1. B ED BUGS - PREVENTION AND TREATMENT Blair Phillips May 2011 Walden University Dr. H. Rubin Environmental Health Photo courtesy of http://www.bed-bug.org/

2. I NTRODUCTION Recent resurgence in bed bugs 81% increase in bed bug calls since 2000 Bed bug outbreaks continue to be the focus of many media outlets Increasing public awareness Failing to provide necessary information Various methods proven effective for prevention and treatment Goal- Increase awareness on the issue of bed bugs among stakeholders- hotels, colleges and universities, rental properties…etc.

3. O VERVIEW Background Information History About bed bugs Impacts on Public Health Physical Bites Psychological Impacts Current trends Economic Costs Lawsuits How to identify bed bugs & where to find them Information on prevention and treatment options

4. B ED B UGS Bed bugs ( Cimex lectularius )- are a type of blood-sucking ectoparasite Small, flat and wingless body Not known to transmit disease Diverse geographic distribution Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm Photo courtesy of Dr. Harold Harlan, Armed Forces Pest Management Board Image Library- CDC

5. H ISTORY OF B ED B UGS Documented as far back as the 17 th century Previously eradicated after WWII with use of DDT (Mayo Clinic Staff, 2011). Mayo Clinic Staff. (2011). Bedbugs. Retrieved from http://www.mayoclinic.com/health/bedbugs/DS00663http://www.mayoclinic.com/health/bedbugs/DS00663 Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm Resurgence as a result of various conditions (CDC, 2011): Pesticide Resistance Increased Travel Lack of Knowledge

6. B IOLOGY & L IFECYCLE OF THE B ED B UG Adult and Nymphal bed bugs require blood from warm-blooded hosts (CDC, 2011). Females can lay up to 5 eggs each day (Bed-bugs.org, 2011) Adults may live 6-12 months (Bed-bugs.org, 2011) May go several months without food (CDC, 2011). Photo courtesy of http://www.bedbugsremovalguide.com/http://www.bedbugsremovalguide.com/ Bed-Bug.org. (2011). Bed bug information. Retrieved from http://www.bed-bug.org/http://www.bed-bug.org/ Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc- epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc- epa_statement.htm

7. T HE B ITE Attracted to carbon dioxide and warmth (Bed- bugs.org, 2011). Bites often appear on exposed areas (CDC, 2011) Face Neck Arms Legs Resemble mosquito and flea bites (CDC, 2011) Photo courtesy of http://www.bed-bug.org/ Photo courtesy of urbanentomology.tamu.edu urbanentomology.tamu.edu Bed-Bug.org. (2011). Bed bug information. Retrieved from http://www.bed-bug.org/http://www.bed-bug.org/ Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm

8. I MPACTS ON P UBLIC H EALTH Singular or multiple bites may be present (Bed- bugs.org, 2011) Mild to severe allergic reactions from bites (CDC, 2011) Secondary infections of the skin (CDC, 2011) Negatively impact mental health (CDC, 2011) Bed-Bug.org. (2011). Bed bug information. Retrieved from http://www.bed-bug.org/http://www.bed-bug.org/ Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm

9. C URRENT TRENDS Complaints increased 500% between 2000 and 2004 Increased trends in New York, Hawaii, and Ohio Many states close behind Bedbug.com. (2009). Bed bugs in the U.S.- the bedbug epidemic in your state. Retrieved from http://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspx http://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspx Graph courtesy of bedbug.com

10. C URRENT T RENDS NY had 13,152 reports in 2009 Reports from EVERY state in the US in 2008 Graph courtesy of http://www.bed-bug.org/ Bedbug.com. (2009). Bed bugs in the U.S.- the bedbug epidemic in your state. Retrieved from http://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspx http://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspx

11. P EST C ONTROL T RENDS 67% of pest management companies have received calls to treat hotels/motels 76% of the companies said that bed bugs are the most difficult pest to remove 90% of companies have treated in homes or apartments 4 – 5% have treated in laundry mats or movie theaters JP McHale Pest Management. (2010). Bed bug statistics in recent years. Retrieved from http://nopests.com/blog/bed-bugs/bed-bug-statistics-in-recent-years http://nopests.com/blog/bed-bugs/bed-bug-statistics-in-recent-years

12. E CONOMIC I MPACTS Lost costs: Health care Wages Revenue Reduced productivity High costs of treatment Negative public opinion Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm

13. E CONOMIC C OSTS - L AWSUITS September 2009- Virginia Beach, VA. $100,000 Chicago woman sues for $20 million Woman in Tennessee sues Rent-A-Center for $575,000 Bed-Bug.org. (2011). Bed bug information. Retrieved from http://www.bed-bug.org/http://www.bed-bug.org/

14. W HERE T HEY H IDE Can travel up to 100 feet each night (CDC, 2011). Transported by people traveling Apartments, houses, shelters, hotels, airplanes, hospitals, cruise ships, trains, or dorm rooms Mattresses, small cracks or openings, headboards, electrical outlets, or even under wallpaper (CDC, 2011). Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm

15. H OW TO I DENTIFY B ED B UGS (EPA, 2011) Look for Dark Spots Eggs and eggshells Skin shed from growing nymphs Live bed bugs Red spots or stains on sheets or mattress Dogs used in detection United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/ Photos courtesy of CDC, 2011.

16. M ETHODS OF P REVENTION Inspect any used furniture for bed bugs Use covers for mattress and box-springs Reduce additional clutter Utilize luggage racks Clean bedding with each new occupant United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/

17. M ATTRESS E NCASEMENTS Proactive use Protect beds Salvage used beds Significant method of control Tested and designed for bugs Ex. BugLock® encasement Cheaper alternative Bed Bug Central. (2011). Bed bugs 101 information every should know about bed bugs. Retrieved from http://www.bedbugcentral.com/bedbugs101/topic.cfm/mattress-and-box-spring-encasements http://www.bedbugcentral.com/bedbugs101/topic.cfm/mattress-and-box-spring-encasements

18. T REATMENT O PTIONS 1. Integrated Pest Management 2. Non-Chemical Treatments 3. Chemical Treatments Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/

19. I NTEGRATED P EST M ANAGEMENT (IPM) (EPA, 2011) 1. Set levels to determine when control measures must be employed. 2. Monitor and identify the bed bugs so that suitable pesticides are used in a varying situations. 3. Prevention- employing necessary actions to ensure bed bugs do not become an issue 4. Management- Determining effective and efficient control methods in each situation United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/

20. IPM WITH B ED B UGS (EPA, 2011) Inspections/monitoring Correct identification Accurate case records Appropriate cleaning methods Sealing cracks Correct use of pesticides Increased awareness among the public United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/

21. P OSSIBLE C AUSES FOR T REATMENT F AILURE All bed bugs not detected Proper prevention not taken Proper treatment methods not taken Pesticide applied incorrectly Pesticide resistance United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/

22. P ROPER D ISPOSAL OF I NFESTED I TEMS Encase or seal any disposed items Heavy sheeting or shrink wrap Disposal bags Inspect travel route for potential bed bugs/eggs that may have fallen off in disposal process Label potentially infested items Bed Bug Central. (2011). Bed bugs 101 information every should know about bed bugs. Retrieved from http://www.bedbugcentral.com/bedbugs101/topic.cfm/mattress-and-box-spring-encasements http://www.bedbugcentral.com/bedbugs101/topic.cfm/mattress-and-box-spring-encasements

23. A DDITIONAL T IPS (EPA, 2011) Never use a pesticide intended for outdoor use inside (EPA,2011) Using the correct pesticide is key in bed bug elimination (EPA,2011) Check the label to verify it includes bed bugs on the list of pests that are effectively treated (EPA,2011) Follow all directions on the labels Bed bug tasks forces (bedbug.com, 2009) Bedbug.com. (2009). Bed bugs in the U.S.- the bedbug epidemic in your state. Retrieved from http://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspx http://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspx United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/

24. T HE I MPORTANCE OF C ONTROL Local public health departments lack resources Blame game Increased resistance and limited treatment options Pesticide misuse Outbreaks create panic among the community Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htmhttp://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm

25. C ONCLUSION Bed bug infestation has seen dramatic increase since 2000, reflective of increased traveling, pesticide resistance, and lack of public awareness. Public health impacts include physical, emotional, and financial consequences. Integrated Pest Management establishes strategies for appropriate prevention and treatment to effectively decrease bed bug populations and thus minimize their impact on public health.

26. A DDITIONAL S OURCES F OR I NFORMATION 1. Bed bug regional contacts: http://www.epa.gov/bedbugs/bedbugs_reg_contacts.html http://www.epa.gov/bedbugs/bedbugs_reg_contacts.html 2. EPA Bed bug search tool- useful in determining which product would meet your needs: http://cfpub.epa.gov/oppref/bedbug/ 3. Hotel Bed Bug Safety Sheet http://public.health.oregon.gov/HealthyEnvironments/Recreation/ PoolsLodging/Documents/bedbughotel.pdf http://public.health.oregon.gov/HealthyEnvironments/Recreation/ PoolsLodging/Documents/bedbughotel.pdf 4. Orkin Bed Bugs: Facts, Identification & Control- useful in determining which treatment method is necessary for different infested areas: http://www.orkin.com/other/bed-bugs/http://www.orkin.com/other/bed-bugs/ 5. Networx Pest Control Services- useful in finding local exterminating companies and free service quotes: http://exterminators.networx.com/?se=a9161&YWZmaWxpYXRlX 2lkPTkxNjE= http://exterminators.networx.com/?se=a9161&YWZmaWxpYXRlX 2lkPTkxNjE

27. R EFERENCES Bedbug.com. (2009). Bed bugs in the U.S.- the bedbug epidemic in your state. Retrieved from http://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspxhttp://www.bedbug.com/Page-Bed-bugs-in-the-US_128.aspx Bed-Bug.org. (2011). Bed bug information. Retrieved from http://www.bed- bug.org/http://www.bed- bug.org/ Bed Bug Central. (2011). Bed bugs 101 information every should know about bed bugs. Retrieved from http://www.bedbugcentral.com/bedbugs101/topic.cfm/mattress-and-box- spring-encasements http://www.bedbugcentral.com/bedbugs101/topic.cfm/mattress-and-box- spring-encasements Centers for Disease Control and Prevention [CDC]. (2011). Joint statement on red bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Retrieved from http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm JP McHale Pest Management. (2010). Bed bug statistics in recent years. Retrieved from http://nopests.com/blog/bed-bugs/bed-bug-statistics-in- recent-yearshttp://nopests.com/blog/bed-bugs/bed-bug-statistics-in- recent-years

28. R EFERENCES Mayo Clinic. (2011). Bed bugs. Retrieved from http://www.mayoclinic.com/health/bedbugs/DS00663 http://www.mayoclinic.com/health/bedbugs/DS00663 Orkin, L.L.C. (2011). Bed bugs: facts, identification, & control. Retrieved from http://www.orkin.com/other/bed-bugs/ http://www.orkin.com/other/bed-bugs/ United States Environmental Protection Agency [EPA]. (2011). Pesticides: controlling pests. Retrieved from http://www.epa.gov/bedbugs/http://www.epa.gov/bedbugs/