Head lice in pupils of a primary school in Australia and implications for control

Background Anecdotal reports suggest that head lice infestations are a common problem in school-aged children in Australia; however, only a few data are available. The present study aimed to determine the prevalence of infestation with head lice in children in an urban Australian school. Methods All 735 pupils from grades preschool to five of a government run primary school were invited to participate in the cross-sectional survey. Overall, 212 boys (46.5%) and 244 girls from 29 classes were examined. The main outcome measures were: (1) the detection of lice or eggs by visual examination of the child's head, and classification into "not infested" and "infested;" infested cases were further classified into "active infestation" (lice or viable eggs found) or "inactive infestation" (only unhatched eggs found); (2) for each child, a parent or guardian was asked to complete a standardized questionnaire. Results Of the 456 children examined, 33.7% (95% confidence interval = 95%-Cl = [26.9%, 40.4%]) had evidence of infestation with head lice, 21.0% (95%-Cl = [15.2%, 25.8%]) with active infestation. The prevalence of infestation (active plus inactive) varied greatly between classes, ranging from zero to 72.2% (p < 0.001). Head lice were more prevalent in girls than boys (p < 0.001). Analysis of questionnaires showed that 47.7% (95%-Cl = [43.0%, 52.4%]) of the children had been infested with head lice in the previous 6 months. For children with active pediculosis capitis on examination, 14.0% (95%-Cl = [7.9%, 22.4%]) of parents or guardians had not noticed the infestation. Conclusions In an urban primary school in Australia, head lice infestation was present at a hyperendemic level. Clustering by class indicated the classroom as a main source of infestation. Control strategies implemented in schools and including the education of teachers and parents need to be evaluated.