Editing Bed bug (section)

==Infestation==
Infestation is rarely caused by a lack of [[hygiene]].<ref name=Hild2009/> Transfer to new places is usually in the personal items of the human they feed upon.<ref name=JAMA2009/> Dwellings can become infested with bed bugs in a variety of ways, such as:
* Bugs and eggs inadvertently brought in from other infested dwellings on a visiting person's clothing or luggage;
* Infested items (such as furniture especially beds or couches, clothing, or backpacks) brought into a home or business;
* Proximity of infested dwellings or items, if easy routes are available for travel, e.g. through ducts or false ceilings;
* Wild animals (such as bats or birds)<ref name="UKY">{{cite web |publisher = University of Kentucky College of Agriculture |title = BED BUGS |last1 = Potter | first1 = Michael F. |url = http://www.ca.uky.edu/entomology/entfacts/ef636.asp |access-date = 27 June 2010 | archive-url= https://web.archive.org/web/20100702114716/http://www.ca.uky.edu/entomology/entfacts/ef636.asp| archive-date= 2 July 2010 | url-status=live}}</ref><ref name="avianadvice.uark.edu">Steelman, C.D. 2000. [http://www.avianadvice.uark.edu/AA%20PDFs/avian_advice2no2.pdf Biology and control of bed bugs] [https://web.archive.org/web/20111005011925/http://www.avianadvice.uark.edu/AA%20PDFs/avian_advice2no2.pdf Archive], ''Cimex lectularius'', in poultry houses. Avian Advice 2: 10,15.</ref> that may also harbour bed bugs or related species such as the [[bat bug]];
* People visiting an infested area (e.g. dwelling, means of transport, entertainment venue, or lodging) and carrying the bugs to another area on their clothing, luggage, or bodies. Bedbugs are increasingly found in air travel.<ref>{{cite web|url=https://www.forbes.com/sites/melaniehaiken/2011/11/21/bed-bugs-on-airplanes-how-to-fly-bed-bug-free/|title=Bed Bugs on Airplanes?! Yikes! How to Fly Bed Bug-Free|first=Melanie|last=Haiken|website=Forbes|access-date=21 May 2020|archive-date=11 April 2019|archive-url=https://web.archive.org/web/20190411215037/https://www.forbes.com/sites/melaniehaiken/2011/11/21/bed-bugs-on-airplanes-how-to-fly-bed-bug-free/|url-status=live}}</ref>

Though bed bugs will opportunistically feed on pets, they do not live or travel on the skin of their hosts, and pets are not believed to be a factor in their spread.<ref name="PAWS SF">{{cite web|publisher=PAWS SF |title=The Truth About Bedbugs: Debunking the Myths |url=http://www.pawssf.org/document.doc?id=16 |access-date=13 October 2013 |url-status=dead |archive-url=https://web.archive.org/web/20131014175351/http://www.pawssf.org/document.doc?id=16 |archive-date=14 October 2013 }}</ref>

===Detection===
Knowing that symptoms are caused by bedbug bites rather than other causes requires seeking and finding the insect in the sleeping environment, as symptoms are not [[Sensitivity and specificity|specific]] to bedbug bites.<ref name=GP2009/> Bites by other arthropods cause similar symptoms, even the linear pattern of bites known colloquially as "breakfast, lunch and dinner bites".<ref name="Parola" />

Bed bugs can occur singly, but tend to congregate once established. Although strictly parasitic, they spend only a tiny fraction of their lives physically attached to hosts. Once a bed bug finishes feeding, it follows a chemical trail to return to a nearby harborage, commonly in or near beds or couches, where they live in clusters of adults, juveniles, and eggs. These places may include luggage, vehicle interiors, furniture, bedside clutter—even inside electrical sockets or laptop computers. Bed bugs may also lodge near animals that have nested within a dwelling, such as bats, birds,<ref name=avianadvice.uark.edu/> or [[rodent]]s. They can also survive by feeding on domestic cats and dogs, though humans are the preferred host of ''C.&nbsp;lectularius''.<ref name=WoodwardQuinn2011>{{cite book |author1 = Susan L. Woodward |author2 = Joyce A. Quinn |title = Encyclopedia of Invasive Species: From Africanized Honey Bees to Zebra Mussels: From Africanized Honey Bees to Zebra Mussels |url = https://books.google.com/books?id=KOGfKRZ0YFIC&pg=PA124 |access-date = 15 August 2013 |date = 30 September 2011 |publisher = ABC-CLIO |isbn = 978-0-313-38221-5 |page = 124 |archive-date = 14 January 2023 |archive-url = https://web.archive.org/web/20230114141615/https://books.google.com/books?id=KOGfKRZ0YFIC&pg=PA124 |url-status = live }}</ref>

A severe bedbug infestation can be detected by their characteristic pungent sweet smell, which has been described as like rotting [[raspberry|raspberries]].<ref>{{cite journal |last = Anderson |first = AL |author2 = Leffler, K |title = Bedbug infestations in the news: a picture of an emerging public health problem in the United States |journal = Journal of Environmental Health |date = May 2008 |volume = 70 |issue = 9 |pages = 24–7, 52–3 |pmid = 18517150 |url = https://www.neha-ecommerce.org/imispublic/members/pdf/JEH/archive/2008/4.May.08/JEH5.08_Feature_Bedbugs.pdf |url-status=usurped |archive-url = https://web.archive.org/web/20120426075229/https://www.neha-ecommerce.org/imispublic/members/pdf/JEH/archive/2008/4.May.08/JEH5.08_Feature_Bedbugs.pdf |archive-date = 26 April 2012 |df = dmy-all }}</ref> [[Bed bug detection dogs]] are trained to pinpoint infestations, with a possible accuracy rate between 11% and 83%.<ref name=Dog2012 /><ref name=Ib2017/>

Homemade detectors have been developed.<ref>{{cite web |url = http://abc7ny.com/archive/7212643/ |title = 7 On Your Side: Get rid of bed bugs for less than $15 |access-date = 1 December 2016 |archive-date = 2 December 2016 |archive-url = https://web.archive.org/web/20161202165313/http://abc7ny.com/archive/7212643/ |url-status = live }}</ref><ref>{{cite web |url = https://njaes.rutgers.edu/pubs/fs1117/ |title = Detecting Bed Bugs Using Bed Bug Monitors (from Rutgers NJAES) |access-date = 1 December 2016 |archive-date = 2 December 2016 |archive-url = https://web.archive.org/web/20161202040225/https://njaes.rutgers.edu/pubs/fs1117/ |url-status = live }}</ref> Bedbug detectors, often referred to as "monitors", "traps" or "interceptors",<ref>{{cite web |author=[[US EPA OCSPP]] |date=2013-03-07 |title=Do-it-yourself Bed Bug Control |url=https://www.epa.gov/bedbugs/do-it-yourself-bed-bug-control |access-date=2022-10-01 |website=[[US EPA OCSPP]] |language=en}}</ref> use the  lactic acid or carbon dioxide associated with the presence of a human body, or [[pheromone]]s, to attract and trap bugs in a container. Bedbug detectors can confirm an infestation, but do not trap enough for eradication.<ref name="Parola">{{cite journal |last1=Parola |first1=Philippe |last2=Izri |first2=Arezki |title=Bedbugs |journal=New England Journal of Medicine |date=4 June 2020 |volume=382 |issue=23 |pages=2230–2237 |doi=10.1056/NEJMcp1905840|pmid=32492304 |s2cid=219315855 }}</ref>
<gallery>
File:Bedbugs1.jpg|Eggs and two adults found inside a dresser
File:BedBugFeces.jpg|Fecal spot
File:Bed Bug On Carpet.jpg|Bed bug on carpet
</gallery>

====Differential detection====
Other conditions which produce symptoms similar to bedbug bites include [[scabies]], [[gamasoidosis]], [[allergic reactions]], [[mosquito bites]], [[spider bite]]s, flea bites ([[pulicosis]]), [[chicken pox]], and bacterial skin infections.<ref name=GP2009/>

===Prevention===
To prevent bringing home bed bugs from outside the home, people are advised to take precautions after visiting an infested site or traveling on means of transport that may be infested; precautions  include checking shoes on leaving the site, changing clothes outside the house before entering, and putting the used clothes in a [[clothes dryer]] outside the house. When visiting a new lodging, it is advised to check the bed before taking suitcases into the sleeping area, and putting the suitcase on a raised stand to make bedbugs less likely to crawl in. Clothes should be hung up or left in the suitcase rather than left on the floor.<ref name=sciam12>{{cite web|url=https://www.scientificamerican.com/article/bed-bug-expert-explains-defend-yourself/|title=Bed Bug Confidential: An Expert Explains How to Defend against the Dreaded Pests|newspaper=Scientific American|date=23 January 2012|author=Kate Wong|access-date=19 August 2018|archive-date=19 August 2018|archive-url=https://web.archive.org/web/20180819182133/https://www.scientificamerican.com/article/bed-bug-expert-explains-defend-yourself/|url-status=live}}</ref> Additional preventative measures include sealing cracks and crevices (where bed bugs often hide), inspecting furniture, and decontaminating clothes and luggage upon returning home.<ref name="Parola" /> The founder of a company dedicated to bedbug extermination said that 5% of hotel rooms he booked into were infested. He advised people never to sit down on public transport; check office chairs, plane seats, and hotel mattresses; and monitor and vacuum home beds once a month.<ref name=obs18au18>{{cite news |url=https://www.theguardian.com/uk-news/2018/aug/19/bedbugs-heatwave-sparks-plage-pest-infestation |title=Bedbugs plague hits British cities |newspaper=The Observer |date=19 August 2018 |access-date=19 August 2018 |last1=Sherwood |first1=Harriet |archive-date=23 April 2019 |archive-url=https://web.archive.org/web/20190423045138/https://www.theguardian.com/uk-news/2018/aug/19/bedbugs-heatwave-sparks-plage-pest-infestation |url-status=live }}</ref> Close all wall openings or gaps; bed bugs tend to hide in dark places such as cracks in walls. Second-hand furnishings may harbour bedbugs.

===Management===
{{Main|Bed bug control techniques}}
Avoiding repeated bites can be difficult since it usually requires [[Bed bug control techniques|eradicating bed bugs]] from a home or workplace; eradication is most effective using non-chemical control methods.<ref name="Parola" /> Non-chemical control methods include vacuuming carpet and furniture (often with scraping) into a disposable bag which is then sealed into a plastic bag to prevent re-infestation.<ref name="Parola" /> Other methods include removing textile materials from an area and washing them in hot water (at least 60 degrees Celsius) or freezing them at {{convert|-20|C|F}}.<ref name="Parola" /> Most consumer-grade freezers are inadequate to kill bedbugs because they cannot create sufficiently low temperatures.<ref name="Parola" /> Unremovable textiles such as mattresses can be steamed to at least {{convert|60|C|F}} and this method can penetrate deep into the textile to effectively kill bed bugs in, potentially, under one minute.<ref name="Parola" /> Heating tents or chambers can be used for infested materials or entire rooms can be heated to at least {{convert|55|C|F}} to effectively eradicate infestation.<ref name="Parola" />

There is no evidence to indicate that a combination of non-chemical methods plus insecticides is more effective than non-chemical methods alone with regards to eradication of bed bug infestations.<ref name="Parola" />

Insecticides are mostly ineffective for the eradication of bedbug infestations as most bedbugs are resistant to insecticides, including pyrethroids which are found in approximately 90% of commercial grade insecticides.<ref name="Parola" /> Furthermore, insect foggers (known as "bug bombs") are ineffective in the eradication of bed bug infestation as they are unable to penetrate bed bug harborages.<ref name="Parola" /> Resistance to pesticides has increased significantly over time, and there are concerns about [[Health effects of pesticides|harm to health]] from their use.<ref name=JAMA2009/>

Once established, bed bugs are extremely difficult to get rid of,<ref name=JAMA2009/> particularly  in buildings with multiple dwellings, as they may be present in other parts of the building than the dwelling being treated,<ref name="Parola" /> and can re-establish populations by moving from infested to decontaminated areas.

<!--Mechanical -->
Mechanical approaches, such as vacuuming up the insects and heat-treating or wrapping mattresses, are effective.<ref name=JAMA2009 /><ref name=Dog2012/> An hour at a temperature of {{convert|45|C|F}} or over, or two hours at less than {{convert|-17|C|F}} kills them.<ref name=Dog2012 /> This may include a domestic [[clothes drier]] for fabric or a commercial steamer. Bed bugs and their eggs will die on contact when exposed to surface temperatures above {{convert|180|F|C}} and a steamer can reach well above {{convert|230|F|C}}.<ref name=birc.org>{{cite journal|last=Quarles|first=William|date=March 2007|title=Bed Bugs Bounce Back|journal=IPM Practitioner|volume=24|issue=3/4|pages=1–8|url=http://www.birc.org/MarApril2007.pdf|access-date=27 May 2010|archive-date=11 November 2013|archive-url=https://web.archive.org/web/20131111193218/http://www.birc.org/MarApril2007.pdf|url-status=live}}</ref><ref>{{cite web| url=https://www.bedbugs.umn.edu/bed-bug-control-in-residences/steamers| title=Using Steamers to Control Bed Bugs| date=22 June 2016| access-date=4 March 2018| archive-date=26 July 2020| archive-url=https://web.archive.org/web/20200726165853/https://www.bedbugs.umn.edu/bed-bug-control-in-residences/steamers| url-status=live}}</ref> A study found 100% mortality rates for bed bugs exposed to temperatures greater than {{convert|50|C|F}} for more than 2 minutes. The study recommended maintaining temperatures of above {{convert|48|C|F}} for more than 20 min to effectively kill all life stages of bed bugs, and because in practice treatment times of 6 to 8 hours are used to account for cracks and indoor clutter.<ref name=PropaneStudy>{{cite report |last=Hulasare |first=Raj |title=Fundamental Research on the Efficacy of Heat on Bed Bugs and Heat Transfer in Mattresses|date=September 2007 – April 2009 |id=PERC docket 12221}}</ref> This method is expensive and has caused fires.<ref name=Dog2012/><ref name=birc.org/> Starving bedbugs is not effective, as they can survive without eating for 135 to 300 days, depending on temperature.<ref name=Dog2012 /><ref name="Parola" />

<!--Insecticides -->
After the withdrawal of most [[Insecticide#Organochlorides|organochlorine insecticides]], {{As of|2012|alt=it was stated in 2012}} that no truly effective insecticides were available.<ref name=Dog2012/><!-- Quote = "widespread insecticide resistance, the current lack of effective insecticidal products" --> Insecticides that have historically been found effective include [[pyrethroid]]s, [[dichlorvos]], and [[malathion]].<ref name=Kolb2009 /> Resistance to pesticides has increased significantly in recent decades.<ref name=JAMA2009 /> The [[carbamate]] insecticide [[propoxur]] is highly toxic to bed bugs, but it has potential toxicity to children exposed to it, and the [[US Environmental Protection Agency]] has been reluctant to approve it for indoor use.<ref>[https://www.nytimes.com/2010/09/05/opinion/05sun3.html "In Search of a Bedbug Solution"] {{Webarchive|url=https://web.archive.org/web/20210309063958/http://www.nytimes.com/2010/09/05/opinion/05sun3.html |date=9 March 2021 }}. ''The New York Times''. (4 September 2010).</ref> [[Boric acid]], sometimes applied as a safe indoor insecticide against pests such as [[Blattoidea|cockroaches and termites]], is not effective against bed bugs<ref>{{cite web |url=https://lancaster.unl.edu/pest/resources/341BBSteps.pdf |title=Got Bed Bugs? Don't Panic! |access-date= 27 August 2018}}</ref> because they do not groom.<ref name=miller>{{cite book|editor=John L. Capinera|last = Miller |first = Dini|title=Encyclopedia of Entomology|chapter = Bed bugs (hemiptera: cimicidae: ''Cimex'' spp.)|chapter-url=https://books.google.com/books?id=i9ITMiiohVQC&pg=PA414|date=11 August 2008|publisher=Springer Science & Business Media|isbn=978-1-4020-6242-1|page=414}}</ref>