Bed bugs - BC Centre for Disease Control

Bed bugs:
Management Options and
Four Canadian Experiences
Presenter: Daniel Fong,
Knowledge Translation Scientist, NCCEH
February 28, 2013 | BCCDC EH Seminar Series
1. Why do they bug us?
2. Re-emergence of bed bugs
3. NCCPH Bed bug workshop
BACKGROUND
1. Why do they bug us?
Feed on
blood
• Physical,
psychological
effects
Elusive
Resilient
Medill DC
http://www.flickr.com/photos/medilldc/5407193465/
• Small
• Mobile
• Nocturnal
• Longevity
• Multiply
rapidly
• Insecticide
resistance
2. Re-emergence of bed bugs
• Unclear, but common themes
suggested:
– Early 20th century, bed bugs were
not uncommon in developed
countries
• Lack of long-term management
and residual activity of
insecticides
– Decline in infestations in the
1940s
• Use of DDT, but resistance
observed shortly after
– Non-specific and „preventative‟
applications were common in the
past, but is now discouraged
David Hill
http://www.flickr.com/photos/afpmb/4709164814/
Mike Lewis
http://www.flickr.com/photos/qazwix/5549755897/
Re-emergence of bed bugs
Alarming number of
bed bug infestations
observed in the last
decade
North America,
Europe, Australia,
Asia, and Africa
Particularly in high
density settings
Hotels, college
dormitories, multifamily housing
units, hospitals, etc.
Limited evidence
that evaluates bed
bug management
options
attention given by
public, researchers,
government
agencies, pesticide
companies
3. NCCPH – Bed Bugs Workshop
Presented at the 2010 CPHA Conference (June 13, 2010)
http://www.nccph.ca/180/Bed_Bugs_Workshop.ccnsp
NCCPH – Bed Bugs Workshop
NCCPH – Bed bug workshop
Resulting knowledge exchange provided the foundation
for two articles produced through the NCCEH
Two pieces
Practice
(management strategies)
Policy
(urban experiences)
1. Prevention
2. Identification
3. Treatment
MANAGEMENT STRATEGIES
Fong D, Bos C, Stuart T, Perron S, Kosatsky T, Shum M. Prevention,
identification, and treatment options for the management of bed bug
infestations. Environmental Health Review. 2012 2012/12/01;55(04):89-102.
Available from: http://pubs.ciphi.ca/doi/abs/10.5864/d2012-013
Will also be made available on the NCCEH website (www.ncceh.ca)
What‟s presented in this article*?
Provides a summary
and update of the
„best practices‟ in
management of bed
bug infestations
discussed at the Bed
Bug Workshop
Discusses of current
management options
and considerations for
implementing effective
bed bug management
strategies
Tabulates control
options
•Description,
effectiveness, limitations,
evaluative studies (if any)
*Fong D, Bos C, Stuart T, Perron S, Kosatsky T, Shum M. Prevention, identification, and treatment options for the
management of bed bug infestations. Environmental Health Review. 2012 2012/12/01;55(04):89-102. Available from:
http://pubs.ciphi.ca/doi/abs/10.5864/d2012-013
Will also be made available on the NCCEH website (www.ncceh.ca)
1. Prevention
Eliminate entry points and
harbourage sites
Building maintenance
Sealing cracks/crevices
Clutter removal
warzauwynn
http://www.flickr.com/photos/warzauwynn/4270270214/
Prevent ingress and
migration
Second-hand items, luggage
(guidelines, inspection)
Isolation of bed and furniture
Moat-style interceptors,
monitoring devices
Encasements
Eastlaketimes: http://www.flickr.com/photos/eastlaketimes/4819967615;
Louento.pix: http://www.flickr.com/photos/lou_bugs_pix/4190184458/;
Brett David: http://www.flickr.com/photos/brettdavis/2751418307/
2. Identification
Clinical signs of bed bug bites
• Some individuals are asymptomatic
Inspection by qualified person (e.g., pest control
professional, entomologist)
• Live/dead bugs, molted skins, fecal deposits, blood stains,
odours
Identify harbourage sites
• Canine detection units, clutter removal, vacuuming
Estimate population
• Moat-style interceptors, monitoring devices
3. Treatment
Assess extent of
infestation, implement
specific controls in a
safe manner
• regulatory officials,
building management,
pest management
professionals, residents
Non-chemical
treatment
• Heat living spaces,
containerized heat
• Steam
• Freezing
• Laundering
Preparation
• Clutter removal
• Disposal of infested
items
• Encasements
• Vacuuming
Chemical treatment
• Pesticides, fumigation
(pyrethroids,
diatomaceous earth,
dichlorvos,
chlorfenapyr)
Treatment carried
out by qualified
person
Ongoing monitoring
and prevention
• Education may
increase early
detection and improve
outcomes of treatment
Insecticide Exposure
Acute health effects
• Neurologic, respiratory, cardiovascular,
gastrointestinal, ocular, death
• US report* identified 111 cases of illness
associated with pesticide exposure during bed
bug treatments in 3 states from 2003-2010
• one fatality (case had underlying health
conditions)
*Jacobson JB, Wheeler K, Hoffman R, Mitchell Y, Beckman J, Mehler L, et al. Acute illnesses associated
with insecticides used to control bed bugs --- seven states, 2003--2010. MMWR Morb Mortal Wkly Rep.
2011;60(37):1269-74.
US EPA
http://cfpub.epa.gov/oppref/bedbug/
For information purposes only. Products registered with EPA may not
be registered with Health Canada PMRA, and vice-versa.
1.
2.
3.
4.
Toronto
Winnipeg
Montreal
Vancouver
URBAN CANADIAN EXPERIENCES
Shum M, Comack E, Stuart T, Ayre R, Perron S, Beaudet S, et al. Beg
bugs and public health: new approaches for an old scourge. Can J
Public Health. 2012. Available from:
http://journal.cpha.ca/index.php/cjph/article/view/3426
Article available free online 6 months after publication
What‟s presented in this article*?
Identifies factors that
may contribute to
successful
management of bed
bugs
Summarizes experiences
of four Canadian cities
with regard to their
response to bed bugs
Tabulates legislation,
owner and tenant
obligations,
assistance for
vulnerable groups,
and evaluation related
to bed bugs in four
Canadian cities
*Shum M, Comack E, Stuart T, Ayre R, Perron S, Beaudet S, et al. Beg bugs and public health: new approaches
for an old scourge. Can J Public Health. 2012. Available from:
http://journal.cpha.ca/index.php/cjph/article/view/3426
Article available free online 6 months after publication
1. Toronto - Public Health as Lead
Toronto Public Health
(TPH)
Political and public pressure
increased demand for services
• 7-fold increase in requests for
services related to bed bugs
between 2005-2008.
• Historically, TPH has not
considered bed bugs a public
health issue
TPH took the lead in bed bug
management
Public Health Inspectors (PHI)
respond to bed bug concerns
Toronto
Encountered complex cases
• Vulnerable groups: Poor, elderly, disability, mental health issue
• Require resource-heavy long-term management
Held a multi-stakeholder forum leading to the
establishment of the Toronto Bed Bug Project (2008)
• Working groups of landlords tenants, pest control firms, social housing,
and shelter managers, community agencies
• Supports education, creation of legislative tools, development of „best
practices‟
• Toronto and Ontario governments provide some funding for preparation
of units and replacement of furniture for those who need assistance.
• Online public survey to report experiences with bed bugs (ongoing)
Toronto
$5 million plan
implemented in 2011
• Education for public, funding
for public health agencies
• Enabled TPH to set up
contracts with private
agencies for unit prep and
extreme cleaning
“Bug and Scrub”
program
• Homeless men were trained
in preparing units for
treatment.
• Since been scaled back due
to employment standards
issues.
• Support model has since
been used in Australia and
Manitoba
Toronto
Funding ended on March 31, 2012
• City and Province recognized the importance of
work, moving toward providing sustainable funding
• Return to minimal response program
• Long term success cannot be achieved without
communication plans, partnerships, donations,
volunteers, social support, and external dedicated
funding
2. Winnipeg - Public Education
Campaigns
Regulatory response to bed
bugs (Winnipeg)
• Neighbourhood Livability By-Law (2008)
• Bed bugs are a “nuisance” and “unsanitary”
• Responsibility of both owners AND occupants to
prevent infestations
• City By-Law Enforcement Officers
• Respond to bed bug complaints
• Can write orders to landlords
Winnipeg
Public Education Campaigns,
March 2011
• MB government - $770,000 to finance a 2
year bed bug response plan
• Public education and information – prevention and
eradication (e.g., posters, website, phone line)
• Bed Bug Grant Program* for community-based,
non-profit organizations and individuals.
• Cost recovery of treatment, prevention (e.g.,
hiring pest control, mattress covers, insect
monitors, laundry bags) – up to $2000
*http://www.gov.mb.ca/bedbugs/nonprofit.html
Winnipeg
Since 2011
• Decrease of complaints and bed bug treatments
• 60% reduction in complaints
• Less media inquiries
• Developed and maintained partnership between
tenants, landlords, and pest management
professionals
• Manitoba Bug N‟Scrub Program*
*http://residents.gov.mb.ca/reference.html?d=details&program_id=5940
3. Montreal - Surveillance and
Support for City Action
Regulatory response to bed bugs
• Municipal or Borough Inspectors
La Direction de Santé publique de Montréal (DSP
Montréal)
• Education of partners and the public
• Produces tools, guides
• Training for municipal inspectors, nurses, social workers,
physicians
• Second-line support for agencies dealing with bed bugs,
communication strategies, field epidemiology
• Survey of bed bug infestations (2010-2011): 2.8% (24,293)
households
Montreal
Centre de Santé et des Services sociaux (CSSS)
• Collaborate with Municipal inspectors:Report unfit housing
units, support vulnerable populations, educate clients, identify
financing
Montreal‟s housing corporation
• For vulnerable populations, they promote IPM and pay for
treatment of its facilities
Municipal bylaw on sanitation and maintenance
• Ensure safe, sanitary and properly maintained residential
buildings
Montreal
In 2011, City of Montreal, Montreal‟s housing
corporation, and DSP Montreal…
• Developed an action plan based on:
•
•
•
•
Knowledge acquisition (surveillance, best practices, research)
Prevention
Communication
Intervention
In 2012, DSP Montreal, Montreal‟s housing
corporation, and CSSS…
• initiated research project to demonstrate effectiveness of providing
assistance and preparation of dwellings of vulnerable households.
4. Vancouver - Complaint-based
Municipal Process
Vancouver‟s Property Use
Division
• Response to bed bug complaints
• Formerly Vancouver Coastal Health but inspection
and enforcement role has shifted to City in 2008
• City Property Use Inspectors (PUI) may discover
infestations during building inspections
• May conduct inspection with fire, police, social
services
Vancouver
PUIs are only able to
inspect unit of complaint
and not adjacent units
• Bed bugs often not completely
eradicated
• Not involved in dispute settlement,
outreach, or educational activities
If the tenant is
non-compliant,
landlord may rely
on rental
agreement to
resolve issue
If the landlord is
non-compliant,
tenant tends to
move
Vancouver
Vancouver Coastal Health
• offers information to public and holds workshops for
healthcare sector landlord groups and hotel operators
• support and consultation to City inspectors
• involved if there is a health hazard
BC housing
• provides education to building managers and tenants
Conclusion
Management strategies
consistent with IPM
practices is likely to yield
more desirable outcomes
• Health, economic, environmental impacts
• Involve regulatory agencies, pest management
professionals, building managers, residents
• Assistance to vulnerable populations
Factors that may
contribute to successful
management of bed bugs
• Funding, partnerships, training and education,
surveillance and evaluation
Value in sharing scientific
and experiential
knowledge
• Publishing and reviewing community and
regulatory experiences
• Innovative practices and projects, updates
• Facilitate discussions to inform practice and policy
Acknowledgements
Mona Shum, Constance Bos, Elizabeth Comack,
Taz Stuart, Reg Ayre, Stéphane Perron,
Shelley A. Beaudet, Tom Kosatsky
NCCPH/NCCEH bed bug workshop facilitators,
presenters, participants
Thank You
Questions?
Comments?
www.ncceh.ca | www.ccnse.ca
Funded by the Public Health Agency of Canada
Photo Credits:
Flickr. Online photo management and sharing application. Creative commons selections. Flickr; 2010
iStock Photo credits from left to right: Alison Trotta-Marshall, Robert Churchill, pierredesvarre, amazonfilm