What are bed bugs

Bed bugs are small oval-shaped, wingless, flat blood sucking insects, often causing itchy bites. Bed bugs can grow up to 7 mm long, changing color from cream to red-brown as they mature. Bed bugs tend to live in cracks and crevices in and around your bed, especially in mattress seams and travel on clothing, furniture, bedding and luggage. Bed bugs hide in cracks and crevices in beds, wooden furniture, floors, and walls during the daytime and emerge at night to feed on their preferred host, humans. Bed bugs are responsible for loss of sleep, discomfort, disfiguring from numerous bites and occasionally bites may become infected. There is currently no scientific evidence that bed bugs can transmit other human diseases, although there is debate on whether they are implicated in Hepatitis B and Chagas disease transmission. Bed bugs are upsetting and can be hard to get rid of. Bed bugs have a lifespan from 4 months up to 1 year.

• While bed bugs need to feed on blood to grow, they are resilient and can live for up to a year without a feed.
• Bed bugs prefer to feed on humans but will also feed on other warm blooded animals. They mainly feed at night.

The common bed bug is found worldwide. Infestations are common in the developing world, occurring in settings of unsanitary living conditions and severe crowding. In North America and Western Europe, bed bug infestations became rare during the second half of the 20th century and have been viewed as a condition that occurs in travelers returning from developing countries. However, anecdotal reports suggest that bed bugs are increasingly common in the United States, Canada, and the United Kingdom.

Bedbug infestations seem to be increasing around the world at an alarming rate, possibly due to insecticide resistance ¹. Resistance to pyrethroid insecticides is already widespread in the United States. The bedbug occurs in aggregations when conditions are favorable, but the arthropods disperse when conditions are unfavorable ². Active female dispersal can potentially lead to treatment failures and should be taken into account when using control methods.

Bed bug bites tend to clear up on their own, or with simple first aid measures.

To relieve itching, take the following steps:

• try not to scratch the area – keep your nails short to prevent breaking the skin if you do scratch
• a cool bath or shower may help to soothe the itching – gently pat yourself dry with a clean towel, but do not rub or use the towel to scratch yourself
• avoid perfumed skin care products
• try to wear loose cotton clothing, which can help prevent you overheating and making the itch worse – avoid fabrics which irritate your skin, like wool or scratchy fabrics
• an ice pack may relieve the itching but should not be placed directly against the skin – you can make an ice pack by using a bag of frozen peas wrapped in a clean cloth
• there are medicines available to ease the symptoms of itching – speak to a pharmacist for further advice and to make sure any medicines you take are suitable for you
• if you are in pain, get advice on medicines from a pharmacist or doctor.

See your doctor if you are concerned about your bites. Your doctor may recommend steroid creams or antihistamines if your bites are very itchy or severe. If a bite has become infected, your doctor may prescribe antibiotics.

How do you get bed bugs

Bed bugs can walk short distances to adjoining rooms or can be carried over greater distances in and on people’s luggage and belongings. This is how bed bugs are moved from infested premises to new premises around America and internationally.

Look for evidence of bed bugs when traveling by examining bedding and mattresses for signs of the insects.

Where do bed bugs come from?

Bed bugs are most commonly found on mattresses, particularly along the stitched edges where there are folds that help to conceal them.

They are also found:

• on bed frames
• in bed side furniture
• in picture frames
• behind wall paper
• in cracks and crevices or other areas of a room that will provide them with protection, such as carpet edges, behind skirting boards or between wooden floor boards.

How to check for bed bugs

Signs that you may have a bed bug infestation include:

• live bed bugs or cast skins
• eggs
• dark spots of bed bug excrement or blood. These can be found on bed sheets, mattresses, skirting boards or in cracks and crevices
• distinct ‘bug’ smell can detect if the infestation is severe
• you may also notice bite marks on your skin, although 1 in 5 people bitten may not experience a reaction and the bite may not be noticed for up to 9 days. Skin reactions include redness, swelling and wheals up to 2cm in size, itching and burning sensations. Humans tend to be bitten most often on the shoulders and arms, in distinctive lines.

These bites and skin reactions are generally not considered a health risk. Some people find the bite painful, while others can react to the saliva the bed bugs inject while feeding, resulting in a localized allergic reaction. Some people do not react or notice bites at all.

Few individual can develop anaphylactic reactions (potentially life threatening allergic reactions) to bed bug bites. If you have experienced a reaction to the bite, avoid scratching as this may lead to it becoming infected. See your doctor if necessary.

How to prevent picking up bedbugs while traveling

Most people get bedbugs while traveling. Bed bugs are tiny insects that feed on human blood. They can crawl into a suitcase or onto clothing unnoticed.

Here’s how you can find bed bugs before they find you and your belongings.

When checking into a hotel, cabin aboard a cruise ship, or elsewhere, you want to check your room before unpacking.

Here’s what you want to do:

1. When you walk into the room or cabin, take a deep breath. Do you notice a sweet or musty odor? If there is a heavy infestation, you may notice this smell. Bedbugs produce chemicals to help them communicate.
2. Next, check the bed. Look carefully at the blankets, sheets, pillows, and mattress pad. Then, check the mattress and box spring. Do you see:
   1. Blackish specks on the bed, mattress, or headboard? Blackish specks could be bedbug excrement.
   2. Are there specks of blood anywhere, especially near the seams?
   3. Do you see shell-like remains on the bed, bedding, or furniture? Bedbugs have an outer shell that they shed and leave behind as they grow.
3. You’ll also want to check all upholstered furniture. While checking, you may see bedbugs or their eggs. A bedbug is about the size of an apple seed.

If you find signs of bedbugs, you should immediately request another room or cabin. The other room should not be near the current room.

How to prevent bringing bedbugs into your home after traveling

If you are concerned that you may have picked up bedbugs, you should inspect everything that you bring home (luggage, purse, and other belongings) for signs of bedbugs. You want to look for blackish specks, drops of blood, and shell-like remains.

If possible, inspect everything before you bring it inside your home.

If you see signs of bedbugs or strongly suspect that you might have brought bedbugs home, you should immediately:

• Wash all the clothing that you brought home in a washing machine. Even clothes that you didn’t wear must be washed in hot water. If you cannot wash something in a washing machine, you can either place it in a hot dryer or seal the items in a plastic garbage bag. If you seal items in a garbage bag, leave the bag securely closed in an extremely cold or hot place for a few months.
• Dry your clothes after washing them in a clothes dryer, using the hot setting.
• Use a hand steamer to clean your luggage. According to the National Pest Management Association, a garment steamer will kill bedbugs and their eggs.

How to prevent bedbugs when buying secondhand beds and other furniture

Bedbugs can be hard to find in secondhand beds and other furniture. If the bedbugs have not eaten for some time, you may not see signs of them. Bedbugs can live for about a year without eating.

You can prevent picking up bedbugs from secondhand furniture by not bringing secondhand furniture into your home.

What do bed bugs look like

The bed bug, Cimex lectularius, is a blood-sucking human parasite that is found worldwide. Bed bugs come from the insect family Cimicidae. The bed bug is oval shaped, flat, reddish brown, and up to 7 mm long. Immature bed bugs are smaller than adults and may be translucent to light yellow.

• Adult bed bugs are 4–7 mm in length, oval in shape and are dark reddish brown in color. Juveniles are 1–5mm in length, depending on the growth stage and are cream in color, becoming red to blackish after taking a blood meal. Adult females can lay up to three eggs per day, which hatch within 10 days (longer in cooler temperature). Eggs are creamy white and about 1mm in length.

In developing countries, bed bugs can be found in the cracks and crevices of the walls of mud houses, as well as thatched roofs. Reports of bed bug infestations appear to be increasing in homes, apartments, hotel rooms, hospitals, and hostels in developed countries. This may be due to increased international travel, immigration, and insecticide resistance.

Figure 1. Bed bug (Cimex lectularius)

Figure 2. Bed bug feeding on human host

Figure 3. Bed bug shells (skin)

What do bed bug bites look like

Bed bug bites are difficult to diagnose due to the variability in bite response between people, and due to the change in skin reaction for the same person over time. It is best to collect and identify bed bugs to confirm bites.

If you have bedbugs, you’re likely to have bites. Bed bug bites usually cause itchy welts. These welts usually appear in a zigzag pattern as show in the photo above.

You’ll seldom see bed bugs, so many people mistakenly believe that mosquitos, fleas, or spiders bit them. Sometimes people mistake bedbug bites for a common skin condition such as an itchy rash, hives, or chickenpox.

To make sure you have bedbugs, you’ll need to look for signs of bedbugs.

Figure 4. Bed bugs rash

Although bedbugs don’t usually require serious medical attention, they can cause a great deal of anxiety and restless nights. To help find bedbugs before they find you (and your belongings), dermatologists recommend looking for the following signs near places where you sleep.

Signs of bed bugs

This step is important. If you have a bedbug infestation, you need to find out so that you can get rid of the bedbugs. Getting rid of the bedbugs is the only way to stop the bites.

If you have a large number of bedbugs, you may see the bugs. Most people, however, only see signs of bedbugs. To look for signs of bedbugs, check the places that people sleep for the following:

• A sweet, musty odor: Take a deep breath. If you notice a sweet, musty in your hotel room, cruise ship cabin, or other sleeping area, there may be a heavy bedbug infestation in the room. Bedbugs produce chemicals to help them communicate, although not everyone will notice the smell.
• Specks of blood on bedding, mattresses, or upholstered furniture such as couches and headboards: Look carefully at your blankets, sheets, and mattress pads and then check the mattress and box spring. Are there specks of blood anywhere, especially near the seams? If so, there could be a bedbug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.
• Exoskeletons: Bedbugs have an outer shell that they shed and leave behind (see Figure 3 above). Do you see shell-like remains on the mattress, mattress pad, or beneath couch cushions?
• Tiny, blackish specks: If you see blackish specks on the bedding, mattress, headboard, or beneath couch cushions, it could be bedbug excrement.
• Eggs: After mating, female bedbugs lay white, oval egs in cracks and crevices. Keep in mind that these will be small, as a bedbug is only about the size of an apple seed. The photo below shows a bedbug near eggs. The photo was magnified so that you can see the bedbug and eggs.

If you do get bedbugs and have many bites or a bite that looks infected, see your doctor. Your doctor can treat an infection and help relieve the itch.

If you see bedbugs, they will likely scurry toward the closest hiding place. Any dark place such as inside a mattress or even a picture frame makes a good hiding place.

As you watch bedbugs move, it can look like they are flying or jumping because they can crawl quickly. Bedbugs cannot fly or jump; they can only crawl.

• If you find signs of bedbugs, call a pest-control company or your property manager. You should not use bug spray or a fogger. These products have little effect on bedbugs.

Prevention of bed bugs

You can help prevent infestations by:

• avoiding using second-hand mattresses
• regularly checking your bed for bed bugs
• keeping your bedroom tidy to minimize hiding spots.

What can I do to reduce the risk of bed bug infestation?

Evidence shows that bed bugs are more commonly found in low cost short stay accommodation. However, they can be found anywhere that people sleep including charter boats, trains and hotels.

When traveling

• Consider spraying the exterior of your luggage with an aerosol insecticide, as this may kill or repel bed bugs that crawl onto your luggage during transit.
• Wherever possible, thoroughly inspect your luggage on arrival at your destination and again before departing.
• Check bedding for signs of bed bug infestations or live bed bugs concealed under mattress stitching.
• Look out for signs of bed bugs wherever you stay.

At home

Ask guests who may be lodging or staying at your home whether they have experienced unexplained insect bites. If they have, help them to inspect their belongings carefully for evidence of bed bugs and treat promptly if anything is found.

Check second-hand furniture carefully, particularly bedroom furniture, for evidence of bed bugs. Have it treated by a licensed pest management technician if bed bugs are found. This should be done before moving it into your premises. Think carefully about picking up furniture from verge collections as it could be infested.

The regular use of a vacuum cleaner with a disposable bag may help to remove adults, nymphs and cast skins. Eggs are more difficult to remove.

Bed bugs signs and symptoms

Bed bugs usually feed without detection by the host, although some people with bed bug infestations report a restless night’s sleep. Bed bugs generally bite in a linear pattern (a line) on exposed areas of skin such as the face, neck, hand, and arms. Most patients do not experience a reaction to a bed bug bite, and the only evidence is a tiny punctum (hole) at the site of the bite.

When a reaction occurs, the lesions are most commonly 2 to 5 mm red, itchy spots. If they are not scratched they usually resolve in a week or so. These are often found on your legs, arms and shoulders. Some bites can become infected. Some people don’t react, while others may not react until up to 9 days after they’re bitten.

Very occasionally, people with multiple bites have lost so much blood they became anaemic. Some doctors believe bed bugs may trigger allergies and asthma.

Some people experience significant skin reactions to the bites including:

• Itchy wheals around a central punctum
• Papular urticaria
• Diffuse urticaria

These reactions may evolve into a bullous rash (fluid-filled blisters) and may become complicated by secondary bacterial infections such as impetigo or cellulitis.

Signs of a bed bug infestation include:

• regularly waking with bites
• bed bugs on your mattress, bed frame and other furniture
• brown spotting (bed bug feces) or blood spots on your mattress
• a musty, sweet smell with large infestations.

Systemic reactions that have been rarely associated with bed bugs include asthma and anaphylaxis.

What is the treatment for bed bug bites?

Treatment is not generally required. However, various treatments may relieve the symptoms of bed bug bites:

• Itchy lesions can be treated with topical steroids and/or oral antihistamines.
• Secondary infection should be treated with antibiotics.
• Systemic reactions to bed bug bites are treated with antihistamines, corticosteroids, and intramuscular adrenaline.

Home remedies for bed bug bites

If you do not have any signs of an infection or a serious reaction, you can often treat the bites at home.

To treat bed bug bites:

• Wash the bites with soap and water. This will help prevent a skin infection and help reduce itchiness.
• If the bites itch, apply a corticosteroid cream to the bites. You can get a weak form of this medicine without a prescription at your local drugstore. Stronger corticosteroids require a prescription.

Bed bug bites usually heal and go away within a week or two.

How to get rid of bed bugs

Firstly bed bugs must be correctly identified. A thorough search of the cracks and crevices of the bed and surrounding areas should be undertaken to detect the easily visible bed bugs or their fecal matter.

Eradication of bed bugs can be difficult and requires chemical and non-chemical control strategies.

• Getting rid of bedbugs can be difficult. Most people need the help of a pest-control company. Make sure the company has experience eliminating bedbugs.
• Several treatments may be necessary to get rid of bedbugs completely. You also will need to follow the guidelines that your pest-management professional recommends.

Chemical treatments

Chemical control – insecticide spray or insecticide-treated bed nets may be moderately effective against bed bugs. However use of these products has raised concerns about the health consequences of exposure to insecticides and the development of insecticide resistant bed bugs.

A range of low toxicity products such as synthetic pyrethroids and carbamates are available for use indoors to control bed bugs. Regular pesticides do not kill bed bug eggs, so residual products are more effective than non-residual products, as these will kill immature bed bugs once the eggs have hatched. Always read the product label before purchase to make sure that the product you choose can be used for bed bugs. Note that some products are only available to licensed pest management technicians.

These products can be used to treat cracks and crevices where bed bugs are found and should not be applied to bedding where human contact may occur. They are designed to be applied to surfaces where bed bugs may be harboring, and should not be used as space sprays. After the initial treatment, a follow-up inspection should be carried out to determine if further bed bugs or eggs are present. In most cases, repeat treatments are required to control bed bugs.

Whenever using a pesticide product, make sure you read and follow label instructions.

Non-chemical treatments

Non-chemical control – methods include vacuuming, heat treatments, laundering, mattress and box spring encasements, and destroying infested objects. Heated pitfall traps collect the bugs. Washing and drying items in a dryer on a hot setting is sufficient to kills bed bugs in clothing or linen.

These are safe and effective in reducing bed bug numbers prior to insecticide treatment.

Regular inspections of mattresses and other areas are essential. If bed linen is infested, wash the items in hot water and then tumble dry on high for at least 40 minutes. A steam iron may also be used on the seams of mattresses or other items where there is stitching or folds in material. The use of high temperature low vapor steam on other areas such as mattresses should also be considered.

If infested items are taken out of a room, the bed bugs can fall off and spread the infestation. It is always advisable to treat such items before disposal and these should be wrapped in plastic before removal from the room. For linen, carry the items to the washing machine in garbage bags then dispose of the bags immediately.

Thorough vacuuming of carpet edges, skirting boards and all cracks and crevices using a vacuum cleaner with a disposable dust bag is important for removing bed bugs and their eggs. Seal the dust bag in plastic and dispose in your council refuse bin.

Disposal of infested objects such as bed heads to landfill is an option, where other methods have not been effective. It is important to wrap the object first so as not to spread the infestation during transport.

• Diatomaceous earth spray is a non-chemical way to control bed bugs.

But it can be hard to get rid of bed bugs.

If you think that you have a bed bug infestation, contact a licensed pest management technician for treatment. Delay or failure to treat promptly and effectively may cause the infestation to spread, making control more difficult and expensive.

The licensed pest management technician will need to thoroughly inspect the premises. After the initial treatment, follow-up inspections may be required, usually with repeated treatments to completely eradicate the pests.

Bed bug control is most effective when chemical and non-chemical treatments are used together. You can discuss bed bug treatment options with your licensed pest management technician.

1. Romero A, Potter MF, Potter DA, Haynes KF. Insecticide resistance in the bed bug: a factor in the pest’s sudden resurgence?. J Med Entomol. 2007 Mar. 44(2):175-8.[↩]
2. Pfiester M, Koehler PG, Pereira RM. Effect of population structure and size on aggregation behavior of Cimex lectularius (Hemiptera: Cimicidae). J Med Entomol. 2009 Sep. 46(5):1015-20.[↩]