A new article on bed bugs in health care facilities from Orkin and the American Society for Healthcare Environmental Services (ASHES) of the American Hospital Association is out:
Here’s an excerpt of the discussion of bite reactions and the implications for detection and control:
In recent research conducted at Orkin’s Training Center in Atlanta, Ga., we introduced each of 900 volunteers to one to three bed bugs from a lab colony for a feeding. Volunteers were monitored closely for reactions to the initial bite. Almost immediately, 3.7 percent of participants reacted with mild to serious skin irritation. Within 18 days, an additional 0.8 percent exhibited some level of reaction. In total, fewer than 5 percent of the participants had a reaction to beg bug bites. In the affected group, there were no discernible correlations between the subjects’ race, age or gender and their reaction to bed bug bites.
Because so few people seem to react visibly to initial bed bug bites, the presence of visible bite reactions – or the lack thereof – may not be a reliable early indicator of bed bug presence. Instead, it would seem that many hosts will have no reaction when first bitten, leaving bed bugs undetected for a longer period.
Orkin recently witnessed this disconnect first-hand at an independent living facility when we were called to consult on a severe bed bug infestation. The source infestation was a colony of 500-1,000 bed bugs – in one room – in various growth phases. Most of these bugs were found in the resident’s bed. Upon further inspection, our Commercial Pest Specialists identified 10 other separate cases of bed bugs in the same facility. It was a severe infestation, but zero bite reactions were reported by the facility’s residents in the other affected areas. This finding was correlated by research at the University of Kentucky that found that the elderly have a diminished response to skin irritants and are less likely than other age demographics to exhibit a reaction.
Quite a lot to think about and evaluate, including new information. Given the paucity of resources, a must read. The authors are Ron Harrison and Bill Lawrence from Orkin.
These pages may be of related interest:
I was under the impression that very few people exhibited bite reactions the first time bitten, but more severe reactions were exhibited as bite exposure rises. This study seemed to expose the volunteers to one episode of bites. I wonder what the outcome would be should the same volunteers would be exposed a second or third time.
I’m no doctor but i would imagine allergic reactions to bedbug bites would be similar to other allergic reactions. The first time a person reacts to peanut butter, it usually doesn’t illicit a fatal response, but subsequent exposures may.
As Far as the elderly, are their diminished responses a function of old immune systems or some kind of immunity, and depending on the reason is it a good or bad thing.
The elderly are more apt to experience severe infestations because of age. Either they don’t see or feel the bedbugs.
Good stuff Renee…..
always appreciate your finding these materials.
I am a bit amazed that in this document vacuuming is not mentioned.
If there was a primary step in starting the process of elimination, I believe that vacuuming is the most straighforward and most available method, and probably not used enough. Some weeks ago, I was in a badly infested unit doing some filming for training purposes. The technician in attendance used vacuum and in a few seconds we had removed most of the bed bugs in a refugia in a fold of a day bed sofa, adults, nymphs and even eggs within a few seconds. Yes, it is true that eggs are not always removed easily, but in fact, most of the eggs were gone in seconds. Steam treatment would have been a good second step in that case. Treating sofas is one of the most difficult aspects of elimination, but whenever physical removal can be accomplished, this is always beneficial. In a hospital setting, the fact of the high standards of sanitation I think can enable a very high quality of prevention. When I was in Israel a few weeks ago we stayed in a hotel in Haifa, and I asked one of the housekeeping staff (through a translator) if she was aware of bed bugs. I was amazed at the extent of her training to address the issue and her description of the procedures in this well known chain .. Crowne Plaza.. It speaks to the high standards that this chain has implemented. I was very impressed.
That is what it takes… good training of staff and well thought out preventive procedures… That is the expectation in the hospital setting as well.. I do hope they advise their staff in the importance of mechanical removal with vacuums.. Only a small piece in the total picture..
Sam
Hi. I think the elderly are also afraid of losing their independence in some circumstances and fear reporting infestations and having their lives upended. We don’t really know all that much about bites. I’m so looking forward to the UKY study. Dying to read it is more like it. Sam, I’m glad you told us about that hotel experience. Good experiences like that are seldom reported and there must be many hotels that have made this investment in training. Must be nice to find people who know all about bed bugs.
This Orkin/ASHES document has been announced for some time and having been burned by such PR before, I waited until it was out and I could read it. I think it’s an important article because it shows where the level of knowledge and thinking is at present but it is not really a comprehensive management guide. (This is a management guide, PDF.)
The Orkin/ASHES article also references these interesting unpublished studies that we all want to know more about and that also makes it noteworthy.
But it’s an industry document through and through, full of self-reverential stuff like this:
I’m not sure what hospitals they’re talking about.
This is Orkin’s health care pest control site.
I want to read everything but I also want to evaluate everything carefully. I’m not so sure that unqualified recommendations of dogs and cold, for example, are reassuring. We all know reality is complicated and it’s more appealing to have honest discussions of pros and cons and challenges.
It’s still a must read in my view.
Renee, or anyone out there, I have searched long and hard for an answer to this question: How long is a bedbug proboscis ?
Whoolly mackerel – no clue!
I’ll ask someone!
much appreciated
In the meantime, look at picture D here where the stylets are in their groove. They do not extend too far. Update: all I can find on my own is that they extend to about the first pair of legs.
wow, great pics, thank you
JohnyCakes
Go to the resource page… Click on Armed Forces Pest Management Board library… On the search page, check the box for books & uncheck journals…. Run a search for bed bugs… On the first result page look for Usinger’s Monograph… Click on it & it will download (39mb)… The monograph is a 585 page book that includes everything you ever wanted to know about bed bug anatomy.
Doug, thank you , this book is amazing. i had been on this site for journals but had not thought to search books. your instructions were great. very much appreciated :)
Thanks Doug,
web site is great.. I have had the book for a few years, but great to have as pdf, but when i searched for it, somehow another article came up..
will try again…
this is the most exhaustive resource i have seen on literature on bed bugs.. Sometimes we just don’t know where things are. I have used DoD stuff before, but didn’t know about the library..
muchos gracias..
Sam
Less than 5% react to a single bite episode… That is amazing…. Over 95% non-responders from a group of 900 volunteers…
Explains why we sometimes find an advanced infestation despite the occupants observation that the bite marks just started to appear.
It will be interesting to see a follow up study that looks into the sensitization process that occurs with extended exposure to bites.
I can’t stop reading this book, it’s fascinating. found this info relative to bite reactions:
“In the experiments 5 bed bugs were fed on the shaved
skin of each of 10 guinea pigs each day. At first, there was no reaction
of any kind (latent period), but on the seventh day (5 days in fleas) the
animals became sensitized and a delayed (24 hours) reaction was ob-
served in the form of a papular lesion at the site of the bites. After a
week with no exposure to bites the animals were again challenged. This
time there was an immediate (20 minutes) reaction, followed the next
day by a delayed reaction. Four days later the same pattern was observed.
One month after the initial exposure a change began to occur. The
reactions were mostly immediate with only a few delayed. This con-
tinued when the animals were challenged after 2, 3, and 6 weeks. At
the end of the experiment all reactions were immediate except one.
Theoretically, continued exposure would have resulted in complete de-
sensitization with no reactions at all, but this stage was not reached in
the experiments with bed bugs.
My own reactions, after 7 years of feeding a colony at weekly intervals,
progressed from delayed to immediate and showed no evidence of de-
sensitization. Kemper (1936), who claimed to have received over 100,000
bites while engaged in experiments over many years, likewise never
reached the stage of complete immunity. On the other hand, Hase
achieved immunity to the bites after permitting himself to be bitten by
2500 bugs over a 9-month period (Hartnack 1939). “
Another good picture is #10 here.
I’m positively obsessed with this bite stuff. Planning some posts to gather everything but I keep finding new things and things I don’t understand.
the best info on the length of what i called the ” proboscis “. “stylet fascicle” i believe is the correct term. ” is enclosed in the rostrum. the rostrum of lectularius was measured at .85mm . on page 35 there is a great diagram showing the workings of the action of the bite. IMHO since the biting parts are enclosed in the rostrum i can’t see them being more than 1mm long. i have read that bedbugs can feed through thin clothing, but i don’t see how this is possible. He goes on to state that even if actual feeding is not attained, just the bite can cause a reaction. i would assume that not all people who are bitten have been fed upon.
Renee, the sheffield pics are fantastic, the bending in the rostrum and labium is clearly shown
It seems possible. I’m reading (or trying to read) an article that suggests C. lectularius is a more efficient blood-feeder than C. hemipterus, making it a more successful pest (tests on mice and pigeons). Blood flow seems to be an interesting factor. Many interesting things along that thread that I’m trying to understand.
However, I think that the fact that mattress encasements have been tested for “bite-through” and also that many bed bugs are fed through membranes indicates that biting through clothes is possible. I’m trying to remember if Lou has told us anything about this. I have the feeling that he has.
i seem to remember an interview where the expert, in answering a question about protection from bites with a travel sheet, said bedbugs can bite through clothing. I guess it’s possible but the fabric would have to be very thin and taught against the skin.
i found it interesting that studies showed bedbugs avoided any wet areas and that their harborage tends to be very close to their food source as they can’t detect heat from very far off, measured in inches.
i remember my grandmother telling a story of how her mother would spread petroleum jelly around their beds when they would stay at cabins in upstate new york during the summer months, to prevent bedbug bites
i also found it interesting that in 1947 in a study done in army barracks in pearl harbor, that bedbugs showed an immunity to DDT even then. this does not bode well for proponents of insecticides.
Getting the most out of the army library? It’s a bit addicting at first.
Actually, I am a “proponent of insecticides.” The reason that we need insecticides is that alternatives to pesticides (like thermal) are expensive and therefore unavailable to the majority of people who have bed bugs. Diatomaceous earth is inexpensive. Can it eradicate infestations? Some people believe that, yes, it can (and by this I mean most infestations, not just some). I personally don’t see DE as the answer. But assuming that it were, people would have to be taught how to use it, use the right kind, safely, and they may still need to do other things. What other things? Steam? A dry vapor steamer is extremely expensive.
Society could choose to raise the effectiveness of conventional pest control treatments — this means increasing the proficiency of pest control providers and introducing effective pesticides, or reintroducing older ones, not DDT, that still work. Or it could choose to subsidize the cost of alternatives (thermal and “IPM”) so that they can be widely deployed. As it is, society is choosing to do neither. The pest control industry says their training is fine (which does little to explain the state of professional proficiency in NYC) and there is resistance to the idea of reintroducing older pesticides. As for subsidizing pest control for the majority of people who are suffering, no takers! Imagine that. Hence this horrible mess.
I think effective pesticides, used correctly, would help tremendously. Pesticides or money. Money would be nice. But there ain’t none.
PS: jc, check this out, not to pimp my own posts or anything, but those are some cool interviews.
great documentary makes me feel nostalgic and it’s not even my generation.
i also feel there is a place for pesticides but there must be better modes of application. applications that limit the leeching of pesticides into the environment outside of the specific are being treated.
personally i’m a big fan of physical barrier methods and traps, unfortunately these will not work well in multi dwellings unless every tenant or owner is dedicated and vigilant.
i think this modern bedbug problem will soon come to a head in the sense that governments and industries affected will have to legislate and provide better solutions.
in my opinion thermal has no future, as you say it’s expensive and isn’t really that effective unless you’re talking small spaces or objects like mattresses.
maybe the answer is trained geckos :)
haha, but geckos are so noisy; New Yorkers are very sensitive about noise.
maybe trained rats:
Mellanby (1939b) reported that bugs in his infested
animal colonies were eaten by the rats. In
my laboratory 70 bed bugs
(fifth instars and adults) were confined in an escape-proof plastic cage
with a white mouse. The mouse ate no bugs during the first 4 hours
(7:00 ‘ to 1:00 A) but all bugs were eaten during the next 10 hours.
Many cuticle fragments were found later in the mouse’s stomach (Bar-bara Wilson).
or…. if all the food writers and tv chefs extoll the flavor of bedbugs, new yorkers may find a new inexhaustible and inexpensive bar snack, bedbugs could replace chicken wings, less fat, more protein, a fraction of the calories, just a thought:)
We’ll forget momentary lapse when you come to NYC for a visit! People of course have eaten bed bugs. I forget whatever for, but they were thought to be good for something, crushed. I’m all for crushed bed bugs in any case.
my this has become a long comment list.
i agree with Johnycakes post as follows
“i also feel there is a place for pesticides but there must be better modes of application. applications that limit the leeching of pesticides into the environment outside of the specific are being treated.” The answer is yes, trhere are better modes of application, but it is not just pesticides. Renee, in one of your posts you put IPM into the category of a method of treatment with the implication that it is either pesticides OR IPM. . It is not that.. Every time IPM is applied properly the results are better control with reduced use of pesticides. It is not because IPM excludes pesticides, but rather it utilizes them as part of a total strategy, not as the whole thing.. One field study by academics is not necessarily the end proof of IPM working or not working. It is not a one shot deal. The whole point about IPM is that it is a way of looking at pest mangement holistically… understanding pest behaviiour, understatnding the ecosystem of housing and all the variations, better quality of service, fair prices for a fair job. Marshalling support for tenants when they need support. and always education..
IPM is not about not using pesticides when needed but it is definitely about reducing volume and safe application and when pesticides are not needed, not using them as a brainless spray jockey baseboard spraying for harmless occasional pests.
I met John Osmun many years ago at a conference here in Toronto. A real privilege.. He is a gentleman. The kind of person who gives his full attention to the person in front him and listens and shares his experiences with warmth. I only met him once hearing him speak and then later asking him questions (I don’t even remember what now), but in those few moments i was left with a very good feeling. My only regret is that I never had more opportunity to meet with him. I have also met many unnamed egotists whose first interest was “me, me ME” to the point they were snobs in spite of their “presented” personnae. Dr. Osmun reminded me of some mentor teachers i have had in my lifetime who left me with the goodness of their spirits for a lifetime.
I know he is retired now and i do hope he is having a wonderful time.
As for the bed bugs, well Renee,, you are right about society needing to step up and set standards and legislation to make things happen taht should happen in managing this pest to elimination. And at end, it all fits within the definition of what IPM is about. It is not a method of treatment, it is a process, and a thought out scientific approach.. not that complicated really if one things of statistical process control, or HACCP approaches (Hazard Analysis Critical Control Point), all methodologies of approach in order to get the job done most efficiently, and with bed bugs or roaches or mice or rats for that matter, when it involves society and people living in the [privacy of their homes and all the variations over which control is impossible, then it takes education and co-operation at all levels and some measure of legislation to help it go…and taht is a societal response.l
ok. i am getting off my soapbox now..
goodnight folks.
Sam, fellow canuck, at the risk of running at the mouth on this post ( or has that already happened ) i am not an exterminator nor am i in the business but the one thing i do know is people, society. if we have to rely on a societal response we will be up to our eyeballs in bedbugs before we know it. we require learned, intelligent decision makers, with input from scientists and pest control professionals to take control and basically force measures upon society to solve this problem. society is incapable of co-operation on the level needed to control bedbugs. all it takes is one lazy stupid tenant to cause an infestation or re-infestaion. i can rely on bedbugs to be predicable in their behavior, i cannot say that about people, unfortunately. i’m going to watch braveheart for the third time, good evening.
J-cakes,
I had composed a response, but as it goes sometimes it was lost before sent.
I am truly amazed at the disconnect of your response from my post.
First, i would suggest that you read my response again and absorb the meaning of my words rather distorting what I have said.
What does society mean? and What does a societal response mean?
Simply put.. society is US…. all the people living in a nation or a city or a town or a village.. collectively and individually. A societal response would mean the overall way in which society addresses the issue.
Your answer about “forcing measures upon society”.. well, in a roundabout way, yes, that means laws. It is sort of like why we object to someone walking down the street stark naked, though on some beaches in the world, it is pretty close to that with thongs and so on.
but guess what? societies are complex organizations of humans, and guess what, the aspiration is to a democratic and just society.
So, a societal response would be something like …………………… you guessed it — IPM… and even if some want to call it something else, no matter,
it is about education and sensible practices, and rules and regulations about who does what and practices to enable prevention. And that, J-cakes, is a societal response.
If you read the article on the e-coli contamination of ground beef in the Sunday edition of the New York Times, you will have a context of the sometime complexities of doing it right. And a recent piece on CNN about pthalates and other derivatives of plastic and their impact on infants…
In the debate about bed bug control, i think that the professionals want to do it right and do it in the safest way possible. Some think that this lies only in pesticides. Most competent professionals know that this is not the case.
The balance between individual and community rights is something that societies have worked on since people began to live in organized complex communities. More often than not, when force was the rule of the powerful, many people suffered for that, sometimes with their lives. A just society works to do it right and protect the rights of individuals and with bed bugs, this has its own complexity in helping people, believe me. Doing it right takes education and accountability and a sense of compassion.
and I think it is far more complex than attributing fialure to “one lazy stupid tenant”.. how about “one lazy stupid property manager” or ……….. you add the characterization because it fits as well as “tenant”…
best wishes johnycakes, whoever you are,
Braveheart for the third time.. a tragic piece. I have seen it once fully and then in bits and pieces. I don’t think I could bear a third time.
Hi Sam,
didn’t mean to distort your response, all I am saying is IPM is fine but it must be put forward as a law. I make no distinction between tenants, managers, landlords etc. The bedbug problem, i feel, is not like the e.coli or phthalate problem. It is easy to legislate companies which manufacture goods, maybe difficult to oversee but laws are written and penalties are handed out. Bedbugs on the other hand are a societal problem not one associated with a few thousand companies but with millions of people. If a tenant or landlord can be held accountable they will think twice about contravening the law. As it stands now, the only recourse is grin and bear it, deal with it, or prove on your own that it is the fault of others. Granted it would be difficult and we already have so many laws governing us but like the public spitting laws, pertaining to TB, of the past, something will have to be done. Yes education, accountability and compassion have their place but society is not what it once was. I for one, have little faith that society can manage this problem. I think when bedbugs become a fiscal problem and start to affect people with the power to enact laws, we will then see a call to arms for legislation. I would rather see your solution, but I won’t hold my breath.
I recently found bed bugs in my hotel room on the first night staying there. I was in bed about 3.5 hours from 11:30pm and awoke at 3 am and saw 2 big bugs, and 3 smaller ones. I saw a few bite marks on me but no symptoms. After changing hotel rooms, I’m pretty sure I wasn’t bitten because I was 14 floors up from my last room and slept with all the lights on at the foot of the bed and woke up up about every hour to check my surroundings. After I returned home from the trip, on exactly the 7th day all the bite marks appeared and itch like crazy. I have over 100 bites from that one night. I’m pretty positive I didn’t bring them home with me as I took some precautions.