Legislative Advocacy Session Amy Ost and Tolu Onigbanjo A “Dr. O” Presentation

1. Bed Bugs Legislative Advocacy Session Amy Ost and Tolu Onigbanjo A “Dr. O” Presentation

2. Outline • Background • Scope of the Problem • Legislation in Motion • New York City’s Action Plan • Resources for Residents

3. Background

4. Background • Beg Bugs (Cimex lectularius) • Wingless, obligate ectoparasites • Feeds on bats, birds, mammals • After blood meal, increase in length by 30%-50% and in weight 150%-200% • Seeks warmth, which helps locate warm-blooded hosts • Hides during the day, and feeds at night

5. Life Cycle

6. Where to Hide? Mattresses Crevices in box springs Backsides of Headboards Clothing Loose wallpaper Behind hanging pictures Migrating from one apartment to another through holes in walls, water pipes or gutters

7. Clinical Manifestations • Common Reactions • 2 to 5 mm pruritic maculopapular, erythematous lesions at feeding sites. • Complex Reactions: Local urticaria, or bullous rash • Resolves within a week • Treatment of Bite Reactions • Antipruritic Agents • Intermediate potency Corticosteriods--Triamcinolone • Topical Mupirocin

8. Beg Bugs as Vectors of Human Disease • Transmission of more than 40 human diseases has been attributed to bed bugs, but there is little evidence of such transmission • HIV • Detected in bed bugs up to 8 days after ingestion • No viral replication • No virus in bed bugs feces • HBV • Hepatitis B surface antigen persist for up to 7 weeks • No viral replication • Seen in beg bugs feces for up to 6 weeks • No effects of a 2-year eradication project in Gambia on the rates of HBV infection despite 100% reduction of bed bug numbers

9. Beg Bugs as Vectors of Distress • Significant health effects including onset of • Stress • Anxiety • Depression • Fatigue • Unable to receive home healthcare services if concerned about an infestation

10. How to Get Rid of Bed Bugs! • Don’t throw away mattresses—vacuum and seal. • Wash all clothing, linens, and bedding in hot water • Vacuum the house to remove bugs and eggs from carpet, and walls • Repair cracks in plaster, and glue down loosened wallpaper • Apply insecticides to cracks but not in your sleeping area. Repeat in 2 weeks • Enlist the services of a professional pest control firm

11. \\\Scope of the Problemdd

12. Scope of the Problem

13. Scope of the Problem • Bed bug complaints and violations have risen dramatically • Homes • Apartments • Hotel rooms • Hospitals • Dormitories • Retail Stores • Resurgence of Beg Bugs • International travel • Immigration • Change in pest control practices • Insecticide Resistance

14. Scope of the Problem • Bed Bugs are historically a problem… • Early 1900s prior to central heating they used to die in the winter • Success against the bed bug battle came with DDT and subsequent pesticides • Related to changes in cockroach management • New bedbugs were likely introduced from overseas • Resistance pattern in insecticides is now commonly being seen with cities

15. Scope of the Problem • Bed bug infestations in NYC are reported to be increasing: • Complaints rose from 537 in 2004 to 10,985 in 2009 • Violations rose from 82 in 2004 to 4,084 in 2009 • 426 confirmed cases of bed bugs reported 243 different New York City public schools in 2009 (twice as many as preceding year) • 311 received 33,772 bed bug-related inquiries (increase of 54% from previous year)

16. Scope of the Problem • Related to several factors: • Lack of public awareness and knowledge • Density of Multi-unit living spaces • Inadequate access (and difficult to afford) to quality pest control services and resources for bed bug treatment • Limitation of the materials and methods • Lack of efficient procedures to resolve landlord/tenant disputes in an equitable way

17. New York City’s Action Plan

18. New York City’s Action Plan 2009 • New York City adopts Local Law 14 • Created a “Bed Bug Advisory Board” • Convened to issue a report to the Mayor and City Council • First convened in September 2009 and spent 7 months gathering information

19. Recommendations for the Management of Bed Bugs in New York City • April 2010, Published a Three-Part Report • I: Education, Awareness and Early Detection • II: Treatment and Remediation • III: Monitoring and Policy

20. Part I: Education, Awareness and Early Detection • Take a proactive approach to public education and awareness • Provide bed bug training to stakeholders • Launch and maintain an online “Bed Bug Portal” devoted to bed bug facts and resources

21. Part I: Education, Awareness and Early Detection http://www.nyc.gov/html/doh/html/vector/vector-faq1.shtml

22. Part I: Education, Awareness and Early Detection http://www.nyc.gov/html/hpd/html/courses/courses.shtml.

23. Part I: Education, Awareness and Early Detection • Take a proactive approach to public education and awareness • Provide bed bug training to stakeholders • Launch and maintain an online “Bed Bug Portal” devoted to bed bug facts and resources

24. Part II: Treatment and Remediation • Establish protocols for proper disposal of infested items • Develop suggested minimum pest management practices • Create guidelines for the donation of used and second-hand items • Develop triage approach for immediate response • Offer guidelines for self-remediation

25. Part III: Monitoring and Policy • Assemble a Bed Bug Team, headed by a qualified entomologist (or equivalent professional) and support staff, to coordinate city-wide bed bugs efforts in conjunction with a Bed Bug Working Group • Develop integrated monitoring, tracking and reporting tools • Improve Department of Housing Preservation and Development (HPD) bed bug infestation inspection protocols and code enforcement capacity • Increase the capability of New York City Housing (NYCHA) to take a proactive stance in preventing and addressing bed bug infestations

26. Part III: Monitoring and Policy • Evaluate current housing court procedures as they relate to both landlords and tenants and look for methods to compel compliance and access to ensure effective bed bug management • Utilize Article 151 of New York City Health Code to help overcome obstacles associated with bed bug management in buildings with widespread infestation • Require landlords to provide written bed bug information to tenants upon lease signing and renewal • Disseminate consumer warnings about bed bug risks from used furniture and mattresses • Encourage small business and social enterprise start-ups to provide bed bug preparation services to low and moderate-income households

27. New York City’s Action Plan: 2010

28. New York City’s Action Plan: 2010 • Deputy Mayor Gibbs and Speaker Quinn announce funding of $500,000 for Web-Based Bed Bug Portal and other initiatives • Implemented by the Department of Health and Mental Hygiene

29. New York City’s Action Plan: 2010 Goals of the City: • To identify the scope of the New York City Bed Bug Epidemic • To effectively disseminate information about proper identification and handling • To assist in the coordination of an effective response to bed bugs • To deter the adverse health and well-being effects that develop among those with bed bug infestation

30. Who’s on the Committee? • Entomologist • Advocates • Representatives from numerous city agencies

31. Who else is helping out?

32. New York City’s Action Plan: 2010 Branches of New York City Government must work together. • Department of Health and Mental Hygiene (DOHMH) • Housing Prevention and Development (HPD) • New York City Housing Authority (NYCHA) • Environmental Health Tracking Network/Portal

33. New York City’s Action Plan: 2010 Fall/Winter 2010 • Department of State Division of Licensing Services issued new bedding regulations • Bed Bug Disclosure Act

34. Action Plan Across the Country: 2010 • Bed Bug Summit in Washington DC (February 2011) • Environmental Protection Agency • Center for Disease Control • Federal Bed Bug Groups

35. The Bedbug Registry

36. There’s an app for that!

37. Reference • Goddard, J. and DeShazo, R. Bed Bugs (Cimex lectularius) and Clinical Consequences of their Bites. JAMA 2009; 301 (13): 1358-1366 • Potter, M. et al. Bugs without Boards-Executive Summary: Defining the Global Bed Bug Resurgence • Recommendations for the Management of Bed Bugs in New York City. New York City Bed Bug Advisory Board. Report to the Mayor and City Council. April 2010. • Stop Bed Bugs in Hotels Safely. The New York City Department of Health and Mental Hygiene. http://www.nyc.gov/html/doh/downloads/pdf/vector/bed-bug-hotel-eng.pdf • Preventing and Getting Rid of Bed Bugs Safely. http://www.nyc.gov/html/doh/downloads/pdf/vector/bed-bug-guide.pdf • Brody, Jane. Keeping Those Bed Bugs from Biting. 2009. http://www.nytimes.com/2009/04/14/health/14brod.html

38. THE END: DON’T LET THE BED BUGS BITE