Occupational medical aspects of the bed bug epidemic
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Occupational Medical Aspects of the Bed Bug Epidemic. A Presentation to: Northeast Regional Industrial Hygiene Conference Howard Sandler, MD Sandler Occupational Medicine Associates, Inc. December 2010. Is There Really A Bed Bug (BB) Epidemic?. Cimex lectularius and Cimex hemipterus

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Occupational Medical Aspects of the Bed Bug Epidemic

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Occupational medical aspects of the bed bug epidemic

Occupational Medical Aspects of the Bed Bug Epidemic

A Presentation to:

Northeast Regional Industrial Hygiene Conference

Howard Sandler, MD

Sandler Occupational Medicine Associates, Inc.

December 2010


Is there really a bed bug bb epidemic

Is There Really A Bed Bug (BB) Epidemic?

  • Cimex lectularius and Cimex hemipterus

  • Websites listing US hotels with reported bed bug infestations

  • BB infestation reporting doubled in San Francisco from 2002-2004

  • Increased reporting in the medical literature in Canada, Germany and Australia

© 2010 Sandler Occupational Medicine Associates, Inc.


Is there really a bed bug bb epidemic cont d

Is There Really A Bed Bug (BB) Epidemic? (cont’d)

  • Less than 60 published medical articles, but no controlled medical studies

  • Reports of BB bites/infestations from homes, apartments, schools, libraries, theatres, hotels, homeless shelters, hostels, businesses

© 2010 Sandler Occupational Medicine Associates, Inc.


Cutaneous reactions to bb bites

Cutaneous Reactions to BB Bites

  • Case reports indicate most “bites” do not produce a reaction, with only a barely visible “punctum” (puncture, wound, small spot, point)

  • Ryckman et al, 1985- approximately 30% react to BB bites; but limited current data available indicating bite reaction prevalence

© 2010 Sandler Occupational Medicine Associates, Inc.


Cutaneous reactions to bb bites cont d

Cutaneous Reactions to BB Bites (cont’d)

  • Complex cutaneous reactions

    • Local urticaria (“hives”)

    • Papularurticaria

    • Diffuse urticaria

    • Bullous rashes

© 2010 Sandler Occupational Medicine Associates, Inc.


Cutaneous reactions to bb bites cont d1

Cutaneous Reactions to BB Bites (cont’d)

  • Bites – single, multiple – linear (single or multiple BBs) or bite grouping

  • Pruritis (itching) may be severe

  • Superinfections following scratching may persist for weeks

    • Folliculitis

    • Cellulitis

    • Eczematoid dermatitis

© 2010 Sandler Occupational Medicine Associates, Inc.


Cutaneous reactions to bb bites cont d2

Cutaneous Reactions to BB Bites (cont’d)

  • Delayed reactions (up to 24 hours?)

  • Increased bite frequency may change response time

  • Local reactions – IgE- mediated to  BB salivary proteins

© 2010 Sandler Occupational Medicine Associates, Inc.


Cutaneous reactions to bb bites cont d3

Cutaneous Reactions to BB Bites (cont’d)

  • Treatment is symptomatic and not evidence-based

    • OTC or Rx antipruritic agents (paroxime, doxepin)

    • Intermediate potency corticosteroids (triamcinolone)

    • Sx resolution generally in 1-2 weeks

© 2010 Sandler Occupational Medicine Associates, Inc.


Systemic bb bite reactions

Systemic BB Bite Reactions

  • Few studies

  • Asthma, generalized urticaria, anaphylaxis (angioedema, hypotension, etc.)

  • Systemic reaction frequency not established

  • Treatment includes traditional asthmatic care and intramuscular epinephrine, antihistamines, and corticosteroids

© 2010 Sandler Occupational Medicine Associates, Inc.


Picture of bed bug bites on arm

Picture of Bed Bug Bites on Arm

© 2010 Sandler Occupational Medicine Associates, Inc.


Bed bug bite on leg

Bed Bug Bite on Leg

© 2010 Sandler Occupational Medicine Associates, Inc.


Bed bug bite photo

Bed Bug Bite Photo

© 2010 Sandler Occupational Medicine Associates, Inc.


Bed bug bite skin reaction

Bed Bug Bite Skin Reaction

© 2010 Sandler Occupational Medicine Associates, Inc.


Bed bug bite wheel reaction

Bed Bug Bite Wheel Reaction

© 2010 Sandler Occupational Medicine Associates, Inc.


Bbs and human disease

BBs and Human Disease

  • Earlier reports of:

    • Plaque, yellow fever, TB, small pox, leishmaniasis

    • Relapsing fever, leprosy, filariasis, cancer, Chagas’ disease

© 2010 Sandler Occupational Medicine Associates, Inc.


Bbs and human disease cont d

BBs and Human Disease (cont’d)

  • HIV, HBV?

    • No “vector competency”  demonstrated

    • Negative for HBV transmission in chimpanzees

  • Evidence is still considered equivocal

  • Litigation

© 2010 Sandler Occupational Medicine Associates, Inc.


Occupational health approaches

Occupational Health Approaches

  • Program as part of overall infectious disease/OSH efforts

  • Reporting/Diagnosis – difficult for medical professionals to tell from the bite/reaction

    • Other insect bites – spiders, chiggers, fleas, mites

    • Other skin eruptions – poison ivy

© 2010 Sandler Occupational Medicine Associates, Inc.


Occupational health approaches cont d

Occupational Health Approaches (cont’d)

  • Management

    • Recording

    • Investigation

    • Confirmation

    • Education – routes of transmission, reassurance of unlikely disease risk

    • Counseling – no employee isolation

© 2010 Sandler Occupational Medicine Associates, Inc.


Occupational health approaches cont d1

Occupational Health Approaches (cont’d)

  • Recordkeeping

  • Addressing “SKIEVITIS”

    • Delusional parasitosis

  • Prevention – pest-control agents, education, housekeeping, travel precautions

© 2010 Sandler Occupational Medicine Associates, Inc.


Thank you for your interest

Thank You For Your Interest!

We invite you to visit our website at www.somaonline.com

© 2010 Sandler Occupational Medicine Associates, Inc.


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