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APHA Scientific Session and Event Listing

Mary Grace N. Muņoz, MPH¹, Cynthia Bentley Rubio, MHS, RN, BSN², Alicia Dorsey Evangelista, RS, BS³, Cynthia Lipsitz, MD, MPH⁴, David Blythe, MD, MPH¹, and Leslie Edwards, MHS, BSN¹. (1) Epidemiology and Disease Control Program, Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201, 410-767-6700, mmunoz@dhmh.state.md.us, (2) Communicable Disease and Preparedness Program, Frederick County Health Department, 350 Montevue Avenue, Frederick, MD 21702, (3) Environmental Health, Frederick County Health Department, 350 Montevue Avenue, Frederick, MD 21702, (4) Howard County Health Department, 7178 Columbia Gateway Drive, Columbia, MD 21046

Background: Anecdotal reports suggest an increase of bed bug infestations in the United States. This abstract details the lessons learned about the diagnosis and eradication of bed bugs following an outbreak at a church camp. Methods: The investigation included case interviews, skin scrapings, and facility inspections. Cases were defined as having new erythematous pruritic body rash after staying at the implicated camp. Results: Over 12 weeks, rash cases were identified in 5 of 14 (36%) groups that stayed at the camp. Attack rates from affected groups ranged from 33% (10/30) to 100% (10/10). All cases either stayed at or spent extensive time in a single lodge at the camp. No stays overlapped and the minimum gap between the stays of affected groups was 72 hours. Thirteen cases sought medical care; diagnoses included scabies, ringworm, chiggers, dermatitis, and insect bites. Skin scrapings for three cases identified no mites. At least nine cases were treated for scabies. None of the camp staff reported having rashes and they slept in a separate lodge. Environmental inspectors identified bed bugs and eradication efforts included five rounds of pesticide applications with a cost of over $1000. Conclusions: Initially, cases were diagnosed with scabies. Further investigation showed evidence that bed bug bites were the likely cause of all rashes. The findings underscore the need to consider bed bug bites as part of the differential diagnosis of body rashes, especially those associated with short-term lodges, so cases are treated properly and appropriate integrated pest management is implemented.

Learning Objectives:

• List the differential diagnoses of bed bug bites.
• Recognize a bed bug infestation in a dwelling.
• Describe the steps of a bed bug outbreak investigation.

Keywords: Outbreaks, Environmental Health

Presenting author's disclosure statement:

Not Answered