Bed bug

Bedbug
Cimex lectularius
Scientific classification
Kingdom:	Animalia
Phylum:	Arthropoda
Class:	Insecta
Order:	Hemiptera
Suborder:	Heteroptera
Infraorder:	Cimicomorpha
Superfamily:	Cimicoidea
Family:	Cimicidae Latreille, 1802
Subfamilies, Genera & Species
Subfamily Afrociminae Genus Afrocimex Afrocimex constrictus Subfamily Cimicinae Genus Bertilia Genus Cimex Cimex adjunctus Cimex antennatus Cimex brevis Cimex columbarius Cimex incrassatus Cimex latipennis Cimex lectularius Cimex hemipterus (C. rotundatus) Cimex pilosellus Cimex pipistrella Genus Oeciacus Oeciacus hirundinis Oeciacus vicarius Genus Paracimex Genus Propicimex Subfamily Cacodminae Genus Aphrania Genus Cacodomus Genus Crassicimex Genus Leptocimex Leptocimex boueti Genus Loxaspis Genus Stricticimex Subfamily Haematosiphoninae Genus Caminicimex Genus Cimexopsis Cimexopsis nyctalis Genus Haematosiphon Haematosiphon inodorus Genus Hesperocimex Hesperocimex coloradensis Hesperocimex sonorensis Genus Ornithocoris Ornithocoris pallidus Ornithocoris toledoi Genus Psitticimex Genus Synxenoderus Synxenoderus comosus Subfamily Latrocimicinae Genus Latrocimex Subfamily Primicimicinae Genus Bucimex Genus Primicimex Primicimex cavernis

Bedbugs (or bed bugs) are small, elusive, parasitic insects of the family Cimicidae. They live strictly by feeding on the blood of humans and other warm-blooded animals. The name 'bed bug' is derived from the insect's preferred habitat infesting houses and especially beds or other common areas where people may sleep. Bedbugs, though not strictly nocturnal, are mainly active at night and are capable of feeding unnoticed on their hosts.

Largely eradicated as pests in the United States in the early 1940s, bedbugs have been resurgent in the past decade to near epidemic proportions.

Biology

The common bedbug (Cimex lectularius) is the species best adapted to human environments. It is found in temperate climates throughout the world and feeds on blood. Other species include Cimex hemipterus, found in tropical regions, which also infests poultry and bats, and Leptocimex boueti, found in the tropics of West Africa and South America, which infests bats and humans. Cimex pilosellus and Cimex pipistrella primarily infest bats, while Haematosiphon inodora, a species of North America, primarily infests poultry.

Adult bedbugs are reddish-brown, flattened, oval, and wingless. Bedbugs have microscopic hairs that give them a banded appearance. A common misconception is that they are not visible to the naked eye. Adults grow to 4–5 mm in length and 1.5–3 mm wide. They do not move quickly enough to escape the notice of an observer. Newly hatched nymphs are translucent, lighter in color and become browner as they moult and reach maturity.

Bedbug (4 mm length 2.5 mm width), shown in a film roll plastic container. On the right is the recently sloughed skin from its nymph stage

Bedbugs are true insects and are not arachnids, unlike dust mites and ticks.

There are 6 recognized subfamilies of Cimicidae and up to 23 genera, while the number of species has been stated as anywhere from 75 to 108. Most species only feed on humans when other prey are unavailable.

C. lectularius and C. hempiterus will mate with each other given the opportunity, but the eggs then produced are usually sterile. In a 1988 study, 1 egg out of 479 was fertile and resulted in a hybrid, C. hemipterus x lectularius.

Bedbugs use pheromones and kairomones to communicate regarding nesting locations, attacks, and reproduction.

The life span of bedbugs varies by species and is also dependent on feeding. (See feeding habits, below.)

Feeding habits

Cimex lectularius, showing the insect’s skin-piercing mouthparts

Bedbugs are bloodsucking insects. They are normally out at night just before dawn, with a peak feeding period of about an hour before sunrise. Bedbugs may attempt to feed at other times if given the opportunity and have been observed feeding during all periods of the day. They reach their host by walking, or sometimes climb the walls to the ceiling and drop down on feeling a heat wave. Bedbugs are attracted to their hosts by warmth and the presence of carbon dioxide. The bug pierces the skin of its host with two hollow feeding tubes. With one tube it injects its saliva, which contains anticoagulants and anesthetics, while with the other it withdraws the blood of its host. After feeding for about five minutes, the bug returns to its hiding place. The bites cannot usually be felt until some hours or even days later, as a dermatological reaction to the injected agents, and the first indication of a bite usually comes from the desire to scratch the bite site. Because of their natural aversion for sunlight, bedbugs come out at night.

Although bedbugs can live for a year or eighteen months without feeding, and purportedly up to three years in the case of the species Oeciacus vicarius (the cliff swallow bug), they normally try to feed every five to ten days. Bedbugs that go dormant for lack of food often live longer than a year, while well-fed specimens typically live six to nine months.

At the 57th Annual Meeting of the Entomological Society of America in 2009, it was reported that newer generations of pesticide-resistant bedbugs in Virginia could survive only two months without feeding.

Low infestations may be difficult to detect and in the early stages, victims may not realize they have bedbugs. Patterns of bites in a row or a cluster are typical, as the insects may be disturbed while feeding. Bites may be found in a variety of places on the body.

Reproduction

A bedbug (Cimex lectularius) traumatically inseminates another.

All bedbugs mate via traumatic insemination. Instead of inserting their genitalia into the female's reproductive tract as is typical in copulation, males instead pierce females with hypodermic genitalia and ejaculate into the body cavity.

The "bedbug alarm pheromone" consists of (E)-2-octenal and (E)-2-hexenal. It is released when a bedbug is disturbed, for example, during an attack by a predator. A 2009 study demonstrated that the alarm pheromone is also released by male bedbugs to repel other males who attempt to mate with them.

Bites

Most observed bites consist of a raised red bump or flat welt, and are often accompanied by very intense itching. The red mark is the result of an allergic reaction to the anesthetic contained in the bedbug's saliva, which is inserted into the blood of its victim. Reactions to bedbug bites may appear indistinguishable from mosquito bites although they tend to last for longer periods. Bites may not become immediately visible and can take up to nine days to appear. Bedbug bites tend not to have a red dot in the center such as is characteristic of flea bites. A trait shared with flea bites is tendency towards the pattern of sequential bites often aligned in rows of three. This may be caused by the bedbug being disturbed while eating and relocating half an inch or so farther along the skin before resuming feeding. Alternatively, the arrangement of bites may be caused by the bedbug repeatedly searching for a blood vein.

People react differently to bedbugs, and individual responses vary with factors including skin type, environment, and the species of bug. This also means the presence of itchy welts cannot be used as the only indicator of a presence. It is possible for an initial infestation within a household to be asymptomatic and go undetected. In some rare cases, allergic reactions to the bites may cause nausea and illness. In a large number of cases, estimated to be fifty percent of all people, there is no visible sign of bites whatsoever, greatly increasing the difficulty of identifying and eradicating infestations. People commonly respond to bed bug infestations and their bites with anxiety, stress, and insomnia. Development of refractory delusional parasitosis is common, as victims develop an overwhelming obsession with bedbugs. Individuals may also develop skin infections and scars from scratching the bedbug bite locations.

A bedbug nymph feeding on host

Most patients who are placed on systemic corticosteroids to treat the itching and burning often associated with bedbug bites find that the lesions are poorly responsive to this method of treatment. Antihistamines have been found to reduce itching in some cases, but they do not affect the appearance and duration of the lesions. Topical corticosteroids, such as hydrocortisone, have been reported to resolve the lesions expediently and decrease the associated itching.

Victims may relieve itching and inflammation for several hours by using a blowdryer or hot washcloth to heat the area of the bite. Many patients experience temporary relief of itching and inflammation with the application of hot water. The water temperature should be about 50 °C (120 °F), or this procedure may aggravate the symptoms. To avoid scalding the skin, this treatment should only be self-administered.

Disagreement exists as to why heat causes symptoms to abate. Varying hypotheses propose that heat overwhelms the nerve endings that signal itch, that heat neutralizes the chemical that causes the inflammation, or that heat triggers a large release of histamine, causing a temporary histamine deficit in the area. Another theory is that the heat denatures the proteins in the bedbug saliva, changing their composition enough so that they no longer trigger the body's defensive mechanisms.

Disease transmission

Bedbugs seem to possess all of the necessary prerequisites for being capable of passing diseases from one host to another, but there have been no known cases of bed bugs passing disease from host to host. There are at least twenty-seven known pathogens (some estimates are as high as forty-one) that are capable of living inside a bed bug or on its mouthparts. Extensive testing in laboratory settings concludes that bed bugs are unlikely to pass disease from one person to another.

Other effects on health

The salivary fluid injected by bed bugs typically causes the skin to become irritated and inflamed, although individuals can differ in their sensitivity. Anaphylactoid reactions produced by the injection of serum and other nonspecific proteins are observed and there is the possibility that the saliva of the bedbugs may cause anaphylactic shock in a small percentage of people. It is also possible that sustained feeding by bedbugs may lead to anemia. It is also important to watch for and treat any secondary bacterial infection. Systemic poisoning may occur if the bites are numerous.

History

An 1860 engraving of parts of a bedbug. A. Intestines.—B. Antenna of the Male.—C Eye.—D. Haustellum, or Sucker, closed.—E. Side view of Sucker.—F. Under Part of Head.—G. Under Lip.—GG. Hair of the Tube, and outside Cases.—H. Egg-Bag.—I. Worm emerging from the Egg.

Names

Bedbugs are also known by a variety of names including wall louse, mahogany flat, crimson rambler, heavy dragoon, redcoat, and simply "bug". Its names in other languages include "stinker" (French punaise), "nightcrawler" (German Nachtkrabbler), "bitter" (Sanskrit uddamsa), "pursuer" (Portuguese percevejo or perceveja, depending on the region), "flat" (Czech plostice), "wood-dry" (Turkish tahtakurusu), and "wall louse" (German Wandlaus).

Middle East

C. lectularius may have originated in the Middle East, in caves inhabited by bats and humans.

Europe

Bedbugs were mentioned in ancient Greece as early as 400 BCE (later mentioned by Aristotle). Pliny's Natural History, first published c. 77 CE in Rome, claimed that bedbugs had medicinal value in treating ailments such as snake bites and ear infections. (Belief in the medicinal use of bedbugs persisted until at least the 18th century, when Guettard recommended their use in the treatment of hysteria.) Bedbugs were first mentioned in Germany in the 11th century, in France in the 13th century, and in England in 1583, though they remained rare in England until 1670. It was believed by some in the 18th century that bedbugs had been brought to London with supplies of wood to rebuild the city after the Great Fire of London (1666). Scopoli noted their presence in Carniola (present day Slovenia and Italy) in the 18th century.

Eighteenth and 19th century Europeans believed bedbugs to feed on the sap of certain trees (especially fir), paste (which may have included tree sap), other insects, and Acari.

Americas

Bedbugs were known at least as early as 1726 in Jamaica.

Bedbugs were originally brought to the United States by early colonists from Europe. Bedbugs thrive in places with high occupancy, such as hotels. Bedbugs were believed to be altogether eradicated 50 years ago in the United States and elsewhere with the widespread use of DDT. One recent theory about bedbug reappearance involves potential geographic epicentres. Investigators have found three apparent United States epicentres at poultry facilities in Arkansas, Texas, and Delaware. It was determined that workers in these facilities were the main spreaders of these bedbugs, unknowingly carrying them to their places of residence and elsewhere after leaving work. Bedbug populations in the United States have increased by 500 percent in the past few years. The cause of this resurgence is still uncertain, but most believe it is related to increased international travel and the use of new pest-control methods that do not affect bedbugs. In the last few years, the use of baits rather than insecticide sprays is believed to have contributed to the increase. With the advent of cockroach bait in the early 1990s, the use of residual insecticides and other liquid sprays were drastically reduced. As it turned out, pest control professionals had not realized that during their monthly treatments for cockroaches (particularly the German cockroach, which infests hotels as bedbugs do) they had helped in the control of bedbugs. This process may have started with the use of DDT but it is no coincidence that the dramatic rise in bedbug activity came approximately 10 or so years after professionals stopped spraying for cockroach activity.

Global resurgence

Bedbug cases have been on the rise recently across the world. Prior to the mid-twentieth century, bedbugs were very common. According to a report by the UK Ministry of Health, in 1933 there were many areas where all the houses had some degree of bedbug infestation. Since the mid-1990s, reports of bedbug cases have been rising. Figures from one London borough show reported bedbug infestations doubling each year from 1995 to 2001. The rise in bedbug infestations has been hard to track because bedbugs are not an easily identifiable problem. Most of the reports are collected from pest-control companies, local authorities, and hotel chains. Therefore, the problem may be more severe than is currently believed.

As stated above, the most-cited reason for the dramatic worldwide rise in bedbug cases in recent decades is increased international travel. In 1999, four separate infestations throughout the United Kingdom alerted people to the possibility of an increase in the worldwide bedbug population, facilitated by international travel and trade. However, there is evidence of a previous cycle of bedbug infestations in the United Kingdom. The Institution of Environmental Health Officers maintained statistics for bedbug infestations—data collected from reports and inspections. In the period 1985–1986, the Institution of Environmental Health Officers reported treating 7,771 infestations in England and Wales, and 6,179 infestations in 1986–1987. There were also reports of infestations in Belfast and in Scotland.

Blood-fed Cimex lectularius (Note the differences in color with respect to digestion of blood meal)

Since 1999, infestations have been reported in the United Kingdom, Germany, Spain, Australia, Canada, India, Israel and the United States.

Many bedbugs have grown resistant to insecticides (including DDT). In a study at the University of Kentucky bedbugs were randomly collected from across the United States. These “wild” bedbugs were up to several thousands of times more resistant to pyrethroids than were laboratory bedbugs. New York City bed bugs have been found to be 264 times more resistant to deltamethrin than Florida bedbugs due to nerve cell mutations. Another problem with current insecticide use is that the broad-spectrum insecticide sprays for cockroaches and ants that are no longer used had a collateral impact on bedbug infestations. Recently, a switch has been made to bait insecticides that have proven effective against cockroaches but have allowed bedbugs to escape the indirect treatment.

The number of bedbug infestations has risen significantly since the early 21st century. The National Pest Management Association reported a 71% increase in bedbug calls between 2000 and 2005. The Steritech Group, a pest-management company based in Charlotte, North Carolina, claimed that 25% of the 700 hotels they surveyed between 2002 and 2006 needed bedbug treatment. In 2003, Burl and Desiree Mathias, a brother and sister staying at a Motel 6 in Chicago were awarded $372,000 in punitive damages and $10,000 in actual damages after being bitten by bedbugs during their stay. These are only a few of the reported cases since the turn of the 21st century.

The resurgence of infestations led the United States Environmental Protection Agency to hold a National Bed Bug Summit April 14–15, 2009.

Infestations

File:DSCF0005.JPG

Bedbug (shown on writing paper)

There are several ways in which dwellings can become infested with bedbugs. One common way is for them to be picked up while traveling or when staying at temporary lodging such as hotels, bed-and-breakfasts, hostels, or motels—which are places that have been traditionally associated with an increased risk for housing bedbugs due to their higher rate of turnover and continual influx of temporary residents. Once acquired at such travel locations, the now hitchhiking bedbugs may then be transported and brought back to the homes of the guests in their luggage where a new infestation can then take place inside the home.

Bedbugs can also be picked up inadvertently through bringing infested furniture or contaminated, used clothing into a household. Though such furniture does not necessarily have to have been previously owned or discarded—as even brand new furniture can be exposed to bedbugs during storage or in delivery vehicles. Nor do the used clothes have to be clothing that had been previously obtained through borrowing, secondhand purchase or through donation—since any exposed and unwashed apparel is capable of transferring bedbugs. Toys such as stuffed dolls or other bedroom items can be infested as well.

Bedbugs may also introduce themselves into a new residence by traveling between multi-unit housing such as condominiums, dormitories, and apartment buildings, or arrive after having exited infested furniture that has been thrown out, discarded and/or placed outside for garbage collection or for treatment. This unintentional spread between adjacent homesites and nearby units is dependent, in part, upon the degree of infestation at the source (i.e., a heavier infestation is more likely to spread), but also upon the building material used to partition units and the material used to seal connecting pipes, vents, wires, etc. Further potential to spread is also directly related to the manner in which infested items are disposed of—such as whether or not contaminated furniture is dragged through common areas while being removed, which can result in the shedding of bedbugs or their eggs while being dragged—and whether or not infested items have been properly sealed once discarded.

Bedbugs can also be transmitted via animal vectors including wild birds and household pets.

In places that are severely infested, bedbugs may actually crawl onto a person's clothes and be carried from location to location allowing the bugs to spread in this manner—though, it should be noted, that this sort of hitchhiking behavior is typically associated only with severe cases or with cases of heavy infestations that are poorly managed. It is also common for bedbugs to nest in clothing articles that are generally not washed often (i.e., living and nesting inside of jackets, coats, purses, shoes, etc.) and for them to then spread when such apparel is either stored publicly with other apparel (as in locker rooms and on coat racks) or to spread when the unwashed, contaminated clothing comes into direct contact with high-trafficked public surfaces. Otherwise, bedbugs will not be usually carried from place to place by people on the clothing they are currently wearing. General machine washing and drying on high heat will disinfect most clothing of potential bedbugs and will kill their eggs as well.

The transmission of bedbug eggs is also an issue. It is not uncommon for the live bedbugs amongst an infestation to be completely eradicated during an effective treatment cycle only to have the remaining or surviving eggs hatch and reinfest the location. The bedbug eggs themselves are usually unaffected by and/or not killed by most approved pesticides. The eggs can also have an incubation period of up to several weeks and may be deposited in hidden areas that are difficult to penetrate, difficult to find, or simply hidden away from what otherwise would have been a quick lethal treatment (i.e., lethal treatment such as the killing of a bedbug's eggs through heat—by hot ironing fabric surfaces where bedbugs have hidden, through steaming [typically using a fabric steamer], via direct machine drying, or through a procedural use of boiling water, etc.). This stubborn tendency of bedbug infestations towards reemergence can be incredibly problematic and all the more difficult to detect, due to the now smaller size of the newly re-emerged bedbug nymphs and their propensity for hiding in small, hard-to-find locations. Reinfestation can be more difficult to discover early enough due to a corresponding decrease in the 'size' of infestation symptoms, such as fewer and now much smaller fecal droppings (resembling pinhead-sized dabs from a black permanent marker) which may be scattered and difficult to detect. There may be other evidence of reinfestation, like sloughed-off skins which are tinier in size.

Adult bedbugs, the nymphs, or their eggs may also follow home movers into their new homesite infesting the new location as well—often following movers who were, in fact, moving out due to an unmanaged infestation.

The numerical size of a bedbug infestation can range from a few staked out offenders up to hundreds, thousands, or even tens of thousands of bedbugs within a single infestation (albeit in the heaviest of cases). And the exact numbers of an infestation can be highly variable, as it is a function of the elapsed time from the initial infestation. Even a single female bedbug brought into a home has a potential for reproduction with its resulting offspring then breeding and potentially leading to a geometric progression of their numbers—that is, if swift measures are not undertaken to contain and control the budding infestation. In any case, bedbugs reproduce prolifically and it is not at all unusual for exterminators to encounter thousands of bedbugs in even a single mattress. Sometimes people are not aware of the insects and do not notice the bites. The visible bedbug infestation does not represent the infestation as a whole, as there may be infestations elsewhere in a home and the sighting of one bedbug typically means that there may be many more in hiding. However, the insects do have a tendency to stay close to their hosts, hence the name 'bed' bugs.

In some critical cases or where warranted, the detection of bedbug infestations can be aided by the use of bed bug detection dogs that have been trained to find bedbugs by their scent—in the same manner that search dogs used for law enforcement are trained to find drugs or explosives. A trained bedbug dog and handler can detect and pinpoint a bedbug infestation within minutes. This remains a fairly costly service that is not used in the majority of cases, but it can be very useful in difficult cases.

Reportedly, bedbugs have shown capable of infesting a variety of institutions and different types of businesses including nursing homes, furniture rental stores, hospitals, jails, homeless shelters, movie theaters, cruise ships, public housing, moving vehicles, and public transportation, etc.

Nesting locations

An engorged female bedbug (Cimex lectularius) with eggs, discovered in the screw hole of a wooden bed frame

Bedbugs travel easily and quickly along pipes and boards, and their bodies are very flat, which allows them to hide in tiny crevices. In the daytime, they tend to stay out of the light, preferring to remain hidden in such places as mattress seams, mattress interiors, bed frames, nearby furniture, carpeting, between the pages of books, baseboards, inner walls, tiny wood holes, and/or room clutter. Bedbugs can be found on their own but will more often congregate in groups once established. They tend not to travel further than 100 feet (30 m) from their host to feed and will usually remain close to their blood supply in the same bedroom or living quarters where people sleep.

Exact nesting locations of a typical infestation can vary greatly as bedbugs will often attempt to hide themselves within a wide range of tiny areas or spaces, within cracks and crevices, or simply in darker locations where they are out of plain sight. Such hiding spots may not always be immediately obvious to an inexperienced searcher—although bedbugs will indeed be much easier to find and locate once an infestation has become concentrated. A single intricate bed frame or mattress can hold a wealth of choice areas for bedbugs to hide so careful, meticulous inspection is a must. A standard mattress, however, is most likely to house bedbugs along the sewn piping material running along the outer edges on both the top and bottom sides of the mattress. The common bedbug is also most likely to hide in certain sections or parts of various types of beds if the segments are, in fact, present (i.e., hiding in the wooden head or footboard, for example, if the bed has one). Bedbugs may also quietly nest themselves under the cover of various materials and lie completely still for long periods making detection even more difficult.

The potential places where a typical bedbug may choose to hide are numerous. It is, however, very common for bedbugs to nest in whatever furniture it is that a person sleeps and naps on—which is not at all limited to beds, but also includes upholstered chairs, loveseats, sofas, plush furniture, futons, etc., as well as other non-traditional beds such as camping cots, floor pads, hide-a-beds, bean bags, strollers, cradles, etc. Bedbugs will attempt to nest in any of these sleeping structures if given the opportunity and will take cover in nearby areas as well (sleeping directly on the floor, for example, may cause them to feed but then nest in the nearby carpeting and furniture). Bedbugs tend to want to hide as close as possible to where they feed. If a person sleeps on a couch within a room where bedbugs are present, for example, then it could be generally expected that the bedbugs in the given room would quickly find their way onto the sofa as well as onto the sleeping person where they may then feed (i.e., unless the couch had been effectively segregated or isolated beforehand to prevent bedbugs from crawling onto it). Then, upon the sleeping host providing a blood meal, it could be expected that the engorged bedbugs will attempt to make the couch itself their nesting location—with the bugs congregating under the sofa, in the seams and folds of the fabric, in the crevices, in the creases atop and behind the headrest, amongst the armrests, in the cushions, in the wooden assembly, etc. Bedbugs usually will not wander too far from their meal. And this process of searching out a host, honing in to feed, then hiding in immediate and nearby crevices can take place over the course of a single night and, in such a manner, a couch or an upholstered chair may become heavily infested with bedbugs within a very short time. An effective isolation of lounge furniture and/or taking steps to avoid sleeping on couches (esp. in high risk environments) will help to prevent this.

Minimizing potential nesting locations (such as through the removing of, disposal, and/or bagging of various clutter often surrounding the typical bed—that is, both on, around, and under it) can make it easier to pinpoint the remaining areas where bedbugs may be hiding. But such additional hiding spots are often times unique to each case of infestation since virtually any small space or crack in a given room can be useful as a nesting site to bedbugs—so long as it is close to the host. Unchecked, bedbugs will eventually expand their overall nesting locations into nearby furniture such as dressers or nightstands, in drawers, in the cracks of picture frames, in screw or nail holes to bedroom fixtures, behind mirrors, etc. Then into the carpet, or under rugs, up the walls, and into the corners and such—the potential for nesting sites among such a wide range of appliances is numerous. Within a single bed, bedbugs may nestle themselves in the mattress (along the tufts, folds, and seams), in the supporting box spring, platform, or bunkie board, in the framed support structures as well as in the cracks where the individual parts and segments are attached. They may hide amongst the remaining bed frame (in the headboard, footboard or hollows of the siderailings and bed posts), within rips and tears or holes in the bed, under the base/platform, in between the bedding between the layers of sheets and mattress covers (etc.), in the wheels of the bed, among the bunk ladder assembly, under bed skirts, in the bedcoverings, etc. Complete disassembly and subsequent treatment of the entire bed frame may be necessary to reveal all nesting spots when bedbugs are present. A thorough inspection would also include checking the entire room for telltale signs of harborages and inspecting the surrounding flooring, baseboards, and walls, etc.

Bedbugs will also infest and nest in clutter that is often scattered around a typical bed—such as in shoeboxes stored underneath or in boxed documents and photos. They may be found in nightstands as well as in objects placed on them. Or they may hide amongst clothes lying about in the room (though, it should be noted, that simply bagging all worn day clothing next to the bed every night while sleeping will help to prevent this). Bedbugs will also tend to nest in the baseboards along the bottoms of the walls, along the molding, under loose flooring or carpet, etc. And, depending on the proximity of such sites to the host and extent of the infestation, these locations should be expected. There are a multitude of other places where bedbugs have been known to hide as this list is by no means exhaustive. Where exactly it is that bedbugs go to nest may, in fact, be dependent on wherever it is that they can go—albeit without going too far. But the extremes of their nesting locations are often relative to the numerical extent of the infestation, its source of origin, and how it is managed. Bedbugs, for example, nesting in the ceiling may indicate that they had entered the room and/or are spreading via the ceiling (i.e., possibly through the ceiling panels, vents, ceiling fixtures, pipes, etc.).

If children are in the house, bedbugs may also hide in toys and other recreational objects or in areas where younger ones play and/or nap. Bedbugs have also been found in door hinges, electrical fittings, in fire alarms, in lighting fixtures, amongst windowsills, in the cracks of plaster, behind peeled wallpaper, around curtains, in the cracks of brick and mortar, inside electronic devices, in various furniture, in floor cracks. And in blankets, purses, suitcases, lamp shades, inside speakers, under lamps, in vents, in shoes, above doorways and windows, under appliances, underneath linoleum, in storage, in books, in scattered paper, in envelopes, behind wiring, along piping (including both gas and plumbing pipes), in velcro, inside hollow doors, in ceiling fixtures, above the bed, in toys, in the ceiling, in phones, etc. -- put simply, it is possible that bedbugs may nest into any cracks or crevices that lie nearest to their hosts. Also, wicker furniture is known to be particularly targeted by bedbugs as a preferred nesting haven and should be removed in suspected areas.

Bedbugs, in some instances, can be incredibly localized in their tendency to remain generally close to their primary meal supply—even making it possible for the sleeping quarters on the side of one room to become heavily infested while the sleeping areas of a different side in the same room can seem to get by relatively untouched. This esoteric tendency of bedbugs toward localized colonization can make detection of a growing infestation even more difficult up until the last minute. But, in any case, bedbugs will expand into nearby locations either as the infestation grows, as they are inadvertently transported from location to location and forced to hide, as they are repelled from various stimuli, or bedbug infestations will expand as they are cut off from nourishment and forced to traverse new whereabouts in search of a new blood supply.

Although bedbugs show a clear preference for hiding amongst certain materials such as wood or fabric, the nesting sites of a bedbug's choosing can literally be in any location that might allow them to remain nearest to their host and meal supply undetected. It is also possible that the nesting location may be physically on the host themselves inside their clothes—especially if the clothes are not washed regularly or if the host is typically immobile, etc.

Bedbugs may also take refuge in unsuspected areas such as cars, luggage, moving vans, RVs, etc. And, where possible, will also feed on and nest nearby pets who may also be bitten. Bedbugs may also nest near other intruding animals that might be living within the house structure (such as near the roosting sites of bats, rodents, or birds, etc.).

The more adept one is at spotting bedbugs and uprooting them at their harborage points, then the better and more equipped one will be in helping to prevent infestations, in greatly minimizing them, and at reducing their spread. Detection of bedbug nesting locations is also of paramount importance because the nocturnal insects have an uncanny tendency, and often frustrating ability, to hide wherever possible. It is not abnormal for the bedbugs within a dwelling to find the host as opposed to the other way around—despite a reasonable search effort. Effective experience in locating them will also contribute to accurately confirming whether or not a bedbug infestation has been thoroughly eliminated. And can also provide additional assistance to pest control operators which is required for successful treatment, or allow one to, perhaps, eradicate a moderate to light infestation altogether on their own.

Detection

Confirming the presence of bedbugs can be a tricky matter—particularly in cases where an infestation is light, recurrent, or when a user has no prior experience in dealing with bedbugs. Because of this, it is advisable that a person become aware of the telltale signs of a budding infestation and, if noted, seek to have it treated immediately (either through self-treatment, in taking measures to isolate the problem, or through the hiring of a professional) before the infestation has a chance to grow and spread into something that will be more difficult to contain later on. In light infestations, bedbugs will often lodge themselves unnoticed into the tiniest of crevices away from viewing and will usually come out to feed only deep in the middle of the night. But this rule is not set in stone as there will be exceptions—particularly in heavy infestations where it will then become common to see bedbugs crawling about in broad daylight.

Early infestations can be difficult to detect and the symptoms of bedbugs might often be detected before the bugs themselves. Typical symptoms of a bedbug infestation may include the discovery of fecal spots, crushed bedbugs and/or bloodstains on the sheets, the finding of cast skins that have been discarded, the development of itchy welts from their bites (in those that react), etc. Use of a crevice tool to reach into small spaces as well as the use of a magnifying glass and/or flashlight can assist in the successful detection of bedbugs and their symptoms. A crevice tool, however, can be improvised but—very importantly—should consist of a non-conductive material such as plastic or wood if it is to be used to probe walls, baseboards, and/or electronics, etc. (to prevent electric shock).

Slide of Cimex lectularius

The presence of defecations will be one of the primary, indirect signs that bedbugs have taken a foothold in a given location. As bedbug droppings are solidly black or nearly black in color, they will often appear as dots or specks that are similar in appearance to a drop of ink that has dried (black in color). The defecation itself is digested blood. These small pitch-black droppings will vary in size (ranging from tiny and difficult to see up to the size of the bugs themselves) but can be distinguished from other dark debris in that bedbug droppings will readily smear (or bleed in color) if rubbed with a wetted finger or if contacted with water. Rubbing the black fecal spots with wet wipes or baby wipes to see if they smear is also an option. The dark droppings may also be discovered appearing as black ink-like markings that already seem to have faded or that already seem to have been partially absorbed into the material they've been deposited on. The deposits may also be found, not as circular dots, but as dark pinstripe-like markings that are small and streaked in appearance. These black defecations can be spotted anywhere bedbugs may be harbored but might also be found at the location of the host site or along route back to a nesting location --- that is, which might be on the pillowcase or in between, on the mattress, sheets, bed frame, curtains, in baseboards, in crevices, in seams, under the couch, under chairs, etc. Successful detection of a bedbug's defecations might require a considerable degree of extra vigilance and careful searching in light cases of infestation. Detection can also be aided, as recommended, through outfitting the bed with white sheets (both fitted and flat) and through the use of pillowcases that are also white in color—which will make it much easier to spot bedbugs and/or the occurrence of their defecations on the bed. White or light-colored sheets may also be placed over a couch or sofa to make crawling bedbugs easier to spot.

Bedbugs are also known for being elusive, transient, and often nocturnal which can make individual bugs difficult to detect in lighter cases. While individuals have the option of contacting a pest control professional to help determine if a bedbug infestation exists, there are several do-it-yourself methods that may work equally well. Often the case is that bedbugs will manage to hide in the cracks of a bed (within the frame), in the mattresses, in furniture, up under couches, in the seams of chairs, in the creases of upholstery, etc. or in areas that an inexperienced person is least likely to check—hence the bedbug's survival. They may also be detected harboring themselves within the pockets and insides of clothes that are not regularly washed (i.e. jackets, coats, etc.). For reasons such as this, it may be a good idea to have the assistance of an experienced person with respect to detecting an infestation.

Finding the exoskeletal remains from the bedbug's molting process (ecdysis) is another indicator that they are present but, perhaps, well hidden. Bedbugs will shed their skins throughout multiple stages of their lives and the discarded outer-shells (which will vary in size according to the stage and can be extremely small) might be found near any of the various locations where they have harbored. The sloughed off skins (pictured above) will appear as clear, empty exoskeletons of the bugs themselves. And the actual living bugs may or may not be nearby the discarded shells.

The presence of bedbugs may also be confirmed through direct discovery and identification of the insects collected or by a pattern of bites. Though bites can occur singularly, they often follow a distinctive linear pattern marking the paths of blood vessels running close to the surface of the skin. It should also be noted that confirmed bedbugs may vary slightly (or even markedly) in appearance, color, or shape and depending on the insect's current size, stage in life, and whether or not they have recently fed. A bedbug's appearance (particularly in color) can vary even to the extent where an identified bedbug may appear, to unfamiliar eyes, to be a different bug altogether.

Detection of bedbugs will be required during infestation as well as after initial treatment efforts. And the difficulties associated with treating bedbugs as well as the possibility of reinfestation means that detection has to be an ongoing process. Daily periodic monitoring for their signs is a good idea even up to several months after an infestation has been cleared or as a preventive measure in suspected areas. It is recommended to search throughout all cracks and crevices (on beds, couches, chairs, furniture, etc. checking underneath as well) using a flashlight to search for signs of bedbugs or for the bugs themselves. And, when searching a dark room at night, bedbugs may be spotted crawling about looking for a blood meal but will usually remain completely stationary congregating in ideal hiding spots nearest to the host. If awakened during the middle of the night, it is also optional do a quick search for bedbugs using red LED night vision lights as opposed to regular white flashlights—with red LEDs being less bothersome to night eyes. Red LED lights are normally used by campers or hikers to read maps in the middle of the night without agitating their eyes or harming their night vision but are applicable to the searching for bedbugs in the dark as they can help prevent from waking light sleepers and will also allow an awakened person to return to sleep easier. Red LED night vision lights are available as stand-alone flashlights, as headlamps, as clip-ons, etc. -- or as an additional 'night' feature to these same types of camping flashlights.

Control and elimination

Pesticides

With the widespread use of DDT in the 1940s and '50s, bedbugs mostly disappeared from North America in the mid-twentieth century. Infestations remained common in many other parts of the world and in recent years have also begun to rebound in North America. Reappearance of bedbugs has presented new challenges for pest control due to their developed resistance to various pesticides including DDT, and organophosphates. In fact, using DDT on today's bedbug makes it more active.

Another reason for their increase is that more pest control services use gel-based pesticide baits for control of cockroaches and ants, the most common pests in structures, instead of residual sprays. When residual sprays were used to kill the more common insect pests, they resulted in the collateral control of bedbug populations. The gel-based insecticides primarily used today to control cockroach and ant populations do not have any effect on bedbugs, as bed bugs are not attracted to baits.

Yet another perceived cause of the bedbug resurgence is the growing push to recycle mattresses. Not only are mattresses to be recycled, collected, and stored with those already processed, but it is very difficult to ensure that no bedbugs or eggs survive the processing.

The National Pest Management Association, a US advocacy group for pest management professionals conducted a "proactive bedbug public relations campaign" in 2005 and 2006, resulting in increased media coverage of bedbug stories and an increase in business for pest controllers.

Controlled atmospheres

Experiments with high concentrations of carbon dioxide have succeeded in killing bedbugs within 24 hours.

Biological control (predatory species)

Natural enemies of bedbugs include cockroaches, ants, spiders, mites, centipedes, and the masked hunter or "masked bedbug hunter" (Reduvius personatus). The Pharaoh ant's (Monomorium pharaonis) venom is lethal to bedbugs. Rodents eat bedbugs, but bats do not, due to their distaste for the bedbug alarm pheromone, which is released when they are attacked. Unfortunately, biological control is not very practical for eliminating bedbugs from human dwellings.

Traditional methods

Plants traditionally used as bedbug repellents include black cohosh (Actaea racemosa), Pseudarthna hookeri, and Laggera alata (Chinese yángmáo cǎo | 羊毛草), though information about their effectiveness is lacking. Eucalyptus saligna oil kills bedbugs, and eucalyptus-based insect repellents may be effective against them.

In the 18th century, turpentine was used in combination with henna (Lawsonia inermis, aka camphire) flowers and alcohol, as an insecticide that also reputedly killed bedbug eggs.

Other items that were believed to kill bedbugs in the early 19th century include "infused oil of Melolontha vulgaris" (presumably a kind of cockchafer), fly agaric (Amanita muscaria), Actaea spp. (e.g. black cohosh), tobacco, "heated oil of Terebinthina" (i.e. turpentine), wild mint (Mentha arvensis), narrow-leaved pepperwort (Lepidium ruderale), Myrica spp. (e.g. bayberry), Robert Geranium (Geranium robertianum), bugbane (Cimicifuga spp.), "herb and seeds of Cannabis", "Opulus" berries (possibly a kind of maple, or European cranberrybush), masked hunter bugs (Reduvius personatus), "and many others."

The use of black pepper is attested in George Orwell's 1933 non-fiction book Down and Out in Paris and London.

Alcohol

Use of steam or by spraying rubbing alcohol on any visible insects is done to effectively rid bed frames of adult bedbugs and eggs, although it does not serve as a permanent treatment. Small steam cleaners have been very effective for local treatment.

Sanitazion

A suspect mattress is sometimes protected by wrapping it in a disposable plastic sheeting, sealing all the seams and putting it on a protected bed after a final visual inspection.

Sanitization: In this method, bedding is sanitized by a 120 °F (49 °C) laundry dryer. Once sanitized, bedding is not allowed to drape to the floor. Storing sanitized sleeping clothes in the bed during the day and bathing before entering the bed are observed to be effective to quarantining a protected bed.

Encasing mattress and box springs in impermeable bed-bug-bite-proof encasements after a treatment for an infestation is an alternative treatment which works better and is more comfortable whereas wrapping bedding in plastic causes sweating.

Extreme temperatures

The use of a fabric steamer on the infestations will kill the eggs and the bugs instantly. The bed bugs cannot handle the intense heat and are killed in a couple of seconds. Since steam will penetrate the pores of a mattress, it can reach deep into the corners of beds.

The thermal death point for the common bedbug (C. lectularius) is 45 °C (113 °F), and all stages of life are killed by 7 minutes of exposure to 46 °C (115 °F). However, to ensure that bedbugs do not survive by hiding in locations that do not quite reach the thermal death point, the US Department of Defense recommends using a temperature of at least 49 °C (120 °F), at 20-30% relative humidity, for at least 20 minutes. Oven-like devices have been designed specifically for this purpose and are available on the market.

Enclosing a mattress in a black plastic bag and placing it in the sun on a hot day is not considered an effective method of killing bedbugs, due to the difficulty of maintaining a high temperature across the entire surface area of the mattress.

There is uncertainty as to how long bedbugs can survive cold temperatures. Below 16.1 °C (61 °F), adults enter semi-hibernation and can survive longer. Bedbugs can survive for at least five days at −10 °C (14 °F) but will die after 15 minutes of exposure to −32 °C (−25.6 °F) It is believed that storing infested items below −19 °C (0 °F) for at least four days will be successful. Carbon dioxide deployed in the form of "snow" may kill bedbugs by rapid freezing.

Food source isolation

Due to the difficulty in eliminating the bugs from the room or dwelling, the (suspected) bed is isolated, thus removing the insects' food source—humans. Bedbugs cannot cross petroleum jelly and have difficulty climbing metal or glass, hence each of the bed legs is put in a tin can (the bottom of which is thickly coated with petroleum jelly) to avoid movement from the bed to the hiding places. Although bedbugs cannot fly, they have been observed climbing a higher surface in order to then fall to a lower one, such as climbing a wall in order to fall onto a bed. They can also jump a few feet, and so could jump from the wall onto the nearby bed. Hence alternatively, a double-sided sticky tape (such as carpet tape) is applied around each bed leg, or to keep each leg on a plastic furniture block in a tray of water. However, this does not prevent bugs from biting you on your couch or in other areas of your dwelling.

Barrier strategy

When it is necessary to live with bedbugs in the short term (either during treatment or while in the process of figuring out the best approach for treatment), it is possible to create a makeshift, temporary barrier around a bed that will help prevent bedbugs from crawling back onto it. A successful barrier, however, assumes the entire bed itself has been completely disinfected of all bedbugs and their eggs beforehand. Using such a strategy to isolate a bed can provide immediate relief and comfort from further bedbug bites.

An example of duct tape curled over lengthwise to create a sticky barrier

A disinfected bed can be isolated and protected by applying a layer of duct tape around each leg of the bed—using regular duct tape that has been curled lengthwise over on itself with the sticky side out. This creates a simple yet sticky barrier that will prevent most bedbugs from being able to crawl up the legs and onto the bed. This barrier technique may also be used in multiple strips or rows placed side by side to create an even stronger barrier (in areas where an infestation is heavy or where there exists a higher chance that bedbugs will attempt to crawl over the sticky tape). However, in using duct tape as a barrier, it is usually necessary to first place down a protective layer of some sort to prevent the duct tape from damaging the surfaces adhered to as well as to the prevent the duct tape barrier from leaving behind a sticky residue once it is finally removed. This protective layer, if used, can be created by placing a layer of painter's tape (also called masking tape) around the legs of the bed first—before placing the duct tape. The painter's tape will help protect the surfaces wherever the 'curled duct tape' barrier is placed as the duct tape is adhered only directly over top the protective layer of painter's tape. Also, as a substitute to masking tape, plastic wrap can be wrapped tightly around the legs of a bed and used as the initial protective layer instead (where the curled duct tape is then placed over the plastic wrap).

Typically, isolating a bed should be done only after encasing both the mattress and the box spring (if the bed has one). As well as done only after successfully disinfecting the entire bed frame. Mattresses can be encased using zippered vinyl or plastic mattress encasements, or by creating a homemade/improvised encasement where the affected mattress is completely wrapped in a layer of plastic (typically plastic drop cloth) then carefully sealed tight with tape. The mattress can also be fully covered and sealed using mattress encasements that are specially designed either for bedbugs and/or dust mites (which are specialized mattress covers which, though they tend to cost more than vinyl and plastic encasements, are usually more comfortable and will also help to prevent sweating).

Improvised duct tape barrier (over protective masking tape) around the leg of a bed

There is also the option to isolate a bed using double-sided duct tape (also called carpet tape) to create the sticky barrier instead, although, carpet tape may be somewhat more expensive in length per foot than regular duct tape curled over—something to consider if the taping method is used extensively. In any case, curled duct tape (with the sticky side out) can also be used in length on floors as a perimeter barrier to help quickly isolate or quarantine furniture (where it can span multiple feet on the floor around furniture or used to surround and isolate 'legless' beds with bases that are flush to the floor, etc.). The technique can also be used to help prevent bedbugs from crawling up along walls where warranted. Long strips of this taping method (i.e., curled duct tape over painter's tape) can be used on standard floors to cordon off, surround, and isolate infested furniture, to protect clean furniture, or as part of a treatment effort to help prevent bedbugs from crawling toward specific areas. If used this extensively, it then becomes particularly more important to apply a protective layer of painter's tape first to prevent the duct tape from damaging and/or ruining painted surfaces or from leaving behind a sticky residue when finally pulled up. It should also be noted that the width of the painter's tape can be as narrow as one inch (which is typically less expensive per foot than wider versions of masking tape) since regular duct tape, though much wider initially, will fit within the one-inch width of the painter's tape—after the duct tape has been curled over on itself lengthwise.

Once a bed is disinfected and isolated, care should be taken to avoid reinfesting the bed by not sleeping or resting on the bed in clothing that has been potentially contaminated.

Vermin and pets may also complicate a barrier strategy. Bedbugs prefer human hosts, but will resort to other warm-blooded hosts if humans are not available, and some species can live up to eighteen months without feeding at all. A co-infestation of mice can provide an auxiliary food source to keep bedbugs established for longer or the isolating of a bedbug's food source may cause the infestation to spread. Likewise, a house cat or human guest might easily defeat a barrier by sitting on a protected bed. Preventing the bed from touching the walls, as well as preventing bedding from draping the floor, or not allowing objects to lean against the bed frame will help to stop bedbugs from being reintroduced onto the bed. Such considerations should be part of any barrier strategy.

Household actions

The cleanliness of the environment has an effect on the control of bedbugs but, unlike cockroaches, it does not have a direct effect as they feed on their hosts and not on waste. Good housekeeping in association with proper preparation and mechanical removal assist in its control.

Catching techniques and traps

A technique for catching bedbugs in the act is to have a light source quickly accessible from your bed and to turn it on at about an hour before dawn, which is usually the time when bedbugs are most active. A flashlight/torch is recommended instead of room lights, as the act of getting out of bed will cause any bedbugs present to scatter before you can catch them. If you awaken during the night, leave your lights off but use your flashlight/torch to inspect your mattress. Bedbugs are fairly fast in their movements, about equal to the speed of ants. They may be slowed down if they have engorged on their food source. When the bedroom light is switched on, it may temporarily startle them allowing time for you to get a dust pan and brush kept next to the bed and sweep the bugs into the pan then immediately sweep them into a cup or mug full of water where the bugs drown quickly. Dispose of the water down the sink or toilet. Disinfect the mattress, skirting boards and so on regularly.

Glue traps placed in strategic areas around the home, sometimes used in conjunction with heating pads or balloons filled with exhaled breath offering a carbon dioxide source, may be used to trap and thus detect bedbugs. This method has varied reports of success. There are also commercial traps like 'flea' traps whose effectiveness is questionable except perhaps as a means of detection. Perhaps the easiest trapping method is to place double-sided carpet tape in long strips near or around the bed and check the strips after a day or more. However, bedbugs can simply walk across the sticky surface of tape, which, while slowing them down, will not stop them from crossing.

Some traps placed around furniture legs use a combination of petroleum jelly and slippery surfaces to catch bedbugs.

Traps have been devised using a combination of heat, carbon dioxide and kairomones to attract bedbugs into a container from which they cannot escape.

Recent methods

A recent trend in bedbug control is to use canine detection teams to pinpoint infestation areas because hiding places are very hard to find. Bed bug detection dogs are trained to find the bed bugs by sweeping through suspected infestation areas and alerting to the scent of bedbugs. A bedbug dog can detect bedbugs in a bedroom within minutes, with an accuracy rate of 90%, whereas a (human) pest control practitioner would need an hour to complete the task.

There are more frequent reports of success in controlling bedbugs by the use of diatomaceous earth as an environmentally friendly non-toxic insecticide to which the bedbugs cannot develop a resistance. The diatomaceous earth abrades the waxy cuticle that covers an insect's exosekeleton, causing them to die of dehydration. Bedbugs exposed to diatomaceous earth typically die within two days of contact.

In the United States, about 100 dogs are used to find bed bugs as of mid-2009, according to Greg Bauman, vice president of technical services for the National Pest Management Association.

See also

• Cimicosis – Bedbug bites
• List of parasites (human)
• Aradidae – Flat bugs
• Triatominae – Kissing Bug

Further reading

• David Cain, Richard Strand. Bed Bug Beware: An easy to understand guide to bed bugs, their prevention and control. Loughborough, United Kingdom: Foxhill Publishing, March 2009. ISBN 978-0-9562617-0-0
• Larry Pinto, Richard Cooper, Sandy Kraft. Bed Bug Handbook: The Complete Guide to Bed Bugs and Their Control. Mechanicsville, Maryland: Pinto & Associates, December 2007. ISBN 978-0-9788878-1-0
• Martin Leverkus, Ryan C. Jochim, Susanne Schad et al. Bullous allergic hypersensitivity to bed bug bites mediated by IgE against salivary nitrophorin. J. Invest. Dermatol. (2006) 126, 91–96. PMID 16417223
• Forsyth, Adrian. A Natural History of Sex: The Ecology and Evolution of Mating Behavior. Richmond Hill, Ontario: Firefly Books, 2001. ISBN 1-55209-481-2.
• MacQuitty, Miranda, and Lawrence Mound. Megabugs: The Natural History Museum Book of Insects. New York: Random House Children's Books, 1995. ISBN 1-898304-37-8, ISBN 1-85868-045-X.
• Goddard, Jerome A. The Physician’s Guide to Arthropods of Medical Importance (second edition). Boca Raton, Florida: CRC Press, 1993. ISBN 0-8493-5160-X.
• Forsyth, Adrian. Die Sexualität in der Natur. Vom Egoismus der Gene und ihren unfeinen Strategien. Munich: Deutscher Taschenbuch Verlag, 1991. ISBN 3-423-11331-6.
• Quammen, David. The Flight of the Iguana: A Sidelong View of Science and Nature. New York: Delacorte Press, 1988. ISBN 0-385-29592-8, ISBN 0-385-26327-9, ISBN 0-684-83626-2. Provides detail about Xylocaris maculipennis.

External links

Generic information

• Template:Dmoz
• bed bug on the University of Florida/Institute of Food and Agricultural Sciences Featured Creatures Web site
• Harvard School of Public Health: Bedbugs: Biology and Management
• Bed Bug Life Cycle From Bed-Bug.org
• Masked Hunters University of Minnesota Extension Service Entomology Yard & Garden Brief (natural enemy of the bedbug)
• bed-bugs information from the Terminix pest library
• National Geographic segment on Bedbugs
• Bedbugs - University of Sydney and Westmead Hospital Department of Medical Entomology

Health and control aspects

• Bed bugs on [1]
• "Vector surveillance and control: Bed bug fact sheet" NYC Department of Health and Mental Hygiene 12 January 2008
• Understanding and Controlling Bed Bugs - National Pesticide Information Center
• U.S. Department of Defense Manual - Bed Bugs - Importance, Biology, and Control Strategies
• Bedbug bites, Robert A. Schwartz, MD, MPH, et al, eMedicine, May 2008: .
• Bed Bug Infestations in an Urban Environment, Stephen W. Hwang, Tomislav J. Svoboda, Iain J. De Jong, Karl J. Kabasele, and Evie Gogosis : Emerging Infectious Diseases, Vol. 11, No. 4, April 2005.
• Bed Bug Management includes photos, control from University of Nebraska-Lincoln Extension in Lancaster County
• University of Kentucky EntFacts Information Sheet on bedbugs
• Personal Experience of Getting Rid of Bed Bugs by An Ex-Sufferer