CDC on “Acute illnesses associated with insecticides used to control bed bugs,” and why bed bugs are more than a nuisance

by nobugsonme on September 23, 2011 · 18 comments

in bed bug treatment, bed bugs, pesticides

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.”

The authors report,

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 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  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

You can also download a PDF of the current issue of MMWR from the CDC website.

1 Koebner September 23, 2011 at 6:14 am

The chief lesson we should take from the CDC report is one we already knew – pesticides should be applied with caution & only according to their label.

The second important feature of this report is its highlighting of the lengths to which people will go to try to rid themselves of these loathsome ectoparasites. It seems to me that it was not pesticides alone that caused that poor lady’s death, but a toxic soup of pesticide, inadequte public education on bed bugs, & the inability of many people to access the services of competent pest controllers.

I do wish though, that the EPA would withdraw the labelling for bed bugs from bombs & foggers. They don’t work against bed bugs & almost invariably make things worse. As ever with bed bugs, the crucial requirement is not that the product contains an effective pesticide but that the effective pesticide is applied in a correctly targeted manner. Bombs & foggers do not answer to this requirement.

2 Dan Wylie-Sears September 23, 2011 at 7:45 am

It seems as though what this make offensive isn’t people trying to calm public perception of BBs, but those who create the impression that desperate measures are appropriate to the problem.

They’re expensive to get rid of. For the small percentage of people who react most severely to the bites, they’re extremely unpleasant. Anyone who’s infested should take appropriate measures to get rid of them and to avoid infesting anyone else in the meantime.

But a BB infestation is not like a diagnosis of pancreatic cancer. They’re not the Black Death. If you can’t afford to get them treated properly, you don’t need to go for chemotherapy-like measures. Get competent professional treatment if you can, absolutely. But if not, take a deep breath, isolate the bed with talc and cottage-cheese containers, and apply some diligence with a flashlight and magnifying glass. They’re not so bad as to justify resorting to weapons of mass destruction.

3 Koebner September 23, 2011 at 9:28 am

“Talc & cottage-cheese containers”? Do you imaginbe that bed bugs know they’re called bed bugs & behave accordingly? Even if one isolates a bed successfully (in which case it would look something like the old-style Boy In A Bubble affairs) that does nothing to shift any population that already be resident in the bed, nor can it prevent BBs not resident in the bed from seeking a blood meal elsewhere in the house.

4 nobugsonme September 23, 2011 at 12:22 pm


I think you’re missing the point. When people can’t rustle up a thousand dollars or more, or when neighboring units go untreated, meaning bed bugs continue to persist and multiply, people are stuck living with bed bugs. you don’t have to have an extreme allergic reaction to suffer.

Self-treatment is more difficult than most people realize (a fact which no doubt accounts for many of the illnesses and partly for the fatality described above). “Talc and cottage cheese containers?” If it was that easy, no one would be suffering.

People can learn to do self treatment safely, using dry vapor steam, and even pesticides. However, it’s not easy and the information on how to do it isn’t easy to find; the problems with foggers, ocerapplying and misapplying dusts, etc. need to be communicated to consumers better.

And Koebner is absolutely right that products like the well-known fogger labeled for bed bugs should be removed from sale, unless it can be proven they work well and do no harm by spreading bed bugs deeper.

5 ravensfan September 23, 2011 at 12:40 pm

I am a longtime reader and participant in your forums. I am disappointed that you would give free publicity to Mr. Winters when it is clear from his essay (satirical in nature as it is) that he does not understand the genuine suffering caused by bed bugs (although, with his book, he seems happy to capitalize on the issue).

6 nobugsonme September 23, 2011 at 12:54 pm

Hi ravensfan,

I can see your point and I was definitely disappointed in Winters’ recent article.

Like Fagerlund’s aricle linked above, the article from Winters appeared on September 14th, five days after my review and the contest were posted. If the Huffington Post piece had been published before I wrote my review of the novel, or arranged the contest, I may perhaps have made different choices.

At this point, having arranged a contest, I can’t cancel it, and I am linking to it again above because I would simply like people to win the copies in question and judge the book for themselves.

Finally, I want to point out that I have alerted Ben Winters to the above post and I hope it may contribute in a small way to his greater understanding of bed bugs.

7 ravensfan September 23, 2011 at 12:57 pm

I understand where you’re coming from, and thank you for your reply.

8 Dan Wylie-Sears September 23, 2011 at 8:06 pm

If you have bed bugs, and you absolutely cannot afford to have a professional get rid of them, which is a better description of what the severity of the situation warrants?

A) Keep the population down as best you can, by stuff like going after them with a flashlight and magnifying glass.

B) Resort to any means necessary, limited only by what you can scrape together the money for.

9 Dan Wylie-Sears September 23, 2011 at 8:32 pm

Ack, I’m posting with my real name. If anyone wants to continue this line of discussion, I’ll be glad to do it on the forum under my familiar user ID.

They’re not so horrible as to justify doing anything unsafe if you can’t afford to get it done right. If you possibly can afford to get rid of them, you should. If you don’t get rid of them, sooner or later you’ll infest someone else, and cost them a ton of money they can’t really afford either. But if you just can’t swing it, stick to safe stuff, even if what you can come up with isn’t very effective.

That much I’m willing to say with my real name.

I’ll also be glad to stand by that opinion “in person” as it were, i.e. posting with the user ID you all know me by. But that’s my final word here, where continuing under my forum identity would just link it publicly to my real name.

10 nobugsonme September 24, 2011 at 2:06 am

Hi Dan,

I guess I am not sure where you’re coming from or whose position you’re engaging with.

Has anything in the post above suggested that I think people should do things which are unsafe in order to eliminate bed bugs? I don’t see anyone else here suggesting that either.

I am simply pointing out that these desperate measures that some people take are evidence of their desperation to get rid of this problem. That does not mean they’re warranted in taking the actions they do, and the post above is quite clear about that.

I don’t think people like Fagerlund or Winters who try to brush off bed bugs as “not a big deal” get it; that doesn’t mean I think anyone should be taking desperate measures, which, again, I think is quite clear from the article above.

By the way, you can actually log in with your normal Forums account on the blog end of the site next time, if you want to. (I understand you don’t want to do that now, however.)

11 chuck007 September 24, 2011 at 9:37 am

Absolutely your best article . My apt was recently treated and I’m estatic with the results proving it can be done . Earlier this week the apt across the hall had to retreated so even though the bugs are still in the building they are not in here , I say that with tongue in cheek

12 Carpathian Peasant September 25, 2011 at 6:35 pm


One small point that may be overlooked here (and elsewhere): what is safe for one person is not necessarily safe for another person.

I think I could survive the insecticide a lot easier than I could survive moving the furniture.

And, some people could survive both, but not time off from work.

13 nobugsonme September 25, 2011 at 7:27 pm

Hi Carpathian Peasant —

Yes, pesticides certainly may be used safely for some, and not for others. We often hear of PMPs who provide different methods to, say, a woman in the 8th month of pregnancy, or someone undergoing cancer treatment.

That we all have different things we can manage, or not (your examples are pesticides, prep, time off from work) is one reason why one can’t generalize about whether bed bugs are a “big deal” or not.

14 evervigilant September 26, 2011 at 1:37 am

Thanks for posting this article…now I just have to get my hubby to read it.

Every time we reach an agreement about how to be safe and avoid bringing bb’s home, my husband gets a lecture from his friends at work – THREE of whom have supposedly had bb’s. They tell him that my actions (i.e., leaving a suitcase on the porch until I can packtite/leaving traveling clothes on the porch when I go in the house, etc.) are unnecessary because all we would have to do to get rid of the bugs is remove our mattress/bedding and buy a new one. After all, that’s all they had to do… :/ It get’s me so irritated sometimes.

Now I worry about him coming home from work with bb’s because the friends are obviously living in la-la land and probably wouldn’t recognize if they had brought them into work. With three people having them, the odds just ain’t looking good.

15 Loneranger September 28, 2011 at 2:47 am

Competent professional treatment does not exist. Pest management folks have not the tools or knowledge to deal with bed bugs, with the exception of thermal treatment. I learned this when my retirement home, (a $30,000 RV fifth wheel) became infested with bed bugs. The first professional was with a “green” pest management company I had used in the past and because of that, I was spared the $800 fee with no guarantee of complete eradication. Instead, I paid $150 for four treatments and no relief. What was most disturbing were the contradictions I heard from the first, the second, the third and fourth “professionals” who followed.

The fight cost me all of my cash and part of a retirement fund. I finally voluntarily
surrendered the RV and lost the diesel pick up that was also infested. I moved to a drier area, but the bugs came with me. Now, I’m 62, I’m broke, no credit, my skin is ruined from bite damage and cleaning constantly.

The worse part, by far, is that my family was so overwhelmed from the beginning, that they choose not to believe that this really happens to people. A quote from me:
“There will be no solution until everyone has bed bugs.”

16 nobugsonme September 28, 2011 at 3:17 am

Hi Loneranger,

I am so sorry you had to deal with bed bugs and such a serious financial burden. Many have had similar experiences. I truly hope your bed bug problems are solved now.

No doubt, there are many PMPs who are not experts on bed bugs and who may provide inadequate or insufficient treatment.

That said, I can assure you there do appear to be many pest management professionals who can competently eliminate bed bugs, with various methods (including but not limited to thermal/heat treatment).

17 lee September 29, 2011 at 2:49 pm

Mrs. Evervigilant, I Like the username by the way. It sounds looked u r doing most of the right things, in addition 2 what your doin now, u can throw all of his clothes in the dryer, and gave him wear cedar oil,.

18 Sam Bryks October 1, 2011 at 2:57 am

When I first saw this report from CDC, I was struck by the actual small number of cases when one considers the thousands of infestations and treatments out there. The one fatality was not due to pesticides per se, but the person had a lot of medical conditions and the insult of the pesticide exposure was likely the tipping point,but not the cause of death.
The other interesting aspect is that most of the cases were from self-application. I agree with the comment about taking bed bugs off the label of these idiotic release “bombs” that are essentially useless for controlling any significant infestation in a home. Sadly, there are still some PMP firms using these useless devices.
It is very tough when a family or a person cannot afford a professional service, and this is not an uncommon situation. The underlying problem I believe is if the home is an apartment, and a building is infested, then it can become an endless battle without prospect if there is not a well managed IPM program in place with proper supports to help people as they need help and help them to help themselves.
People often react to this by getting out the spray.. I saw a case in which a Bed and Bath store is selling pesticides without even having bed bugs on the label, as “the solution” , and just having people waste their time and make things worse. The store is selling a domestic product, but ignorance rules.. untrained, ignorant staff advising people on something they know nothing about…zero!.. And then, not staff fault if the owner/manager has decided to turn a profit without considering if this is helping anyone or making the issue worse.
I wonder what the poisoning stats were when organophosphates and carbamates were widely available to the public..
If anything at this point, we have to be grateful there weren’t more cases, or is this really just the tip of the classic “iceberg” with many unreported incidents.

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