Bed bugs and public health: new approaches for an old scourge.

OBJECTIVE To share four Canadian cities' experiences with bed bug infestations and to explore public health roles in managing them. METHODS We summarize presentations from a workshop at the 2010 Canadian Public Health Association Conference which examined the re-emergence of bed bugs in Canada and compared management approaches of municipal and public health authorities in four large Canadian cities. We include updates on their activities since the workshop. RESULTS Cities across Canada have observed an increase in complaints of bed bug infestations over recent years. Toronto Public Health considers bed bugs to be a threat to health and has been heavily involved in the front-line response to bed bug complaints. In Winnipeg, Montreal and Vancouver, city inspectors are responsible for investigating complaints, and public health plays a supporting or secondary role. We identified factors that may contribute to successful management of bed bugs: sufficient funding, partnerships among many stakeholders, training and education, and surveillance and evaluation. CONCLUSION Various public health agencies in Canadian cities have played key roles in the fight against bed bugs through new initiatives, education, and encouragement and support for others. By working with the public, owners, tenants, the health sector and other stakeholders, public health practitioners can begin to curb the resurgence of bed bugs and the social strains associated with them.