Is Hair Lice Still a Public Health Problem?

Dear Editor-in-Chief

Pediculosis capitis is a dermal parasitic disease. The causing agent, which develops the infestation in human being, is Pediculus humanus capitis. The human being is the specific host of the hair lice and this external parasite live on the scalp and the hair (1). Hair lice infestation is the most prevalent parasitic infection among children (2). It is a worldwide problem, with more frequency in developing countries (3). The highest degree of prevalence is seen among children 3–11 yr old, more in girls than boys is. Establishing a diagnosis requires observing the live lice instead of simply observing the hatched empty eggshells (nits). Combing is also a more effective way of detecting than visual inspection (2). All members of the family and the friends of the infested person should be inspected as well (4). Since louse is an obligate parasite and needs to nourish from human blood, it cannot stay alive in the absence of the host. Thus, the major way of transmission is head-to-head contact. The transmission via fomites such as, hat, comb, bedding and hair accessories may occur (2).

Despite using strong insecticides and parents and health staff attempts, the management of head louse infestation is still aborted in many countries (5). The epidemiological studies in Europe indicate the great variety of the prevalence of 1% to 20% (1). In Iran, different prevalence rates have been reported among school going children in various parts of the country. The general prevalence is 4.7% (1.6% boys and 8.8% girls) (3).

Ineffective control of hair lice is due to using ineffective pediculicides, increasing resistance of the lice against current pediculicides and the neurotoxic side effect of most of the pediculicides. Other factors include employing methods without proved clinical effectiveness, ignoring the transmission routes, the social stigma of the parents of the infested children. Therefore, the hair lice still remain a worldwide health problem among children (2, 5).

In Iran, regarding the health and social progress in recent decades as well as educational enhancement of many parents, especially in large cities, people do not expect to find their children infested by hair lice. They consider the problem as something belonging to the past. In Iran, with increasing presence of women in different social fields and activities, the lifestyle is changing and many people send their children to daycare centers from early childhood. On the other hand, because of poor health super visionary action on the functions of day care centers, preschools and schools, and lack of knowledge of parents about the transmission routes and preventive measures, hair lice remains as a problem in the country. On the other hand, the management of the disease is becoming more difficult regarding the easy transmission, side effects of the treatment, and the increasing resistance of the hair lice to pediculicides. As a result, increasing the awareness of parents, day care staff and school health educators on prevention methods are necessary for effective control of the infestation.