Joint Statement on Bed Bug Control in the
 

United States from the U.S. Centers for Disease
 

Control and Prevention (CDC) and the U.S.
 

Environmental Protection Agency (EPA)
 

Introduction and Purpose 

The Centers for Disease Control and Prevention (CDC) and the U.S. Environmental 

Protection Agency (EPA) developed this document to highlight emerging public health 

issues associated with bed bugs (Cimex lectularius) in communities throughout the 

United States. 

Bed bugs (Photo 1) have been common in U.S. history. Although 

bed bug populations dropped dramatically during the mid-20th 

century (1), the United States is one of many countries now 

experiencing an alarming resurgence in the population of bed 

bugs. Though the exact cause is not known, experts suspect the 

resurgence is associated with increased resistance of bed bugs to 

available pesticides, greater international and domestic travel, 

lack of knowledge regarding control of bed bugs due to their 

prolonged absence, and the continuing decline or elimination of 

effective vector/pest control programs at state and local public 

health agencies. 

In recent years, public health agencies across the country have 

been overwhelmed by complaints about bed bugs. An integrated 

approach to bed bug control involving federal, state, tribal and local public health 

professionals, together with pest management professionals, housing authorities and 

private citizens, will promote development and understanding of the best methods for 

managing and controlling bed bugs and preventing future infestations. Research, 

training and public education are critical to an effective strategy for reducing public 

health issues associated with the resurgence of bed bug populations. 

Impact of Bed Bugs on Public Health 

Although bed bugs are not known to transmit disease, they are a pest of significant 

public health importance. Bed bugs fit into a category of blood-sucking ectoparasites 

(external parasites) similar to head lice (Pediculus humanus capitis). Bed bugs, like 

head lice, feed on the blood of humans but are not believed to transmit disease. Other 

ectoparasites, such as body lice (Pediculus humanus corporis), are known to transmit 

several serious diseases. Differences in the biology of similar species of pests, such as 

body lice and head lice (or bed bugs) can greatly impact the ability of pests to transmit 

disease. 

Photo 1. Bed Bug. Photo 

courtesy of Dr. Harold 

Harlan, Armed Forces Pest 

Management Board Image 

Library 
 

 

 

 

 

 

	 

	 

	 

	 

Bed bugs cause a variety of negative physical health, mental 

health and economic consequences. Many people have mild 

to severe allergic reaction to the bites with effects ranging 

from no reaction to a small bite mark to, in rare cases, 

anaphylaxis (severe, whole-body reaction) (2). These bites 

(Photo 2) can also lead to secondary infections of the skin 

such as impetigo, ecthyma, and lymphanigitis (3,4). Bed bugs

may also affect the mental health of people living in infested 

homes. Reported effects include anxiety, insomnia and 

systemic reactions (1). 

Research on the public health effects of bed bugs has been 

very limited over the past several decades, largely due to the 

noted decline in bed bug populations in the latter half of the 20th century. Now that bed 

bug populations are rapidly increasing, additional research is needed to determine the 

reasons for the resurgence, the potential for bed bugs to transmit disease and their 

impact on public health. 

Economically, bed bug infestations are also a burden on society. Although the exact 

dollar amount is not known, the economic losses from health care, lost wages, lost 

revenue and reduced productivity can be substantial. The cost of effectively eliminating 

bed bugs may be significantly more than the cost of eliminating other pests because bed 

bug control usually requires multiple visits by a licensed pest control operator and 

diligence on the part of those who are experiencing the infestation. Control in multifamily homes is much more difficult than in single family homes because bed bugs 

frequently travel between units, either by direct transport by humans or through voids 

in the walls. There are additional costs and complexities associated with coordinating 

and encouraging participation from multiple residents. 

When a community starts to experience bed bug infestations, control is often more 

challenging because: 

•	 Local public health departments have very limited resources to combat this 

problem and bed bugs frequently are not seen as a priority. 

•	 Municipal codes struggle to identify those responsible for control of bed bug 

infestations. Tenants and landlords often dispute who is ultimately responsible 

for the cost of control and treatment. Treatment costs are high and transient 

populations make it difficult or impossible to assign responsibility. 

•	 Pesticide resistance and limited control choices make treatment even more 

difficult. Some bed bug populations are resistant to almost all pesticides 

registered to treat them. Residents may use over-the-counter or homemade 

preparations that are ineffective (or even dangerous) and may promote further 

resistance. 

•	 Pesticide misuse is also a potential public health concern. Because bed bug 

infestations are so difficult to control and are such a challenge to mental and 

economic health, residents may resort to using pesticides that are not intended 

for indoor residential use and may face serious health risks as a result. 

Additionally, residents may be tempted to apply pesticides registered for indoor 

use, but at greater application rates than the label allows. This results in a much 

greater risk of pesticide exposure for those living in the home. Pesticides must 

Photo 2. Skin Reaction to Bed Bug 

bites. Photo courtesy of Dr. Harold 

Harlan 
 

 

 

 

 

 

 

 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 

always be used in strict accordance with their labeling to ensure that the 

residents and applicators are not exposed to unsafe levels of pesticide residues. 

Bed Bug Biology
 

Bed bugs are small, flat insects that feed on the blood of sleeping people and animals.
 

They are reddish-brown in color, wingless, and range from 1 to 7 millimeters in length.
 

They can live several months without a blood meal.
 

Infestations of these insects usually occur around or near the areas where people sleep
 

or spend a significant period of time. These areas include apartments, shelters, rooming
 

houses, hotels, nursing homes, hospitals, cruise ships, buses, trains, and dorm rooms.
 

Bed bugs are experts at hiding. They hide during the day in places such as seams of
 

mattresses, box springs, bed frames, headboards, dresser tables, cracks or crevices,
 

behind wallpaper, and under any clutter or objects around a bed. Their small flat bodies
 

allow them to fit into the smallest of spaces and they can remain in place for long
 

periods of time, even without a blood meal. Bed bugs can travel over 100 feet in one 

night, but they tend to live within 8 feet of where people sleep.
 

Bed bugs are usually transported from place to place as people travel. Bed bugs travel in
 

the seams and folds of luggage, overnight bags, folded clothes, bedding, furniture, and
 

anywhere else where they can hide. Most people do not realize they can transport stowaway bed bugs as they travel potentially infesting new areas, including their homes, as 

they relocate.
 

One of the easiest ways to identify a bed bug infestation is by
 

bite marks that appear on the face, neck, arms, hands, and any
 

other body parts. However, these bite marks may take as long
 

as 14 days to develop in some people so it is important to look
 

for other clues when determining if bed bugs have infested an
 

area. These signs may include the exoskeletons (Photo 3) of 

bed bugs after molting, bed bugs in the fold of mattresses and
 

sheets, a sweet musty odor, and rusty-colored blood spots
 

from their blood-filled fecal material that is often excreted on
 

the mattress or nearby furniture.
 

When bed bugs bite, they inject an anesthetic and an
 

anticoagulant that prevents a person from feeling the bite.
 

Because bites usually occur while people are sleeping, most
 

people do not realize they have been bitten until marks appear

The bite marks are similar to that of a mosquito or a flea - a 

slightly swollen and red area that may itch and be irritating. The bite marks may be
 

random or appear in a straight line. Other symptoms of bed bug bites include insomnia,
 

anxiety, and skin problems that arise from profuse scratching of the bites.
 

Everyone is at risk for bed bugs bites when visiting an infested area. However, anyone 

who travels frequently and shares living and sleeping quarters where other people have
 

previously slept has an increased risk for being bitten and for spreading a bed bug
 

infestation.
 

Photo 3. Bed Bug 

Exoskeletons. Photo courtesy 

of Dr. Harold Harlan, Armed 

Forces Pest Management .
 
 Board Image Library 
 

 

 

 

Integrated Pest Management for Bed Bugs 

The current national problem with bed bugs is likely due to the convergence of three 

human behaviors: lack of awareness of the historical and biological link humans have 

with bed bugs, increased international travel, and past over-reliance on pesticides. Bed 

bugs are a “nest parasite” that resides in the human nest – the bedroom. Over time, bed 

bugs have evolved to develop resistance to many of the chemical pesticides currently 

used. In fact, bed bugs were widely resistant to DDT by the mid-1950s (5). 

Integrated pest management (IPM) is an effective and environmentally sensitive 

approach to pest management that relies on a combination of common-sense practices. 

IPM programs use current, comprehensive information on the life cycles of pests and 

their interaction with people and the environment. This information, in combination 

with available pest control methods, is used to manage pest damage by the most 

economical means, and with the least possible hazard to people, property, and the 

environment. 

Bed bug control is most effective when an IPM approach is implemented with diligent 

participation by the residents. In multi-family housing, diligent participation is also 

required of the building management. IPM takes advantage of all appropriate pest 

management options, including the judicious use of pesticides. Although bed bugs may 

sometimes be controlled by non-chemical means alone, this approach is often very 

difficult, potentially less effective, and usually more resource intensive. A 

comprehensive IPM program to control bed bugs may include a number of methods 

such as: 

• using monitoring devices, 

• removing clutter where bed bugs can hide, 

• applying heat treatment, 

• vacuuming, 

• sealing cracks and crevices to remove hiding places, 

• using non-chemical pesticides (such as diatomaceous earth) and 

• judicious use of effective chemical pesticides 

A coordinated community IPM program can alleviate both the discomfort and cost of 

managing bed bugs. The underlying philosophy of bed bug IPM is based on the fact that 

bed bug infestations will not go away without intervention. Intervention is most 

effective when populations are low. Such a coordinated effort could create a partnership 

among government, property managers, citizens, and pest management professionals to 

ensure an effective intervention facilitated by environmental health professionals. EPA 

and CDC recommend that pest management and environmental health professionals 

throughout the U.S. continue to use IPM strategies as they address the bed bug issue. 
 

 

 

 

 

 

The Role of Government Agencies and the Public in Bed Bug 

Control 

CDC, EPA, and other federal agencies are working closely with state, tribal and local 

health departments, academia and private industries to monitor and better understand 

the recent resurgence of bed bugs in communities throughout the United States. CDC 

and EPA are facilitating communications and working to expand the knowledge base 

among agencies and programs that may have a role in reducing bed bug populations. 

The two agencies are also fostering cooperation with the private sector and the public to 

encourage their help with this endeavor. 

CDC is partnering with experts in the areas of medicine, entomology, epidemiology and 

environmental toxicology to better understand the resurgence of bed bugs and the 

methods and tools that are needed for effective bed bug control. CDC will provide timely 

information on emerging trends in bed bug control with the goal of developing national 

strategies to reduce bed bug populations. CDC recognizes that very limited research has 

been conducted on bed bugs during the past several decades and encourages increased 

bed bug research to determine the causes of the resurgence, the most effective methods 

of control and the potential for bed bugs to transmit disease. 

EPA’s primary responsibility is the dual statutory charges to ensure that the pesticides 

with public health uses are (1) safe and (2) effective against the pests on their labels. 

EPA carries out this responsibility by conducting rigorous scientific screening of 

pesticides and imposing limits through registration of pesticides to ensure that when 

used to control pests, they do not harm people or the environment. 

EPA is working to ensure that pest management professionals and the public have 

access to the latest information on effective bed bug control tools. EPA realizes that 

certain bed bug populations in communities across the nation are becoming increasingly 

resistant to many of the existing pesticides. EPA is actively working with industry and 

researchers to identify new compounds (or new uses of existing compounds) to control 

bed bugs. In addition, EPA is working to educate the general public, pest professionals, 

and public health officials about bed bug biology and IPM, which is critical to long-term 

bed bug control. 

Other federal agencies are also involved in research and education about bed bugs. For 

example, the U.S. Department of Housing and Urban Development (HUD) is funding 

research on bed bug monitoring and control in low-income, multi-family housing, along 

with educating public housing authorities and other housing industry groups about bed 

bug identification and control. Health departments can use local HUD field office 

personnel or local housing officials as resources when addressing bed bug issues in 

multi-family housing. 

State, tribal, and local government agencies and health departments play a critical role 

in protecting the public from bed bugs. Public health departments serve on the front 

lines, providing information on prevention and control of bed bugs through various 

programs to the public and private sector. 

The public, together with their local health agencies, must be involved in the control and 

management of bed bug populations and must be provided with the knowledge of best 

practices to prevent and control bed bug infestations. In some cases, a coordinated 

community control program may be necessary to reduce or eliminate bed bug 

populations. 
 

 

 

 

 

 

 

 

 

 

	 

	 

	 

	 

	 
 


 

	 
 


 

	 
 


 

	 

	 
 


 

	 
 


 

	 


 

	 

	 
 


 

	 
 


 

	 

Additional Information 

For additional information about bed bugs and their control, please see the following 

print references: 

•	 Cooper RA, Harlan HJ. Ectoparasites, part three: bed bugs and kissing bugs. In: 

Mallis A, Hedges SA, Moreland D, editors. Handbook of pest control, ninth 

edition. Richfield, OH: GIE Media, Inc.; 2004. p. 495-529. 

•	 Harlan HJ, Faulde MK, Bauman GJ. Bedbugs. In: Bonnefoy X, Kampen H, 

Sweeney K, editors. Public health significance of urban pests. Copenhagen: World 

Health Organization; 2008. p. 131-53. 

•	 Miller DM. Bed bugs (Insecta: Hemiptera: Cimicidae: Cimex spp.). In: Capinera 

J, editor. Encyclopedia of entomology. Dordrecht, Netherlands: Kluwer Academic 

Press Springer; 2008. p. 405-17. 

•	 Usinger RL. Monograph of Cimicidae. Lanham, MD: The Entomological Society 

of America; 1966. 

For additional information about bed bugs and their control, please see the following 

Web sites: 

•	 U.S. Environmental Protection Agency:
 

http://epa.gov/pesticides/controlling/bedbugs.html
 

•	 Centers for Disease Control and Prevention:
 

http://www.cdc.gov/nceh/ehs/Topics/bedbugs.htm
 

•	 Bed Bug Hotel Safety:
 

http://www.oregon.gov/DHS/ph/pl/docs/bedbughotel.pdf
 

•	 Central Ohio Bed Bug Task Force Information: http://centralohiobedbugs.org/ 

•	 Cornell Bed Bug Guide:
 

http://www.nysipm.cornell.edu/publications/bb_guidelines/
 

•	 Harvard School Public Health Bed Bug Management:
 

http://www.hsph.harvard.edu/bedbugs/
 

•	 National Pest Management Association: http://www.pestworld.org/forconsumers/pest-frequently-asked-questions/bedbug-faq
 

•	 National Pesticides Information Center: http://npic.orst.edu/pest/bedbug.html 

•	 New Jersey Bed Bug Fact Sheet:
 

http://www.nj.gov/health/eoh/phss/documents/bedbugfactsheet.pdf
 

•	 University of Kentucky Bed Bug Fact Sheet:
 

http://www.ca.uky.edu/entomology/entfacts/entfactpdf/ef636.pdf
 

•	 University of Minnesota Bed Bug Information for Travelers: 

http://www.extension.umn.edu/distribution/housingandclothing/M1196.html 
	 

	 

	 

	 

	 

References 

1.	 Anderson A, Leffler K. Bed bug infestation in the news: a picture of an emerging 

public health problem in the United States. Journal of Environmental Health. 

2008;70(9):24-7, 52-3. 

2.	 Thomas I, Kihiczak GC, Schwartz RA. Bed bug bites: a review. International 

Journal of Dermatology, 2004;43:430-3. 

3.	 MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); 

[updated 2010 Feb 17]. Impetigo; [updated 2010 Jan 12; cited 2010 Feb 17]. 

Available from http://www.nlm.nih.gov/medlineplus/impetigo.html. 

4.	 Burnett JW, Calton GJ, Morgan RJ. Bed bugs. Cutis 1986;38(1):20. 

5.	 Pinto LJ, Cooper RA, Kraft SK. Bed bug handbook: the complete guide to bed 

bugs and their control. Mechanicsville, MD: Pinto and Associates, Inc.; 2007. 

Suggested citation: Centers for Disease Control and Prevention and U.S. Environmental 

Protection Agency. Joint statement on bed bug control in the United States from the U.S. 

Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection 

Agency (EPA). Atlanta: U.S. Department of Health and Human Services; 2010.