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Bed bugs: a public health problem in need of a collaborative solution.

Editor's Note: This article is part of our series of columns sponsored by the U.S. Environmental Protection Agency's (U.S. EPA's) Community Action for a Renewed Environment (CARE) program. The CARE program brings columns to the Journal that reflect the U.S. EPA programs, tools, or approaches to help local communities address a wide variety of environmental health issues. We think this column is of interest to a broad range of environmental health professionals. The agency will report here on the activities and lessons learned from communities across the nation and describe the range of U.S. EPA resources and programs available to support local environmental health initiatives. This column will also help keep readers up-to-date on U.S. EPA's progress in building partnerships that span federal, state, and local environmental and environmental health agencies. We believe that this column is an indication of U.S. EPA's commitment to joining with environmental health professionals to better meet the needs of communities, and we are pleased to make it available to our readers.

Lois Rossi is the director of the Registration Division at U.S. EPA's Office of Pesticide Programs (OPP) and is responsible for the regulation of all conventional pesticides. Throughout her tenure at U.S. EPA, Lois has been a champion of and provided leadership for public health initiatives involving pesticides. She was one of the major forces behind last year's Bed Bug Summit, and is actively working to promote global review and availability of pesticides with public health uses. Rossi received an MS in biostatistics and epidemiology from Georgetown University, School of Community Medicine and a BA in zoology from the University of New Hampshire. Susan Jennings is the public health officer for U.S. EPA's Office of Pesticide Programs. She works to promote and coordinate the concerns of stakeholders for pesticides with public health uses across OPP.

Reports of bed bug infestations are surging in communities across the United States, affecting people from almost every ethnic and socioeconomic background. Bed bugs are equally comfortable in dwellings in rural or urban settings, multi-or single-family neighborhoods, or any type of climate (hot, cold, wet, or dry). Reports of infestations in school and office buildings are not uncommon.

What is the Impact on Communities?

Although bed bugs are not known to transmit disease, bed bugs can still be a significant public health problem. Bed bugs cause a variety of negative physical, mental, and economic health consequences. Many people have mild to severe allergic reaction to the bites, with reactions ranging from none to a small bite mark to, in rare cases, anaphylaxis. These bites are also responsible for numerous secondary infections such as impetigo, ecthyma, and lymphanigitis. Mental health effects from bed bug infestations include anxiety, insomnia, or worsening of an existing mental health condition.

Economically, bed bug infestations are also a burden on society. Although the exact dollar amount is not known, the economic losses from health care, lost wages, and lost productivity can be substantial. The cost of bed bug eradication may be significantly more than that of other pests since bed bug control usually requires multiple visits by a licensed pest control operator. The cost of treating multi-unit dwellings is exponentially more than treating single-family units.

Bed bugs are a challenge to communities for a variety of reasons:

* Local public health departments have limited resources to combat this problem. When viewed under the wider prism of public health problems such as teenage pregnancy or disease transmission, bed bugs are not frequently seen as a priority.

* Municipal codes struggle to identify responsible parties. Tenants and landlords spar over who is responsible. Treatment costs are high and transient populations make it difficult or even impossible to assign responsibility.

* Control in multi-family homes is much more difficult than in single family homes because the bed bugs frequently travel between units, either by direct transport by humans or through the wall voids.

* Pesticide resistance and limited control choices make treatment even more difficult. Many bed bug populations are very resistant to almost all pesticides registered to treat bed bugs. Residents may use over-the-counter or homemade preparations that are ineffective or, in some cases, promote further resistance.

What Can a Community Do?

An Integrated Pest Management (IPM) approach is the most effective means of controlling bed bugs. A well designed IPM program will incorporate surveillance, modification of the environment to make it less hospitable to bed bugs (remove clutter, encase bedding, thorough cleaning of areas with evidence of bed bugs), and selective chemical or nonchemical treatments to kill bed bugs. An IPM program on a community-wide scale, however, requires active participation from residents to be successful.

Bed bug programs developed by communities are as varied as the communities themselves. Examples of community-driven initiatives include the following:

* passing local legislation to clarify who is responsible for pest control, successfully addressing the landlord/tenant issues;

* creating extensive education programs to alert the public to the issue, help them identify the pest, and sources of help for obtaining effective control; and

* using dogs to identify bed bug infestations in multi-unit or public housing, which is more effective and less costly than using human inspectors.

What Can the Federal Government Do?

In April 2009 U.S. EPA conducted a National Bed Bug Summit, attended by over 350 stakeholders (231 in person and 138 via webinar). Stakeholders attending the summit included departments of public health, researchers, pest control professionals, and community advocates. U.S. EPA has been implementing a number of recommendations from the summit, including the following.

* Create a bed bug web page to provide the public with information about bed bug infestations, and options for their control (both chemical and nonchemical) with a focus on Integrated Pest Management (IPM). The web page will be available in spring of 2010.

* Identify new tools for use in bed bug control efforts by working with industry, academia, state health officials, and pest control experts. A new pesticide tool was recently registered for bed bug control and U.S. EPA is continuing its efforts to encourage the addition of new tools to those already registered. To help the public choose pesticide tools for use in their homes, the new web page will include a listing of all active ingredients registered for bed bug control.

* Organize an interagency taskforce with federal partners (Centers for Disease Control and Prevention, Housing and Urban Development, U.S. Department of Agriculture/Agricultural Research Service, USDA/National Institute of Food and Agriculture, Department of Defense, and National Institutes of Health). This taskforce has identified two focus areas: 1) inventorying and identifying gaps in bed bug research, and 2) improving communications between agencies and with the public on bed bugs and their control.

* Obtain $550K funding for community outreach and education grants to deal with bed bug control in communities with concerns about environmental justice. These funds will be made available through the State and Tribal Assistance Grants (STAG) program. Additional information on STAG funds and eligibility criteria can be found at

Can We All Work Together?

The summit received significant media attention and increased the public's awareness of bed bugs while presenting an opportunity for attendees to network and collaborate on a national level. Many communities, though geographically quite distant and distinct, may face similar problems when controlling bed bugs. By effectively networking and collaborating, these communities can learn from each other's successes and failures, which could result in improved control of bed bugs and conservation of valuable limited health resources.

Because resources are increasingly scarce, it is crucial that all facets of government, industry, and academia work together efficiently. Effective bed bug control takes active participation and cannot be done in isolation, especially when multi-unit housing is involved. Collaboration and communication among all stakeholders are critical to minimizing cost and maximizing control at the community level.

Corresponding Author: Susan Jennings, Public Health Officer, U.S. EPAs Office of Pesticide Programs. E-mail:
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Author:Rossi, Lois; Jennings, Susan
Publication:Journal of Environmental Health
Date:Mar 27, 2010
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