• Tone Birkemoe, Heidi Heggen Lindstedt, Preben Ottesen, Arnulf Soleng, Øyvind Næss, and Bjørn Arne Rukke.
• Department of Ecology and Natural resource management, Norwegian University of Life Sciences, PO Box 5003, NO 1432 ÅS.
• Fam Pract. 2016 Feb 1; 33 (1): 232923-9.

BackgroundHealth providers need to know which measures to take and children to prioritize in order to decrease costs associated with head lice infestations.ObjectiveOur aim was to determine the most important predictors for head lice and identify the major drivers of an infestation outbreak in a low-prevalence area.MethodsThe study was based on three datasets of head lice prevalence (retrospective, point prevalence and prospective approach) from primary school children (ages 6-12) at 12 schools in Oslo, Norway. The tested predictors were siblings with lice, individual and household characteristics as well as class and school affiliation. Self-reported monthly incidences (prospective approach) of head lice were used to evaluate infestation dynamics.ResultsInfested siblings strongly increased the odds of head lice infestation of school children (odds ratio 36, 26 and 7 in the three datasets) whereas having short hair halved the odds. Household characteristics were of minor importance, and class affiliation proved more important than school affiliation. Having head lice in one school term increased the odds of an infestation in the next, but this effect diminished over time. About 97% of all self-reported infestations were noted in two consecutive months or less.ConclusionsWith the exception of hair length, we have found that individual and household characteristics are of minor importance to predict head lice infestations in a low-prevalence country and that unnoticed transmissions in school classes and families are likely to be the major driver upon outbreaks.© The Author 2015. Published by Oxford University Press.

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