1. Bed Bugs in Schools
Dealing with Special Needs Situations
Rosmarie Kelly, PhD MPH
Public Health Entomologist
GDPH

2. What are bed bugs?
• Bed bugs are small, brownish, flattened insects that feed on the blood of people while
they sleep.
• Bed bugs do not transmit disease, but they can cause significant itchiness, anxiety, and
sleeplessness.

3. What are bed bugs?
• Usually, bed bugs will hide during the day and only come out to feed
during the night.
• Unlike head lice, they usually do not live on a person.
• They can hitchhike from one place to another in backpacks, clothing,
luggage, books, and other items.

5. Bed bugs were once a
common public health pest
worldwide.
•Bedbugs were originally
brought to the United States by
early colonists from Europe.
•Bedbugs thrive in places with
high occupancy, such as hotels.
•Bedbugs were believed to be
altogether eradicated 50 years
ago in the United States and
elsewhere with the widespread
use of DDT.

6. They’re Back!
Bed bugs are once again a The cause of this resurgence is
problem within residences of still uncertain, but most believe it
all kinds, including homes, is related to increased
apartments, hotels, cruise international travel and the use
ships, dormitories and shelters. of new pest-control methods that
do not affect bedbugs.

7. Of the 90 or so species in the
family Cimicidae,
approximately 7 will feed on
human blood, but only 2 are
commonly found: Cimex
lectularius (bed bug) and
Cimex hemipterus (tropical
bed bug).
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8. Habits & Habitats
Bed bugs are active mainly at night; they reach peak activity before
dawn.
During the daytime, they prefer to hide close to where people sleep.
Their flattened bodies enable them to fit into tiny crevices - especially
those associated with mattresses, box springs, bed frames, and
headboards.
Bed bugs do not have nests like ants or bees, but do tend to congregate
in habitual hiding places.
Bed bugs do not fly, but can move quickly over floors, walls, ceilings and
other surfaces.
Bed bugs will travel 5-20 ft. from an established harborage to feed on a
host. Egg-laying females also wander.

9. Bed Bug Facts
Bed bugs respond to warmth and carbon dioxide when searching for a
blood meal.
All nymphal stages and adults of both sexes require blood for nutrition
and development.
Bed bugs ordinarily feed within 24 hours of hatching, once between each
molt and once before egg deposition; an average period of 8 days is
required between molts.
Adult females will continue to take blood meals every 3-4 days depending
on ambient temperature and humidity.
Bed bugs take up to 10 minutes to complete a blood meal, and will
consume 2-5 times their own body weight in blood during that time.

10. More Bed Bug Facts
Individual bed bugs usually do not feed every
night but at intervals of a few days to a
week.
Bed bugs do not remain on the host
between feedings.
Once a bed bug is finished feeding, it quickly
retreats back to its hiding place.
Bed bugs may also feed on small animals,
such as pets.

12. Bed Bug Bites
The bite of a bed bug is painless.
The amount of blood loss due to bed bug feeding typically does
not adversely affect the host.
Bed bugs feed on any bare skin exposed while sleeping (face,
neck, shoulders, arms, hands, etc).
Skin reactions are commonly associated with bed bug bites,
which result from the saliva injected during feeding.
Some individuals do not react to bed bug bites, while others note
a great deal of discomfort often with loss of sleep from the
persistent biting.

13. Reactions to Bites
Common allergic reactions include
the development of large welts
that are accompanied by itching
and inflammation.
The welts usually subside to red
spots but can last for several days.
Blister-like eruptions have been
reported in association with
multiple bed bug bites and
anaphylaxis may occur in patients
with severe allergies.

14. Disease Issues
• Bed bugs require blood in order to reproduce and complete their life cycle.
• There is no evidence that bed bugs are involved in the transmission (via bite
or infected feces) of any disease agent, including hepatitis B virus and HIV,
the virus that causes AIDS.
• However, the CDC & EPA issued a joint statement saying that “Although bed
bugs are not known to transmit disease, they are a pest of significant public
health importance.”
• Frequent feeding can disrupt people's sleep and make them irritable.
• Seeing bites may cause emotional distress in some people.
• Heavy rates of feeding can result in significant blood loss and eventually
lead to anemia, especially in malnourished children.
http://www.cdc.gov/nceh/ehs/publications/bed_bugs_cdc-epa_statement.htm

16. Could my classroom be infested?
• Actual bed bug infestations in non-residential
schools are uncommon.
• More commonly, a few bed bugs will hitchhike
to school from an infested home by hiding in a
student’s clothing or backpack.
• Bed bugs that hitch a ride into the school in one
student’s backpack could be carried home by
another student, making the school a potential
hub for bed bug spread.
• This is not a minor concern – bed bugs are very
expensive and difficult to eradicate.

17. Preparing for a Bed Bug Problem
Suggested Supplies: disposable gloves, trash
bags, plastic tarps, plastic storage bins, and
tape on hand to hold infested items and for
moving infested items (clothing, backpacks,
desks and other equipment)
Designate areas where potentially infested
items can be held temporarily (several days, if
necessary).
Initiate a policy of keeping all “Lost and Found”
clothing, backpacks, etc. in closeable plastic
storage bins (rather than in cardboard boxes)
preferably in a central location.
Establish a list of primary school personnel who
need to be aware of the situation immediately
in order to address the problem and to deal
with questions from parents, staff, and
potentially the news media.

18. What if I find a bed bug on a student?
• If a bed bug is found on a student, it may indicate that the student
has bed bugs at home.
• However, bed bugs can crawl onto or off of a person (or their
belongings) at any time, so it is also possible that the bed bug was
brought to school by someone else.

19. verify that the problem is due to bed bugs
eggs
19

20. nymph

21. female male

22. Not Bed Bugs
Key to Common Pests of Man and Animals
http://ipm.ncsu.edu/AG369/keys.html

23. Try to determine the source
• How many bed bugs were found?
• Were they found associated with one person or more
than one person (e.g., on clothing, backpack/bag,
desk)?
• If more than more person is involved, are those
individuals related or have something in common such
as being classmates, use the same transportation, etc.
• Where were the bed bugs found in the school
(classroom, lockers, office, gym or other facility, or
transportation, etc.)?

24. Conduct a thorough inspection –
questions to ask
• Does the student/teacher switch rooms over the course of the day?
Identify and inspect those rooms as well.
• Does the student participate in after-school activities (athletics,
band, etc.) where they may have taken potentially-infested personal
items with them?
• Where does the person keep their personal belongings during the
day?
• Have any new items been brought into the room/school? (e.g.,
boxes, bags, “lost and found” items, etc.)
• Has the individual (student, staff, etc.) experienced the same
problem at home?
• Have they done any traveling (particularly involving overnight stays
at a hotel or other vacation rental property)?
• Have they had any visitors stay at their home recently?

25. If you suspect a student has bed bug
• The student should be discreetly
removed from the classroom.
• If a confirmed bed bug was found on
a student, then the school principal or
nurse should contact the student’s
parents or guardian.
• Educational materials should be
provided to the family.
• The school should consider notifying
families of the affected class or
classes.

26. If a bed bug infestation is suspected or a
number of students are getting bitten during
class, the school should contact a licensed pest
management professional for assistance.

27. What can I do to eliminate bed bugs
from my classroom?
• Work with licensed pest control - DO
NOT allow untrained staff to apply
pesticides on school property.
• Backpacks, lunch boxes, and other
items that travel back and forth to
school can also be inspected daily and
sealed in plastic containers to prevent
bed bugs from getting into them at
home.
• Hard surfaces can be cleaned with
standard cleaning products.

28. Control of Washables
Washing clothes at 60°C (140°F) is effective against all life
stages.
Tumble drying in a hot (>40°C; 104°F) dryer for 30 minutes or
freezing at –17°C (1.4°F) for 2 hours will also kill bed bugs.
Adults and nymphs can be drowned by soaking laundry, but this
will not kill the eggs.
NOTE: It takes about 8 hours to disinfest 5 lbs of laundry by
putting it in a freezer at –18°C (0.4°F).

29. Temperature Extremes -
Steam Heat
Bed bugs are very sensitive to heat, and a combination of steam
cleaning and insecticide use has been found to be more effective
for long-term control than insecticides alone.
The steam emission tip must usually be about 2.5-3.8 cm from
the surface being steamed.
If the tip is too far away, the steam may not be hot enough to kill
all the bed bugs and eggs that it contacts.
If the tip is too close, excess moisture may be injected into the
treated material, which may lead to other problems

30. Temperature Extremes -
“Dry” Heat
For heat treatment to be effective, it is critical that high temperature
and low relative humidity be attained for a minimum length of time
(49-52oC [120-125oF] and 20-30% relative humidity for 20-30
minutes).
Heat treatment provides no residual effect, and bed bugs can re-
occupy any site so treated immediately after temperatures return to
suitable levels.
Laundering infested linens or cloth items in hot water with detergent,
followed by at least 20 minutes in a clothes dryer on high heat,
should kill all life stages of bed bugs but would not prevent their
reinfestation.

31. Temperature Extremes - Cold
Exposure to low temperatures can kill bed bugs if they are kept
cold enough long enough.
Bed bugs can tolerate -15oC (5oF) for short periods and, if
acclimated, they can survive at or below 0oC (32oF) continuously
for several days.
Freezing furniture or other items within containers or chambers
[e.g., below 0oF (-19oC) for at least four days] may be a practical
alternative for limited infestations or to augment other control
measures.
A new commercial technology uses CO2 from cylinders deposited
as a “snow” to kill bed bugs and a variety of pests by rapid
freezing.

32. Pesticides - THE LABEL IS THE LAW
With the exception of dry heat, non-chemical products and techniques are
incapable of efficiently or quickly controlling or eliminating established
bed bug populations.
Precise placement of a suitably labeled, registered and formulated
chemical insecticide is still the most practically effective bed bug control.
The choice of chemical products and specific application techniques can
depend on many factors, including the physical location and structural
details of the bugs’ harborages, the product’s labels (which can vary by
political jurisdiction), the immediate environment, and local or national
laws.

33. Pesticides Available for Bed Bug Control
This list is changing fairly rapidly as more products are relabeled for use
in bed bug control.
• Residual Applications
• Crack-and-Crevice Applications
• Dusts
• IGRs
• Fumigation
• ULVs, Aerosols, & Foggers
http://cfpub.epa.gov/oppref/bedbug/
http://www.techletter.com/Archive/Technical%20Articles/bedbuginsecticides.html

34. The use of “bug bombs” or total release foggers is
NOT advised.
These devices release insecticide in small droplets that
land on exposed surfaces and do not penetrate the
cracks and crevices where bed bugs hide.
This results in increased pesticide exposure to the
resident and poor control of these pests.
This has been linked to pesticide resistance and
suspected repellency to bed bugs, causing them to
spread.

35. Control Update
• The resurgence of common
bedbugs is partly due to their
increase resistance to
insecticides — like many other
nuisance species, they’ve
evolved to develop an immunity
to the toxins.
• A team of researchers at the
University of Pennsylvania say
they may have discovered the
key to effective biocontrol of the
nuisance bugs — a natural
fungus that causes disease in
insects.

36. Control Update
• As anyone who has ever had bed bugs can attest, the tiny,
blood-sucking parasites are a big pain to get rid of. But a new
study suggests there might soon be a new weapon in the fight
against the household pests.
• Stromectol, a Merck brand of the drug ivermectin, which is
already used to fight worm parasite diseases, such as river
blindness and elephantitis, killed three out of five bed bugs in a
study presented at the annual meeting of the American Society
of Tropical Medicine and Hygiene on Nov. 12, Bloomberg News
reports.
• The bugs fed on ivermectin-laced blood and began to get sick
and die within three hours.

37. Special Situations
• Transportation
• Wheelchairs
• Therapy equipment

38. Buses and Other Transportation
• When buses (or other transportation services) are involved, ask the
student where he/she sat on the school bus that morning.
• The school transportation coordinator should contact the operator
to bring the bus immediately to the school or maintenance facility
for inspection.
• Check if the bus was used subsequent to dropping off the students.
• If the problem is noticed late in the day, the seat occupied by the
student and those in adjacent rows, should be inspected before
allowing students to board the bus.
• Do not allow students/staff to use potentially infested items.
• Parents should be encouraged to inspect the contents and contact
their child’s school if they have questions or concerns.

39. Wheelchairs
• While transporting a client from a bed bug infested home, take
measures to protect the car used.
– Use large garbage bags to contain the client’s personal items
and to line the car seats.
– If the client has a wheelchair that must be transported, use
large garbage bags or a small tarp to cover the wheelchair.
– If the infestation is high, ask the client to wear coveralls while
traveling in the car.
• After the client and the client’s belongings have been transported:
– Vacuum the car.
– Wipe down the seat belts and seat seams with wet wipes to
remove any bed bugs.

40. Steam Cleaning a Wheelchair
• http://youtu.be/Mh3WydbqDDE
Using hot steam is an effective and safe method
to get rid of bed bugs on a wheel chair.

41. What if one of my students has an
infestation at home?
• When a student is dealing with an infestation
at home, it is important to be sensitive to
their problem.
• Although bed bugs have nothing to do with
cleanliness or socioeconomic status, there is
still a stigma that can come with having bed
bugs.
• As a result, parents may be hesitant to admit
to having bed bugs, and students may not
want others to know they have an infestation
at home.
• Students living in an infested home may also
feel anxious or tired during the school day.

42. What if one of my students
has an infestation at home?
• Determine if the infested home is being treated.
• In an infested home, parents should store their child’s freshly laundered
clothing in sealed plastic bags until they are put on in the morning.
• Backpacks, lunch boxes, and other items that travel back and forth to school
can also be inspected daily and stored in sealed plastic containers at home to
prevent bed bugs from getting into them.
• At school, the student could be provided with plastic bags or bins in which to
store their belongings in order to prevent any bed bugs from spreading to
other students’ belongings.
• Continue to use these measures until successful treatment of the home has
been verified.

43. Bed Bugs and Book Bags
The University of Florida teamed up with the
Jacksonville Bed Bug Task Force to create the “Bed Bugs
and Book Bags” curriculum for grades 3-5 (the kids that
seem to bring the most bed bugs to school).
The "Bed Bugs and Book Bags" curriculum follows
learning standards for science and health educators, but
many housing authorities have on-site after school
programs that could use the activities. Any organization
that works with kids should know about these lessons.
Check out the curriculum at
http://entnemdept.ufl.edu/bug_club/Bed_bugs.html.

44. Resources
• http://www.michigan.gov/documents/emergingdiseases/Bed_bugs_schools_293498_7.pdf
• http://www.vdacs.virginia.gov/pesticides/pdffiles/bb-schools1.pdf
• http://www.afpmb.org/pubs/tims/TG44/TG44.pdf
• http://ento.psu.edu/extension/bedbugs
• http://schoolipm.ncsu.edu/documents/Bed%20Bug%20Protocol.pdf
• http://www.cdc.gov/nceh/ehs/Topics/bedbugs.htm
• http://www.ca.uky.edu/entomology/entfacts/ef636.asp
• http://www.mayoclinic.com/health/bedbugs/DS00663
• http://www.nysipm.cornell.edu/publications/bed_bugs/files/bed_bug.pdf
• http://centralohiobedbugs.org/school.html
• http://www.idph.state.il.us/envhealth/BedBugs_Schools_DayCareCenters.pdf
• http://schoolipm.ifas.ufl.edu/Florida/bedbugpests.htm
• http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/bedbugs/documents/bed-
bugs.pdf

45. Any Questions?
Rosmarie Kelly, PhD MPH
2 Peachtree St NW
Atlanta
Office: 404-657-2912
Cell: 404-408-1207
rmkelly@dhr.state.ga.us
http://health.state.ga.us/epi/zvbd/infest/index.asp
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