To the Editor: Pediculosis capitis has been well-known since antiquity (1). Human infestation can result in psychological frustration for parents and children (2); furthermore, preventive and therapeutic practices, such as head shaving and the “no-nit” policy of excluding infected children from school, can also induce social stress.

We sought to synthesize the available evidence regarding the worldwide prevalence of lice infestation in the 21st century by conducting a literature search of PubMed and Scopus databases in which we searched for the term pediculosis. We also searched Google for the terms head lice/pediculosis capitis and individual country names and evaluated references of the articles and reports retrieved through this search. Eligible studies were archived from January 1, 2000, to January 18, 2008.

We retrieved 55 studies (Technical Appendix). Most studies referred to schoolchildren, but some involved refugees, urban slums, child labor, jails, orphanages, and fishing communities.

Most studies had been conducted in Asia; Turkey was overrepresented. Prevalence varied from 0.7% to 59% and was higher in girls and women. Of the 29 studies, 24 involved schoolchildren; the other studies involved refugee children, child laborers, the general population, street children, jail inmates, and children accompanying their mothers in prison.

In Europe, prevalence varied from 0.48% to 22.4%. However, 1 study reported a much higher annual incidence (37.4%) in England (3). A study in the Ukraine showed increasing adult representation in the overall affected population (4). Six studies involved schoolchildren; the remaining studies involved refugees, homeless persons, and the general population.

Data from Africa, with the exception of 1 study in South Africa, were derived from Egypt. Prevalence varied from 0% to 58.9% and was higher in females. The study in South Africa (5) challenges the generally accepted concept that head lice infestation refers to lower socioeconomic status; of 2 schools, 1 in a low socioeconomic status area, populated by black students only, and the other in a high socioeconomic status area, populated by students of various races, head lice infestation was found only in the second school, solely among white pupils. Of 6 studies in Egypt, 4 involved diverse populations: urban poor preschool children, orphanage children, and the general population.

Most studies in the Americas were conducted in Brazil, although we also found data from the United States, Cuba, and Argentina. Prevalence varied from 3.6% to 61.4% and was higher in females. Of 7 studies, 4 involved populations other than schoolchildren to some extent: urban slum residents, fishing community residents, adolescents and adults sampled randomly from the general population, elderly nursing home residents, and persons living with repeatedly infested children. A recent study in Brazil (6) noted that prevalence rates determined by visual inspection are twice that of rates determined by hair analysis.

Only 1 study has been performed in Oceania. This study in Australia reported prevalence of 13% and that girls were more likely to have active infection.

Our review shows that pediculosis capitis is widespread throughout the world and does not discriminate on socioeconomic status grounds. The traditional perception of head lice as a parasitosis exclusively associated with schoolchildren of low socioeconomic status is challenged by some of the reports (Technical Appendix).

Most studies underestimate overall prevalence by assessing it in a specific timeframe; to the contrary, head lice infestation is a dynamic process that can spread hypergeometrically in closed environments such as schools and in the community (7). The point-prevalence reported by Heukelbach et al (8) may represent a more accurate indicator.

Although socioeconomic status seems to be an indicator of the magnitude of lice infestation, more specific determinants are the dynamic processes of hygienic status and overcrowding. A recent study in Turkey compared 2 neighboring villages with different socioeconomic status. The only factor that was statistically significantly related to pediculosis capitis was size of the household; >6 inhabitants was associated with increased prevalence (9).

Another parameter that may indirectly influence overall prevalence and account for the leveling of the prevalence gradient between rich and poor is awareness of head lice and preventive and therapeutic practices. A study in Australia showed that although parents prefer to play a major role in prevention and treatment, they may lack insight into recent advances and dilemmas regarding these measures (10).

Variations in reported prevalence were found even in data from the same country. These differences can result from surveys being conducted during different seasons, various examination techniques, reporting of active infestation or presence of nits, and potential introduction of effective pediculicides.

Although head lice account for a substantial number of missed schooldays in children, among others, it is surprising that pediculosis capitis is not monitored and prevalence is not regularly reported. Although we cannot extinguish the parasite, effective monitoring and planning will enable us to limit the prevalence and distribution of this parasitosis.

Worldwide prevalence of head lice.

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61444-0/pdf

Insecticide resistance in head lice: clinical, parasitological and genetic aspects

Total of 7,495 children including 3,908 boys and 3,587 girls from a kindergarten and 15 primary schools were examined for head lice infestation (HLI). The overall prevalence of HLI in this study was found to be 5.8%. Head lice were much more commonly detected in girls than in boys with prevalence of 11.2% and 0.9%, respectively. Sixty-nine children with HLI were treated with 1% lindane shampoo alone (group 1), and 45 children with HLI were treated with 1% lindane shampoo and oral trimethoprim/sulfamethoxazole (group 2), and follow-up visits were conducted 2 and 4 weeks later. The children who still had HLI 2 weeks after the primary treatment were treated again. At the 2-week follow-up visit, the treatment success rates of groups 1 and 2 were 76.8% and 86.7%, respectively, and at the 4-week follow-up visit, the rates were 91.3% and 97.8%, respectively. No statistically significant synergistic effect was observed for the combination of a 1% lindane shampoo and oral trimethoprim/sulfamethoxazole.

/pdf/a-survey-on-head-lice-infestation-in-korea-2001-and-the-4fs3qgy7kk.pdf

A survey on head lice infestation in Korea (2001) and the therapeutic efficacy of oral trimethoprim/sulfamethoxazole adding to lindane shampoo.

Pediculus humanus capitis is an ectoparasite, which causes scalp pruritus particularly among children. A total of 15,373 children including 8,018 boys and 7,355 girls from 26 primary schools and 15 kindergartens attached to the primary schools and a total of 33 children from an orphanage were examined for head lice infestation (HLI). The overall prevalence of HLI in this study was 4.1% including 3.7% of the urban areas and 4.7% of the rural areas. Head lice were found more frequently in girls than in boys with prevalence of 6.5% and 1.9%, respectively. The infestation rate by school grade was 3.2%, 4.7%, 4.2%, 5.0%, 4.9%, 3.8%, and 2.1% for kindergarten, first, second, third, fourth, fifth, and sixth grades, respectively. The infestation rate of the children in an orphanage was 66.7%. The prevalence of HLI has decreased especially in the rural areas. However, HLI is a still health problem of kindergarteners and primary schoolchildren in Korea.

Prevalence of pediculosis capitis among Korean children

BACKGROUND: Pediculosis is the most prevalent parasitic infestation of humans. Resistance to pyrethrin- and pyrethroid-based pediculicides is due to knockdown (kdr)-type point mutations in the voltage-sensitive sodium channel α-subunit gene. Early detection of resistance is crucial for the selection of effective management strategies.



RESULTS:Kdr allele frequencies of lice from 14 countries were determined using the serial invasive signal amplification reaction. Lice collected from Uruguay, the United Kingdom and Australia had kdr allele frequencies of 100%, while lice from Ecuador, Papua New Guinea, South Korea and Thailand had kdr allele frequencies of 0%. The remaining seven countries investigated, including seven US populations, two Argentinian populations and populations from Brazil, Denmark, Czech Republic, Egypt and Israel, displayed variable kdr allele frequencies, ranging from 11 to 97%.



CONCLUSION: The newly developed and validated SISAR method is suitable for accurate monitoring of kdr allele frequencies in head lice. Proactive management is needed where kdr-type resistance is not yet saturated. Based on sodium channel insensitivity and its occurrence in louse populations resistant to pyrethrin- and pyrethroid-based pediculicides, the T917I mutation appears to be a key marker for resistance. Results from the Egyptian population, however, indicate that phenotypic resistance of lice with single or double mutations (M815I and/or L920F) should also be determined. Copyright © 2010 Society of Chemical Industry

/pdf/determination-of-knockdown-resistance-allele-frequencies-in-j2tq77pzbf.pdf

Determination of knockdown resistance allele frequencies in global human head louse populations using the serial invasive signal amplification reaction.

The infestation status of head louse among children attending primary schools and kindergartens in Chinju-shi, Kyongsangnam-do, Korea, was investigated between June and July 1999. Out of 2,288 children examined, 3.9% of boys (48/1,242) and 23.5% of girls (246/1,046) were infested with nits or adult/nymphs of lice. The effectiveness of lindane shampoo (1% gamma benzene hexachloride solution) was evaluated after one or two time applications to all the children infested. The negative conversion rate of pediculosis was 93.5%. Effective control measures are needed to control and prevent such ectoparasite infestation amongst children.

http://www.parasitol.kr/upload/pdf/kjp-38-41.pdf

Infestation status of head louse and treatment with lindane shampoo in children of primary school and kindergarten in Chinju-shi, Kyongsangnam-do, Korea.

Hyee Young Song

Papers

Infestation status of head louse and treatment with lindane shampoo in children of primary school and kindergarten in Chinju-shi, Kyongsangnam-do, Korea.