New York vs Bed Bugs » Public Health

Government of Ontario bed bug website

Renee Corea — Tue, 11 Jan 2011 06:40:46 +0000

The provincial government of Ontario bed bug website that was announced as part of the new funding push to fight bed bugs in the province is now live: bedbugsinfo.ca. See The Star, our brief note and do take a look at The Star again today on the criticism by some stakeholders of the Ontario funding action as too limited.

About the website, I like the easy navigation, links to more developed Toronto Public Health resources, to local public health units, the tenant information sheet and, above all, the speedy début. By contrast, the “identify” section needs some work, or maybe a lot of work, and photographs.

This seems like such swift action. I am impressed. It should not be hard, or not too hard, to set up an educational website. But, as we know, what looks simple and straightforward is not really, or everyone would have done it already. On the NYC situation what needs to be said? I hope we’ll have a bed bug portal here, eventually, and I hope it measures up?

The government’s bed bug reading list

Renee Corea — Tue, 30 Nov 2010 06:48:19 +0000

Take a look at the very interesting Federal Bed Bug Work Group’s Bed Bug References and Information Sources (PDF).

One feels like shooting Dr. Feldlaufer, or whoever keeps this list, a friendly email. Then again, the word volunteer appears twice on the first page, maybe it’s best (kinder) to leave them alone. (On the list itself, briefly: I think a persistent blind spot is the social history of bed bugs. A few history sources would not be out of place, especially if the list is intended for a broader audience.)

What is the FBBWG doing, do you think?

Because you know what it sounds like from reading the intro to that list.

It sounds like they don’t got no money!

And with almost too easy a search, one can confirm that is about right (PDF).

And yet here is this radio interview today with EPA Office of Pesticide Programs Registration Division Director Lois Rossi:

The workgroup is currently working toward a researchers meeting to “identify the knowledge gaps that we have about bedbugs, about how to control them, about how they behave, about different techniques that work in controlling them, and the efficacy of tools that are already out there,” Rossi said.

The workgroup is also working as a whole to improve communication with the public and provide a one stop guide for information on bedbugs. There are many Websites and fact sheets floating around, Rossi said, so the group wants build a clearinghouse where “the public can go to one spot and get reliable information.”

Improved communications — desperately needed and one hopes not just in the form of another website — but the first thing. A national research agenda. Is that what she meant?

Perhaps an overly imaginative reading, since having one without actual money to set it in motion would be sad? I don’t think the Feds do that, sad, intentionally.

There’s a bit at the end in which Lois Rossi seems ever so not so slightly to wish to walk back that whole public health pest designation thing. I may be misreading that too.

So then, a “very annoying” “nuisance pest” that nevertheless apparently merits another federal bed bug summit to be held February 1-2, 2011.

Bed bugs and poverty in cold bar-chart blue

Renee Corea — Mon, 15 Nov 2010 11:45:50 +0000

The data of last year’s community health survey which for the first time included a bed bug question is now available at the city’s Environmental Health Tracking Portal:

Name	Number of Adults Reporting	Percent of Adults Reporting
New York City	404,000	6.7%
Bronx	74,000	8.1%
Brooklyn	161,000	8.9%
Manhattan	74,000	5.8%
Queens	87,000	5%
Staten Island	8,000	2.5%

Source: NYC Community Health Survey (CHS), 2009 – NYC Environmental Public Health and Sustainability Tracking Portal

See also a breakdown by neighborhoods (PDF): Williamsburg-Bushwick: 16.5%, Borough Park: 12.2%, etc.

You’ll see there are many ways to explore the data, including a map, but this is the easiest prize:

Adults Reporting Bed Bugs in their Home by Neighborhood Poverty - 2009 NYC Community Health Survey - NYC Environmental Public Health and Sustainability Tracking Portal

On the neighborhood poverty calculations:

Neighborhoods are ranked according to the percent of people whose annual income falls below twice the federal poverty level. Rankings are then divided into 3 approximately equal groupings of low, medium and high poverty.

For more on the neighborhood poverty indicator, see this poverty map document (PDF).

I think all of this is perhaps a bit like Orwell’s notes from his slum sojourn:

But mere notes like these are only valuable as reminders to myself. To me as I read them they bring back what I have seen, but they cannot in themselves give much idea of what conditions are like in those fearful northern slums. Words are such feeble things. What is the use of a brief phrase like “roof leaks” or “four beds for eight people”? It is the kind of thing your eye slides over, registering nothing. And yet what a wealth of misery it can cover!

I am also reminded of something else, from an article written at that familiar, precarious point of false triumph over the bed bug, this time from Iceland. In a section titled Eradicated Ectoparasites, Skírnisson et al. (2003):

Gígja (1944) and Fristrup (1945) state that C. lectularius was the worst pest that had ever occurred in human dwellings in Iceland.

The worst pest that had ever occurred. What does that mean? No bar chart is up to the task.

A pest of significant public health importance, cont’d

Renee Corea — Sat, 07 Aug 2010 19:30:12 +0000

With people’s backs against the wall in various cities of the United States, the CDC and EPA pronounce themselves officially on the case of “alarming” U.S. bed bug resurgence: CDC-EPA Joint Statement on bed bug control in the U.S.

What one can expect from the CDC:

CDC is partnering with experts in the areas of medicine, entomology, epidemiology and environmental toxicology to better understand the resurgence of bed bugs and the methods and tools that are needed for effective bed bug control. CDC will provide timely information on emerging trends in bed bug control with the goal of developing national strategies to reduce bed bug populations. CDC recognizes that very limited research has been conducted on bed bugs during the past several decades and encourages increased bed bug research to determine the causes of the resurgence, the most effective methods of control and the potential for bed bugs to transmit disease.

And the EPA:

EPA realizes that certain bed bug populations in communities across the nation are becoming increasingly resistant to many of the existing pesticides. EPA is actively working with industry and researchers to identify new compounds (or new uses of existing compounds) to control bed bugs. In addition, EPA is working to educate the general public, pest professionals, and public health officials about bed bug biology and IPM, which is critical to long-term bed bug control.

Hopeful/desperate emphasis added.

Read the whole thing, of course. Not every day that the painfully obvious is spelled out so satisfyingly.

There are a thousand quibbles, but I will allow myself one:

In some cases, a coordinated community control program may be necessary to reduce or eliminate bed bug populations.

In some cases?

Bite sensitivity, new data

Renee Corea — Thu, 18 Feb 2010 02:33:39 +0000

The results of the bed bug bite survey we heard so much about are reported in this new article, The Sensitivity Spectrum: Human Reactions to Bed Bug Bites (PCT February 2010, Michael F. Potter, Kenneth F. Haynes, Kevin Connelly, Michael Deutsch, Erich Hardebeck, Don Partin, and Ron Harrison).

This is unprecedented stuff, so let’s take a very close look.

474 respondents, all with confirmed bed bug infestations, in Chicago, New York, Cincinnati, Louisville, Atlanta, LA and Miami. 66% living in apartments and 15% in single-family homes. All ages. 58% female, 42% male.

The breakdown for infestation level:

Infestation level	Bugs	Respondents
Low	≤10	34%
Moderate	11-100	47%
High	101-500	14%
Very high	> 500	5%

“Have you experienced any bites or skin reactions from the bed bugs in your dwelling?”

70% yes, 30% no.

Essentially the reverse of what was previously thought. Though there were also skeptics—see this note about last year’s article by Reinhardt and others.

The female/male differences were not statistically significant. And neither were ethnicity differences. The level of infestation was also not a factor.

Not so with age, however:

Significantly more people over the age of 65 reported no bites or skin reactions than those who were younger. Forty-two percent of the eldest individuals surveyed said they had no bites or reactions from bed bugs in their dwelling, whereas 26 percent of those aged 11 to 65 reportedly did not react.

This corresponds with an earlier survey where 76% of elderly tenants in one “severely infested” building did not react to bites (or reported not reacting). Possible reasons for this mentioned by the authors include reduced responsiveness to allergens in the elderly, medications that suppress the immune response (corticosteroids), and “diminished awareness due to other competing health issues.” For another discussion of a similar case, see the ASHES/Orkin white paper (PDF) from last year.

I think everyone is rightly worried about the elderly. Their infestations may go unreported, grow undetected, and then may be treated incorrectly.

Relationship to mosquito bites

The bed bug bite response reported in this survey corresponded with the level of mosquito bite response in the following way:

“Barely visible” mosquito bite reactions = 53% reacted to bed bugs
“Small (dime-size) welts” from mosquito bites = 77% reacted to bed bugs
“Large (quarter-size)” / “severe (half-dollar size or larger)” mosquito bite reactions = 89% reacted to bed bugs

Characterizing the reactions of the 70%

72% had “itchy red welts”
50% had “redness or discoloration”
28% had “itching in the absence of welts”
21% had “a ‘pinprick’ or ‘stinging’ sensation”

Okay, let me pause here. On this last point the authors say: “which may or may not be symptomatic of bed bugs.”

Personally I have to say I can’t count the times people have reported this. Bed bugs!

There’s a lot more about the reported reactions.

The public health question, etc.

This is remarkable:

Other oft-mentioned symptoms from respondents living with bed bugs included nervousness, paranoia, anger, frustration, embarrassment, devastation and depression. Anxiety, stress, sleeplessness and depression are medically important symptoms that can lead to other conditions. Dismissing bed bugs as “not a public health pest” on the grounds that they are unproven disease vectors ignores the pain, suffering and emotional distress inflicted on their victims. When government agencies finally concede this point, additional resources may be allocated to combat the problem, as they were years ago.

I may have to put that on a post-it.

I hope they’re right.

#44

Renee Corea — Wed, 17 Feb 2010 23:18:23 +0000

Not sure how I missed this but check out the CDC’s internal site search stats for 2009. Bed bugs rank #44 on the list of keywords, behind scabies, above smoking.

25,506 searches. Frustrated searchers to be sure.

I’m good for at least 20.

As previously noted, nothing but some journal articles and a key.

Ohio’s Section 18 exemption request, draft labels and public comment period

Renee Corea — Fri, 08 Jan 2010 14:02:10 +0000

The Environmental Protection Agency has published Ohio Department of Agriculture’s Section 18 exemption request for propoxur in the Federal Register. The public comment period ends on January 21.

The docket is EPA-HQ-OPP-2009-0856.

The notice: Propoxur; Receipt of Application for Emergency Exemption; Solicitation of Public Comment (PDF)

ODA’s application and supporting documentation, including draft labels and supporting letters: Supporting and Related Materials (PDF)

The three products are:

Prenbay 1% Oil Solution (Prentiss Incorporated)
Invader HPX Residual with Propoxur (FMC Corporation)
Prescription Treatment Brand 250 Propoxur (Whitmire Micro-Gen Research Laboratories)

From Matt Beal’s letter:

Ohio is requesting a Section 18 Exemption for the use of three formulations of Propoxur for the control of bed bugs in residential single or multiple unit dwellings, apartments, hotels, motels, office buildings, modes of transportation, and commercial industrial buildings in Ohio.

From Dr. Susan Jones’ supporting letter:

In my opinion, the current bed bug crisis represents an urgent, non-routine situation that warrants a FIFRA Section 18 emergency exemption.

The draft labels (restricted use for certified applicators) are included; all three are ready to use products and include a 14-day re-treatment restriction — and needless to say cannot be used for treating mattresses.

I would suggest to individuals and organizations in Ohio looking for guidance to contact the Central Ohio Bed Bug Task Force.

Australian medical entomologists on what GPs should know

Renee Corea — Mon, 30 Nov 2009 08:18:01 +0000

Not everyday that you read this:

Mental health impact

One aspect of the medical affects of bed bug bites that is almost never addressed is the significant psychological distress caused by the bites. This is a very real health problem and should not be ignored. There is an apparent stigma associated with bed bugs that relates the insect with poor housekeeping and hygiene,²⁹ even though five star hotels do not escape infestations. Often when people learn that there is an insect in their bed that is biting them at night, they are horrified and disgusted. This can develop into a delusionary state, whereby the patient feels bites and insects crawling on them, even if the bed bugs have been eliminated for some time.³⁰ As bed bugs often bite on the face and neck, the resulting bite marks can affect an individual’s self esteem and possibly interfere with employment performance or prospects. Another aspect of how bed bugs impact on the mental health of people relates to the trauma of the cost of eradication, which can be from hundreds to thousands of dollars per infestation.

Not to mention this:

[S]ince the mid 1990s there has been an unprecedented global bed bug pandemic.

Doggett, S.L., Russell, R. (2009) Bed bugs – What the GP needs to know. Australian Family Physician. 38(11). 880-884. (free PDF download)

The authors include several photos of bed bug bite reactions, including blister-like reactions. There is mention of the Canadian bed bug anemia report (see our interview with one of the authors here) and a brief discussion of bite sensitivity with reference to Reinhardt et al. 2009 (we discussed here) and Goddard/deShazo (JAMA 2009), and also to this other Goddard/deShazo article (Midsouth Entomologist 2009) which I suppose we should have discussed earlier but, well.

One more quote from Doggett and Russell:

As bed bugs are not known to transmit infectious diseases, most regional and local health authorities do not strictly consider them to be a health issue. Clearly, however, they are a community health problem. Bed bugs produce variable irritating skin reactions and are responsible for considerable mental anguish, as well as being a major economic imposition on the community. Unfortunately, such an apathetic stance by health authorities can allow the bed bug resurgence to continue and become an increasing problem in more communities. As a result, more medical practitioners will be consulted by more victims of bed bug bites.

I think the apathy of public health authorities has indeed been an agent of the spread. But this apathy would not have persisted so long were it not for the stigma. I’m not sure how this will play out in the years to come, given all current evidence that suggests bed bug problems will continue to increase. Some interesting times ahead for sure.

What has been your experience with doctors and bed bugs? I hope more doctors start to ask about bed bugs. In my experience it does pay to start the conversation yourself. Educate your doctor, for the next patient who seeks advice.

And what do you make of the p word and bed bugs? Can we finally start calling this a pandemic? I never properly understood the reluctance.

Finally, on a barely related note of wishful thinking, I have been intrigued by NYC’s public health detailing program. What a great idea. Could we possibly piggyback some bed bug literature in there?

So, it’s propoxur

Renee Corea — Wed, 11 Nov 2009 06:27:10 +0000

Update: Federal Register notice published; public comment period ends January 21, 2010.

When we noticed the talk about the active consideration by EPA of Section 18 emergency exemptions for bed bugs, it wasn’t clear which pesticides were being discussed.

The Columbus Dispatch reported today that Ohio is in a position to get propoxur for bed bugs.

The story about today’s Central Ohio Bed Bug Summit has Matt Beal of the Ohio Department of Agriculture citing University of Kentucky trials:

In tests at the University of Kentucky, the chemical killed 100 percent of the bedbugs exposed to it within 24 hours and kept on killing after eggs hatched, Beal said. That compared with a 16 percent kill rate after 72 hours for a commonly used household insecticide against one strain found in Cincinnati, and 40 percent in another strain.

The stakes are high as we all know. “Overwhelmed” and “bleak” are the words from Paul Wenning and Susan Jones.

Will this happen?

Getting the U.S. EPA to sign off will be a high hurdle, Beal said.

I’m curious to know what you make of this.

The city’s new flu portal

Renee Corea — Thu, 01 Oct 2009 20:54:09 +0000

http://www.nyc.gov/flu

This is one of the things we would want for bed bugs.

I say this with humility. I know these are two different public health problems. And there are no comparable resources.

But still.