Frances Fry's scientific contributions

In the 1970s Donaldson applied the principles of infectious disease surveillance to pediculosis capitis infestation with head lice. This provided a lasting insight into an effective strategy for prevention. Research in Teesside, UK, proved that the first step in breaking the chain of transmission is the engagement of parents in an intensive detection/treatment campaign. United action halved the infestation rate, even though failing lindane treatments were in use. Subsequently although effective malathion treatment was introduced, it became clear that the late detection of light cases of head lice still undermines eradication. This paper analyzes the development by the health charity, Community Hygiene Concern, of the Bug Busting programme based on this solid evidence. In the 1990s the charity solved the problem of detecting asymptomatic lice using a specially designed Bug Buster louse comb in wet, conditioned hair. It undertook the popularization of this method and the co-ordination of national detection days (Bug Busting Days) through primary schools. In 2004 this structured approach to prevention was adopted in Chester. It produced a 24% reduction in health authority spending on treatment products in the first year and appreciable savings in professional time. It is concluded that participation in the Bug Busting programme benefits community health providers and schools. Provision of dependable detection combs with the correct instructions to families at risk, empowers them to gain sustainable, cost-effective control of head lice.

The aim of this paper was to illustrate the socially inclusive nature of the Bug Busting 'whole-school approach' to head louse eradication. In the UK, Belgium and Denmark, persistent head lice in families of all socio-economic status (SES) is a problem. Since 1995 in the UK and 1998 elsewhere, an educational programme intended to teach families how to detect and treat head lice by using the Bug Busting wet combing method has been organized in some areas. Local schools lead this community strategy for prevention, known as a 'whole-school approach' (UK). We describe five studies applying the Bug Busting approach, four set in districts where some disadvantaged families live (UK and Belgium) and a fifth set in Denmark. Feasibility and consumer satisfaction are examined. One UK study analyses data on area prescribing for head lice and the impact in a deprived locality of raising the profile of Bug Busting. We find parental education in Bug Busting enables families of all SES to participate in a 'whole-school approach' to head lice. Best results are obtained when each family has a Bug Buster Kit. This provides all the combs necessary with full instructions on their use with ordinary shampoo and conditioner to detect lice, eradicate an infestation mechanically, or to check the success of any treatment. In the UK, the promotion of the Bug Busting approach is reducing primary care expenditure on treatment for head lice and professional time spent with worried parents. As a result, healthcare providers can give time to the few families who require one-to-one guidance. Incorporation of the Bug Busting approach to head lice into clinical practice in school communities contributes to sustainable control whilst overcoming health inequalities in participating families.

Dr Vander Stichele and his colleagues (July 2002 JRSM1) make a welcome contribution to the debate on the merits of wet combing for the detection and treatment of head lice. The comb they have tested is the Bug Buster comb2. This forms part of the kit now available in the UK on NHS prescription to assist parents who are encouraged to remedy head lice at home. However, the Belgian researchers do not seem to have tested the full Bug Busting method. In our experience, dry and damp lice move swiftly away from disturbance created by combing, thus evading detection. We find that it is important to shampoo and rinse the hair before applying conditioner. This takes moisture (which temporarily immobilizes lice) to the hair roots, their main habitat. The omission of shampooing in the Belgian study produces a protocol which is easier for school screening, but not the most effective.