmission Regular surveillance by parents and school nurses to

targeted examination of symptomatic children is beneficial School screening should not replace parental screening Children with live

6 Alternative Treatments Manual Removal Safest treatment avoids chemical treatment Advocated for parent-child bonding May require manual removal after pediculicide treatment since most are not ovicidal Louse comb manual or electronic 16 Prevention Infested children should be treated promptly to reduce opportunities for transmission Regular surveillance by parents and school nurses to detect and treat early infestations 17 Control Measures in Schools Screening for nits alone or live lice is not cost effective; targeted examination of symptomatic children is beneficial School screening should not replace parental screening Children with live lice should be allowed to complete the day and parents should be notified Targeted evaluation of close (head to head) contacts of children with live lice 18 6

7 Eliminate No-Nit Policies 19 7

Managing Head Lice in the School Setting AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE

Managing Head Lice in the School Setting AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE What is Head Lice A small parasitic insect that lives on the scalp and neck hairs of a human host Originated and