HealthCommentary

Exploring Human Potential

The Bed Bug In The Bra – CDC Cautions Against Over-Reaction.

On July 16, 2010, New York City dwellers reacted with shock and disgust at the news, Cimex lectularis had been detected in a wonder bra at Lexington and 58th. The tenant? Victoria’s Secret. Obviously it was time to get serious. But a recent report by the CDC preaches caution. For 2003–2010, a total of 111 cases of poisoning by people using insecticides to fight the menace were identified in seven states.
The over-reaction isn’t a matter of disease – the bug doesn’t transmit disease. It is it’s reputation for being nearly impossible to get rid of (having developed resistant to most insecticides); for striking in the middle of the night and sucking your blood (you don’t feel the bite because the bug injects an anaesthetic and anticoagulent into your skin); and for leaving you with itchy trail marks, a bad reputation, and insomnia.
You never heard of Cimex lectularius. Well, it used to be very common, estimated to have been in 30% of all American homes just before World War II. Then it all but disappeared with the widespread use of residential pesticides post-World War II until around 1998 when it started to be reported again in the US and other countries around the world. Why? We don’t know for sure, but worldwide travel, pesticide resistance and a lack of public health focus for years may all be contributors. It’s common name? BED BUG!
With their re-emergence, the CDC and EPA have joined hands and are encouraging much more research into how to control this pest. In the meantime education and integrated pest management are major goals. A starting point is to become better aquainted with the enemy. So here are some facts thanks to J.L. Gangloff-Kaufmann and C. Pichler of the New York State Integrated Pest Management Program at Cornell University from their published Guidelines for Prevention and Management of Bed Bugs in Shelters and Group  Living Facilities.

“What are bed bugs?
Bed bugs are insects of the Order Hemiptera and Family Cimicidae, which has over 90 species around the world and 15 in North America. Bed bugs and their relatives are wingless, blood-feeding parasites of animals. The common bed bug (Cimex lectularius) is a pest of humans this species has recently become a problem in the United States and countries all over the world.

Bed bugs have three basic life stages; egg, nymph, and adult. They begin as a very small but visible egg, hatch to become a first instar nymph or juvenile, which is 1 millimeter long or about the size of a poppy seed. There are five juvenile stages, which feed on blood, molt and grow over time. The adult is about the size of an apple seed.

Bed bugs tend to gather together in hidden and undisturbed places where a person sleeps, or sits for an extended period of time. They are usually found in the bed, along the seams and sides of the mattress and box spring, the headboard, and bed frame, creating clusters of live bed bugs, shed skins, dark-colored fecal spots, and eggs. In heavily infested locations bed bugs can be found anywhere in the room. As bed bugs grow they shed their amber-colored, transparent skins, leaving behind what look like hollow bed bugs.

A fecal spot, the result of bed bug digestion, may look like a brownish-black bump on a hard surface, or a dark stain (like a magic marker dot) on fabric. Eggs are cemented to fabric, wood, paper, and most other surfaces as the female hides or wanders in search of a host.
Where did bed bugs come from?
It is unclear exactly why and from where bed bugs re-emerged as a pest in our homes, dormitories, hotels, and shelters, but the resurgence was noticed throughout the world in the late 1990’s.  During pre-World War II times, it was estimated that nearly 30% of American homes had bed bugs. After World War II, many long-lasting pesticides were commonly used indoors. Bed bugs were nearly absent for 50 years in America. However, stories and reports indicate that bed bugs may never have truly disappeared in America but they were very uncommon, until recently.

What is the risk of having bed bugs?
Bed bugs must bite to feed on blood. They have pointed mouth parts, like mosquitoes, and feed for just a few minutes at a time. They must feed to grow and although they primarily feed at night, bed bugs will bite during the day if necessary.  Bed bugs have never been shown to transmit disease to humans. The most common symptom of bed bug bites are itchy welts on the skin of most but not all sufferers. Reactions vary widely from person to person and bites alone cannot be used to confirm bed bugs. Bites may develop secondary infections through scratching. Anemia has been reported in the elderly and very young in cases where homes are heavily infested. Asthma has also been linked to the presence of bed bugs in homes, though not yet in the Unites States.


More risks can arise with the use of insecticides to treat bed bug problems in the home, particularly when individuals attempt to eradicate bed bugs without the help or advice of a professional pest manager. People with no pesticide application experience are using total release aerosol foggers (“bug bombs”), professional products, and sometimes illegal products to attempt to control bed bugs in their homes. The impact on public health from overexposure to pesticides used to control bed bugs is unknown. The New York City Department of Health and Mental Hygiene strongly discourages the use of “bug bombs” and foggers because of the potential of human exposure to insecticides and the risk of device explosions.

Bed bugs can be transferred among people, and that places a great deal of social, emotional and financial stress on sufferers. Control is challenging and costly, and there is still a certain amount of social stigma attached to living with bed bugs. Having bed bugs may restrict the social lives of people. Sufferers avoid visiting friends and family and often throw away belongings, at great cost, and minimal benefit. Tenant-landlord disputes over who is responsible continue to take place and these battles can be damaging to both parties.

How can we get rid of them?
Pesticides alone, or the use of any single method, will not eliminate bed bugs. A strategy that includes a number of methods is absolutely necessary, especially in multiple unit facilities like apartments, shelters, dormitories, group homes, and hotels.  The following are needed for effective bed bug control:
• Cooperation of landlord, management, and resident to focus on the problem
• Accurate identification to be sure it is a bed bug and not another pest
• Identification of the source (especially if bed bugs are moving from an adjacent room or apartment unit)
• Thorough inspection of the facility and identification of all possible hiding spots
• Cleaning and organization of the living area
• Reducing clutter in the home
• Bagging and removal of bedding and clothing from the affected area
• Washing sheets and blankets and drying on HOT setting
• Encasing the mattress and box spring in a zippered encasement
• Washing or treating the headboard and bed frame
• Cleaning and removing bed bugs from other items
• Isolating the cleaned (bed bug free) items until bed bugs are gone
• Careful and targeted use of insecticides, following label instructions
• Inspection and treatment of all surrounding adjacent units
• Follow up inspections and all other procedures as needed (there should be at least one follow up inspection 3 weeks after initial treatment)

Management of bed bugs should begin at the first sign of a problem. The longer an infestation is allowed to exist, the more difficult and expensive it will be to control. It may take several months to get rid of bed bugs if there is a large infestation.

There must be cooperation among tenants and the management staff in multiple dwelling facilities. A bed bug management program must be coordinated for the entire building as well as the individual room or person, because bed bugs can go undetected for long periods of time and can spread very easily through walls, on electrical and plumbing conduits. Cooperation from the tenant includes following the pest reporting procedures, cleaning and preparation of the room for treatment, and taking measures to avoid reintroduction of bed bugs.

Building management must ensure that tenants are aware of these procedures and are provided with the necessary contact information they need to report a complaint. Complaints must be addressed in a timely manner. Most building managers cannot deal with a bed bug infestation without the help of a pest management professional (PMP). The PMP should be involved at an early stage. Professionals know how and where to look for bed bugs, and can thoroughly assess an infestation to ensure the right measures are taken.

Identification of Bed Bugs

Bed bugs are small but visible insects. There are three main life stages: the whitish egg (about 1 mm in length), five pale juvenile (nymph) stages that range from 1mm to 4.5 mm (1/4 inch), and the adult which can be as long as 7 or 8 mm (3/8 inch) when fed. The newly hatched nymph is very pale until it feeds. Then it looks like a tiny droplet of blood. Each nymph stage will feed and become filled with red blood. The adult is about the size and shape of an apple seed, and dark red to brown in color and as flat as a credit card before feeding.

The first sign of a bed bug infestation is usually the appearance of bites on the arms, neck, torso, or legs. Read on for more information about bed bug bites. One may also find live or dead bugs. Collect a sample for positive identification. Clusters of small stains or droplets of dried blood on furniture and bedding may also be found. These stains are the bed bugs’ fecal droppings. They may be accompanied by shed skins, because bed bugs shed their outer skin, or molt, as they grow. Shed skins are amber in color and resemble the shape of a bed bug. There may also be live bugs and eggs where droppings are found.
DON’T mistake bed bug droppings for cockroach droppings. Cockroaches leave behind tiny rectangular pellets, not round droplets or stains. There may also be rectangular egg cases or dead cockroaches nearby.

When searching for bed bugs it is important not to overlook the nymphs, which can be difficult to spot. Look for nymphs where droppings and stains appear, especially in crevices on fabric and wood surfaces.

A newly hatched bed bug is smaller than a poppy seed  and the color of a sesame seed. The stains from bed bug fecal droppings can appear as rounded bumps or blackish, soaked-in stains. This adult bed bug is waiting to feed on blood. Adult bed bugs are very flat and fit into crevices as thin as a credit card before they feed. Nymphs are even thinner. Once fed, they are longer and plump until they begin to digest the blood meal.

Bed Bug Bites and the Bites of Other Arthropods

Bites are usually the early warning sign of a bed bug infestation. Bed bugs feed only on blood. Each life stage feeds, except the egg. They insert the fine stylets from their beak directly into the skin in search of a tiny blood vessel, and may move and bite repeatedly until they find the right spot. At each point the beak releases saliva into the skin. The saliva contains proteins and enzymes that will cause an allergic reaction in many people. Allergic reactions vary widely from practically no reaction, to small itchy red or white bumps, to blisters or pustules.  Not every person in a household will react the same way and many times only one person will show signs of bites, leading others to believe it cannot be bed bugs.

It is difficult, if not impossible, to distinguish bed bug bites from those of other biting pests without other circumstantial evidence that will link to a specific pest. It is critical to confirm bed bugs in the sleeping or living area through inspection to be sure that bites are caused by bed bugs. Bed bug bites can resemble mosquito and flea bites.”

Cimex lectularis. Not a good bedfellow.

For Health Commentary, I’m Mike Magee
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