A new article appeared today in the CDC’s Morbidity and Mortality Weekly Report (MMWR), cautioning against the dangers associated with using pesticides to treat bed bugs. A preview of “Acute Illnesses Associated With Insecticides Used to Control Bed Bugs — Seven States, 2003–2010” is on the CDC website.
The article describes how the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides program and the New York City Department of Health and Mental Hygiene (NYC DOHMH) identified and studied 111 cases during that time period of illnesses associated with bed bug-related insecticide use in seven states: California, Florida, Michigan, North Carolina, New York, Texas, and Washington.
Of these, 90 (81%) were “low severity,” but others were more severe and one was fatal. Most cases (89%), including the fatality, involved “pyrethroids, pyrethrins, or both.”
For 2003–2010, a total of 111 cases were identified in seven states. The majority of cases occurred during 2008–2010 (73%), were of low severity (81%), and were identified by poison control centers (81%). New York City had the largest percentage of cases (58%). Among cases with known age, the majority occurred among persons aged [or older than] 25 years (67%). The majority of cases occurred at private residences (93%); 40% of cases occurred in multiunit housing. Among cases, 39% of pesticide applications were performed by occupants of the residence who were not certified to apply pesticides. The majority of insecticide exposures were to pyrethroids, pyrethrins, or both (89%) and were in toxicity category III (58%). The most frequently reported health outcomes were neurologic symptoms (40%), including headache and dizziness; respiratory symptoms (40%), including upper respiratory tract pain and irritation and dyspnea; and gastrointestinal symptoms (33%), including nausea and vomiting.
Among cases, 13 (12%) were work-related. Of these, three illnesses involved workers who applied pesticides, including two pest control operators, of whom one was a certified applicator. Four cases involved workers who were unaware of pesticide applications (e.g., two carpet cleaners who cleaned an apartment recently treated with pesticides). Two cases involved hotel workers (a maintenance worker and a manager) who were exposed when they entered a recently treated hotel room, and two cases involved emergency medical technicians who responded to a scene where they found white powder thought to be an organophosphate pesticide. Contributing factors were identified for 50% of cases. Factors that most frequently contributed to insecticide-related illness were excessive insecticide application (18%), failure to wash or change pesticide-treated bedding (16%), and inadequate notification of pesticide application (11%).
It is notable that 39% of cases involved occupants of residences not certified in pesticide application. One other, of course, involved a rogue pest management “professional” applying Malathion illegally and excessively. Not the only such case we’ve heard of.
The tragic case of the woman in North Carolina who died involved a history of illness and concurrent heavy medication use, misapplication of pesticides, the use of pesticides not labeled for the purpose and on sensitive areas like mattresses, overuse of insecticide products (a staggering nine foggers in one day), and — this last detail in particular brings tears to my eyes — inappropriate applications of household pesticides to human skin and hair.
That behavior (both on the part of the woman who died and her husband) speaks of a desperation to get rid of bed bugs which is extreme, but not entirely uncommon.
And this is partly why perspectives like the one Richard Fagerlund expresses in this recent SFGate.com article — where the author waxes poetic about his life spent peacefully coexisting with happy and fat hotel bed bugs — are particularly offensive.
Even Ben H. Winters — who found bed bugs to be appropriate material for his new horror novel, no doubt soon to be a terrifying movie — doesn’t get why bed bugs are a big deal in real life. (Note: you can win a copy of Winters’ novel here — and yes, I really did like it.)
It’s impossible to explain to those who have not lived with bed bugs and failed to easily solve this problem the misery they can cause.
Folks like Winters and Fagerlund haven’t lost hope after spending thousands of dollars treating the problem which still persists months later. They haven’t gone for three weeks on four hours sleep as they tried to prep their homes for treatment while keeping jobs and family going.
Sure, for many people — perhaps even most people — bed bugs are a nuisance that lasts a few weeks or months. However, in this economy, when many lack the funds to treat, and in multi-unit housing, where neighbors may have persistent under- or untreated infestations, for many of us, bed bugs persist longer. They rob us of money and sleep and time and peace of mind.
For some, bed bug bites result in no symptoms, or a few itchy bite marks. For others, the physical discomfort is more severe and the ongoing fight can mean living for long periods with much less sleep than one needs. That causes a lot of stress, as well as other health problems.
And bed bugs can make people desperate — sometimes desperate enough to unwittingly cause harm to themselves or others. This study surely represents just some of the cases in the same time period, with others occurring in other states or otherwise going unreported.
The last thing anyone should take away from the MMWR article and the mass of coverage it has been receiving (such as this and this and this) is that bed bugs can’t be treated safely with pesticides. They can. You can get rid of bed bugs. Pesticides can be used safely and effectively. And pesticide treatment of the problem has relieved many, many people of the misery of living with bed bugs.
Integrated Pest Management best practices involve using non-pesticide methods of control when possible, and using pesticides appropriately. There is a middle ground between avoiding pesticides completely and mis-applying or over-applying them.
However, your best bet really is an experienced and knowledgeable pest management professional who knows where and how to apply pesticides safely, and when alternative methods like heat are more appropriate. And therein lies the problem: we don’t all have the money to hire a good PMP, and we aren’t all in a position to choose which one gets hired, or whether they are empowered to inspect and treat our attached neighbors.
Thanks to Dr. Jody Gangloff-Kaufmann and Lou Sorkin for pointing me to the latest Fagerlund bed bug-themed “Ask the Bugman” column on SFGate.com. I have a hunch I’d enjoy and agree with a regular column from Jody or Lou a whole lot more. Is it perhaps time to “Ask the Bugwoman” or “Ask a Different Bugman” instead?
Acute Illnesses Associated With Insecticides Used to Control Bed Bugs — Seven States, 2003–2010, Morbidity and Mortality Weekly Report (MMWR).
September 23, 2011 / Vol. 60 / No. 37