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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?. Cimex lectularius and Cimex hemipterus

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Occupational Medical Aspects of the Bed Bug Epidemic

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  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. Cutaneous Reactions to BB Bites (cont’d) • Complex cutaneous reactions • Local urticaria (“hives”) • Papularurticaria • Diffuse urticaria • Bullous rashes © 2010 Sandler Occupational Medicine Associates, Inc.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Picture of Bed Bug Bites on Arm © 2010 Sandler Occupational Medicine Associates, Inc.

  11. Bed Bug Bite on Leg © 2010 Sandler Occupational Medicine Associates, Inc.

  12. Bed Bug Bite Photo © 2010 Sandler Occupational Medicine Associates, Inc.

  13. Bed Bug Bite Skin Reaction © 2010 Sandler Occupational Medicine Associates, Inc.

  14. Bed Bug Bite Wheel Reaction © 2010 Sandler Occupational Medicine Associates, Inc.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. Occupational Health Approaches (cont’d) • Recordkeeping • Addressing “SKIEVITIS” • Delusional parasitosis • Prevention – pest-control agents, education, housekeeping, travel precautions © 2010 Sandler Occupational Medicine Associates, Inc.

  20. 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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