Bedbug infestation is the contamination of bedding, clothing, and household furnishings with the small parasitic insects active at night. The insects belong to the family Cimicidae, commonly known as bedbugs. Bedbugs feed on the blood of humans and other warm-blooded animals. Bedbug bites can result in skin rashes and sores, psychological effects, and allergic reactions.
Bedbugs have been recognized as human parasites for thousands of years. The development of the pesticide DDT eliminated bedbugs from most developed countries by the early 1940s. However, after DDT use was banned because of its harmful effects on the environment, bedbugs returned. Bedbug infestation is relatively common in developed countries and very common in developing countries. Bedbugs spread easily, often carried by international travelers or by the exchange of secondhand furnishings and other items among households. Bedbugs are difficult to exterminate because of insecticide resistance and use of pest control methods with chemicals that are less toxic and less persistent than needed to destroy the insects.
Generally, adult bedbugs are 0.25–0.5 in. (4–5 mm) long, brown, and have a flat, oval-shaped body. Young bedbugs (also called nymphs) are smaller and lighter in color. They are primarily nocturnal, feeding on the blood of birds and mammals at night. When bedbugs bite, they inject an anesthetic and an anticoagulant that prevent a person from feeling the bite. Because bites usually occur while people are sleeping, most people do not realize they have been bitten until marks appear. Bedbugs are attracted to their hosts by carbon dioxide, blood, and warmth. During the day, the bugs hide in mattress seams, cracks in bed frames or other furniture, behind loose wallpaper, and in bedding and clothing. Female bedbugs lay from one to five eggs a day, up to 500 in a lifetime. The eggs hatch in seven to ten days. Adults can live for months without feeding.
Although bedbug bites are painless, they can cause an allergic reaction after a few days, resulting in an itchy, red rash. Bedbug bites rarely are medically dangerous, but they can become infected through scratching. A bedbug infestation also can cause emotional distress, resulting in anxiety, stress, and sleep disruption.
People often associate bedbugs with poor or dirty living conditions, but bedbugs can be found in pristine environments. In the early 2000s, complaints about bedbugs in both budget and first-class hotels increased. A 2015 study from the National Pest Management Association (NPMA) and the University of Kentucky reported on bedbug infestations found by pest control professionals. Of those surveyed, 75% had found bedbugs in hotels or motels, but 05% had found them in apartments or condominiums, and 93% reported having found the bugs in a single-family home. The problem is much worse in poor regions of the world.
The risk of exposure to bedbugs increases with certain activities including the following:
A 2010 survey from the NPMA and University of Kentucky found that calls to exterminators in the United States increased 57% nationwide in the previous five years. More than 95% of 519 U.S. exterminators participating in the survey reported finding at least one bedbug infestation in the previous year. In the 2015 survey, pest control professionals in all 50 states reported finding bedbugs, and the infestations were fairly evenly spread around the country. Still, risk of bedbug infestation is much higher in large, typically port, cities. The number of reported bedbug infestations in the United States increased 10- to 100-fold between 1990 and 2010.
Orkin, a pest control provider, releases annually a Most Bedbug-Infested U.S. Cities ranking, based on an evaluation of service calls and confirmed cases by service professionals. In January 2018, the top most bedbug-infested cities (in order from 1 to 10) were:
The bite of a bedbug causes an allergic reaction in most people that can be difficult to differentiate from skin reactions caused by other bites or allergies. The rash caused by bedbugs is red and itchy and typically darker in the center of the bite. Often, but not always, bites form lines or groups of three, sometimes called breakfast, lunch, and dinner. Although bedbugs will bite any exposed skin, bites are most often found on the face, neck, arms, and hands.
The time it takes a bedbug rash to appear varies, from as brief as one minute to as long as ten days. Generally, the more frequently a person is exposed to bedbugs, the shorter the time it takes for the rash to appear. In rare cases, individuals can have an extreme, life-threatening allergic reaction to bedbug bites called anaphylaxis or anaphylactic shock.
A bedbug infestation also can cause anxiety for weeks or months, depending on the person and the severity of the infestation. Shame and embarrassment are also common among bedbug sufferers, mostly because of social stigma against bedbugs and other insects. Although a 2017 study reported bedbugs preferred dirty laundry to clean, this is likely because the insects can smell more than 100 compounds produced by human skin. It is a misconception that a bedbug infestation is the result of poor housekeeping.
Medical diagnosis is not always necessary; an individual can make the diagnosis based on past experience with bedbugs, recent history of travel, or examination of bedding for signs of infestation. When a medical diagnosis is sought, it is made based on the appearance of the rash along with a detailed history of recent travel and hotel stays. The doctor also might ask about any drugs, herbs, or supplements being taken to help eliminate other possible causes of the rash. There are no tests available to diagnose bedbug bites.
The symptoms and rash associated with bedbug bites go away on their own, usually within a week to ten days. An over-the-counter skin cream containing hydrocortisone can be applied to reduce itching. An over-the-counter antihistamine containing diphenhydramine (such as Benadryl) also can help reduce itching. Parents of affected infants and children or pregnant and breastfeeding women should consult an appropriate healthcare professional before using these medications. In addition, if a person is experiencing distress, anxiety, or insomnia, a healthcare professional can be helpful.
Bedbugs can be killed by heat. Bedding and clothing should be washed in hot water and dried at very hot temperatures. The temperature must reach at least 120°F (49°C). Items that cannot be washed can be put in sealed plastic bags and placed in a car with the windows rolled up in the summer when the temperature will reach 120 degrees or more inside the car. Freezing is less effective. Items must be left at temperatures below 32°F (0°C) for several days to kill bedbugs.
Seven classes of insecticides are registered for use against bedbugs, although some can be used only by specially trained professionals. The seven classes include pyrethrins, pyrethroids, desiccants, biochemicals, pyrroles, neonicotinoids, and insect growth regulators. In addition, a pest strip with dichlorvos is registered to treat small enclosures. The use of a professional exterminator is the safest way to rid the environment of bedbugs.
Fumigation, the process of sealing infested areas and applying a gas that is registered for use by the federal and state governments can control live insects and bedbug eggs. Fumigation has a long history of success against insects, including bedbugs. Sulfuryl fluoride is the most common fumigant used to control bedbugs. This material is a gas and is released into an infested area or materials using very controlled procedures. Homeowners cannot purchase sulfuryl fluoride. It can only be used by a properly licensed company that has specially trained technicians. Fumigation usually requires vacating the property several days while the structure is being fumigated. When fumigating, the gas penetrates all cracks and crevices in the fumigated area. After the fumigation is complete, the area is aired out and monitored for residual gas. Another method of fumigation is to remove belongings that are infested to a chamber. These infested items are then fumigated and returned to the rooms. Precautions must be taken so that infested items do not spread bedbugs when they are removed and relocated. Fumigation does not provide any residual protection, although it does penetrate all accessible areas, including cracks and crevices. It will not prevent bedbug infestation and re-infestation can occur after treatment.
Room foggers and sprays against mosquitoes and ticks do not work against bedbugs. Many treatments for the elimination or prevention of bedbugs are sold over the Internet. These vary considerably in cost and effectiveness, so it is important to research products before buying them.
Bedbugs pose both a social and economic threat to owners and residents of apartment buildings, hotels, and public buildings. Economic losses from health care, lost wages, lost revenue, and reduced productivity can be significant. The cost of effectively eliminating bedbugs can be significantly more than the cost of eliminating other pests because bedbug control usually requires multiple visits from a licensed pest control operator and diligence on the part of those who are experiencing the infestation. Control in multifamily homes is much more difficult than in single family homes because bedbugs frequently travel between units, either via direct transport by humans or through voids in the walls. There are additional costs and complexities associated with coordinating and encouraging participation from multiple residents.
Although bedbugs are not considered vectors of disease, control is important. State, tribal, and local government agencies and health departments play a critical role in protecting the public from bedbugs. Public health departments serve on the front lines, providing information on prevention and control of bedbugs through various programs to the public and private sector. The community, together with local health agencies, must be involved in the control and management of bedbug populations and must be provided with the knowledge of best practices to prevent and control bedbug infestations. In some cases, a coordinated community control program might be necessary to reduce or eliminate bedbug populations.
Almost everyone recovers from bedbug bites within two weeks. Complications can arise from scratching the bites until they become infected. If infection occurs, a doctor might prescribe an antibiotic. Bedbugs have been shown to carry at least 28 human pathogens, but no study has clearly found that the insect can transmit the pathogens to humans.
Prevention is difficult. Avoiding secondhand furniture, couches, bed frames, mattresses, and beds is helpful. Birds and bats can carry bedbugs, so they should be eliminated from attics and eaves. Reducing clutter in the home reduces hiding places for bedbugs. The use of a protective cover that encases mattresses and box springs will eliminate many hiding spots. The light color of the encasement makes bedbugs easier to see. A high-quality encasement that will resist tearing should be used. The encasements should be checked regularly for holes.
When traveling, checking the seams of mattresses for dark specks of bedbug excrement in hotels is helpful but not foolproof. Using luggage racks to hold luggage when packing or unpacking rather than setting the luggage on the bed or floor can prevent bugs entering suitcases. Upon returning home, travelers should unpack dirty clothes directly into a washing machine and inspect the luggage carefully.
See also Parasites .
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Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, 30333, (404) 639-3534, (800) CDCINFO (232-4636). TTY: (888) 232-6348, firstname.lastname@example.org, http://www.cdc.gov .
National Institute of Allergy and Infectious Diseases, 5601 Fishers Lane, MSC 9806, Bethesda, MD, 20892-9806, (301) 496-5717, (866) 284-4107, Fax: (301) 402-3573, https://www.niaid.nih.gov .
Judith Sims, AM
Revised by Teresa G. Odle, BA, ELS