An interview with the bug buster

David Buffin recently met up with Joanna Ibarra to discuss her work promoting the use of non-chemical control for head lice problems.

Could you outline the role of Community Hygiene Concern?
We are a voluntary non-profit-making charity set up in 1988 with the specific aim of helping parents and professionals to over-come the head louse problem and other common UK parasitic problems. We are here to protect people and pets from toxic chemicals that are used to controls these parasites. We are particularly concerned about the carbamate carbaryl, the organophosphate mal-athion and the synthetic pyrethroids permethrin and phenothrin. These chemicals are all nerve poisons used on young sensitive heads.

What is the average age of children being treated for head lice?
Seven is the peak age group of children who are treated. Until recently, most of the chemical treatments suggest that the entire family should be dosed at the same time as the child. This would mean many pregnant mothers and nursing mothers were also treated. 
    Little information is available on the direct effects of these chemicals on children as all the toxicity is based on full grown adults.

Are there any reporting systems in the UK which record adverse effects from pesticide head lice treatment?
There is a Yellow Card system whereby GPs report on any adverse effects noticed from prescribed treatment. However some adverse effects could go unreported because many head lice treatments are bought over the counter of chemists without the involvement of GPs. We are much more likely to pick up on adverse effects being reported to our help line.

Could you explain your solution to the problem - the Bug Busting Kit?
When we first started, our main concern was making sure that parents had a reliable method of detection. On average there are only 10 lice on an infested head, and you are not going to find them looking through dry hair, because the dry louse moves away from disturbance very quickly.
    I was looking for something to alert people to the problem. I found that washing the hair with ordinary shampoo wets any there. While a louse is really wet it stays still and then can be simply lifted out with a special fine tooth plastic comb. Lice are much easier to spot on the comb than on the head.
    The Bug Busting Programme relies heavily on involving children. They get really enthusiastic about the programme-giving them the comb and making it fun. They can help get information to parents, and make sure that it all happens together in the home on the evening of 31 October (Bug Busting Day).
    We have developed the programme further using 'action research methodology' which seeks to bring about change by trying out new ideas and checking whether they work. This process carries on in an endless spiral until you have got to the ultimate comb, as we did!
    We realised removing all hatched lice on the head breaks the life cycle of the louse completely. The hatching period is 10 days. On day one you remove all the hatched lice and then you repeat on day four and a further two times at the same intervals: the last session occurs on day 13. In this way you can remove all the lice as they hatch from the eggs that were on the head.

Is there an official treatment policy in the UK?
The Department of Health (DoH) supports our work and wants the kit to be used widely, because you only need one kit per family. This would save the National Health Service (NHS) an enormous amount on their prescribing budget.
    However, we are worried by the fact that the British National Formulary (set up by the British Medical Association in conjunction with the Royal Pharmaceutical Society) recommends double dosing whereby children are doubly exposed to the pesticides. During 1999 some 20,000 community nurses whose will be trained to prescribe for head infestation. The National Prescribing Centre recommends that they allow for two applications per year.

How do you raise awareness about Bug Busting Kits?
The number we currently distribute is still low. We would be delighted that more people were aware of it. We hope to do this by influencing the nursing training programme.
    In 1997 the Public Health Medicines and Environment Group set up a working party to look at head louse treatment policy. It comprised doctors and nurses and included a medical entomologist from the London School of Hygiene and Tropical Medicine and myself.  A break away minority, three public health doctors advised by the Medical Entomology Centre, called the Stafford Group, then pronounced against any community level use of the Bug Busting method (wet combing) for treatment on the grounds that evidence of efficacy is lacking. They claim the only scientific evidence proves the efficacy of licensed pesticide medicines. This is highly inaccurate. We have case studies which show that Bug Busting is effective if you follow the instructions and use the right comb.
    We will publish the results later on in the year. We have presented a series of reports to the DoH which will be available on our website. This is more reliable than the pre-launch data for medicines, which rarely tests egg kill on genuine head lice, and does not include post-monitoring for development of resistance.

[This article first appeared in Pesticides News No.45, September 1999, page 19]