Human Health Considerations: General Information, Multiple Factors, Reviews


Small, E. 2019. In defence of the world’s most reviled invertebrate ‘bugs’. Biodiversity, 20(4), 168-221: doi: 10.1080/14888386.2019.1663636

“Species of invertebrate animals, notably insects, are undergoing an alarmingly high rate of extinction, coupled with minimal support for their protection, even from the world’s leading conservation organisations. This is intolerable, as invertebrates constitute over 95% of the world’s species, have indispensable economic values and provide ecological services without which life on earth would virtually cease. Much of the lack of public and governmental support for invertebrate conservation is due to the abhorrent tiny pests that have persuaded most people that ‘bugs’ are bad and consequently the only species worthy of support are the charismatic superstar mammals like pandas and tigers that currently are the mainstays of biodiversity fundraising. Just as these respected, highly attractive icons are effective ambassadors of biodiversity conservation, so certain detested pests have poisoned the public image of invertebrates, and indeed have made it seem to many that most wildlife is hostile. The ‘dirty dozen’ bugs that particularly are a hindrance to improving public investment in biodiversity are: bedbugs, clothes moths, cockroaches, fleas, houseflies, leeches, lice, locusts, mosquitoes, spiders, termites and ticks. Except for spiders, these species, admittedly, are responsible for enormous damage to health and economic welfare. Nevertheless, this paper shows that most have at least some compensating values, their harm has often been exaggerated and all have related species that are good citizens. Six of the dozen ‘least wanted’ invertebrates highlighted are blood parasites of humans, and these ‘bad apples’ are very hard to defend since parasitism seems abhorrent. Remarkably, however, at least half of the world’s tens of millions of species are also parasites, and without them most ecosystems would be in danger of collapse. To improve invertebrate conservation, it is advisable that efforts be made to educate the public regarding their importance. Since prejudices against ‘bugs’ are primarily acquired during childhood, special attention is needed to persuade the young that most invertebrates are harmless, valuable and entertaining. Recent advances in genetic engineering (‘synthetic biology’, ‘genetic drives’) have led to very serious consideration of deliberately eliminating the world’s worst pests of humans. While these extermination technologies could greatly increase support for invertebrate conservation by annihilating their most despised representatives, the dangers of unforeseen damage to ecosystems and hence to biodiversity are substantial.”


Mekonnen D., Y. Zenebe, A. Derbie, Y. Adem, D. Hailu, W. Mulu, F. Bereded, Z. Mekonnen, E. Yizengaw, B. Tulu, F. Biadglegne, A. Mihret, and U. Sack. 2017. Health impacts of bedbug infestation: A case of five towns in Amhara Region, Ethiopia. Ethiopian Journal of Health Development. 31(4): 251-258.

“Background: Bedbug is a wingless human blood-sucking bug that generally infests houses and beds. Bedbug infestation is prevalent across the country. Despite its prevalence, however, there is scarce information on the epidemiological, psychological, social and public health impacts of the infestation. This lack may arise from the absence of sufficient research in the area. The impetus for this study arose from this recognition. This study therefore assessed the extent of bedbug infestation in five towns in Amhara Regional State, Ethiopia, and its impact on public health in the areas considered in this study. Methods: A community-based cross sectional study was conducted in five towns of Amhara Regional State from 1 March 2015 to 30 June 2016. Bedbug inspection was done following the Michigan manual for prevention and control of bedbug recommendation. The presence of a living or dead bedbugs, their eggs, their skin discarded in shedding, and their fecal stains or droppings were taken as an infestation. In addition, data from households were collected using pretested, structured and interviewer-administered questionnaire. The data were analyzed using SPSS version 20. Both bivariate and multivariate logistic regressions were computed to identify associated factors. Results: From the 203 residential institutions surveyed, evidence of prevalence of bedbugs was located in 75.9% (154) houses. From among the infested residents, 87%, 83.1%, and 71.4% had faced one or more psychological, social and health impacts, respectively. Residential institutions in Bahir Dar town administration were 3.4 times more likely to be infested by bedbug than those in Amanuel town (AOR: 3.4; 95% CI: 1-11). The chances that residents of Kobo town administration had to be infested by bedbug were 41 times more than that of the residents in Amanuel town (AOR: 41; 95% CI: 8-206). However, no statistically significant difference was observed between the rates of bedbug infestation and the type of residential institutions. Conclusions: Bedbug infestation was found to be a major public health problem in Bahir Dar, Woreta and Kobo towns. A significant psychological, social and health impact was observed in the communities. Thus, aggressive public health promotion campaigns against bedbug are recommended to empower the communities and equip them with preventive strategies. Moreover, an effective pest management strategy also needs to be made a priority health agenda, in the particular areas of study. A larger study is recommended to assess more in-depth impacts of bedbug infestation on public health.”


Bandyopadhyay, T., A. Kumar, and A. Saili. 2015. Bed bug outbreak in a neonatal unit. Epidemiology and Infection. 143(13): 2865-2870.doi: 10.1017/S0950268814003690

“There has been a worldwide increase in bed bug infestations over the last 10-15 years. A major stigma is placed upon the institutions found to be infested. We report our experience with an outbreak of the tropical bed bug, Cimex hemipterus, in a neonatal unit. The outbreak not only affected the admitted newborns and mothers by causing a wide variety of rashes and inducing sleeplessness, but also impinged upon the health professionals and their families by producing similar symptomology. It is important for healthcare providers to be aware of, and for each healthcare facility to have, bed bug prevention and control policies.”

Kaushal, A., K. Gupta, and M. Hoek. 2015. Characterization of Cimex lectularius (bedbug) defensin peptide and its antimicrobial activity against human skin microflora. Insect Science. 470: 955-960. doi: 10.1016/j.bbrc.2016.01.100

“Antimicrobial peptides are components of both vertebrate and invertebrate innate immune systems that are expressed in response to exposure to bacterial antigens. Naturally occurring antimicrobial peptides from evolutionarily ancient species have been extensively studied and are being developed as potential therapeutics against antibiotic resistant microorganisms. In this study, a putative Cimex lectularius (bedbug, CL) defensin is characterized for its effectiveness against human skin flora including Gram-negative and Gram-positive bacteria. The bedbug defensin (CL-defensin), belonging to family of insect defensins, is predicted to have a characteristic N-terminal loop, an α-helix, and an antiparallel β-sheet, which was supported by circular dichroism spectroscopy. The defensin was shown to be antimicrobial against Gram-positive bacteria commonly found on human skin (Micrococcus luteus, Corynebacterium renale, Staphylococcus aureus and Staphylococcus epidermidis); however, it was ineffective against common skin Gram-negative bacteria (Pseudomonas aeruginosa and Acinetobacter baumannii) under low-salt conditions. CL-defensin was also effective against M. luteus and C. renale in high-salt (MIC) conditions. Our studies indicate that CL-defensin functions by depolarization and pore-formation in the bacterial cytoplasmic membrane.”

Zorrilla-Vaca, A., M. M. Silva-Medina, and K. Escandón-Vargas2015. Bedbugs, Cimex spp.: their current world resurgence and healthcare impact. Asian Pacific Journal of Tropical Disease. 5: 342–352. doi: 10.1016/S2222-1808(14)60795-7

“Over the past two decades there has been a worldwide spread of blood-sucking bedbugs (Cimicidae), leading to naming them a re-emerging plague. New hosts and species have been reported and even vector-borne diseases have been associated to Cimicidae, though the latter is not fully established yet. Cimex, which is the most representative genus, is well-known for its parasitic capacity, worldwide distribution and for being considered by many authors as a man-spread plague. The healthcare impacts of Cimex invasion are being studied, but currently it is considered an alarming public health concern that has been defined by the U.S. Environmental Protection Agency as “a pest of significant public health importance”. In this review, the general characteristics of Cimex, its morphology and its current geographical distribution are discussed not only in developed countries but also including nations from South America, Africa and Asia. Furthermore, we briefly describe the impact that Cimicidae has had on public health, and especially the medical importance of bites, focusing on the possible vector-borne diseases newly reported in the literature including wild species of cimicids.”


McGoldrick, M. 2014. Bag technique: preventing and controlling infections in home care and hospice. Home Healthcare Nurse. 32: 39–45. doi: 10.1097/NHH.0000000000000003

Home care and hospice staff are provided with guidelines for the management of their nursing bag. Strategies are discussed for carrying equipment and supplies in order to prevent and control the transfer of microorganisms.

Podczervinski, S., J. Fauver, L. Helbert, M. Minser, J. Bosze, H. Nolting, T. M. Gonzalez, and S. Pergam. 2014. A multidisciplinary approach to minimize exposures to bed bugs (Cimex lectularis {sic}) in a large ambulatory cancer center. American Journal of Infection Control. 42: S85–S86. doi: 10.1016/j.ajic.2014.03.196

Brief description of policy changes and their effect on reducing the spread of bed bugs among patients and rooms in a cancer center.


Bashir, B., S. G. Sharma, H. D. Stein, R. A. Sirota, and V. D. D’Agati. 2013. Acute kidney injury secondary to exposure to insecticides used for bed bug (Cimex lectularis) control. American Journal of Kidney Diseases. 62(5): 974-977. doi: 10.1053/j.ajkd.2013.04.020

“Bedbug (Cimex lectularis) infestation is becoming a worldwide epidemic due to the emergence of insecticide-resistant strains. Pyrethroids are approved by the US Environmental Protection Agency for use against bedbugs and are considered minimally toxic to humans, with known respiratory, neurologic, and gastrointestinal effects. We present the first reported case of pyrethroid-induced toxic acute tubular necrosis (ATN). A 66-year-old healthy woman receiving no prior nephrotoxic medications presented with extreme weakness, decreased urine output, and acute kidney injury. She had administered multiple applications of a bedbug spray (permethrin) and a fogger (pyrethrin), exceeding the manufacturer’s recommended amounts. She was found to have severe nonoliguric acute kidney injury associated with profound hypokalemia. Kidney biopsy revealed toxic ATN with extensive tubular degenerative changes and cytoplasmic vacuolization. With conservative management, serum creatinine level decreased from 13.0 mg/dL (estimated glomerular filtration rate, 3 mL/min/1.73 m2) to 1.67 mg/dL (estimated glomerular filtration rate, 37 mL/min/1.73 m2) within 6 weeks. Literature review uncovered no prior report of pyrethroid insecticide–induced ATN in humans, although there are reports of ATN with similar tubular vacuolization in rats exposed to this agent. Bedbug insecticides containing pyrethroids should be used with caution due to the potential development of toxic ATN after prolonged exposure.”

Murray, B. S and E. R. Barnes. 2013. Bedbugs: what nurses need to know. American Journal of Nursing. 32: 58–62. doi: 10.1097/01.NAJ.0000435350.76405.0d

A literature review for health care professionals focusing on bed bug bites, control measures, emotional and psychological effects of bed bug infestations, and preventative measures.


Doggett, S. L., D. E. Dwyer, P. F. Peñas, and R. C. Russell2012. Bed bugs: clinical relevance and control options. Clinical Microbiology Reviews. 25: 164–192. doi: 10.1128/CMR.05015-11

“Since the late 1990s, bed bugs of the species Cimex lectularius and Cimex hemipterus have undergone a worldwide resurgence. These bed bugs are blood-sucking insects that readily bite humans. Cutaneous reactions may occur and can start out as small macular lesions that can develop into distinctive wheals of around 5 cm in diameter, which are accompanied by intense itching. Occasionally, bullous eruptions may result. If bed bugs are numerous, the patient can present with widespread urticaria or eythematous rashes. Often, bites occur in lines along the limbs. Over 40 pathogens have been detected in bed bugs, but there is no definitive evidence that they transmit any disease-causing organisms to humans. Anemia may result when bed bugs are numerous, and their allergens can trigger asthmatic reactions. The misuse of chemicals and other technologies for controlling bed bugs has the potential to have a deleterious impact on human health, while the insect itself can be the cause of significant psychological trauma. The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides. For accommodation providers, risk management procedures should be implemented to reduce the potential of bed bug infestations.”

Shum, M., E. Comack, T. Stuart, R. Ayre, S. Perron, S. A. Beaudet, and T. Kosatsky2012. Bed bugs and public health: new approaches for an old scourge. Canadian Journal of Public Health. 103: 399–403. doi: 10.17269/cjph.103.3426

“OBJECTIVE: To share four Canadian cities’ experiences with bed bug infestations and to explore public health roles in managing them. METHODS: We summarize presentations from a workshop at the 2010 Canadian Public Health Association Conference which examined the re-emergence of bed bugs in Canada and compared management approaches of municipal and public health authorities in four large Canadian cities. We include updates on their activities since the workshop. RESULTS: Cities across Canada have observed an increase in complaints of bed bug infestations over recent years. Toronto Public Health considers bed bugs to be a threat to health and has been heavily involved in the front-line response to bed bug complaints. In Winnipeg, Montreal and Vancouver, city inspectors are responsible for investigating complaints, and public health plays a supporting or secondary role. We identified factors that may contribute to successful management of bed bugs: sufficient funding, partnerships among many stakeholders, training and education, and surveillance and evaluation. CONCLUSION: Various public health agencies in Canadian cities have played key roles in the fight against bed bugs through new initiatives, education, and encouragement and support for others. By working with the public, owners, tenants, the health sector and other stakeholders, public health practitioners can begin to curb the resurgence of bed bugs and the social strains associated with them.”


CDC (Centers for Disease Control and Prevention). 2011. Acute illnesses associated with insecticides used to control bed bugs–seven states, 2003–2010. Morbidity and Mortality Weekly Report. 60(37): 1269–1274.

Researchers analyzed records of severe illness associated with insecticides used for bed bug control including cases from 2003–2010 that were reported by 12 states participating in the Sentinel Event Notification System for Occupation Risks (SENSOR) Pesticide program as well as the New York City Department of Health and Mental Hygiene (NYC DOHMH). Seven of twelve states reported cases of severe illness—of 111 total cases, 90 cases were determined to be of low severity and 99 cases were associated with improper applications of insecticides.

Criado, P. R., W. B. Junior, R. F. J. Criado, R. V. e Silva, and C. Vasconcellos2011. Bedbugs (Cimicidae infestation): the worldwide renaissance of an old partner of human kind. The Brazilian Journal of Infectious Diseases. 15: 74–80. doi: 10.1016/S1413-8670(11)70144-1

“Bedbugs have been known as a human parasite for thousands of years, but scientific studies about this insect are recent and limited. Cimex lectularius, the common bedbug, was a well-known parasite in human dwellings until the end of the Second World War. Nowadays, bedbugs are considered uncommon in the industrialized world. Anecdotal reports suggest that bedbugs are getting more common in the United States, Canada, and United Kingdom. In Brazil, there are few reports about bedbug infestations in the literature. The aim of this article was to alert physicians, especially in Brazil, about this ectoparasitosis, including aspects of the bedbug biology, their parasitism in human host, treatment and prophylaxis.”

Eddy, C. and S. C. Jones. 2011. Bed bugs, public health, and social justice: part 1, a call to action. Journal of Environmental Health. 73: 8–14.

A literature review focusing on the human health effects caused by bed bug bites and social justice issues related to bed bug infestations. Housing and the built environment now are recognized as major influences on human health. The public health community is in a precarious social justice position if its lack of response to bed bug infestations disproportionately impacts underserved populations. Bed bugs are an urgent public health and environmental justice concern.

Eddy, C. and S. C. Jones. 2011. Bed bugs, public health, and social justice: part 2, an opinion survey. Journal of Environmental Health. 73: 15–17.

Surveys were conducted of attendees at the 2009 Central Ohio Bed Bug Summit, 2009 National Environmental Health Association Annual Educational Conference and Exhibition, 2009 Ohio Association of Health Commissioners Fall Conference, and 2010 Hamilton County Council on Aging Annual Conference. The survey results indicated that 73% of respondents thought that bed bugs were an environmental justice issue and 90% thought that bed bugs were a public health concern. The findings indicate that federal, state, and local public health agencies should use their authority and respond to the escalating bed bug problem.

Hurst, S., and M. Humphreys. 2011. Bedbugs: not back by popular demand. Dimensions of Critical Care Nursing. 30: 94–96. doi: 10.1097/DCC.0b013e318205214f

Literature review describing the biology of bed bugs, inspection and treatment of bed bugs, and nursing interventions.

Ratnapradipa, D., D. O. Ritzel, L. D. Haramis, and K. R. Bliss2011. Bed bug epidemic. American Journal of Health Education. 42: 245–251. doi: 10.1080/19325037.2011.10599194

“In recent years, reported cases of bed bug infestations in the U.S. and throughout the world have escalated dramatically, posing a global public health problem. Although bed bugs are not known to transmit disease to humans, they pose both direct and indirect public health challenges in terms of health effects, treatment, cost, and resource allocation and coordination. Education is an important component of prevention and treatment of infestations and health educators can play a key role in educating the public about this re-emerging problem and in organizing community-based responses. Therefore, the two goals of this paper were to: (1) provide an overview of the public health threat from bed bug infestations, and (2) provide prevention and treatment guidance for health educators to utilize in educating the public about this challenge.”


Lyons, J. 2010. The social impacts of bed bugs on inner-city residents. MS Thesis. University of Manitoba, Winnipeg, Manitoba

Master’s thesis that utilizes the Community Economic Development and Social Determinants of Health approaches to delineate the economic and social threats in terms of health issues for inner-city residents in Winnipeg, Manitoba, Canada. Bed bugs disproportionately impact the lives of low-income people. Policy documents and other secondary sources are used (1) to assess the effectiveness of policies and existing practices to respond to bed bugs and (2) to offer a more comprehensive approach for responding to the social impacts of bed bugs in the city of Winnipeg.

Rossi, L., and S. Jennings. 2010. Bed bugs: a public health problem in need of a collaborative solution. Journal of Environmental Health. 72: 34–35.

The socioeconomic impacts of bed bugs are described, and suggestions are given for communities and federal governmental agencies to provide education for individuals impacted by bed bug infestations.


Heukelbach, J., and U. R. Hengge. 2009. Bed bugs, leeches and hookworm larvae in the skin. Clinical Dermatology. 27: 285–290. doi: 10.1016/j.clindermatol.2008.10.008

A literature review covering the causative agents, transmission, clinical signs, diagnosis, and treatment for bed bugs, hookworm larvae, and leeches.

Krause-Parello, C. A., and P. Sciscione. 2009. Bedbugs: an equal opportunist and cosmopolitan creature. Journal of School Nursing. 25: 126–132. doi: 10.1177/1059840509331438

An article focusing on bed bugs in schools and information for school nurses regarding causes of the bed bug resurgence, transmission modes, and eradication options for school and community settings.


Ter Poorten, M. C., and N. S. Prose. 2005. The return of the common bedbug. Pediatric Dermatology. 22: 183–187. doi: 10.1111/j.1525-1470.2005.22301.x

A medical case study documenting the presentation of skin disease in a child from a home with a bed bug infestation.


Gbakima, A., B. C. Terry, F. Kanja, S. Kortequee, I. Dukuley, and F. Sahr2002. High prevalence of bedbugs Cimex hemipterus and Cimex lectularis in camps for internally displaced persons in Freetown, Sierra Leone: A pilot humanitarian investigation. West African Journal of Medicine. 21(4): 268–271. doi: 10.4314/wajm.v21i4.27994

“The prevalence of bedbugs Cimex hemiperus and C. lectularis was investigated in camps for the internally displaced persons (IDPs) in Freetown, Sierra Leone. Two hundred and thirty eight rooms were searched during the day and at night, and 233 (98%) of those rooms in 30 booths were infested with different life cycle stages of bedbugs. There hundred and ninety-eight (68%) of the bedbugs were adults, 145 (24.8%) were nymphs of various instars, and 41 (7%) were clusters of eggs. Significantly (P > 0.05) more bedbugs were recovered during the night inspections 64.6% as compared to 35.4% during the day inspections. In addition, more adult bedbugs were recovered at night than during the day, a manifestation of their peak feeding period. Of the total of 570 adults and nymphs collected and identified, 320 (56.1%) and 250 (43.9%) were Cimex lectularis and Cimex hemipterus respectively. Clinical examination of 221 individuals living in the booths during 3 consecutive weeks of examinations and treatment for conditions suggestive of bedbug infestation (bites and skin reactions as well as treatments for other health and medical conditions) showed that 196 (86%) had wheals as a direct result of bedbug bites. The data of this pilot humanitarian investigation shows a high prevalence of bedbug infestation in these displacement camps. It is recommended that some control measures be instituted, like residual insecticide application along with integrating control methods within the primary health care system, because bedbugs are a source of great irritation and sleepless nights that could lead to stress.”