Good Night……Don’t let the Bed Bugs Bite! Shannon Drake, MPH Student Walden University PUBH 6165-4 Instructor: Dr. Howard Rubin Winter Quarter, 2011 Good (morning, afternoon, or evening), my name is Shannon Drake and I’m here to talk about bed bugs. This presentation focuses on the characteristics associated with bed bug infestations.  It offers some suggestions for preventing an infestation, and the treatment options available to those that find themselves in the middle of a biting situation.  This presentation is directed to educate the general public about how bed bugs may carry a stigma and cause anxiety and insomnia, but they do not carry known diseases. Bed bugs are effective worldwide travelers that use humans to move from one place to another by hiding in luggage, clothing, bedding, and furniture. They were common in the United States before World War II, but the widespread use of the pesticide DDT reduced their existence to rare. There has been an increase in reported bed bug infestations in recent years, mostly because of increased immigration and travel, and the restriction of harsh pesticides. Cities like New York City and Cincinnati have made the media headlines for having infestations in hotels and apartment buildings, but bed bugs can live and breed anywhere that they can find a meal, and their meal of choice is human blood.

Learning Objectives Characteristics Diseases Infestations Design Treatment The learning objectives for this presentation are to inform the general public about: The characteristics that are associated with the bed bug. We’ll look at diseases associated with bed bugs, and determine if they pose a threat to public health. We’ll look at a few tell-tale signs that point to a bed bug infestation A bed bug is actually designed to survive a harsh environment, and this design makes it very difficult to get rid of them. Finally, we will discuss the treatment options that are available to the general public.

A picture is worth a thousand words………. We’ve all heard the old saying “a picture is worth a thousand words”, so let’s just jump right in and see what we’re talking about. This is a video from the National Geographic website about bed bugs. Let’s take a look. Click picture to play video National Geographic. (2012). Bed Bugs. Retrieved from http://video.nationalgeographic.com/video/player/animals/bugs-animals/other-bugs/bedbugs.html

Characteristics Parasitic insect Non-discriminate blood Wingless nocturnal meals Wingless Reddish-brown Lincoln’s head Non-discriminate Centers for Disease Control and Prevention. (2012). Parasites – Bed Bugs. Retrieved from http://www.cdc.gov/parasites/bedbugs/faqs.html So, what is a bed bug? They are actually parasitic insects, meaning that they rely on another living being for their survival. They prefer to feed on the blood of humans and other animals while they sleep, which is why they are normally found near beds and in bedrooms. They are usually reddish-brown in color and very small in size, roughly the size of Lincoln’s head if you placed one on a penny. The fact that they lack wings prevents them from traveling large distances for a meal and confines them to staying within walking distance of their prey. A bed bug infestation can happen in even the finest hotels, and they can inhabit the cleanest of homes. They do not discriminate based on color, religion, socioeconomic status, or cleanliness.

Diseases Not known to spread disease Annoying Reaction: Secondary infections Annoying Reaction: nothing serious allergic reaction Bed bugs have not been linked to the spread of disease; however, they are known to carry microorganisms that can cause disease. The bite and mere presence of a bed bug can cause itching which can lead to excessive scratching. That scratching can break the skin and allow bacteria and other microorganisms to invade the area and cause an infection, known as a secondary infection. Not everyone reacts in the same way. Some people can get bitten and have no physical signs. Others can have a reaction that ranges from a small bite mark all the way to a serious allergic reaction.

Signs of Infestations Bite marks Exoskeleton Mattresses and sheets Fecal material Sweet musty odor Anxiety Insomnia One of the easiest ways to know if you have either been exposed to bed bugs or if you have an infestation is to look for the tell-tale bite marks. Bed bugs prefer to feed on their prey while they are sleeping and usually will bite exposed body parts like the face, neck, arms, and hands. Some bites may appear randomly, but they may also appear in a straight line due to the bed bug eating several blood meals during their journey. So, besides the bite marks, how else can you tell if bed bugs are present in your home or in the place that you will be staying (like a hotel or college dorm)? If you look in the folds of the mattress and sheets, you might actually find the bugs’ exoskeleton or rust-colored spots that is actually the blood in their feces. Places with extensive infestations may actually have a sweet musty odor caused by the feces of the bed bug. The profuse scratching caused by the bites may actually cause anxiety and insomnia in some people. Centers for Disease Control and Prevention. (2010). Parasites – Bed Bugs. Retrieved from http://www.cdc.gov/parasites/bedbugs/faqs.html

S.L.E.E.P. Survey Lift Elevate Examine Place One way to prevent being bitten by a bed bug while traveling, or bringing bed bugs home with you, is to use the acronym S.L.E.E.P. First, you want to Survey the area for signs of an infestation. Check the bed sheets, mattress tags and seams, bed skirts and furniture for tiny rust-colored spots. Next, LIFT the mattress, bed frame, headboard, and furniture to expose their hiding spots. Although bed bugs typically only come out at night to feed, they can most likely be found within a 5-foot radius of the bed during the day. Next, ELEVATE all of your luggage on a rack away from the bed and the wall. Bed bugs will use headboards, artwork, picture frames, and electrical outlets as their hiding spots, so it is important to not place any luggage near these items. Next EXAMINE all of your luggage very carefully when repacking it and upon returning to home. Do not place your luggage on the bed or near your bedroom until you have completely removed all items and ensured that it is free of bed bugs. Finally, PLACE all clothing items from your luggage immediately into the dryer on the highest heat setting for at least 15 minutes. This intense heat will kill adult bed bugs and their eggs. ORKIN. (2012). Bed Bugs. Retrieved from http://www.orkin.com/other/bed-bugs/

Design Body design Fasting Ability to travel If you are unlucky enough to have to endure a bed bug infestation, then you will want to focus on getting rid of them. Bed bugs are very difficult to get rid of for a few reasons. First, their flat slim bodies allow them to fit into very small spaces, including cracks in the wall and under bubbled paint. Second, they can survive over a year without feeding, which allows them to go into hiding far away from an insecticide or other treatment method. Although bed bugs do not live on the human body, they are great hitchhikers and can move from an infested site to bags, furniture, and clothing. Environmental Protection Agency. (2011). Bed Bug Information. Retrieved from http://www.epa.gov/pesticides/bedbugs/

Treatments Environmentally sensitive approach Chemicals Non-chemical methods Freeze Heat Encasements Although bed bugs may be difficult to get rid of, there are a few treatment options available. An Integrated Pest Management (IPM) program uses information on the life cycles of the bed bugs and how they interact with their environment to help eliminate the problem. Some examples of IPM methods are checking luggage and clothing for bed bugs when returning from a trip, reducing clutter to eliminate hiding places, and raising awareness through education on prevention mechanisms. IPM programs are effective when combined with other pest control methods like pesticides. There are over 300 products registered by the EPA for use against bed bugs, so there are chemical treatment options available. The toxic nature of these chemicals make them dangerous if they are handled inappropriately. Always read the label for the correct use of the products and keep in mind that chemicals tend to linger on the treated surfaces, so if you treat a mattress, you may be inhaling harmful fumes even after the treatment. There are non-chemical treatment options too. Placing contaminated articles into a freezer below 0◦F for at least 4 days can be useful at eliminating some infestations. Extreme heat can also kill bed bugs, so placing infested articles in a clothes dryer set on high heat – at least 113◦ F for 1 hour – can be effective. Mattress and pillow encasements are effective at entrapping bed bugs that are already present, and at preventing bed bugs from taking up residence in that area. You have to choose a treatment option that works for you and your family. Environmental Protection Agency. (2011). Bed Bug Information. Retrieved from http://www.epa.gov/pesticides/bedbugs/

Summary Characteristics Diseases Infestations Design Treatment Today we discussed the characteristics that make bed bugs the incredible survivors that they are. We looked at the overall design of the bug that allows it to survive some of the harshest environments and gives it the ability to survive for over a year without a blood meal. This same design makes it excessively difficult to get rid of an infestation, so the best way to stop an infestation is to prevent it from happening in the first place. The acronym S.L.E.E.P. can be used to help you remember how to prevent bed bugs from feasting on you and your family. By Surveying the unfamiliar sleeping area, and Lifting the mattress, you can look for the signs of an infestation. Elevating luggage and personal belongings can keep the pests from hitching a ride home with you. Even if you complete these steps, you will still need to EXAMINE all personal belongings for bed bugs upon returning home and PLACE all appropriate articles into the dryer on high heat just to make sure you don’t have any hiding out. Although a bed bug bite may not cause any primary diseases, the scratching may cause a secondary infection, anxiety, and insomnia. There are chemical and non-chemical treatment options available to those that find themselves in the middle of an infestation. The treatment choice must be made on an individual basis taking into account the level of infestation and the household occupants that may be exposed to these treatments. I hope that you leave today feeling better prepared to wage the war against bed bugs, and believe me, fighting an infestation is a war. Thank you for your time.

References: National Geographic. (2012). Bed Bugs. Available from http://video.nationalgeographic.com/video/player/ animals/bugs-animals/other-bugs/bedbugs.html Environmental Protection Agency. (2011). Bed Bug Information. Retrieved from http://www.epa.gov/pesticides/bedbugs/ Centers for Disease Control and Prevention. (2010). Parasites – Bed Bugs. Retrieved from http://www.cdc.gov/parasites/bedbugs/faqs.html ORKIN. (2012). Bed Bugs. Retrieved from http://www.orkin.com/other/bed-bugs/

Want to know more? Hwang, S.W., Svoboda, T.J., De Jong, I.J., Kabasele, K.J., & Gogosis, E. (2005). Bed Bug Infestations in an Urban Environment. Emerging Infectious Diseases. serial on the Internet. doi: 10.3201/eid1104.041126 Goddard, J., & deShazo, R. (2009). Bed bugs (Cimex lectularius) and clinical consequences of their bites. JAMA, 301(13), 1358-66. National Environmental Health Association. (2008). Journal of Environmental Health - Bed Bugs: Infestations in the News - They're Back!  Retrieved from http://www.cdc.gov/parasites/bedbugs/publications.htm l . The Pennsylvania State University. (2012). Bed Bugs Fact Sheet. Retrieved from http://ento.psu.edu/extension/factsheets/bedbugs For those of you that just can’t get enough about bed bugs, here are a few sources for additional reading.