Conclusions Human body lice
9.9. Conclusions
The majority of environmental health and public health workers currently consider body lice a low priority. The exception to this is a small group of investigators who have iden- tified residual body louse populations as potentially active vectors of disease causing orga- nisms, mainly rickettsiae – some of which are zoonotic. The survival of both body lice and the diseases they have carried for the past half century, despite intensive efforts to eradicate them in the middle of the 20th century, indicates that they are not in decline. Indeed, the limited and often anecdotal information about body louse infestation in populations in high- and middle-income countries suggests that levels of infestation are increasing slowly, despite various efforts to reduce poverty and deprivation. Irrespective of the possibility of body louse prevalence increasing, the risk of disease trans- mission to a larger segment of the populace remains, because rickettsial organisms are spread primarily by dried faecal matter that can drift on air currents from the clothing of infested individuals to others in the vicinity that are not infested. Any services directed towards the homeless also require some matched services for the remainder of society, because body lice carry a greater stigma than other infestations and because the public facilities established long ago for dealing with this infestation have now disappeared from most countries. To reduce the risk of disease from body louse infestations, some policy options should be consi- dered by environmental and public health services as a first stage of the process: • make voluntary organizations that offer assistance to homeless and vagrant people more aware of body lice and their disease vector capacity; • monitor lousiness through medical services directed towards the homeless community, especially when an infestation is associated with febrile illness; • advise the homeless about louse-borne disease, with the aim to encourage them to seek help; • increase the availability of treatment options for lousiness – such as disinfestation or replacement of clothing, the use of impregnated materials, and possibly group iver- mectin therapy Foucault et al., 2006 – to reduce the prevalence of lice; and Human body lice 296 control, although the actual resistance of body lice throughout most of the world is cur- rently completely unknown. Following the use of pyrethrin and DDT in controlling outbreaks of louse-borne typhus in North Africa and central Italy during the Second World War, neurotoxic insecticides – first DDT, then lindane, followed by malathion and permethrin – became the treat- ments of choice until resistance rendered most of them ineffective in mass treatment pro- grammes Hurlburt, Altman Nibley, 1952; Kitaoka, 1952; Nicoli Sautet, 1955; Miller et al., 1972; Cole et al., 1973; Sholdt et al., 1977; Gratz, 1985.9.7.3.1. Impregnated fabric
Fabrics impregnated with insecticides are one way to prevent or restrict body louse infes- tations. Where deemed a viable option, treating the garments of people likely to be affec- ted is the approach of choice. For example, among other functions, impregnation of mili- tary uniforms with permethrin may help to prevent their infestation should exposures arise – say, through contact with refugees or prisoners of war who have acquired a body louse infestation. Impregnation of clothing of so-called at-risk groups, such as vagrants in high- and middle-income communities or people living in areas where body louse infestation is endemic, is often impractical, as it is usually easier to provide alternative means of control – for example, by offering replacement clothing or by treating garments with heat. Under some circumstances, it may be possible to use impregnation as a control measure – for example, under conditions of social disruption. Products applied to skin are inappropriate for control of body lice, as the insects colonize clothing rather than the skin.9.8. Benchmarks for lice management
Parts
» TAP.COM - PUBLIC HEALTH SIGNIFICANCE OF URBAN PESTS - WHO/EUROPE - WORLD ...
» Risk of developing allergic sensitization
» Risk factors for developing asthma
» Public health impact of urban asthma
» Dust sampling Airborne sampling Comparison of various methods of allergen exposure assessment
» Cockroach sensitization and asthma
» Size characteristics of airborne mouse and rat allergens Residential exposures
» Dust mites Studies examining thresholds of exposure relevant to disease
» Cockroaches Rodents Studies examining thresholds of exposure relevant to disease
» Comprehensive avoidance of dust mite allergens Multifaceted primary prevention studies
» Limited avoidance of dust mite allergens
» Targeting housing conditions of high-risk groups
» Smokybrown cockroach American cockroach Oriental cockroach
» Brownbanded cockroach Allergy and asthma overview
» Food contamination and disease transmission
» Cost of control and management
» Impact of poverty Cockroaches
» Public costs 1. Cost of health-related conditions
» IPM of cockroaches Cockroaches
» Baits Cockroach control: pesticide applications
» Alternative strategies Cockroach control: sanitation practices
» Biological control Conclusions Cockroaches
» Origins and natural history Habitats within the home
» Food Limiting factors Distribution in Europe and N orth America
» CEH Distribution in Europe and N orth America
» The building envelope Impact of building construction
» The ventilation and heating system
» Furniture and furnishings Overall effect of the housing environment on health or illness
» Sampling methods Dust mite and allergen inspection and detection methods
» Mechanical solutions Modifying environmental conditions
» Washing Dusting Dry cleaning Vacuuming
» Home disinfectants Electric blankets Bed heaters Freezing
» Sunlight Steam cleaning Cleaning
» Autoclaving Steam cleaning Temperature control
» Barrier fabrics Temperature control
» Habitat modification Carpets Physical control methods
» Soft furnishings Air filters
» Anti-allergy sprays Antimicrobial treatments Dehumidifiers
» Pesticides Building construction Methods of house dust mite control
» Control methods Medical practitioners Other
» Background Biology and bionomics
» Other species of Cimicidae that can affect people
» Evidence of resurgence in N orth America
» Future prospects Resurgence of bedbug populations in Europe and North America
» Importance as pests Economic impact Bites and health effects
» Conducive environmental conditions An integrated approach to bedbug management
» Physical removal Exclusion Physical removal and exclusion
» Inspection Detection Inspection, detection and education
» Heat Cold Controlled atmospheres
» Use of pest management products
» Benchmarks for success in bedbug management Conclusions
» Introduction Flea biology Fleas
» Health risk and exposure assessment
» Cost for control and management
» Cost of health-related conditions
» Flea exclusion and physical removal Pesticide applications for flea control
» Foggers General surface treatments IGRs
» On-animal products Conducive environmental conditions
» Pharaoh ant biology Overview of biology and distribution in Europe and North America
» Health hazards 1. Pharaoh ant infestations: pathogen transmission and contamination
» Pharaoh ant distribution and population monitoring
» Fire ant population assessment and monitoring methods
» Fire ant geographic range and potential expansion Fire ants: stinging incidents
» Fire ants: cost of eradication
» Physical exclusion Residual contact insecticides
» Insecticidal baits Fire ants: cost of health-related issues, control and management
» Efficacy of management practices
» Implementation of fire ant control programmes
» Confirmation. Determine where control is needed.
» Fire ants Emerging problems and policy options
» Introduction Biology and bionomics of filth flies in Europe and North America
» N uisance Health hazards 1. Diseases
» Myiasis Health hazards 1. Diseases
» Pesticide applications for fly control Granular baits
» Fly exclusion practices Crack-and-crevice treatments Biological control
» Ultraviolet light traps Sticky traps Jar or bag traps Window traps
» Attractants Perimeter treatments Fly management
» Togaviridae: genus Alphavirus Viruses
» Orthomyxoviridae: genus Orthomyxovirus Bacteria
» Coxiellaceae Anaplasmataceae Spirochaetaceae Bacteria
» Regular nonsporing Gram-positive rods Mycobacteriaceae
» Microsporidia Babesiidae Eimeriidae Protozoa
» Zoonoses and sapronoses of wild birds in the urban ecosystem
» Monitoring and surveillance Management implications 1. Benchmarks
» Techniques for dispersing birds in cities
» Control of wild and feral birds in urban areas
» Economic impact of wild urban birds on human health and of controlling birds
» Introduction Human body lice
» Biological factors Implications for public health
» Louse infestation in Europe and North America
» Physical removal Pesticides Louse management 1. Inspection and detection
» Socioeconomic influences Conducive environmental conditions
» Benchmarks for lice management
» Introduction Ticks of Europe and North America
» LB in Europe and N orth America
» Geographical distribution Lyme borreliosis
» Public health impact of TBE in Europe
» Geographical distribution Geographical distribution Epizootiology and epidemiology
» HME HGA Crimean-Congo haemorrhagic fever
» Boutonneuse fever Rickettsia helvetica
» Clothing Tick removal Clothing impregnation Vaccination
» Host-centred methods Habitat manipulation and urban design
» Tick and tick-borne disease surveillance IPM
» Public activities Pesticide applications
» Surveillance and management Research
» Other mosquito-borne viral infections that cause encephalitides
» Malaria Mosquitoes as a pest nuisance
» Dengue haemorrhagic fever and yellow fever
» Dirofilariasis The spread of mosquitoes and mosquito-borne pathogens
» National reporting and Mosquitoes
» Mosquito control and management
» Sanitation and water management
» Adulticiding Larviciding Mosquito monitoring
» Use of predators biological control Passive protection
» Genetic control and transgenic mosquitoes
» Feeding Biology of commensal rodents 1. Description and natural history
» Reproduction and life cycle of commensal rodents
» Behaviour relevant to control
» Movement Biology of commensal rodents 1. Description and natural history
» Population growth and socialization of commensal rodents
» Sewers and drains Association with urban infrastructure 1. Rodents in housing
» Case study 1 – rat bites in Philadelphia: identifying the factors contributing to risk
» Zoonoses of mice Public health risks in urban areas
» Case study 2: Fairhill case study
» Tree squirrels Types, distribution and abundance
» Chipmunks Ground squirrels, antelope ground squirrels and prairie dogs
» Hamsters Voles Types, distribution and abundance
» Beavers Types, distribution and abundance
» Rabbits and hares Types, distribution and abundance
» Francisella tularensis Major rodent- and lagomorph-related bacterial and rickettsial agents
» California group viruses primarily La Crosse virus CTF virus
» Yersiniae Major rodent- and lagomorph-related bacterial and rickettsial agents
» Borrelia burgdorferi s.l. Tick-borne relapsing fever borreliae
» Toxoplasma Toxocara Major rodent- and lagomorph-related parasitic agents
» Babesiae Leptospirae Major rodent- and lagomorph-related parasitic agents
» Bartonellae Rat-bite fever agents
» Flying squirrels Ground squirrels and antelope ground squirrels
» Tree squirrels Voles and other microtine rodents
» Chipmunks Disease associations with particular types of rodents
» Beavers Disease associations with particular types of rodents
» Rabbits and hares Old World mice
» Dormice N ew World rats and mice
» Introduction The impacts of anthropogenic transformations
» Risk factors for rodent- and lagomorph-related diseases Public health impact
» Costs, control and management of infestations
» Control and management of non-commensal rodents and rodent-related diseases
» Conclusions Non-commensal rodents and lagomorphs
» EU community-level authorization of technical grade active ingredients
» Acute toxicity The precautionary principle
» The substitution doctrine Special considerations given to children’s health
» Toxicity end-points Pesticide hazard identification
» Long-term effects Pesticide hazard identification
» Insecticide synergists N eonicotinoid insecticides
» Spot applications Primary exposure of non-professional users and secondary exposures
» Inhalation Routes of exposure
» Incidental oral exposure Routes of exposure
» Exposure potential Steps of pre-market risk assessment of pesticides
» Tiered approaches to exposure estimation: a basis for risk assessment
» Mathematical mechanistic models Empirical models Some existing models
» Statistical mathematical models SOPs and exposure scenario types
» Comparing pesticide risks from residential and dietary exposures
» Residential applicator exposure assessment
» Toxicity end-points and MOS Residential applicator exposure
» Future actions and data development
» Identification Establishment of threshold levels
» Inspection Evaluation of effectiveness
» Develop an IPM plan Employment of two or more control measures
» Definitions of IPM An integrated approach to managing urban insects and rodents
» Case study 3 Case study 4 Case study 5
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