Transcript Head Lice - Glen Ridge, New Jersey

A Parent’s Guide to Head Lice
Presented by:
The Glen Ridge Board of Health
Contact Information
• Borough of Glen Ridge (973)748-8400
• Glen Ridge Board of Health
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Donna Lifson, MD – President
Jacqueline Yustein – Vice President
Sujana Chandrasekhar, MD
Elizabeth Baker
Deborah Priestman, RN
Mike Sherman, PhD
Chris Valerian, MD
Donna Heinzen, PA
What are head lice?
• Lice (singular louse) are tiny,
wingless insects that survive by
feeding on human blood.
• Head lice cannot jump or fly and
do not burrow under the skin.
• Head lice are the most common
type of lice and live mainly on the
scalp, at the base of the neck, and
in the eyebrows and eyelashes.
• They lay up to six eggs per day,
attaching the eggs (called nits) to
strands of hair close to the scalp.
Life Cycle
Nymph
hatching
Nymphs
Nit
Female &
Male Louse
What are the symptoms of head lice?
• Head lice are not known to spread infectious diseases and
should not be thought of as a medical problem.
• A person who has head lice may feel itching, but children often
show no symptoms.
• Persistent scratching can lead to skin irritation or infection.
• Head lice are certainly a nuisance, but they are not generally
considered a health hazard.
How are head lice spread?
• People or objects that are infested can transmit the live lice or
their eggs (nits) through:
• Direct head to head contact.
• Indirectly by shared combs, brushes, hats, pillowcases.
• Head lice cannot jump or crawl distances.
• Head lice do not survive on pets or animals.
• Head lice need body temperature conditions to live.
• Survival time away from the human head is short (few hours).
How are head lice diagnosed?
• Nits may be present two to three weeks before itching begins.
• The most accurate way to diagnose head lice is to find a living
adult louse. However, adult head lice are rarely seen because
they are fast and hide well.
• Identification is usually made by detecting nits attached to the
hair near the scalp. Nits are tiny, white or grey oval specks that
do not come off of the hair easily like a speck of dandruff would.
• Nits are most noticeable on the back of the neck, behind the
ears near the hairline and at the very base of the hair shaft.
• Nits found within ¼ of an inch from the scalp usually mean the
nits are alive and treatment is needed.
• Generally, nits found more than ¼ of an inch from the scalp are
dull yellow in color and no longer carry a live louse. Called
casings, they can be manually removed with a fine toothed
comb.
Empty nit case
Hair spray droplets
Dandruff
Hair casts
Viable nits
How are head lice treated?
• Medicated Shampoo 80 to 95% effective
• Mechanical Removal 38% effective
• Alternative methods not proven
• Environmental controls
• Measures you can take at home in conjunction with
treatment.
Medicated Shampoo (pediculicide)
• Shampoo the hair with a medicated shampoo or
cream rinse containing one of the following
chemicals: pyrethrin or permethrin.
• These OTC shampoos used for treatment should be
used with care. Read and follow the package or label
instructions very carefully.
• After shampooing, hair should be combed with a fine
toothed comb. Removal of all nits after treatment is
not necessary to prevent further spread.
• If nits or newly hatched lice are still present after 10
days, an additional treatment may be necessary.
Mechanical Removal
• Effective as sole
treatment in 38% cases.
• Use fine-toothed comb.
• May take several hours
each day.
• Combing should be
repeated daily until no
lice are seen, then
continued for 3 weeks.
Alternative Methods
(not proven)
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No FDA standards or licenses of approval.
Kill adults and nymphs, but not eggs (nits).
Must be combined with combing.
Suffocants
• Petroleum jelly, mayonnaise, oil-based products.
• Enzyme products
• Claim to dissolve/soften the adhesive glue.
attaching the nit to the hair shaft.
Follow up at Home
Head lice do not survive for long periods of time off of the scalp.
The following steps should be taken to avoid recurrence of lice that have
recently fallen off of the head of an affected person.
• Check every family member for lice prior to cleaning the home
environment and treat if necessary.
• Wash personal items: hats, pillow cases, bed linens, towels,
soft/stuffed animals, etc. in the washing machine in hot (130°F)
water and dry in a machine dryer on the hot cycle for 30
minutes.
• Any items that cannot be laundered should be sealed in a
plastic bag and stored for 24 hours in sub-freezing temp, or at
room temp for 2 weeks to kill lice on these objects.
• Thoroughly vacuum large items such as bare mattresses, box
springs, carpets, floors, hard toys, coat collars, couches, chairs,
car upholstery and children’s car seats.
Follow up at Home, cont’d.
• Wash (128°F for 5 minutes) or boil combs, brushes and hair
accessories (barrettes, elastics, headbands).
• Alternately, combs and brushes can be washed with one of the
lice-killing shampoos or by soaking in mild bleach solution
(tablespoon bleach per quart cool water), rubbing alcohol or
Lysol for one hour, then scrub with soap and hot water .
• Disinfect helmets with mild bleach solution.
• Do not spray surfaces with insecticides and do not use
insecticide sprays to treat people. These chemicals can be
harmful to both people and pets.
Family Education
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Make head checks part of routine family hygiene. Check
children’s heads during an outbreak or if you notice symptoms.
The earlier lice are found, the easier they are to treat.
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Teach children not to share clothing, hats, brushes, or combs
with other children.
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Teach children to hang coats and other personal belongings
separately if possible and/or to tuck hats and scarves into their
sleeve.
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Education of schools, families and professionals is important in
changing our culture’s emotional response to head lice.
Impact of Exclusion (no-nit) Policies
by School Districts
• 4-8 million children in the US are over treated each
year.
• 12 to 24 million school days are lost annually.
• Missed workdays by parents having to stay home
with their child costs $4-8 billion annually.
• Psychological impact to child and parent caused by
teasing and/or anger directed at infested child/family.
• Anxiety over head lice often leads to inappropriate
treatments that pose health hazard to child and
household.
Centers for Disease Control and
Prevention (CDC) School Guidelines
• "No-nit" policies that require children to be free of nits
before they can return to school should be
discontinued:
• Many nits are more than ¼ inch from the scalp. Such nits are
usually not viable and very unlikely to hatch to become
crawling lice, or may in fact be empty shells, also known as
casings.
• Nits are cemented to hair shafts and are very unlikely to be
transferred successfully to other people.
• Misdiagnosis of nits is very common during nit checks
conducted by nonmedical personnel.
• The burden of unnecessary absenteeism to the
students, families and communities far outweighs the
risks associated with head lice.
www.cdc.gov/parasites/lice/head/schools.html
Updated November 2010
American Academy of Pediatrics
Head Lice Guidelines, Aug 2010
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Head lice are not a health hazard or a sign of poor hygiene and, in
contrast to body lice, are not responsible for the spread of any disease.
• No healthy child should be excluded from or miss
school because of head lice, and no-nit policies
for return to school should be abandoned.
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Informed school nurses can help with diagnosis and suggestions about
treatment.
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Because head lice are usually transmitted by head-to-head contact,
parents should carefully check a child’s head before and after attending
a sleepover or camp where children share sleeping quarters.
aappolicy.aappublications.org/cgi/content/full/pediatrics;126/2/392
National Association of School Nurses
Nit Free Policies in the Management of Pediculosis
It is the position of the National Association of School Nurses
that nit-free policies disrupt the education process and should
not be viewed as an essential strategy in the management of
head lice.
DESCRIPTION OF ISSUE:
Families and school staff expend innumerable hours and resources
attempting to eradicate infestations, expending equal efforts on live lice
and their nits.
RATIONALE:
Rarely, if ever causing direct harm, head lice are not known to transmit
infectious disease person-to-person. Furthermore, current research does
not support the conclusion that enforced exclusion (nit free) policies result
in reduced transmission of head lice.
Adopted: November, 1999
http://www.nasn.org/positions/nitfree.htm
Michigan School Head Lice Prevention
and Control Policy
• Any student with live lice may remain in school until the end of
the school day.
• Immediate treatment at home is advised.
• The student will be readmitted to school after treatment and
examination. If, upon examination, the school-designated
personnel finds no live lice on the child, the child may reenter
the school.
• Any student with nits (farther than ¼” from scalp) should be
allowed in school.
• Parents should remove nits daily and treat if live lice are
observed.
Michigan School Head Lice Prevention
and Control Policy, cont’d
When member of school staff suspects a child has head lice:
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Restrict child from activities involving close contact (i.e. hugging) or
sharing personal items with other children.
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Notify school/facility administration.
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Contact parent (verbal communication preferred). Immediate removal
of the child is unnecessary. The child can be sent home at the end of
the day (allowed to ride school bus home).
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A letter should be sent home to notify classmate’s parents that a case
of head lice is suspected, asking them to check all of their children.
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Provide information sheet on head lice infestation and treatment.
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http://www.michigan.gov/documents/Final_Michigan_Head_Lice_Manual_103750_7.pdf
Who recommends No-Nit Policies and
exclusion of children from school?
• National Pediculosis Association –
www.headlice.org
• Sells the LiceMeister™ comb.
• Mission statement equates lice and nit control to
“responsible personal health behaviors” and “a
commitment to health and wellness.”
• Contradicts CDC, AAP, NASN guidelines.
• No clinical relevance.
• No data to support the claims.
Local Policies
• Glen Ridge joins many school districts and day care centers to
enforce a “no-nit” policy, requiring that children be excluded
from school until they are “nit-free.”
• Due to scientific evidence and research that shows “no-nit”
policies are ineffective in controlling transmission of head lice,
the following entities do not support or recommend them:
• US Centers for Disease Control - CDC
• American Academy of Pediatrics - AAP
• National Association of School Nurses - NASP
• The Glen Ridge Board of Health therefore recommends that
policy changes be made to allow children back to school once
treatment has been initiated.
Where can I find more information?
• US Centers for Disease Control and Prevention www.cdc.gov/ncidod/dpd/parasites/lice/default.htm
• NJ Department of Health and Senior Services
http://www.state.nj.us/health/cd/documents/f_headlice.pdf
• American Academy of Pediatrics
http://www.aap.org/
• National Association of School Nurses
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http://www.nasn.org/Home
Michigan School Head Lice Prevention and Control Policy
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http://www.michigan.gov/documents/Final_Michigan_Head_Lice_Manual_10375
0_7.pdf