Bed bugs depend largely on humans for their dissemination. They take refuge in or near their host’s bed during the day, and when the bed or other object in which they are hiding is moved, they are transplanted to a new location. They also migrate directly to adjacent apartments, hotel rooms, etc, along plumbing and wiring or through cracks.16 Bed bugs are effective at hiding, and can survive for up to a year without feeding.31 This contributes to the frequent failure of elimination efforts and the presence of bed bugs in hotels, furnished apartments, theaters, shopping centers, airplanes, newly purchased houses, and other places.
FAST TRACK
Bed bugs are good at hiding and can survive for up to a year without feeding.
Avoiding bites while in an infested facility is difficult, if not impossible. But people can take steps to decrease the likelihood of bringing them home. Although there are no strong evidence-based guidelines on preventing infestation, pest control experts make a number of recommendations,32 which you can pass on to your patients.
Protect luggage when traveling. When staying in hotels, for instance, patients should keep suitcases tightly closed when not in use. Protection is further enhanced by placing suitcases in a sealed plastic bag; “contractor” trash bags available at hardware stores are large and durable. Keeping suitcases in the bathroom rather than the sleeping quarters also decreases the possibility of stowaways, as bed bugs typically shelter within a few feet of their host’s sleeping place.
Immediate laundering of clothes upon returning home from a trip, and storing suitcases outside the living quarters can decrease risk, too.33 There are commercially available suitcase heaters that raise the temperature of the suitcase and its contents to insecticidal levels, but they are fairly cost-prohibitive.
Screen items brought into the home. Used items, especially furniture, may harbor bed bugs. Fumigating used furniture was once common; it is still a good idea before second-hand items are brought into the house. Cardboard boxes in which used items are commonly stored or transported can shelter bed bugs, too.33
Deprive bed bugs of hiding places. Decluttering one’s sleeping quarters decreases the number of places bed bugs can hide. This tactic diminishes the likelihood of an infestation becoming firmly established before being discovered. Intervention early in the course of infestation, when it is limited to a single room, increases the likelihood of successful elimination.33
Mattress and box-spring encasements can prevent bed bug infestations by blocking movement of the bugs into and out of their shelters. If encasements are placed during an infestation, it is important to keep them in place for an extended period, given that bed bugs can survive for up to a year without feeding. Also effective is caulking and sealing molding, joints, and cracks wider than the thickness of a credit card in the room and in furniture.33
Vacuuming is part of the CDC’s recommendation for household pest control. But vacuum cleaners can also transfer bed bugs from infested to uninfested rooms. During an infestation, it’s important to empty vacuum bags immediately. And sharing vacuum cleaners between dwellings is best avoided.
A need for better solutions
Although bed bugs are not competent as vectors for the transmission of infectious diseases, they are responsible for significant dermatitis, allergic reactions, and psychological distress. Treatment of symptoms is effective in the short-term, but current methods of eliminating infestation are cumbersome, toxic, and are seldom completely successful. New strategies are desperately needed. The CDC Web page (http://www.cdc.gov/nceh/ehs/topics/bedbugs.htm) is regularly updated, and is a good source of information as new approaches are developed.
CORRESPONDENCE Mark K. Huntington, MD, PhD, Center for Family Medicine, 1115 East Twentieth Street, Sioux Falls, SD 57105; mark.huntington@usd.edu