Running head: EPIDEMIOLOGY AND THE NURSE'S ROLE: PEDICULOSIS 1

Epidemiology and the Nurse's Role: Pediculosis

John Christensen

Grand Canyon University

Community Nursing

NSG 403

Sherri Spicer

October 4, 2015
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Epidemiology and the Nurse's Role: Pediculosis

Introduction:

Louse is the common name given to the more than 3000 species of insect that are obligate

ectoparasites that effect most avian and mammalian species. An ectoparasite refers to any

parasitic organism that lives on the outside of its host. Louse often live on the skin and hair of

other organisms and feed off of skin cells, sebaceous secretions, and the blood of their host

organisms. Obligates also known as holoparasites, are parasitic organisms that depend on a

suitable host in order to complete their lifecycle. In the case of louse they have a 3 stage life

cycle in which all three stages depend on their host for survival ("Louse," 2014).

Clinical Description:

The most common symptom of Pediculosis is itching of the scalp and other areas of body

hair. The most common sign is the presence of lice and nits (eggs) that are found in the hair, the

nape of the neck and behind the ears (CDC, 2013). Nits are laid by adult female lice at the base

of hair shafts where the temperature from human body heat is just right for incubation. The nit

incubates for 6-12 days and then hatches, they then immediately need a blood meal from their

hosts in order to survive (Euchner, 2015). The lice are thought to feed up to six times per day,

and with each blood meal there is lice saliva that is inoculated into the skin of the host. As a

result the host becomes sensitized by the lice antigens and waste, this elicits an inflammatory

response causing sores and itching (Madke & Khopkar, 2012).

Diagnosis of a lice infestation is usually done by sharp observation skills by the attending

physician. After a brief assessment of a patient’s reported symptoms (itching), the physician will

need to search for the presence of nits either by observing in the hair or by using a nit comb to

comb nits and lice out of the hair of the patient. Also the use of magnifying glass may be needed
EPIDEMIOLOGY AND THE NURSE'S ROLE: PEDICULOSIS 3

to make an accurate diagnosis as to confirm that some of the lice are living and present in

multiple stages of their life cycle (Madke & Khopkar, 2012).

Treatment of a lice infestation are all similar in that they often entail using

pharmaceuticals in the hair to treat the scalp and hair. The most common items used are hair

shampoos that can be purchased over the counter, such as items containing 0.3% pyrethrin and

permethrin creams. It is recommended that if these items are used that they must be reapplied by

day 9 after the initial use to ensure that all nits and live lice have been killed effectively. If the

patient has a more serious infestation or over the counter treatments have not worked, the

physician can write a prescription for Sklice or Natroba that are much more effective at killing

lice and nits (Feldmeier, 2014). The CDC also recommends washing all clothing, bedding,

towels, brushes, and combs in hot soapy water. All non-washable items need to be placed in a

sealed plastic bag for 14 days, this is because human lice cannot survive away from a host for

longer than this period (Ford, 2014).

Treatments aimed at killing live lice and nymph (immature) lice are very effective, but

the over the counter treatments are not as effective at killing the nits. This is why the CDC

recommends two treatments to ensure that any nymphs that hatched from surviving eggs from

the first treatment are killed off by the second treatment. Causes of therapeutic failure are

usually due to misdiagnosis by physicians, non-compliance of using lice killing agents as

prescribed, and re-infestation from hair to hair contact with other hosts and/or sharing clothing,

towels, bedding or other items from an infested individual (Feldmeier, 2014).

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Epidemiological Model:

Host: Humans: Pediatric population (ages 3 – 13)

Pediculosis

Agent: Head and Body Louse Environment: Human body

sebaceous glands and hair follicles.
Direct contact and shared items.

The Agent, Host, and Environmental Characteristics:

The Agent of pediculosis is a pervasive parasitic skin disease that is caused by an

infestation by Pediculus humanus, or the human louse and more commonly called lice (Hellwig

& Horn, 2015). There are two distinct species of lice. Pediculus humanus is the most common

type to infect humans. There are two subtypes to this species, Pediculus humanus capitis or head

lice and Pediculus humanus humanus, also known as body lice. These are ecotypes or ecospecies

in that they differ from one another due to environmental differences, in this case they reside in

two distinct locales of the human body (Veracx & Raoult, 2012). The second species of lice that

infect humans is Phthirus pubis also known as pubic lice. Pubic lice are a sexually transmitted

disease and will not be discussed in this report.

The hosts are any member of the human species. The lice agents of pediculosis are

known to infect only humans, and can only survive off of blood meals from a human host and

are specifically adapted to living at the temperature/moisture conditions present on the human
EPIDEMIOLOGY AND THE NURSE'S ROLE: PEDICULOSIS 5

scalp. Lice infestations are especially common among school aged children (Madke & Khopkar,

2012).

The environment in which lice infestations proliferate are in large populations of

children. The pediatric ages associated with lice infestations range from 3 – 15 years of age.

Female children are more susceptible than males, this is due to gender and social differences.

Young girls often come into close hair to hair contact or they may share items that are used in the

hair such as hats, combs, hair ties, scarves and other items that may come into close proximity to

the hair. It is also more prevalent in rural or developing populations, this is thought to be due to

a difference in hair length and because of socio-economic reasons (Madke & Khopkar, 2012).

Global Impact of Pediculosis:

Globally lice infests their human hosts on every corner of the globe. Pediculosis is an

endemic disease in third world nations and developing countries and it is more prevalent in girls

just as it is seen here in the United States. Prevalence of infections are thought to be as high as

58.9% in Africa and range from 3.6% – 61.4% in South America, and range from 0.5% - 22.4%

in European nations. Here in the United States prevalence rates range from 10%-40% with most

infestations occurring during the summer and fall months (Guenther, 2015).

Locally in Maricopa, the county health department does not have anything specifically

written about pediculosis and lice infestations. All inquiries about an infestation redirect the

reader to the CDC website. The Arizona Department of Public Health has a communicable

disease resource guide that informs readers about what head lice is and steps in prevention,

control and treatments of lice infestations (Ford, 2014). They also have it listed as a reportable

disease, however they do not have any information regarding the prevalence of cases in the state

of Arizona. At the National level there is the Center for Disease Control (CDC). The CDC
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website has many resources on pediculosis including pictures of what lice look like under

microscopes. They also give information on how to diagnose an infestation as well as available

treatment options. For worldwide implications the CDC website is also a great resource because

it has worldwide data on the prevalence of lice infestations broken down by country and the

populations most affected (CDC, 2013).

The Nursing Role:

Professional nurses on the other hand can play a major role in the surveillance of

pediculosis. Since there is such a high prevalence of lice and pediculosis in pediatric populations

and school aged children, the role of nurse surveillance is usually played by pediatric nurses and

more importantly by school nurses. Pediculosis is no longer on the National Notifiable Disease

Surveillance System (NNDSS), therefore doctors are not obligated to report findings of lice to

any state or federal government agencies. However it is still recommended that the parents

infected children let the school know that their child has an infestation. School and pediatric

nurses are at the front lines of preventing, analyzing, and reporting cases of Pediculosis (Pontius,

2014).

The first step in surveillance of pediculosis is case finding. Pediatric and school nurses

should know how to accurately screen children for pediculosis infestations. In the past nurses

used to full classroom checks where everyone was screened for lice. This was later found to be

wasteful of valuable education time and nurse resources. Nurses can detect infestations by the

use of wet combing, in which hair is made damp and then it is run through with a fine toothed nit

comb. The immersion in water actually makes lice become motionless. The use of the fine

toothed comb then allows for the capture of lice and accurate diagnosis. The nurse can also
EPIDEMIOLOGY AND THE NURSE'S ROLE: PEDICULOSIS 7

teach these skills to parents so that they can also detect the presence of lice on their children

(Ibarra, 2010).

From this point the nurse must next report the presence of pediculosis to the proper health

department. As of 2015 pediculosis is no longer a reportable disease. However cases can still be

reported for research purposes, however reporting is no longer required. Some states however

may still require the voluntary reporting of disease prevalence. Nurses must refer to state laws in

order to see if reporting of pediculosis is required. Furthermore even though individual cases are

not reportable, the CDC and Arizona Department of Health require nurses to report any sudden

outbreaks of pediculosis (Pontius, 2014)

Next the nurse must collect data and analyze it. In the school setting the nurse can

carefully record the names of students who they believe have pediculosis and they can also keep

track of those cases reported by parents. After this data has been gathered the nurse can then

evaluate the information in terms of demographics and comparisons with epidemiological data.

In the past the school nurse would send a letter to parents informing them of the presence of lice,

however it was found that letters sent home did not prevent the transmission of pediculosis and it

was found to be a violation of confidentiality and privacy. Now nurses are required to report to a

health agency only if an outbreak of pediculosis is suspected (Pontius, 2014).

The nurse can plan follow up care if needed. This entails using further screening at the 9

day mark after the first treatment. This is to ensure that the patient is nit free and free from

living lice infestation. If there still appears to be a presence of lice, a second application of

medication may be recommended. The nurse can also depend on the parents to ensure that

proper care has been taken to use the treatment on the patient. Some interventions to help

prevent the spread of pediculosis is to have children limit hair to hair contact with one another.
EPIDEMIOLOGY AND THE NURSE'S ROLE: PEDICULOSIS 8

Also they must teach children to carefully guard items that come in contact with hair. Hats, hair

ties, scarves, and like items should all be guarded carefully by school children in order to prevent

the spread of head lice. Clothing items must also be refrained from sharing with one another in

order to prevent spread of body lice (Pontius, 2014).

Conclusion:

In conclusion it is important that all nurses be aware of diseases that affect their

communities. They must also be prepared to know where to look to find pertinent information

regarding the disease process and learn ways of diagnosing and treating the disease. Finally the

nurse should know how to conduct surveillance of the disease in question. Information must

then be carefully compiled and then reported to the proper health departments. Finally the nurse

must then stay in contact and follow up with all infected patients that they attended to.
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References

Center for Disease Control and Prevention. (2013). Parasites - Lice. Retrieved from

http://www.cdc.gov/parasites/lice/

Euchner, R. (2015). Body Lice. In Salem Press Encyclopedia of Health. Retrieved from

http://library.gcu.edu

Feldmeier, H. (2014). Treatment of Pediculosis Capitis: A Critical Appraisal of the Current

Literature. . American Journal Of Clinical Dermatology, 15(5), 401-412.

http://dx.doi.org/10.1007/s40257-014-0094-4

Ford, K. (2014). Communicable Disease Resource Guide. Retrieved from Arizona Department

of Health Services: http://www.azdhs.gov/phs/owch/pdf/communicable-disease-resource-

guide.pdf

Guenther, L. (2015). Pediculosis and Pthiriasis. Retrieved from

http://emedicine.medscape.com/article/225013-overview#a5

Hellwig, J., & Horn, D. L. (2015, January). Head Lice. Salem Press Encyclopedia of Health, 2.

Ibarra, J. (2010). Diagnosis of head lice in the community. British Journal Of School Nursing,

5(4), 191. Retrieved from www.library.gcu.edu

Louse. (2014). In Funk & Wagnalls New World Encyclopedia (1, p. 1). Retrieved from

http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true

&db=funk&AN=LO094500&site=eds-live&scope=site

Madke, B., & Khopkar, U. (2012). Pediculosis Capitis: An Update. Indian Journal Of

Dermatology, Venereology & Leprology, 78(4), 429-438. http://dx.doi.org/10.4103/0378-

6323.98072
EPIDEMIOLOGY AND THE NURSE'S ROLE: PEDICULOSIS 10

Pontius, D. J. (2014). Demystifying Pediculosis: School Nurses Taking the Lead. Pediatric

Nursing, 40(5), 226-235.

Veracx, A., & Raoult, D. (2012). Biology and genetics of human head and body lice. Trends In

Parasitology, 28(12), 563-571. http://dx.doi.org/10.1016/j.pt.2012.09.003