BED BUGS - What you need to know

BED
             BUGS

What you need to know   Rosana Pellizzari, MD, CCFP, MSC, FRCPC
                                           No conflicts to declare.

By the end of this session, participants will:

• Understand the biology, risk and epidemiology of bed
  bugs;
• Learn how to determine when bed bug infestations are
  present;
• Understand the prevention and control of bed bug
  infestations;
• Acquire the knowledge and expertise to respond
  effectively to various clinical scenarios involving bed bugs.

Overview of what patients are told:

• Reports of bed bugs in Ontario and across Canada are on
  the rise.
• It’s important to know the facts.
• Anyone, anywhere can get bed bugs.
• But…they can be prevented and controlled.

THE BASICS

What are Bed Bugs?

Bed Bugs Do Bite

Naming History
• Ancient Rome, bed bugs were called Cimex (meaning “bug”), while
  the species designation lectularius referred to a bed or couch.
• Early Greek term for bed bug was Coris, meaning “to bite,” from
  which the word coriander comes. Coriander (cilantro) is one of the
  world’s oldest spices.
• England, bed bugs were simply referred to as “Bugs”.
• Early Spanish word for bed bug — “chinche” is especially relevant
  today since Spanish-speaking customers often refer to bed bugs as
  chinches or chinche de cama — bug of the bed.
• Other names used include wall louse, bed louse, wallpaper
  flounder, night riders, red coats and crimson ramblers.
• Bed bugs did not occur in North America before the arrival of
  European settlers, thus there is no word for them in the language
  of Native Americans.

Family Cimicidae

~ 91 species
  –   bat hosts – 13 genera, 61 species
  –   bird hosts (swallows and swifts) - 26 species
  –   mammals and birds – 2 species
  –   hosts unknown – 2 species

Cimex lectularius   Cimex adjunctus

Quick Facts…
• The human bed bug (Cimex lectularius) and its relatives (Cimicidae)
  form a small group of bloodsucking Insects.
• It has never been demonstrated that bed bugs transmit any human
  disease (including Hep A and HIV/AIDS).
• Because of the different habits of the various bed bugs, proper
  identification determines where to direct controls to be most
  effective.
• The bite of these bugs often is painless, but a toxic saliva injected
  during feeding will later cause severe itching and an inflamed welt.
  However, individuals may vary widely in sensitivity to these bites.
  Often, a series of two to three welts are produced in close
  proximity following feeding by bed bugs. Pictures to follow…
• Bed bugs have a short broad head, broadly attached to the
  prothorax, and an oval body.

Medical Importance
• Naturally infected with >41 human pathogens
• Never proven to transmit any human disease
• Several species feed on humans
  Common & Tropical Bed Bugs, Bat Bugs & “Bird” Bugs
• Salivary proteins cause “sensitivity” to repeated
    bites by large numbers of bed bugs
• Serious social stigma to “having” an infestation
• Secondary infection

Biology
Life Cycle
   – Females can lay ~200-500 eggs
   – Eggs hatch in 1-2 weeks
   – Nymphs start to feed immediately
   – Nymphal stage is 14-30 days
   – Entire life cycle is 4-9 weeks
   – Adults can survive, conditions
     dependent, up to 12-18 months,
     or longer, without feeding
   – May migrate if it ‘senses’ a
     potential food source

                                                  .
                                        © Orkin Inc

Lifecycle

Eggs

1st Instar

1st Instar

Feeding

Longevity (mean in days) in Once-fed Bed Bugs
  (70-75%RH) (Omori, 1941)

Stage      10C        18C         27C        37C
Instar 1   275        114         28         17
Instar 2   399        171         46         30
Instar 3   413        214         71         35
Instar 4   433        235         73         37
Instar 5   485        161         40         33
Female     425        277         87         32
Male       402        176         43         29

Feeding

• Adults/Nymphs feed ‘usually’ at night
• Nymphs – 3 min average 1st instar; Adults – 10 to 15 min
• Saliva causes the allergic reaction
• Digest blood meal; molts and feeds again when its ready
  or ‘wait’ until host present
• They do not stay on the host longer than it takes to get a
  blood meal
• “Bites” – usually in two to three spatially close welts

WHAT CAN
YOU DO?

Identify

Worried you may have bed bugs? Get a hair dryer
(set on hot), a vacuum, thin knife or credit card, and
search their favourite hiding spots:
   –   Mattresses
   –   Box spring/bed frame
   –   Cracks/crevices on or near bed
   –   Bedroom baseboards
   –   Nightstands
   –   In or near clutter

Fecal Matter/Blood Spots

    M Potter,
    2004

Bedbug Evidence

                  M Potter,
                     2004

M Potter,
   2004

CLINICAL DIAGNOSIS

Characteristic ‘Immediate’ Reaction

Delayed Reaction (>24 hours)

Bedbug Prevention
• Be wary of acquiring secondhand beds, bedding, clothing,
  books, electronics and furniture, anything that can carry a
  bed bug on/in it
• Vacuum suitcases after returning from a vacation (put in
  freezer to slow them down then into hot dryer)
• Repair cracks in plaster and glue down loosened
  wallpaper
• Remove and destroy wild animal roosts and bird nests
  when possible (Bat Bugs)
• Check furniture, bedding or normal sleeping areas
  regularly
• Clean and vacuum regularly as per normal home
  sanitation measures

Take Action

If you find bed bugs in your home, don’t wait – take action:
• Tell your landlord or building maintenance person at once.
• Don’t try to do it yourself. Insect foggers will not get rid of
   bed bugs.
• To control bed bugs you will need a licensed professional
   pest control operator with bed bug experience.

Take Action
What you need to do before the pest control operator arrives:
 • Wash all bedding in hot water or dry clean. Place pillows in the dryer on
      high heat for a minimum of 30 minutes.
 • Steam clean, wet vacuum or shampoo carpeting and furnishings.
 • Vacuum mattresses, bed frames, baseboards and objects close to the
      bed. Discard the vacuum bag in a tightly sealed garbage bag before
      disposal.
 • Empty all dressers and closets - including linen closets. Clean articles
      should be placed in the dryer on high heat for a minimum of 30 minutes.
 • All soiled articles need to be washed in hot water and dried on high
      heat.
 • Remove all clutter, such as: books, magazines, toys and home
      accessories. Clutter is home to bed bugs. Place all items in tightly sealed
      garbage bags and leave them in the room to be treated.

Control of Bedbugs
Non-chemical control (not an all inclusive list)
   –   Sticky Traps/Double-sided tape
   –   Mattress covers – Allerzip, Gardex; Bed posts in BB Cans/traps
   –   Heat clothes in dryer for 15-20 min.; will kill all stages (>120°F)
   –   Hot steam along baseboards, wallpaper etc.
   –   Vacuum often with strong suction
   –   Use a scrub brush along the seams of mattresses
   –   Heat (> 130°F/55°C) (put in heat box, rooms, buildings etc)
   –   Expose bugs to cold temperatures below 32°F/0°C
       Generally Does Not Work : Chilling period must be maintained for
       many days (adults) greater than -20°C; colder than most freezers
         • Eggs - NOT a control option
         • Overall, it is NOT an effective control option and is not
           recommended

Control of Bedbugs

• Chemical control
   – Various aerosol sprays, liquids, and dust products are
     available
   – Permethrin (Prelude/Dragnet), Cyfluthrin (Tempo),
     Bendiocarb (Ficam), and Diatomaceous earth
   – Linens and mattresses should not be sprayed unless
     products are registered/labeled for this use

Why they are a control challenge?

1. Often hard to detect in small numbers (small, generally
   nocturnal, cryptic, & fairly mobile).
2. No reliable attractant available (currently).
3. Readily detect (& avoid) many chemicals.
4. Adults can live > 1 yr. without feeding. [Nymphs fed >
   once can live > 3 mo. w/o feeding].
5. Insecticide resistance newly documented.
6. Very easily re-introduced and/or spread.

Challenges to Effective Control

• Hoarding Issues
• Laundry
• Lack of client co-operation due to cost, mistrust of
  technician, lack of education
• Room not properly prepared for treatment
• Client embarrassed does not tell anyone with an active
  infestation or re-introduction

The Social Impacts of an Infestation
                                 Dr. Elizabeth Comack
                              Department of Sociology
                               University of Manitoba

More than just itchy bites

•   Loss of belongings
•   Health problems exacerbated
•   Insecticide exposure
•   Social Stigma
•   Social Isolation
•   Negative impact on identity

MYTHS

Myth #1

Throwing out my bed will get rid of bed bugs

FACT. Bed bugs can occupy almost any dark crack
or crevice in a room. Almost everything including clothing,
bedding, furniture and electronics can be treated to remove
bed bugs.

Myth #2

Bed bugs are only found in low-income neighborhoods.

FACT. Bed bugs happen to anyone, anywhere. You get bed
bugs simply by coming into contact with them.

Myth #3

Bed bugs cannot survive in Canada due to cold winters.

FACT. Even with our cold winters bed bugs continue to survive
in all parts of Canada. Bed bugs can be found in almost every
country and region. They are a global pest.

Myth #4

I don’t travel very much, so I’m safe.

FACT. Travel, whether overseas or in Canada, is not the only
possible source of bed bugs. Situations such as riding public
transit, having a houseguest or purchasing a piece of second-
hand furniture can offer bed bugs a free ride into your home.

Myth #5

My partner seems to have signs of bites, but I do not – so
we don’t have bed bugs.

FACT. Two people sleeping in the same bed may both be
bitten by bed bugs but react in a different way. Some people
immediately have a reaction to the bites while others show
little or no sign.

Myth #6

There are over-the-counter treatments available for bed
bugs.

FACT. Such remedies are considered to be ineffective and
some are fire hazards. The best way to get rid of bed bugs is
to hire a licensed pest control expert and follow their
instructions.

Myth #7

I have a metal bed, so I have nothing to worry about.

FACT. Although metal beds are less hospitable to bed bugs,
simply replacing all beds with metal ones will not solve a bed
bug problem. In some cases, metal beds may cause bed bugs
to hide in less obvious areas of the bed, making the matter
worse.

TENANTS

Information for Tenants

• If you find bed bugs, here is what you should do:
   – Tenants: Immediately inform your landlord, superintendent, or
     property manager.
   – Landlords are responsible for maintaining the unit so it is fit for
     habitation, and complies with health standards.
   – If landlord fails to act, a tenant may make a complaint to the
     municipality.
   – You are responsible for cooperating with efforts to control bed
     bugs.

Tenants

• What you should know:
   – Landlords have right to enter to inspect and maintain rental units
     (written notice, 24 hours in advance).
   – Landlords are responsible for the cost. Only licensed pest control
     companies should be used.
   – You will need to prepare (eliminate clutter, clean your belongings,
     moving furniture, etc.).

Naming and Framing the Problem:
Bed Bugs are Serious Threat to Public Health

  Encountering Bed Bugs
                               Social and
                               Economic
  Social stigma, Social        Marginalization
    isolation, Stress          (lack of resources
                               and control over
                               living conditions)

  Compromised Health

For More Information

• To learn more about bed bugs, and what you can do to
  prevent, identify and treat them, visit:
   – www.bedbugsinfo.ca
   – Contact your local public health unit – visit:
     http://www.health.gov.on.ca/english/public/contact/phu/phuloc
     _mn.html