From School Health Highlights, a publication by
New York City Dept. of Health; Spring 1998
|by Deborah Z. Altschuler
President and founder of the National Pediculosis
Association (NPA) and Adjunct Assistant Professor of Preventive Medicine
at the Uniformed Services Medical University in Bethesda
Since it's grass-roots beginnings in
1982, the National Pediculosis Association, lnc.(NPA) the only non-profit health
agency dedicated to protecting children from the misuse and abuse of pesticides,
has focused its efforts on helping parents make informed decisions about
treating their children and themselves for head lice. For many years we
apologized for head lice (pediculosis), saying that it was not a 'designer
disease". Pediculosis as a health problem did not have "cause" appeal. There
were no legions of workers to help get the word out. On the contrary, head lice
have long been a distasteful subject to many people which makes the NPA's
mission a difficult one.
At the basic level, the NPA's
mission is to encourage schools, camps, child care centers and other facilities
where children congregate to adopt appropriate and standardized lice management
programs. Bogged down with a full plate of other issues - many of them important
as well - these facilities have often assigned lice a low priority. The result
in 1998 is a childhood population endemically infested with blood-obligate
parasites and often on the receiving end of over-zealous, potentially harmful
and often repeated pesticide applications.
Looking at the big picture,
complacency about head lice fosters a complacency about public health standards.
How can parents be expected to deal with an emotionally charged issue like AIDS
for example, if they have never been expected to play a role in controlling even
a widespread communicable disease like pediculosis?
Lice management programs can serve
as a model of responsible public health behavior. By promoting rational
responses to children with head lice, we at the NPA are working to create a
climate of accountability in which parents can become resourceful and
self-reliant for the sake of their families and their communities. Parents can
learn not only to accept their role in keeping their children lice-free, but
also to embrace the highest public health standards.
It is important to remember that
no commercial remedy on the market today is 100% effective in killing both lice
and nits. Moreover, there is documentation that lice have developed resistance
to a variety of the available treatment products. Reports to the NPA's National
Reporting Registry document the fact that treatment failures are common.
Frustration and disruption abound while everyone involved suffers.
The NPA recommends that
communities learn about head lice before an outbreak occurs. Parents need to
know what head lice and their eggs, called nits, look like. They must also know
how to screen, detect, and remove lice and nits. The NPA recommends a special
comb to accomplish this public health measure (Editor's note: As a public
agency, the DOH cannot recommend a particular product).
The NPA has long discouraged the
continual reliance on any one particular treatment of choice. Product
recommendations must be fit to the specific needs and vulnerabilities of
patients, their families, and their communities. Public health education,
awareness, routine screening and the earliest possible detection of an
infestation remains the best preventive edge against the head louse.
the Doctor's Desk:
|by Gary Krigman, MD
The perpetrator wreaks havoc each year at schools throughout the city.
It moves from person to person in discrete, inconspicuous ways and may cause
mild discomfort or obvious unsightly infestation on hair shafts. Occasionally it
may be seen creeping across one's forehead searching for
territories to conquer.
ITS NAME: pediculus capitis or also known as the human head louse.
ITS WHEREABOUTS: Worldwide
ITS CRIMES: Public menacing and disorderly conduct. It not
infrequently is responsible for inciting parents to riot or causing public
ITS DEFENSES: It is armed with enzymes which allow its eggs (nits) to
adhere to, hair shafts. They mature and hatch producing a new generation,
immediately ready for combat. Over time, they have developed defense mechanisms
which make them resistant to our arsenal of medications.
We are increasingly aware of our need to strategize and develop a citywide
plan against the enemy. Our efforts must be directed toward public health
education to parents, children, and school staff. As each school year begins, a
vigorous campaign should begin. We certainly cannot completely eliminate the
menace, but as the public becomes more knowledgeable and as control measures are
instituted we should gradually see a reduction in the spread and hysteria.
Our charge is to develop informational materials which introduce the topic to
all parents and prepare them for the possible eventual outbreak at their school.
Providing this information at the start of the school year would hopefully
reduce the myths that conditions at the school or that specific children are the
root of the problem.
As a public health program, our efforts should be directed towards prevention
and public health education. It is not our role to promote specific products or
treatment. We can acquaint parents with the variety of possible treatments and
special measures to follow to result in complete elimination of head lice and
Our policy remains a "no nits" policy in spite of the controversy over the
necessity to exclude children with visible nits if they have been treated. Our
position is that it would be unrealistic to expect school staff as well as
Bureau of School Health staff to distinguish dead nits from live nits. Thus, we
must help parents and children through this "inconvenience". We must be prepared
to answer questions regarding pediculosis when posed to us; to assist school
administrators and staff in implementing protocols for identification and
control; and overall to provide the necessary support which schools require to
deal with a time consuming, unwelcome perennial menace.