AN EPIDEMIC OF NITSAuthor(s): J. M. H. HopperSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 62, No.2 (March/April 1971), pp. 159-160Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41984638 .

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AN EPIDEMIC OF NITS

J. M. H. Hopper, m.b., d.p.h.1

ATITS is the popular term for the eggs of head lice, and head lice are man's most

constant associate throughout history. "The head louse is morphologically indis-

tinguishable from the body louse but has the peculiar characteristic of confining its activi- ties to the scalp or, rarely, to the beard and pubic regions. Children are chiefly affected, long-haired females most frequently. The dis- ease is very uncommon in Negroes. The lice themselves have a brief life cycle and consid- erable mobility and are not commonly seen.

The diagnosis is made chiefly from the nits which are found along the hair shafts. These are first deposited near the scalp surface at the bottom of the hair shaft and are carried out as the hair grows. The nearer the nits are to the distal ends of the hair, therefore, the longer the infestation has been present. The nits are small, oval, whitish, transparent ob- jects, about 0.5 mm. in length, firmly at- tached to one side of the hair by a chitinous sheath which completely encases the shaft. Nits may be distinguished from the scales of dandruff by the fact that they cannot easily be moved along the shaft of the hair or flicked off."*

In early November 1969 several children attending a school in Town A in southeast British Columbia, were found to have nits. Students from other schools in the area were inspected and the incidence of nits was found to vary from between 5 per cent to 15 per cent of students present. After six weeks of concentrated work by public health nurses who inspected the heads of over 2,000 stu- dents on a twice weekly basis, little or no re- duction in the percentage of children infested was noted despite intensive treatment. In oth- er parts of the health unit area public health nurses, school principals and school superin- tendents were alerted to the possibility of spread of this infestation.

During this time some local people brought pressure to bear on the health unit 1. Medical Health Officer, East Kootenay Health Unit, 2205 - 2nd Street North, Cranbrook, B.C. *A Manual of Cutaneous Medicine. Pillsbury,

Shelley, Kligman. 1965, P. 359.

staff to recommend the use of DDT dusting powder at a time when there was considera- ble public reaction to the use of this pesti- cide. There was also pressure to have the schools closed but it was felt that by closing the schools there could be no day-to-day sur- veillance and treatment of the school popula- tion. The suggestions to use DDT and to close schools were resisted.

By the Christmas holidays it became ob- vious that the public health nurses alone could not, by inspection of the students' heads and exclusion of infested students, abate the outbreak of this infestation. Volun- teers were called for and a good response was received both in quantity and quality. These volunteers, men as well as women, were informed of what to look for and how to carry out the examination. Each volunteer had his or her class which was examined every morning between 9 and 9.30. Children with nits or with questionable nits were then sent to the public health nurse or the acting school nurse who made the decision whether these were nits and, if so, the child was ex- cluded from school in order to take treat- ment. Other members of the family were also advised to take treatment. The children re- turned to school next morning for head inspection. If no nits were present they were allowed back into class. The use of the vol- unteers released the public health nurses so that they could carry out home visiting in cases which proved to be recalcitrant. It was interesting to note that no particular area of this community or no particular social class or ethnic group harboured nits more than any other.

Press releases had been issued and educa- tional sheets describing the nature and pres- entation of the problem were given to all stu- dents. These early releases stressed that this was a public health problem. It was perhaps unfortunate that the community understood this to mean that it was a problem of the public health department. Later press releases were altered semantically to say that this was a community health problem.

March/ April 1971 Health Topics 159

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Although on the average 10 per cent of students had nits in their hair very few lice were found.

Topical medication such as Kwellada, which contained the chlorinated hydrocarbon lindane, Bornex and Cuprex were available at the local pharmacy. Home remedies such as coal oil, sometimes with vinegar or olive oil added, were forms of topical medication which some persons reported using. DDT so- lution was prescribed by some family doctors to a few sufferers.

After about two months of this infestation some reaction from some families was ob- served; from the wage earner as the price of medication was high; from the infested stu- dent who was embarrassed by being excluded from class (others enjoyed a free day's holi- day); from mothers who were asked to carry out extra laundry, particularly of headwear, scarves, sheets and pillow-slips. In some schools where lockers were shared it was noted quite commonly that if one person be- came infested then two or three days later the locker partner followed suit. Sharing of lockers was, therefore, discontinued in sever- al schools. Janitors sprayed 'Raid' into empty lockers during weekend breaks. Medication and nit combs were supplied free of charge to the needy. Several samples of nits were submitted to the provincial entomologist who confirmed them as lice eggs.

Within six weeks of the commencement of the program using volunteers and public health nurses, the infestation rate among the school population had fallen from 10 to 0.06 per cent (14 out of 2,300 students).

At the same time as the outbreak in Town A was waning, reports of nit infestation were being received from other parts of the region. In one area the percentage of stu- dents affected was reported to be as high as 27 % . There was only one area, City B, where nits were seldom found. The regime described in detail in the Town A outbreak was carried out in all other areas affected. By late April and early May the outbreak of nits appeared to have come to an end.

Discussion Out of a school population of 14,500 stu-

dents, 1,680 were found to have nits (11.5%).

160 Canadian Journal of Public Health

All grades of students experienced infesta- tion but during the height of the outbreak students in Grades 7, 8 and 9 proved to be- come infested more frequently. In students attending high schools the outbreak persisted later than in other schools and towards the end of the epidemic infestation lingered on in these schools. Girls were affected about four times more frequently than boys. Girls with long hair seemed particularly prone.

Although nits were plentiful the number of lice detected was few. A number of speci- mens of nits were sent to government ento- mologists, both federal and provincial. The majority of specimens being submitted were reported to be lice eggs, the remains of lice eggs or the gelatinous material from lice eggs. The lice submitted were identified by the Provincial Laboratory as Pediculus Hu- mānus.

Persons living within this health region have been free from infestation by nits over the past 20 years and only the occasional child coming into the area was found to be infested. Initially the present outbreak of nits was attributed to the introduction of lice from outside the area. However, this view was later revised and the final hypothesis to explain this widespread outbreak was that some natural condition favouring the recru- descence of a small but a chronic focus of lice in each community, and not previously recognized, had occurred. Long hair in both boys and girls, climatic conditions, particu- larly a very mild November, may also have played a minor part. It was noted that the outbreak first occurred in a low altitude area whose climate was the most equable within the health region, it next occurred in areas of a cooler climate; in a high altitude area where the climate was, on average, cooler than elsewhere, cases were rare.

SUMMARY In a region where the presence of nits and

lice had not been manifest for a period of about 20 years, 1,680 children out of a school population of 14,500 or 11.5% were found to have nits during an epidemic of nit infestation which lasted about six months.

Details are given of the manner in which this widespread epidemic was curtailed.

Vol. 62

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