Real-time nits register needed to reduce rates of ‘hidden’ disease - expert

Health researchers are calling for the establishment of a real-time register of head lice cases to help reduce growing rates of the disease around New Zealand.

Latest Ministry of Health data shows the number of subsidised prescriptions for the treatment of head lice reached 25,848 in 2022, up 27% over the past five years. Some North Island regions have experienced increases of up to 185% over this period.^[1]

Experts say the lack of accurate data on head lice prevalence in the country has hindered effective research and preventive measures, leaving many children and whanau vulnerable to infestations.

Kate Ricketts, founder of ISpyNits, the world’s first treatment designed to address the entire lifecycle of lice, while at the same time tackling the stigma associated with the condition, says the increase in prescriptions is concerning as many of these are likely to be more severe cases.

She says while indicative of a growing health issue, the Ministry’s prescription data is historical and represents only one cohort of patients, and there is no existing tool for recording cases of the condition - or the targeted dissemination of this information in real-time.

International research shows New Zealand is one of the few developed countries in the world, where the nationwide prevalence of head lice (pediculosis capitis) is unknown.^[2]

Ricketts, who holds a postgraduate research Masters degree says her work with researchers at the University of Auckland in developing a new fluorescent powder to identify lice eggs in low light highlighted the lack of local data - which has forced scientists to extrapolate rates based on those of other countries.

She says the establishment of a nits tracking tool would be world-leading and could help reduce thousands of unnecessary doctor visits and school absences each year.

“Currently pediculosis (head lice infestation) is not a notifiable condition and nits do not transmit any infectious diseases; however children often scratch so much that infections occur on the scalp - in some cases these can be severe.

“If caught in its early stages, head lice can be treated by over-the-counter products. Many of the cases reflected in the Ministry’s data are likely to represent our most vulnerable tamariki. These more severe cases may have been referred to a doctor by a social worker or another support organisation.

“With greater awareness of localised outbreaks and earlier intervention we may be able to reduce the 25,000+ subsidised visits annually to a GP to generate a prescription for a condition that could be addressed in pharmacy or by purchasing a kit at school,” she says.

Ricketts says the stigma associated with the condition is a significant barrier to treatment and contributes to the number of outbreaks that occur regularly throughout regional New Zealand.

The proposed crowdsourced register of head lice, which Ricketts says could be modelled on COVID-19 tracer technology used during the pandemic, would allow parents and caregivers to anonymously log a case of nits online or via a mobile device.

Schools and health care providers could then be alerted to outbreaks in their area, helping to raise local awareness and support with treatment advice.

“Currently, the data on head lice in New Zealand is limited and mainly extrapolated from research conducted in Australia. This lack of local data has hindered academic research and the development of effective strategies to combat the issue.

“The absence of accurate information also poses challenges in securing funding for necessary education and treatment initiatives,” she says.

Ricketts says the proposed nits register aims to bridge this data gap and provide valuable insights into the prevalence and severity of head lice infestations. By aggregating anonymous reports, the register would enable researchers, universities, and public health authorities to conduct in-depth analyses and develop targeted interventions.

“One of the key benefits of the nits register would be its ability to provide real-time data on head lice clusters. By mapping out hotspots on a regional level, parents, schools, and communities can be alerted to potential outbreaks, allowing for prompt preventive measures and treatment.

She says the need for a nits register is particularly crucial in regions experiencing significant population growth, such as Auckland and Christchurch. The rise in high-density housing and overcrowded schools has created an environment conducive to the spread of head lice. The register would help identify areas with the highest risk and enable proactive measures to be implemented.

“The nits register would play a vital role in raising awareness about head lice and dispelling misconceptions. The stigma associated with head lice often leads to underreporting, resulting in an inaccurate representation of the problem. By providing concrete data, the register would help combat the stigma and encourage open discussions about prevention and treatment,” she says.

The Ministry of Health advises tamariki stay away from school or kura while infected with lice until treatment has begun - which Ricketts says can contribute to increased school and workplace absenteeism and social stigma for some of our most vulnerable.^[3]

“What we know about head lice is that the time lag between infection and diagnosis is often long enough for nits to spread through an entire classroom. While keeping students at home during treatment can be a prudent step in eradication in some cases, the reality is a more comprehensive approach is needed to reduce disruption to their education,” she says.

Ricketts says she is currently seeking funding for the development of the nits index and is looking to collaborate with organisations and technology providers interested in helping to address growing rates of the condition in New Zealand communities.