Jones, S.C. 2021. Magnitude and Spread of Bed Bugs (Cimex lectularius) throughout Ohio (USA) Revealed by Surveys of Pest Management Industry. Insects 12 (2) 133.

“Bed bugs are small blood-sucking insects that live indoors and feed on humans. They have become a problem in countries worldwide. In this study, the problem in Ohio (Midwest U.S.) was measured based on treatments by licensed pest control companies throughout the state. Results from 2005 showed that Ohio’s bed bug problem likely started in Hamilton County, which includes Cincinnati. Much larger numbers of bed bug treatments were performed in 2011 and again in 2016, especially in counties with large cities. Almost every Ohio county had numerous bed bug treatments in 2016. Most treatments were in apartments/condos and single-family homes. Residents misused many pesticides, especially over-the-counter “bug bombs” and household cleaners, trying to eliminate bed bugs. Many people also threw away unwrapped infested furniture, which may further spread these bugs. More public education is needed to stop such practices. This study shows that bed bug problems can grow and spread quickly. Federal, state, and local officials and the public should immediately deal with bed bugs rather than waiting until they become an even bigger problem.”


Sheele, J.M., O. Hamid, B.F. Chang, and J.H. Luk. 2020. Knowledge, Experience, and Concerns Regarding Bed Bugs Among Emergency Medical Service Providers. Cureus 12(5): e8120. doi: 10.7759/cureus.8120

“Bed bugs are commonly encountered by emergency medical service (EMS) providers. The objective of this study was to determine the frequency with which EMS providers encountered bed bugs, assess their knowledge about bed bugs, and analyze the actions they take after finding bed bugs. We anonymously surveyed 407 EMS providers from 180 EMS agencies in northeast Ohio between September 1, 2018, through March 31, 2019. Among the providers surveyed, 21% (n=84) of the EMS providers reported seeing bed bugs at least monthly, and 6% (n=24) reported seeing bed bugs at least weekly. Being younger, male, and working in an urban environment (vs. rural) were associated with EMS providers reporting more frequent bed bug encounters (p:<=.05). The mean level of concern for encountering bed bugs among EMS providers was 3.54 (SD: 1.15; scale: 1=no concern, 5=very concerned). Among the EMS providers who reported seeing bed bugs at least monthly, 30% took the affected EMS stretcher out of service when they encounter a bed bug, 43% took the EMS rig out of service, 83% cleaned the EMS stretcher with a disinfectant, and 88% notified the ED that their patient has bed bugs. EMS providers scored poorly (mean: 69% correct responses) in a seven-question assessment of basic bed bug biology and public health. Based on our findings, we concluded that EMS knowledge and behavior related to bed bugs are suboptimal.” 


Schoelitsz, B., P. M. Poortvliet, and W. Takken. 2018. Factors driving public tolerance levels and information-seeking behaviour concerning insects in the household environment. Pest Management Science. 74(6): 1478-1493. doi: 10.1002/ps.4839

“BACKGROUND. The public’s negative attitudes towards household insects drive tolerance for these insects and their control. Tolerance levels are important in integrated pest management (IPM), as are pest knowledge and information. The risk information seeking and processing (RISP) model describes the relationships between personal factors and information‐seeking behaviour. We combined IPM and RISP to determine important relationships between factors driving insect tolerance levels and information‐seeking behaviour through an online survey and tested whether this model is valid and generally applicable.

RESULTS. Relationships between variables from both IPM and RISP models were tested for seven insect species. Tolerance levels were measured with two factors: willingness to pay for pest control and whether insects are tolerated. Willingness to pay for control was positively affected by age, experience, risk perception, insect characteristics, and negative emotions and affected behavioural intention, by influencing information sufficiency and information‐seeking behaviour. Tolerability was influenced by perception of insect characteristics and determines whether control measures are taken.

CONCLUSION. It was possible to combine the RISP and IPM models. Relevant driving factors were a person’s age, experience, risk perception, negative affective responses, tolerance levels, relevant channel beliefs about online forums, information sufficiency and information‐seeking behaviour. There was, however, variation in important factors between different insects. tolerance for household insects drive a person’s control behaviour. This article presents relevant factors that drive tolerance levels, information-seeking behaviour and behavioural intent regarding household pest management.”


Penn, J. M., H. J. Penn, M. F. Potter, and W. Hu2017. Bed bugs and hotels: traveler insights and implications for the industry. American Entomologist. 63: 79–88. doi: 10.1093/ae/tmx023

Summary: A nationwide survey of United States business and leisure travelers investigates travelers’ attitudes and behaviors toward bed bugs and discusses their implications for the hospitality industry.

Sheele, J. M., S. Gaines, N. Maurer, K. Coppolino, and J. S. Li2017. A survey of patients with bed bugs in the emergency department. The American Journal of Emergency Medicine. 35(5): 697-698. doi: 10.1016/j.ajem.2016.12.076

“Bed bugs are one of the most important human ectoparasites in the United States, and a growing problem in the emergency department. We evaluated 40 emergency department (ED) patients found with a bed bug. The data show that ED patients with bed bugs are statistically more likely to be male, older, more likely to be admitted to the hospital, have higher triage emergency severity index (ESI) scores, and arrive by ambulance than the general ED patient population (p<0.05). On average bed bugs were found 108 min after a patient arrived to the ED, after 35% of subjects had already received a blood draw, and after 23% had already received a radiology study; putting other ED patients and staff at risk for acquiring the infestation. We found that 13% and 18% of subjects had wheezing and a papular rash, respectively on physical exam. Of those patients found with a bed bug in the ED, 42% reported having bed bugs at home and 21% reporting having a possible home infestation.”


Jourdain, F., P. Delaunay, J.-M. Bérenger, Y. Perrin, and V. Robert2016. The common bed bug (Cimex lectularius) in metropolitan France. Survey on the attitudes and practices of private- and public-sector professionals. Parasite. 23: 38. doi: 10.1051/parasite/2016038

“The common bed bug, Cimex lectularius, had virtually disappeared from France in the 1950s; however, a worldwide resurgence of bed bugs (C. lectularius and C. hemipterus) has been observed since the 1990s. To document modern pest control activities for the management of bed bugs, a survey was conducted in metropolitan France among the two main categories of professionals regularly called upon to deal with the control of infestations: Municipal Health and Safety Services (MHSSs) and private Pest Management Companies (PMCs). These professionals responded to a questionnaire targeting their knowledge, attitude and practices related to the process for diagnosing a bed bug infestation and the processes taken to actually control an infestation. There were 68 responses received from MHSSs and 51 from the PMCs. The responses indicate that every single département (French administrative division) in metropolitan France has witnessed at least one intervention for bed bugs. Among the criteria considered sufficient to confirm a bed bug infestation, direct observation of bugs was the most commonly cited response. Faced with an infestation, most PMCs used a combination of non-chemical and chemical methods, and systematically performed two treatments. This survey is the first of professionals involved in bed bug control in metropolitan France and confirms the growing importance of bed bugs as a public health pest. Establishing a database to monitor this emerging pest would improve the understanding of the distribution of these insects, help guide educational requirements, identify research needs and assist in ensuring that the most appropriate control practices are undertaken.”

Totten, V., H. Charbonneau, W. Hoch, S. Shah, and J. M. Sheele2016. The cost of decontaminating an ED after finding a bed bug: results from a single academic medical center. The American Journal of Emergency Medicine. 34(3): 649. doi: 10.1016/j.ajem.2015.12.020

“Letter to the Editor: The common bed bug, Cimex lectularius L, is a resurgent problem in industrialized nations, including the United States. The US National Electronic Injury Surveillance System–All Injury Program showed that emergency department (ED) visits related to bed bugs rose from 2,156 in 2007 to 15,945 in 2010, a 7-fold increase in 3 years. In 2013, Orkin Inc. listed the Cleveland/Akron/Canton area as the 13th most bed bug-infested city in the United States. Terminix, another large pest management company, estimated that between 2012 and 2013, bed bug infestations rose 36% in the Cleveland area. There have been few published epidemiologic investigations of bed bugs in hospitals and no reports on the costs of bed bugs in the ED. The objective of this study was to identify the financial burden of bed bugs in our ED.”

Wang, C., N. Singh, C. Zha, and R. Cooper2016. Bed bugs: prevalence in low-income communities, resident’s reactions, and implementation of a low-cost inspection protocol. Journal of Medical Entomology. 53(3): 639-646. doi: 10.1093/jme/tjw018

“We examined bed bug prevalence in 2,372 low-income apartments within 43 buildings in four New Jersey cities using a combination of resident interviews, brief visual inspections, and monitoring with Climbup Insect Interceptors. Infestation rates ranged from 3.8 to 29.5% among the buildings, with an overall infestation rate of 12.3%. Within each apartment, the bed area trapped significantly more bed bugs per trap than the sofa (or upholstered chair) area. African American residents had a proportionally higher number of bed bug infestations than white residents. Women were more likely to report bed bug bite symptoms than men. Only 68% of the residents who experienced bed bug infestations reported symptoms after being bitten (n  = 475). Among those with self-reported symptoms (n  = 319), the frequency of the reported symptoms was: pain 90%, itchiness 20%, welts 13%, and insomnia 8%. Fifty-nine percent of the residents (n  = 539) who experienced bed bug infestations applied insecticides to control bed bugs. Climbup interceptors detected 89 ± 1% and brief visual inspections detected 72 ± 3% of the infestations. Only two out of 291 infestations were not detected by brief visual inspection or interceptors. Assuming US$50 per hour labor rate, the average per apartment cost for the building-wide bed bug monitoring protocol was US$12 per apartment. Forty-nine percent of the infestations detected by the protocol were in apartments whose residents were unaware of the bed bug activity.”


Kaylor, M. B., P. Wenning, and C. Eddy2015. Prevalence, knowledge, and concern about bed bugs. Journal of Environmental Health. 78(1): 20-24.

“Recent research suggests that the resurgence of bed bugs in the U.S. has occurred at an alarming rate. Assumptions have been made that socioeconomic status is not associated with the prevalence of bed bug infestations. Little information is available at the local level, however, about the prevalence of bed bugs in private homes. The authors’ pilot study aimed to identify prevalence, knowledge, and concern about bed bugs in one higher income village in Ohio utilizing survey methodology. Responses from 96 individuals who completed the Prevalence, Knowledge, and Concern About Bed Bugs survey were utilized for analysis. The majority of the sample respondents were white and 95% reported that they owned their residence. Only 6% knew someone with bed bugs. Additionally, 52% reported they were somewhat concerned about bed bugs. About 46% reported that they had changed their behavior. For a higher income area, the prevalence was dissimilar to the rate reported in the general public (about 20%). This suggests that bed bugs may be an environmental issue effecting low-income populations disproportionately. Further research is needed in areas of differing socioeconomic levels.”

Sutherland, A., D.-H. Choe, V. Lewis, D. Young, A. Romero, H. Spafford, and D. Gouge2015. Survey sheds light on bed bugs in multi-unit housing. Pest Control Technology. 43: 26-36.

“In brief summary, responding PMPs reported substantial use of many different bed bug detection and control methods, though visual inspections and insecticide applications were clear mainstays. Regular monitoring programs and the use of several complementary control methods are primary components of urban IPM, advocated for strongly by members of our Work Group. We will consider these data as we work collaboratively with regional PMPs to design effective IPM programs for bed bugs in MUHs.”


Potter, M. F., and K. F. Haynes2014. Bed bug nation: is the United States making any progress? Proceedings of the 8th International Conference on Urban Pests, 20-23 July 2014, Zurich, Switzerland. 51–58.

“Contrary to recent news reports, the United States continues to be inundated with bed bugs (Cimex lectularius L.). Based on a nationwide survey of pest professionals, infestations still are increasing. While most pervasive in residences, the bugs are becoming more common in schools, offices, public transportation and other locales where beds are not normally present, paralleling historical trends for this insect. Bed bugs continue to be the most challenging pest encountered by professionals. The cost of extermination is exceeding the budgets of many households and businesses, the majority of whom are averse to spending more on pro-active inspections and other preventative measures. Pest managers in the U.S. are becoming more experienced with bed bugs, and have better tools for providing relief to those who can afford their services. Prospects are less hopeful for the poor, and widespread resistance to insecticides is a global predicament. Absent of a coordinated societal response with affordable science-based pest management tactics, prospects for curtailing the resurgence appear unlikely.”

Wu, Y., D. M. Tracy, A. M. Barbarin, C. M. Barbu, and M. Z. Levy. 2014. A door-to-door survey of bed bug (Cimex lectularius) infestations in row homes in Philadelphia, Pennsylvania. American Journal of Tropical Medicine and Hygiene. 91(1): 206-210. doi: 10.4269/ajtmh.13-0714

“We conducted a door-to-door survey in a residential census tract of Philadelphia to estimate the prevalence and spatial patterns of recent bed bug infestations. We interviewed 596 residents, of whom 66 (11.1%) reported recent bed bug infestations. We confirmed current infestations in a subset of 15 (68.2%) of 22 inspected households. Most residents reported that their infestation began within the past year (2012-2013). We found no correlation between property value and infestation status. Spatial analyses showed significant clustering of bed bug infestations only at fine scales, suggesting limited active dispersal of the insects. Residents used a large variety of treatment methods to eliminate bed bugs, but only 48.1% reported success. Our results provide a prevalence estimate of recent bed bug infestations and highlight the importance of passive rather than active dispersal of bed bugs even among dense urban row homes.”


Goodall, C. E., and P. Reed. 2013. Threat and efficacy uncertainty in news coverage about bed bugs as unique predictors of information seeking and avoidance: an extension of the EPPM. Health Communication. 28(1): 63–71. doi: 10.1080/10410236.2012.689096

“Reader’s responses to print news stories about bed bugs were evaluated using the Extended Parallel Process Model (EPPM). Results suggested that news reports that contained uncertainty about the bed bug threat may motivate people to actively seek out additional information. News reports referencing uncertainty as to the effectiveness of proposed solutions were more likely to cause information avoidance than stories referencing certainty of proposed solutions. Information avoidance is a maladaptive response to fear appeal messages, and indications of uncertainty when discussing solutions to threats in news stories might result in problematic avoidance responses that discourage people from taking protective action.”


Bencheton, A. L., J. M. Berenger, P. Del Giudice, P. Delaunay, F. Pages, and J. J. Morand2011. Resurgence of bedbugs in southern France: a local problem or the tip of the iceberg? Journal of the European Academy of Dermatology and Venereology. 25(5): 599–602. doi: 10.1111/j.1468-3083.2010.03804.x

“Background: Bedbugs (Cimex lectularius) have been feeding on sleeping human beings since prehistory. In Europe, bed bugs were common and endemic until World War II when improved body and home hygiene, and widespread use of insecticides led to almost complete eradication. Current evidence indicates that bedbugs are making a comeback in Europe, USA, Canada and Australia. In our practice in Southern France, we observed several cases within a period of only 1 year.

Objectives: Based on this experience, we conducted an epidemiological study to evaluate the status of bedbugs in France.

Methods: During summer 2009, we mailed a short questionnaire to all hospital professors in the CEDEF (Collège des Enseignants de Dermatologie de France) asking four questions: number of suspected diagnosis of bedbugs in the year 2009, and number of certain positive diagnosis, difficulties in treatment, use of a pest control professional for treatment, and finally personal opinion on actual incidence of bedbugs, compared with past years.

Results: Of the 84 questionnaires sent, there were only 26 responses despite two reminders. The responses were predominantly southern France, probably as a result of intensive immigration and increased travel and trade. Difficulties encountered during diagnosis and treatment are also mentioned. Utilizing the services of entomological experts and pest control professionals is essential.

Conclusions: France has the same experience regarding the resurgence of bedbugs as several European countries, USA, Canada and Australia, especially the southern regions. This emerging health problem has to be known by dermatologists. A national programme has been launched in France to assess actual incidence and study C. lectularius– related diseases.”

Goddard, J. 2011. Bed bugs (Cimex lectularius L.) in Mississippi: survey of the scope, extent, and control of the problem. Midsouth Entomologist. 4: 57–62.

“Bed bugs are blood-sucking insects which had nearly disappeared in developed countries until fairly recently, when a dramatic increase and spread of the insects began in the 1980s. Since then, bed bugs increasingly have been reported inside U.S. hotel rooms, dormitories, and apartments. In this study, entomologists at the Mississippi Department of Health, as well as licensed pest control personnel throughout the state, were queried for information about the scope and extent of bed bug infestations throughout Mississippi for the time period from 1 September 2010 through 28 February 2011. In addition, pest management personnel were asked to provide information about pesticides and other control methods used for bed bug control in Mississippi. A total of 179 bed bug infestations were reported by the respondents covering the six-month period. Health department personnel reported 40 infestations around the state, with an average of 5.0 infestations per responder, while pest management personnel reported 139 infestations with an average of 5.1 infestations per responder. About 30% (8/27 pest control; 3/11 health dept) of responders reported no infestations in their area, so bed bug problems appear to be focal in distribution. Pesticides remain the primary control tool for bed bugs in Mississippi, with most responders saying they use products in the pyrethroid class of pesticides. This particular finding is worrisome in light of widespread pyrethroid resistance. New and expanded educational efforts aimed at both homeowners or tenants and pest management professionals are needed in the fight against this emerging pest.”

Wang, C., and X. Wen2011. Bed bug infestations and control practices in China: implications for fighting the global bed bug resurgence. Insects. 2: 83–95. doi: 10.3390/insects2020083

“The bed bug resurgence in North America, Europe, and Australia has elicited interest in investigating the causes of the widespread and increasing infestations and in developing more effective control strategies. In order to extend global perspectives on bed bug management, we reviewed bed bug literature in China by searching five Chinese language electronic databases. We conducted telephone interviews of staff from 77 Health and Epidemic Prevention Stations in six Chinese cities in November 2010. We also conducted telephone interviews of 68 pest control firms in two cities during March 2011. Two species of bed bugs (Cimex lectularius L. and Cimex hemipterus (F.)) are known to occur in China. These were common urban pests before the early1980s. Nationwide “Four-Pest Elimination” campaigns (bed bugs being one of the targeted pests) were implemented in China from 1960 to the early 1980s. These campaigns succeeded in the elimination of bed bug infestations in most communities. Commonly used bed bug control methods included applications of hot water, sealing of bed bug harborages, physical removal, and applications of residual insecticides (mainly organophosphate sprays or dusts). Although international and domestic travel has increased rapidly in China over the past decade (2000–2010), there have only been sporadic new infestations reported in recent years. During 1999–2009, all documented bed bug infestations were found in group living facilities (military dormitories, worker dormitories, and prisons), hotels, or trains. One city (Shenzhen city near Hong Kong) experienced significantly higher number of bed bug infestations. This city is characterized by a high concentration of migratory factory workers. Current bed bug control practices include educating residents, washing, reducing clutter, putting items under the hot sun in summer, and applying insecticides (pyrethroids or organophosphates). There have not been any studies or reports on bed bug insecticide resistance. Difficulties of control were noted in our surveys of dormitories in which crowded living, seasonal worker migration, and financial constraints contributed to control failures. This study supports the following conclusions: (1) the bed bug infestation in China dramatically decreased following the campaigns from 1960 to the early 1980s; (2) In our survey of Health and Epidemics Prevention Stations, no bed bug cases were reported in Beijing and Shanghai for the past 12 months, but complaints were reported in Guangzhou, Lanzhou, Urumqi, and Shenzhen; (3) Current bed bug infestations primarily are reported in crowded living environments or transient environments such as worker dormitories and military dormitories. These findings suggest that community-wide bed bug monitoring and control campaigns are necessary for effective control of bed bug infestations as a societal response.”


How, Y.-F., and C.-Y. Lee. 2010. Survey of bed bugs in infested premises in Malaysia and Singapore. Journal of Vector Ecology. 35: 89–94. doi: 10.1111/j.1948-7134.2010.00063.x

Public accommodations, hotels, and residences in Malaysia and Singapore that were infested with bed bugs were surveyed to determine the most common species and locations of bed bugs inside the infested areas. The tropical bed bug, Cimex hemipterus, was the only species, and it was most frequently located in the bedding and headboard. Bed bug infestations were more common in hotels and public accommodations than in residences.

Omudu, E. A., and C. N. Kuse2010. Bedbug infestation and its control practices in Gbajimba: a rural settlement in Benue state, Nigeria. Journal of Vector Borne Diseases 47(4): 222–227. doi: 0972-9062

“BACKGROUND & OBJECTIVES: The common bedbug Cimex lectularius Linnaeus (Hemiptera: Cimicidae) is a globally re-emerging pest of serious public health concern. We investigated bedbug infestation in randomly selected apartments in Gbajimba community in Guma Local Government area in Benue state, Nigeria.

METHODS: Beddings and furniture (bed frames, pillows, mattresses, cushion chairs, mats, mosquito nets and bamboo beds) were thoroughly inspected for bedbug infestation using the hand-picking technique. Data were analysed using chi- square analysis for differences in the infestation levels in harbourages and sampling locations.

RESULTS: Only 16% of the apartments investigated showed no evidence of bedbug infestation as egg cases and faecal marks were sighted in 62.2% of apartments surveyed. The highest infestation rate was observed in Angwan Jukun area and infestation here was higher compared to other study locations within the town though the difference was not statistically significant (x2 = 7.92, df = 6, p >0.05). Bamboo beds harboured the highest number of bedbugs collected, accounting for 35.8%, while other harbourages like iron bed frames and sleeping mats had 23 and 22.7% infestation rates respectively. The infestation rates in these household items were significantly higher than other items inspected (x2 = 11.8, df = 4, p > 0.05).

INTERPRETATION & CONCLUSION: This study demonstrates the urgent need for identification of evidences of infestation and bedbug management involving community participation in inspection, detection and education, including physical removal and exclusion as well as pesticide application.”

Yaguchi, N., and S. Kasai2010. Current situation and problem of bedbug infestation in Tokyo, Japan: from public health officer’s angle. Medical Entomology and Zoology 61(3): 231–237. doi: 10.7601/mez.61.231

A Japanese review paper focusing on the current frequency and location of bed bug infestations and a public health officer’s point-of-view on bed bug infestations and what works and doesn’t work. Many infestations are seen in poor accommodations in urban sites around Japan. Movie theatres, restaurants, grocery stores, and buses are among the places that bed bugs are found. Bed bug control is difficult due to pyrethroid resistant bed bugs. It is necessary to survey the level of insecticide resistance of bed bugs in Japan.


Doggett, S. L., and R. C. Russell2008. The resurgence of bed bugs, Cimex spp. (Hemiptera: Cimicidae) in Australia. 6th International Conference on Urban Pests, Budapest, Hungary, 13-16 July 2008. 407–425.

“From 2001 to 2004, Australia experienced a resurgence in bed bug infestations involving both the common (Cimex lectularius) and tropical (Cimex hemipterus) species. It was found that all Australian mainland states had experienced an exponential rise in bed bug infestations since 2001, with an overall national increase of 4.5%. A conservative estimate of the economic impact of the resurgence was $AUS100 million. To combat the resurgence, a four point strategy was implemented. The first strategy was to better define the degree of the resurgence through a survey of professional pest managers. The second strategy was the defining of best practice in bed bug management, which led to the development in 2005 of a Code of Practice for the Control of Bed Bug infestations in Australia (CoP) ( The aims of the CoP were to promote best practice in the eradication of active bed bug infestations and the management of potential infestations. Education of stakeholders affected by bed bugs on best practice management as defined by the CoP was the third strategy and encompassed the production of industry publications and lectures. Research, and investigations have begun in relation to both non-chemical and chemical means of control.”