head lice; prevention
Donaldson; Bug Busting Abstract
In the 1970s Donaldson applied the principles of infectious disease surveillance to pediculosis capitis infestation with head lice. This provided a lasting insight into an effective strategy for prevention, Research in Teesside, UK, proved that the first step in breaking the chain of transmission is the engagement of parents in an intensive detection/treatment campaign. United action halved the infestation rate, even though failing lindane treatments were in use. Subsequently although effective malathion treatment was introduced, it became clear that the late detection of light cases of head lice still undermines eradication.
This paper analyzes the development by the health charity, Community Hygiene Concern, of the Bug Busting programme based on this solid evidence. In the 1990s the charity solved the problem of detecting asymptomatic lice using a specially designed Bug Buster louse comb in wet, conditioned hair. It undertook the popularization of this method and the co-ordination of national detection days (Bug Busting Days) through primary schools.
In 2004 this structured approach to prevention was adopted in Chester. It produced a 24% reduction in health authority spending on treatment products in the first year and appreciable savings in professional time.
It is concluded that participation in the Bug Busting programme benefits community health providers and schools. Provision of dependable detection combs with the correct instructions to families at risk, empowers them to gain sustainable, cost-effective control of head lice.
Individual cases of pediculosis capitis are not only a personal problem but intrinsically a community problem. Between 1986 and 1990 exploratory studies were made in the UK on the incidence of head lice in all members of families where some children attended playgroup. primary or secondary school. The results suggest that outbreaks are perpetuated by a transient reservoir of undetected but contagious cases, in primary school -aged children.1,2 Typically child A is found to have lice, treatment immediately follows detection, concurrent precautions are taken with other family members, and child A returns to school. At school child A comes into contact with child B, who has undiagnosed lice. Child A becomes re-infested and so on. Although point prevalence can be relatively low, between half and two thirds of primary school children may suffer repeated episodes of head lice, reaching 10 consecutive times.' This feature of an outbreak can push the annual incidence rate among pupils very high.1-7 In 2003 Harris et al.7 recorded a 2.03% point prevalence in primary school children in North Essex, assessed by questionnaire survey of their parents. The responses also showed that 37.4% of the children had caught head lice at some time during the past year. This figure did not take the number of recurrences per child into account. However distressed parents complaining about head lice almost invariably emphasize the frequency with which they have to treat their children.
Monitoring is essential to determine the effectiveness in the community of measures to eradicate head lice. Prevalence and incidence studies,1,7-15 survey of healthcare providers and families at risk15-21 and expenditure on treatment and services22,25 serve as monitoring tools. In the past, official figures on infested schoolchildren were collected for England and Wales.27,28 Legislation to control lice dates back to the 19th century. Before the establishment of the School Medical Service in 1907, obligations had already been placed on school nurses under the Children Act 1902 to manage the re-admittance of children to school following exclusion for head infestation. From 1918 onwards a child with head lice has had the right to state-funded treatment (Fisher Education Act). …