December 5, 2001

Schools Try to Stay Ahead Of Lice

But there's more to stopping infestation than just nit-picking
By Tamara Henry

Amid new worries about safety in the nation's schools is an age-old health problem that drives millions of children to the nurse's office each year: head lice.

This common communicable disease horrifies parents everywhere, from inner cities to the posh suburbs. And while the malady is not new, the increasing numbers of new treatments on the market leaves many schools and parents confused.

Cases of head lice - or pediculosis- show up mainly in elementary schools because the itchy, creepy, sesame seed-sized bugs tend to invade the scalps of children age 12 and younger. The insects crawl from head to head as young schoolchildren- who tend to have more physical contact than older kids- share clothing, hats or brushes or just huddle together to play games.

"Head lice is always a problem," says Suzanne Rue, communicable disease resource nurse for the Los Angeles Unified School District, one of the nation's largest school systems. "It crosses all ethnic groups and all economic boundaries. It's not the ‘dirty kid' syndrome. Head lice aren't just something for poor people or people whose hygiene may be questionable."

In fact, she says, lice like clean heads best "because they want to get down to the blood. They are blood mills. I would venture to say you can find head lice in almost any school district on any given day, just because it is so common."

The louse feeds on human blood and excretes a substance to prevent blood from clotting. While the "bite" into the scalp doesn't hurt, the substance can cause itching and allergic reactions. Lice have a life span of 40 days and lay about 200 eggs, called nits. Using a very strong natural "glue," the louse attaches one egg per strand of hair. The eggs hatch within seven to 10 days and mature in another seven to 10 days.

Solid statistics on head lice cases are difficult to come by. On a national level, Mary Shephard, medical information specialist for the Centers for Disease Control and Prevention, says statistics are not kept because lice are not an officially reported disease and adds that there is a "big problem with misidentification."

Other experts speculate that school districts avoid keeping their own statistics because of the stigma attached to the disease.

Companies that make head lice treatments offer their own estimates:
-Officials at ARR Health Technologies, Inc. an importer of pharmaceutical and personal care products based in Swampscott, Mass., estimate there are 21 million cases annually nationwide.
-Quantum Inc. in Eugene, Ore., a distributor of lice treatments, estimates between 6 million and 12 million children get head lice every year and says that schools have a so-called "no-nits" policy that requires that children be sent home if they have lice or nits in their hair.

(Another debate: The National Pediculosis Association supports keeping children with nits out of school as a way to prevent huge outbreaks, but the National Association of School Nurses doesn't. Judith Robinson, executive director of the nurses association, says " head lice is a nuisance" that is quite harmless, and children should not be kept from getting their education.)

Even though it's clear that lice infestation can strike anywhere, Terri Meinking, professor of dermatology at the University of Miami School of Medicine, says her research has found that states such as California, Florida and Texas have more cases of lice because of the warmer climate and influx of immigrants from Central and South America.

Years ago, head lice infestations were treated with Kerosene, gasoline and mayonnaise, or with creams, shampoos and gels laden with harmful chemicals. Parent's also shaved their children's heads. Today, remedies are more humane, using fewer chemicals and more natural ingredients.

How well these treatments work is a subject of much debate. And some experts believe that certain types of head lice have developed resistance to the prescription and over - the - counter chemical treatments.

But CDC's Shephard is skeptical of claims of "super lice" that are resistant to the most widely used lice-killing chemicals. She says that both the CDC and researchers at Harvard University's School of Public Health are studying the issue.

The super lice theory is difficult to prove, she says, because "It's hard to determine whether parents use the products as directed and to the letter, or that they pick out the nits out" as instructed.

Meinking, who says her daughter used a special shampoo eight times in six months and still had lice, believes that lice have become resistant to several of the products now in use. She says findings from her research will be reported in the February issue of Archives of Dermatology.

Strategy helps fight itchy war

Problems with estimating cases of head lice have accompanied the controversy over the best treatment of the disease.

Deborah Altschuler, president of the non-profit National Pediculosis Association, says " there's know way of measuring an increase in head lice" and changes that manufactures of special shampoos, repellents, chemical treatments and lice-removing combs create interest in their products by inflating statistics and overstating school absenteeism resulting from lice infestations.

She complains that many manufactures today set up their own expert panels on treatment. "They are not done by peer review, balanced, scientific approach," she says. " The same people who make money off doing the studies are promoting the products."

Terri Meinking, Assistant professor of dermatology at the University of Miami School of Medicine, counters that the NPA has created its own conflict of interest by developing and promoting its own remedy, a specially designed comb. And Meinking takes issue with claims that the NPA comb is all parents need to rid themselves of supplement chemical on the market:
-The NPA was the first to develop a comb. The LiceMeister, which costs $10, has closely spaced stainless steel teeth.

Diligent, thorough combing with the special $10 comb is the best solution, says Altschuler, who started NPA in Needham, Mass., in 1983, after battling head lice on her own children's heads. Proceeds from the comb go to educating the public and other NPA work, she says.

-School Nurses in the Los Angeles Unified School District use a vibrating, mechanical comb called MagiComb, which Meinking favors. The school district used a grant to buy 700 of the $47.99 combs, one for each of the 600 nurses with the extra ones lent to families. The comb, developed by an Israeli physician, uses two CC batteries.

" The comb helps to get the nits out of the hair," says Suzanne Rue, communicable disease resource nurse for the district. "The steel-coated fine teeth come out and can be cleaned."

The comb, she says, was recommended by manufactures of a popular natural, licorice-smelling treatment called Hair Clean 123. The district uses this product, too.

Taking care of head lice

There are several types of combs on the market specifically designed for dealing with lice. Follow manufacture's instructions for these combs. Directions for using a very fine-toothed comb:

Work under a good light, using a clean comb. Boil comb before using on a different people.

Divide the hair in sections and fasten off the hair that is not being worked on.

Using a comb, go through the section from the scalp to the end of the hair. You can dip the comb in a cup of water, and use a paper towel to remove any lice, nits or debris from the comb between passings.

Look through that same section of hair for attached nits (lice eggs) and live lice. Nits are always oval-shaped. While usually grayish-white, they can vary in color. Viable nits are generally laid close to the scalp but can be found anywhere on the shaft.

Wash bedding and recently worn clothing in hot water and dry in a hot dryer. Vacuuming is the safest and best way to remove lice or fallen hair with attached nits from upholstered furniture, rugs, stuff animals and car seats. Avoid lice sprays.

Use the comb to screen the infested person every day and regularly thereafter. Seeing a nit or two the day after does not mean reinfestation. However, be sure to remove nit immediately.

If additional nits (3 to 5 per day) are discovered, this may signal that live lice may be on the head. Another thorough, manual search is recommended. Daily screening is vital.

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