Is Bed Bug Spray Toxic

The common bed bug, Cimex lectularius, is a wingless, reddish-brown insect that requires blood meals from humans, other mammals, or birds to survive (1). Bed bugs are not considered to be disease vectors (2,3), but they can reduce quality of life by causing anxiety, discomfort, and sleeplessness (4). Bed bug populations and infestations are increasing in the United States and internationally (3,5). Bed bug infestations often are treated with insecticides, but insecticide resistance is a problem, and excessive use of insecticides or use of insecticides contrary to label directions can raise the potential for human toxicity. To assess the frequency of illness from insecticides used to control bed bugs, relevant cases from 2003–2010 were sought from the Sentinel Event Notification System for Occupational Risks (SENSOR)-Pesticides program and the New York City Department of Health and Mental Hygiene (NYC DOHMH). Cases were identified in seven states: California, Florida, Michigan, North Carolina, New York, Texas, and Washington. A total of 111 illnesses associated with bed bug–related insecticide use were identified; although 90 (81%) were low severity, one fatality occurred. Pyrethroids, pyrethrins, or both were implicated in 99 (89%) of the cases, including the fatality. The most common factors contributing to illness were excessive insecticide application, failure to wash or change pesticide-treated bedding, and inadequate notification of pesticide application. Although few cases of illnesses associated with insecticides used to control bed bugs have been reported, recommendations to prevent this problem from escalating include educating the public about effective bed bug management.

Is Bed Bug Spray Toxic

To evaluate illnesses associated with insecticides used to control bed bugs, data from 2003–2010 were obtained from states participating in the SENSOR-Pesticides program* and from NYC DOHMH.† Acute illnesses associated with an insecticide used to control bed bugs were defined as two or more acute adverse health effects resulting from exposure to an insecticide used for bed bug control. Cases were categorized as definite, probable, possible, and suspicious based on three criteria: certainty of exposure, reported health effects, and consistency of health effects with known toxicology of the insecticide (causal relationship) (Table 1). Data were analyzed for demographics, health effects, report source, case definition category, illness severity,§ insecticide toxicity,¶ insecticide chemical class, work-relatedness, and factors contributing to illness. A 2010 case report from Cincinnati Children’s Hospital Medical Center (CCHMC) in Ohio also was obtained.**

For 2003–2010, a total of 111 cases were identified in seven states (Table 2). 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 ≥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%) (Table 2). 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%) (Table 3).

The one fatality, which occurred in North Carolina in 2010, involved a woman aged 65 years who had a history of renal failure, myocardial infarction and placement of two coronary stents, type II diabetes, hyperlipidemia, hypertension, and depression. She was taking at least 10 medications at the time of exposure. After she complained to her husband about bed bugs, he applied an insecticide†† to their home interior baseboards, walls, and the area surrounding the bed, and a different insecticide§§ to the mattress and box springs. Neither of these products are registered for use on bed bugs. Nine cans of insecticide fogger¶¶ were released in the home the same day. Approximately 2 days later, insecticides were reapplied to the mattress, box springs, and surrounding areas, and nine cans of another fogger*** were released in the home. On both days the insecticides were applied, the couple left their home for 3–4 hours before reentering. Label instructions on the foggers to air out the treated area for 30 minutes with doors and windows open were not followed on either day. On the day of the second application, the woman applied a bedbug and flea insecticide††† to her arms, sores on her chest, and on her hair before covering it with a plastic cap. She also applied the insecticide to her hair the day before the second application. Two days following the second application, her husband found her nonresponsive. She was taken to the hospital and remained on a ventilator for 9 days until she died.

Another example of insecticide misuse to control bed bugs occurred in Ohio in 2010. An uncertified pesticide applicator applied malathion to an apartment five times over the course of 3 days to treat a bed bug infestation. The malathion product was not registered for indoor use and was applied liberally such that beds and floor coverings were saturated. A family resided in the apartment that consisted of a father, mother, four children, and an adult roommate. One of the children, aged 6 years, attended kindergarten and arrived home around the time of the afternoon malathion applications. The father and roommate also were in the home during the applications. The child began experiencing diarrhea on the first application day, and headache and dizziness began on the second application day. The two adults present during the applications reported nausea, vomiting, headaches, and tremors. During the malathion applications, three younger children were in child care while their mother was at work, and they did not exhibit symptoms of insecticide poisoning. Each night following application of malathion, the children slept on sheets placed on the floor to avoid sleeping on saturated beds.

Because symptoms in the child aged 6 years persisted on the third application day, he was taken to a community hospital emergency department (ED) and decontaminated. Because the hospital did not have pediatrics specialty care, he was transferred to CCHMC by ambulance for evaluation and treatment. His pseudocholinesterase level was within normal limits. He received 1 dose of pralidoxime and was observed in the CCHMC ED before release. The two adults were seen in a community hospital ED, treated, and released. The family did not return to the contaminated residence following the ED visits. The incident was investigated by the Cincinnati fire department and the Ohio Department of Agriculture. The applicator pled guilty to criminal charges, resulting in a fine and probation.

 

 

Is Bed Bug Spray Toxic

Bed bug populations and infestations are increasing in the United States and internationally. Bed bugs have an increased prevalence of insecticide resistance, including resistance to commonly used agents such as pyrethroids.

What is added by this report?

During 2003–2010, seven states reported 111 acute illnesses associated with insecticides used to control bed bugs. The most frequently identified causes of illness were excessive application of insecticides, failure to wash or change pesticide-treated bedding, and inadequate notification of pesticide application.

What are the implications for public health practice?

Inappropriate use of insecticides to control bed bugs can cause harm. Media campaigns to educate the public on nonchemical methods to control bed bugs, methods to prevent bed bug infestation, and the prudent use of effective insecticides, can reduce insecticide-related illness. Making insecticide labels easy to read and understand also might prevent illnesses associated with bed bug control.

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