HEALTH: The lice wars

Yes, I have had students with them, but I will get in trouble with my principal if I talk to you about it,” whispers an elementary school teacher from a private school.
All I needed was background information. I promised to withhold all clues to her school’s identity. I promised to go to jail before I would reveal her name or school, just like those reporters who get in trouble with congressional committees.
“I never spoke to you,” said the teacher who would not budge as she hung up and probably blocked my phone number. At the school, lips are sealed when it comes to “them”
“Them” is not a problem we can blame on Katrina, but it will be interesting to see if closer living quarters and FEMA trailers will exacerbate “it” as students across southeastern Louisiana return to school this month.
A couple of Vodka martinis did loosen the lips of a former Catholic schoolgirl who vividly recalled a school outbreak way before Hurricane Betsy.
“We had an epidemic of them at St. Louis Cathedral School when I was in the fifth grade. I think it was about 1958. Mother Maria was the principal, and she was just frantic. I think Sister Hortense was around too. They called the Board of Health,” says a downtown girl who moved Uptown and sports a husband who is a member of Rex and the Boston Club.
Her sister confirmed her story.
“A nurse came and lined us all up like a cattle. She used the same comb to inspect each head. My mother said if you didn’t have them to begin with, you did after standing in that line. I was sent home with a note that I had them. But my mother went all through my hair and said I didn’t. If girls had long hair, the nurse was more likely to say you had them whether you did or not,” says the sister.
“One mother couldn’t handle it. She sent her son and daughter to my mother who took them out on our Frenchman Street balcony. First she put something that smelled like kerosene all over their hair. Then she combed out all their nits. We were inside watching and giggling. One is an attorney now, and his sister sells real estate. If you use their names, they will kill you,” says the Uptown matron as she finishes yet another vodka martini.
“Richard Simmons was going to school with us then. He was a few years younger. I don’t know for sure if he had them, but he lived in that upper end of the quarter where it all started,” she concluded.
It was hard for my sources to even speak “its” name. Of course, the feared “it” or “them” are head lice. These flat insects are about the size of a sesame seed. Six hook-like claws anchor them in place while they pierce tender scalps to feed on minuscule amounts of blood.
Head lice are more common in children than adults, girls than boys, and whites and Asians than blacks. These pieces of motorized dandruff have clung to human scalps for eons, but they prefer our little darlings. Children five to 11 years old are their favorite bait. In New Orleans, head lice are more common in the fall with return to school. Drugstores always stock up each fall with various products to get rid of head lice.
They live only on humans and can crawl, but head lice are wingless and cannot fly or hop. Nobody dies of head lice, and you can’t get them from pets unless you are a teacher with a teacher’s pet.
Close contact is the most important risk factor – not hair length. The most efficient mode of transmission is direct head-to-head contact with hair, which is more common with young girls than boys. There is minimal, if any, evidence that head lice are spread by shared hairbrushes, combs, hats and bed linen; however, I doubt if generations of mothers are totally wrong. It is not a good idea to share hair care instruments and today that non-sharing may well extend to headgear and earphones.
Adult head lice live three to four weeks. Lice never willingly leave the head for good reasons. They do not care about a child’s intelligence or lack thereof. All your run-of-the-mill head louse wants is to be close to food, shelter, warmth and moisture – and that is usually some child’s scalp.
Mature females deposit six to 10 eggs a day. Each pale gray egg or nit is cemented to a hair shaft close to the base of the scalp with a glue-like substance. After a week or so, the immature nymphs hatch and leave empty, pale nit casings on hair shafts that are easy to see. It takes two or three weeks of scalp feeding before the nymphs mature into adults to begin the life cycle over again.
These insects need a blood meal every three to six hours. Head lice survive only a day or so without eating. A live louse on a hairbrush or comb at room temperature will die of hypothermia and starvation within 48 hours. So forget about special cleaning of sheets and clothing, or the treating of earphones, baseball helmets and furniture with insecticide sprays unless you are type who enjoys suffering.
Initial infestations are often asymptomatic, but subtle scalp irritation and itching are common. Scratching can cause skin breaks and secondary infections. However, true pustules and scalp impetigo are uncommon. Over time, however, a child may develop a hypersensitivity reaction manifested as more severe itching, especially with re-infestations.
The gold standard for diagnosing head lice is to find a live one crawling on the scalp. Adult lice prefer areas of the scalp around the ears and at the nape of the neck. The typical infested child whose hair is brushed daily will harbor about 10 adult lice.
With an established infestation, there are always many more nits than adult lice so it is easier to detect the nits and especially the empty egg cases that remain attached to the hair shafts. Nits are sometimes confused with dandruff, but nits are firmly cemented in place and cannot be moved up and down the hair shaft like dandruff.
Treatment for head lice is simple and straightforward [see box]. Teachers and parents make it much more complicated than it should be. Myths abound: Head lice cannot live in sheets, furniture and stuffed animals for days. You do not have to remove the nits. Those clear egg cases are not “filled with baby lice about to come out and further infest the head.”
Beware of professional looking head lice consumer websites that promote “nit free” polices. One large nonprofit group is mostly funded by a company that sells millions of dollars of nit picking combs and kits.
“McDonough 15 sent home a note about head lice. I went nuts disinfecting everything – sheets, mattresses, the boys and even me,” e-mailed a mother who once lived in the French Quarter.
“At that same time the private schools had some cases. They were reluctant to acknowledge it, and their situation with lice exploded. Then they tried to blame its origin on the sisters and brothers of their students who went to public school.”