                      Draft Federal Strategy on Bed Bugs
September 2013
                                       
Prepared by
The Federal Bed Bug Workgroup

Table of Contents

Introduction	1
The Federal Bed Bug Workgroup	1
Goals for the Strategy	1
Organization of Document	1
Background	2
Nature of the Problem	2
Federal Involvement and the Strategy	2
Key Elements of Successful Bed Bug Management	3
Priority Area I: Prevention	4
Defining the Problem	4
Recommended Actions	4
Measuring Progress	6
Priority Area II: Surveillance and IPM for Bed Bugs	6
Defining the Problem	6
Recommended Actions	7
Measuring Progress	8
Priority Area III: Community Efforts	9
Defining the Problem	9
Recommended Actions	9
Measuring Progress	10
Priority Area IV: Education and Communication	10
Defining the Problem	10
Recommended Actions	11
Measuring Progress	11
Priority Area V: Research	12
Defining the Problem	12
Recommended Actions	13
Measuring Progress	14
Conclusions	15
Appendix: Mission Statements for Participating Federal Agencies	16

Introduction
The Federal Bed Bug Workgroup
The Federal Strategy on Bed Bugs (the strategy) reflects a broad-based consensus of several federal agencies that make up the Federal Bed Bug Workgroup (the workgroup). A recommendation from the first National Bed Bug Summit led five federal agencies to establish the workgroup in August of 2009. The current workgroup comprises representatives from the Centers for Disease Control and Prevention (CDC), the Department of Defense (DoD), the Environmental Protection Agency (EPA), the Department of Housing and Urban Development (HUD), and the U.S. Department of Agriculture (USDA). The workgroup is a cooperative effort; no single federal agency has the lead in the fight against bed bugs. Because each agency's mission influences its bed bug work, the individual missions and agency-specific activities are listed at the end of this document. By combining their collective expertise and knowledge, the workgroup created this strategy for the federal government and others who are affected by bed bugs.
Goals for the Strategy
The goals of the strategy are to help stakeholders by: 
   * Coordinating and guiding federal responses;
   * Guiding collaboration among stakeholders and levels of government;
   * Raising awareness of the issues surrounding the bed bug problem;
   * Maximizing efficient and effective use of resources to address high priority needs; and 
   * Encouraging realistic appraisal and management of bed bug problems through education and integrated mitigation measures.
Interested parties in this effort include federal staff, state and local government officials, governmental and private funders looking to provide resources for research or control, affected commercial sectors (health, pest control, hospitality, housing, real estate, chemical manufacturing, etc.), concerned Americans and others. 
The workgroup recognizes that implementation of this strategy depends on regulatory and budgetary circumstances and that implementation of this plan will require collaboration with many partners.
Organization of Document
The strategy is organized into five priority areas for bed bug control. The goals listed above are addressed in more detail within the priority areas, as appropriate. Each of these areas is critical to national efforts, but the workgroup recognizes that interest in an individual area may vary among localities or among stakeholders. For each priority area, the strategy defines the problem, recommends actions and discusses ways to measure the success of actions. Evaluating the success of individual actions, which can be conducted by the lead local/state/federal agency, provides an objective means to determine future resource allocations as well as a way to determine which actions are most effective and the best candidates for sharing with other communities. 
Background
Nature of the Problem
Bed bug infestations can happen to anyone− at home, at work, at school or anywhere people bring their belongings. Because bed bugs are small, it is easy for people to unknowingly transport them from place to place on clothes, luggage or other goods. They can also sometimes relocate to adjacent rooms or housing units by crawling. Bed bug infestations can be small and isolated or more extensive and complex. Small and isolated infestations are more easily controlled, however, extensive and complex infestations can persist for an extended period of time. 
The United States, like many countries, has recently seen increases in bed bug populations. Although bed bugs are not known to transmit disease, CDC, EPA and USDA have all declared that bed bugs are a pest of significant public health importance. Bed bugs cause a variety of negative physical health, mental health and economic consequences, including: 
   * Allergic reactions to bed bug bites, ranging from no reaction to mild or severe reactions; 
   * Secondary infections of the skin; 
   * Mental health implications for people living in infested homes; and
   * Time consuming and expensive control measures.
 In 2010, CDC and EPA issued the Joint Statement on Bed Bug Control in the United States, which discusses the public health implications of bed bugs and their control. 
The management of bed bugs continues to pose a major challenge to state and local governments, private industry and the American public. This strategy provides guidance for how the various parts of the government can contribute to minimizing the negative effects of bed bug infestations on human health and the economy.
Federal Involvement and the Strategy
Federal involvement in bed bugs can be structured using the five priority areas defined by the strategy (Prevention, Surveillance and IPM, Community Efforts, Education and Communication, and Research). No federal agency has the lead for bed bug control and an individual agency's involvement varies across priority areas, with most of the agencies being active in more than one area. Because considerations of bed bug management (infestation levels, resistance levels to pesticides, access to effective pest control, resource availability, etc.) can vary widely from one geographic region to another, the workgroup recognizes that a one-size-fits-all national recommendation for bed bug control is not feasible or appropriate.
Because local leaders are likely to have the most success managing bed bugs, the workgroup believes that the federal agency's role is to support these local leaders. When communities customize implementation at the local level, they are able to draw on their own unique characteristics and strengths to develop a more robust management program. The federal government can reduce costs to communities and improve the success rates of bed bug control efforts by: 
   * providing current science-based, quality information and education materials;
   * facilitating interactions among communities to leverage knowledge and experience; 
   * encouraging objective evaluations of interventions; and
   * promoting research activities to improve prevention and control techniques.
Community-level stakeholders with an interest in bed bug management may include schools, housing providers, social service providers, pest management firms, local businesses, law enforcement and local public health departments. Engaging a broad range of stakeholders in their response, can help communities improve the effectiveness and sustainability of their management programs by ensuring access to key local, cultural, or scientific information. Communities can lower costs and improve bed bug control by working with their stakeholders to develop and share the following kinds of information:
   * infestation rates in specific areas of the community, including potential reservoirs of bed bug infestations that serve as sources for new infestations;
   * levels of resistance to specific pesticides in local bed bug populations; needs and existing resources to support underserved audiences; and
   * cultural considerations (for example, values, ethnicity, national origin, language, gender, age, education, mobility, beliefs, standards, thinking patterns, behavioral norms, communication styles, literacy, etc.) that potentially affect management efforts and recommendations.
When complete elimination is not feasible, people living or working in an infested area can take steps to prevent the spread of this pest to new areas within the community and strive to reduce the bed bug population(s) as much as possible given the factors in play at the infested site. In this way, local efforts in even the most difficult cases can contribute to the management of bed bugs communitywide.
Key Elements of Successful Bed Bug Management
Although successful bed bug management programs will vary regionally, they frequently share certain elements. The workgroup has identified the following five key elements that are generally found in a well-run, successful program:
   * Collaboration - Programs that draw on the strengths of the various participants and include diverse stakeholders are able to enhance outcomes and broaden the reach of their efforts, accomplishing more as a group than the sum of their efforts if each works independently.
   * Plain Language, Targeted - Materials and educational efforts are most likely to be effective when project planners define the audience, customize materials for that audience and target delivery of materials. Developing resources and educational programs in plain language will help audiences find what they need, understand what they find and use what they find to meet their needs (see http://www.plainlanguage.gov/).
   * IPM-Based - Bed bug control is most likely to succeed when it uses an integrated pest management (IPM) approach. IPM is an effective and environmentally sensitive approach to pest management that relies on a combination of common-sense practices that present the least possible hazard to people, property and the environment. IPM takes advantage of all appropriate pest management options including the judicious use of pesticides. 
         o IPM programs use current, comprehensive information on the life cycles of pests and their interaction with the environment to create programs that are efficient, effective and safe. A site-specific IPM plan helps coordinate the efforts of everyone who has a role in pest management and serves as the standard operating procedure at a site.
   * Science-Based - Recommendations are most likely to be consistent and successful when project planners base them on objective and accepted scientific evidence. Basing actions on assumptions instead of scientific evidence can result in wasted or duplicative effort and resources.
   * Evaluated for Measurable Success - Developing sustainable programs, especially over time or distance, is most easily accomplished by evaluating the success of individual intervention efforts. Evaluations conducted by those who lead the effort can measure changes in knowledge, behavior or infestation rates. Communicating the results of these evaluations to other communities, states or federal agencies will help all stakeholders to develop increasingly efficient and effective control programs.
Priority Area I: Prevention
Defining the Problem
Prevention is a very cost-effective tool for managing bed bugs. Effective prevention efforts can work in a wide range of settings, taking into account the cultural considerations in each setting. Prevention strategies are particularly valuable to owners/agents of settings such as shelters, some group homes and other housing accommodations for transient populations where the risk of bed bug introductions and subsequent infestations are high. Site-specific early detection and rapid response measures within the IPM plan can prevent further spread if prevention efforts fail.
The workgroup recognizes the need for:
Increasing awareness through effective outreach and education programs;
Increase Americans' awareness of bed bugs through information provided on a dedicated website hosted by EPA at www.epa.gov/bedbugs;
Facilitate communities' abilities to educate their stakeholders about prevention through clearinghouse portion of EPA's website;
Examine potential solutions through research and other projects;
Continuing to inform housing policy through HUD notices;
Providing technical information and help when infestations occur in settings under federal oversight, such as during disaster relief efforts or at military sites; and
Using education to reduce the myths, fears and stigmas associated with bed bugs. 
Recommended Actions
To stop the spread of bed bugs, there are steps that people living with bed bugs can take to reduce the opportunities for bed bugs to migrate to new locations. By developing a strategy in advance, those who travel or have jobs that may expose them to bed bugs can reduce the likelihood of bringing bed bugs home. Integrating prevention strategies into IPM plans can help property owners and agents keep their buildings free of bed bugs. 
Effective prevention begins with individuals and communities having current information about bed bugs. Education and communication are the foundation for effectively preventing bed bug infestations. For more information, please see Priority Area IV: Education and Communication.
While education can be conducted by distributing educational materials and providing training, it can only be effective if it results in changes in behavior. Such changes in behavior may include:
   * Ability to accurately identify bed bugs (which are easily confused with other pests);
   * Monitoring for early detection of new infestations and/or for infestations that may remain after treatments; 
   * Knowledge about where to go for more technical information on bed bugs (particularly for high-risk settings); and
   * More open communications about bed bugs and infestations, leading to cooperatively solving the problem, rather than assign blame or foster a stigma.
Creating a prevention program involves three main concepts:
   * Minimizing movement of bed bugs to new locations; 
   * Creating living space that is less receptive to bed bug infestations; and
   * Identifying and eliminating highly infested areas that can serve as reservoirs for spreading bed bugs.
The workgroup recommends:
   * Preventing the movement of bed bugs by:
         o Installing door sweeps on the bottom of doors to discourage movement into hallways;
         o Sealing cracks and crevices around baseboards, light sockets, etc., to discourage movement through wall voids;
         o Treating existing infestations quickly and notifying all neighbors of the problem to ensure they are on the lookout for bed bugs;
         o Choosing appropriate insecticides for treating existing infestations, to increase effectiveness of treatment and reduce movement of bugs into adjacent units (while there are many registered products available, every situation is different);
         o Carefully inspect all used clothing and furniture for bed bugs brought into the home;
         o Having multifamily dwellings invest in:
               # Washers and dryers on each floor to reduce the spread of bugs when bedding is carried to laundry facilities via the elevator or stairwells; and
               # Portable heating units for returning travelers to heat their luggage before unpacking it.
   * Making areas less receptive to new infestations by:
         o Removing clutter;
         o Installing mattress and box spring encasements (if funds are severely limited, consider at least encasing the box springs);
         o Installing, inspecting and maintaining interception devices or traps; and
         o Providing clothes dryers that are hot enough to kill bed bugs.
   * Implementing an IPM plan in high-risk settings (hostels, shelters, etc.), that encourages:
         o Inspecting and/or treating incoming personal belongings;
         o Monitoring areas around where people sleep or rest; and
         o Identifying and destroying reservoir populations whenever possible.
Measuring Progress 
The following types of data can show whether programs and activities are successfully preventing bed bug infestations: 
   * Results of inspections such as bed bug numbers from monitoring devices, visual inspections or numbers of locations where scent-detecting canines alert;
   * Knowledge or behavior change of participants completing training events and courses, as measured by polls and questionnaires;
   * Information about distribution of educational materials.
Priority Area II: Surveillance and IPM for Bed Bugs
Defining the Problem
Even if residents diligently engage in prevention activities, bed bugs can still infest an area and an infestation may become well established before being noticed. If an IPM plan is already in place that describes how the people living and working in a building should find and deal with an infestation, then bed bug experts can stop the infestation before it becomes overwhelming. In most cases, the longer an infestation remains unchecked, the harder and more expensive it will be to eliminate. Early detection methods and educational efforts that are reliable and cost effective can help communities succeed. 
Effective site-specific IPM plans tailor educational efforts and IPM procedures to the community. The plans also address any factors that could affect program effectiveness, such as: 
   * cultural considerations, 
   * pesticide and applicator availability, 
   * potential for pesticide misuse and 
   * financial resources. 
Identifying and planning for complicating factors when designing a site-specific IPM plan are important both for budgeting and for anticipating special considerations that could lengthen the time needed to eliminate the infestation. In addition, bed bug populations vary in their level of resistance to pesticide products. If pesticides are used to control bed bugs, it is critical to select those that will be effective against the population being controlled. 
Using community-wide surveillance to identify bed bug sources and places where bed bugs can transfer easily can help target community resources to areas where they will be most effective. IPM best management practices require use of reliable surveillance data to verify the presence of living bed bugs after an initial report of bed bugs, rather than relying on anecdotal information because other pests and their symptoms may be easily mistaken for bed bugs.
Although the community and its leaders are the focal point for broad-based bed bug control efforts, these efforts can be significantly improved when the community has access to quality resources and information. The workgroup recognizes the need for collaboration among stakeholders to:
   * Provide science-based information and educational materials about the importance of early detection;
   * Share success stories on management efforts with others who have similar issues;
   * Promote research activities that may lead to reliable, portable and affordable detection methods; 
   * Ensure that scientifically sound information is collected and made readily available to stakeholders about bed bugs, effective monitoring, control strategies, properly labeled chemical insecticides and related regulatory requirements;
   * Facilitate the incorporation of new discoveries into training, education and communication materials; and
   * Encourage funding for basic and applied research on bed bugs, bed bug biology, and effective control techniques and products. Conduct such research or facilitate funding where possible.
Recommended Actions
By having an IPM plan for bed bugs in place, occupants and staff will be able to act quickly and confidently if they find bed bugs. Those living or working at a property can conduct basic bed bug inspections as an added step to scheduled routines (for example, housekeeping inspections), which will help minimize costs. 
However, residents should not serve as the sole source of reporting of bed bug infestations. Inspecting every area at-risk for bed bug infestation will help find bed bug infestations while they are still relatively easy to eliminate. The frequency of such inspections should be part of the IPM plan, based on the local situation and conditions. Hiring a pest management professional (such as experienced specialists who use certified canine bed bug detectors or other effective bed bug monitors) or training specific staff members to conduct intensive inspections can be an effective way to encourage surveillance and IPM efforts. 
Bed bugs can be detected before an infestation becomes severe by using devices and practices that facilitate early detection. These include the following:
Using rip-resistant, bite-proof and escape-proof mattress and box spring encasements that make it easier to see the signs of bed bugs;
Managing the environment so that when infestations occur they are more easily detected (such as routine cleaning, removing evidence of past infestations, using light-colored bedding, etc.);  
Using passive bed bug monitors that intercept and trap bed bugs; and  
Using active monitors that attract bed bugs by releasing heat, carbon dioxide and/or a scent lure.
 Research into basic bed bug biology and behavior shows certain characteristics are common to all bed bugs. Focusing detection efforts on the following characteristics can help reduce costs: 
The majority of bed bugs are found in or near sleeping and resting areas. As an infestation grows within an apartment or home, bed bugs will travel to more distant locations from sleeping and resting areas, which makes determining their various locations more difficult, time consuming and expensive.
Because bed bugs can move between units, the best IPM practice is to inspect adjacent areas or units, units above and below the infested unit, and units across the hall. If a unit is vacant, bed bugs may behave differently (for example, by becoming more inactive or more active during the day) while waiting for a new host to arrive.
Although not preferred hosts, pets and rodents can serve as alternate hosts in some circumstances (such as when other hosts suddenly become unavailable or when an infestation is severe), which can greatly increase the bugs' survival.
Bed bugs can be difficult to differentiate from other common insects; therefore, a qualified expert should confirm the presence of a bed bug infestation before beginning control efforts. Once a bed bug expert confirms the infestation, site occupants and staff follow the predetermined IPM plan to efficiently control the infestation. If no IPM plan is in place, follow research-based recommendations available at EPA's bed bug website (www.epa.gov/bedbugs). Each bed bug infestation site is unique, so control options and IPM plans will vary. 
The workgroup has also identified the following areas where additional efforts could be productive:
   * Encourage discussions about appropriate ways to quarantine infested items;
   * Advocate for clear guidelines to minimize potential for bed bugs to develop resistance to pesticides; and
   * Establish minimum acceptable standards for detecting an active infestation versus a prior infestation. 
Measuring Progress 
Sometimes residents or landlords will treat for bed bugs based on anecdotal reports, without proper evidence. Such evaluation is vital to ensuring that limited resources are directed to the treatment methods that will provide the greatest opportunities for successful and complete control. Professional organizations have recommended best management practices, but not all of these practices have been adequately evaluated for effectiveness.
Measuring results from surveillance and IPM programs at the federal, state and local levels helps ensure effective and efficient use of resources. The following could demonstrate whether an approach has resulted in better bed bug management:
   * Collecting data on availability and distribution of information and educational materials from the surveillance system, coupled with data on increased knowledge of residents and housing employees.
   * Documenting reduction in pest control expenses over time.
   * Compiling and analyzing results of inspections, both routine and nonroutine, showing infestations to be less frequent and with a smaller population of bugs.
   * Verifying that infestations are only being found in one dwelling area (not multiple areas in a home or adjacent units).
   * Recording that no more than two services and follow-up interviews are required to eliminate an infestation.
   * Documenting and verifying that monitors and resident surveys show no activity for months after one or two treatments of an active infestation.
   * Conducting satisfaction surveys and showing an increase in satisfaction. 
Priority Area III: Community Efforts
Defining the Problem
Each community and region of the country is unique. Infestation levels can vary widely among geographic regions and so can access to effective pest control. When communities customize implementation of bed bug control programs at the local level using IPM plans, they are able to draw on their own unique characteristics and strengths to tailor and develop the most robust program.
Communities cannot expect to effectively manage bed bugs without coordinated community involvement using the principles of IPM. This is especially true in multifamily housing, lodging and institutional facilities. To manage bed bugs at the local level, communities need the capacity to coordinate prevention, surveillance, IPM, education and communication activities. 
To effectively support community efforts for effective bed bug management, the workgroup recognizes the need for:
Sharing control or education success stories through communication networks;
Maintaining EPA's dedicated bed bug website with current information, educational materials and peer-reviewed research;
Providing technical expertise and guidance for communities; and
Acting as a facilitator among communities, states, federal entities and external partners.
Recommended Actions
Collaboration is paramount for effective bed bug management. Resourceful and innovative communities can take information disseminated at the national or state levels and apply it to their unique local context. Private and nonprofit organizations, or commercial businesses, can work with local governments, adding their expertise or resources to the community response. 
Bed bug action committees (such as task forces) made up of recognized and respected leaders can be an effective way to organize collaborative local efforts. In addition, the state's IPM Coordinator may be a source of information about groups doing bed bug work in the state (www.ipmcenters.org/contacts/IPMDirectory.cfm). Guidance from existing programs that shared their success at the Second National Bed Bug Summit can be found at http://www.epa.gov/oppfead1/cb/ppdc/bedbug-summit/2011/2nd-bedbug-summit.html. 
Measuring Progress 
If a community has specific goals for bed bug management, it is important for them to measure and monitor progress using metrics such as surveys, questionnaires and studies. When communities objectively measure the success of their community-wide communication and control efforts, they are better able to target future efforts into those that use resources most effectively (such as, are more successful at lower costs). In addition, measuring needs, progress and results helps gauge success and justify resource allocation.
Continuing to measure (monitor) for pests at the site being treated is a critical element of any IPM-based management program. Communities can also measure a variety of other changes brought about by their bed bug control efforts. Such changes could include:
   * Community or locality infestation rates, which indicate successful interventions and likely reduction in transmissions; 
   * Behavior, which leads to better prevention and early detection (surveillance); or
   * Knowledge, which is a precursor to changes in behavior.
After measuring intervention efforts, it is important to widely disseminate the results to other levels of government. Sharing the results will lead to improved quality of efforts between communities, allow communities to build on each other's successes and justify and support efficient use of resources.
Priority Area IV: Education and Communication
Defining the Problem
How much participants know about bed bugs often determines how willing they are to cooperate. It also often determines the outcome of implementing an IPM plan. Information about bed bug basics, prevention and control is critical for all stakeholders so they can contribute to the management effort. Training and communications materials that are current, targeted, science based and consistent are key to a successful program. In addition, target audience members are most likely to access the information if it is transmitted in formats that are in plain language (see www.plainlanguage.gov).
Although pest control companies are on the front lines of the bed bug battle, they vary in their ability or willingness to educate their employees and train clients. In addition, bed bug information is limited in existing training curricula.
To improve the quality of education and training materials, the workgroup recognizes the need for:
Defining core competencies for groups that need training or education;
Setting audience-specific learning objectives (based on core competencies) for various stakeholders involved in bed bug management;
Ensuring enough effective trainers are available to help convey consistent information and quality delivery;
Promoting current, science-based messages (skimming multiple websites or learning from private sector sources can give an incomplete or incorrect understanding of bed bugs and their management);
Reducing costs of developing and disseminating quality education, training and communications materials for all stakeholders whenever possible;
Understanding that the greatest cost savings can be derived from prevention programs;
Refining models of coordination among communities to serve as templates for minimizing costs;
Planning and delivering communications to those with different learning styles or those who rely on electronic communications such as social media; and
Tailoring messages to the target community by factoring in cultural considerations and current needs, recognizing that new, uninformed people may rotate through some settings (for example, offices, shelters, group homes, hostels, camps, etc.).
Recommended Actions
Training efforts will reach the most people in the most effective way when they use current information based on standardized learning objectives that demonstrate core competencies. In addition to bed bug-specific training programs, cooperating with broader training programs (such as Healthy Homes, IPM and training for management of other pests) to discuss bed bugs can be cost effective. Training can be provided through in-person classroom training, on-the-job training and webinars. Regardless of training format, regularly updating training programs will be necessary to keep them current. 
Developing a federally endorsed set of core competencies and learning objectives for bed bug training may help define the level of training needed in a bed bug management program. A professional certification program indicating a level of knowledge, experience and educational ability would help consumers select a qualified training provider. Interaction among communities can lead to more effective and efficient use of resources. Costs can be significantly reduced by using existing strategies for communications and instructional design whenever possible. Use of the clearinghouse portion of EPA's bed bug website can help format and tailor communications to a target audience by:
   * Providing accurate information on bed bug management from unbiased sources;
   * Discrediting myths linking sanitation, poverty and immigration status to bed bugs; 
   * Offering consistent, but not duplicative, information; and
   * Promoting more efficient communications on a local level.
Measuring Progress
Measuring the progress of a training program is critical to determining whether those resources are being used productively. Core competencies should align with measureable learning objectives and the objectives should be audience specific for the various stakeholders and/or sectors involved in bed bug management. Once developed, communities could use these standard objectives to measure the level of training expertise in a community. Nationally, achievement of objectives could be compared across communities to measure success in communication and training programs.
Likewise, those in communications can track efforts and evaluate the results to support efficient use of resources and improve effectiveness of messaging. Ideally, target audiences have the opportunity to provide feedback. By using the feedback, communities can provide valuable information to those developing the messaging through public forums and in social media. Ultimately, the effectiveness of communication strategies will be measured through delivery of effective bed bug management.
The following are examples of data that could assess the effectiveness of communication strategies and messaging: 
Documented results from customer satisfaction surveys;
Outcomes from focus groups during development of communication strategies and after dissemination to determine whether the target audience receives the message and understands it as intended; 
Evaluation of participants through interviews to determine effectiveness of communication strategies; and
Use of initial and follow-up surveys to analyze participants' behavior changes with regard to bed bugs.
Priority Area V: Research
Defining the Problem
When the numbers and geographical distribution of bed bugs began to increase, knowledge of this pest was based on previous research. Since that time, our understanding of bed bugs and their management has improved. Additional research about bed bugs answers many questions and allows program planners and the American public to develop more effective management options. 
Research activity can be divided into two areas: basic and applied. Basic research answers questions about the biology of the bed bug in its environment and its association with hosts. Not every basic research study results in a practical application, but sometimes unexpected answers to basic research questions can lead to innovative solutions. Peer-reviewed basic research on topics such as colony growth, movement behavior and the pest's apparent inability to transmit pathogens that cause human diseases would improve our current body of knowledge about this pest.
Applied research provides new methods for IPM of bed bugs or new information that allows better pest control as part of an IPM program. Such research activity creates and evaluates tools. Applied research can also bring together many techniques into a clear, site-specific IPM plan and test the effectiveness of the plan. 
Research pertaining to the priority areas will likely come from:
   * Academic institutions (examples include departments of entomology, schools of medicine, schools of public health, departments of social work, departments of communication, departments of consumer economics and schools of architecture); 
   * Private industry (Examples include insecticide manufacturers, product formulators, venture companies, pest control); user group associations (for example, builders, hoteliers, private housing groups, insecticide manufacturers); 
   * International research entities; and 
   * Federal, state and local governments. 
Because both basic and applied research will provide the foundation for new, more effective control options, the workgroup recognizes the need to:
   * Promote partnerships that leverage resources and expertise; 
   * Integrate the results of peer-reviewed research into management programs through education, training and communications.
   * Further investigate potential health effects from bed bugs, including potential to trigger an allergic reaction;
   * Improve access to study sites and the potential use of human subjects;
   * Quantify the costs for control, prevention and the value of tailoring intervention efforts to unique communities;
   * Improve access to research colonies, including field strains;
   * Maintain defined strains of bed bugs with known resistance levels to insecticides;
   * Create a source of reagents (for example, plasmids, antibodies, DNA and other materials), samples, or testing protocols; and
   * Integrate results with international collaborators to make research and, ultimately, control more effective and less costly.
Recommended Actions
Research is important to improve bed bug management techniques. Basic research is often the source of innovative new solutions, while applied research directly supports information used in establishing pest control best practices. Both are necessary to build a foundation of knowledge that can be used to develop solutions.
Basic research topics may include:
Basic biology of modern bed bug populations;
Health effects caused by bed bugs;
Property damage caused by bed bugs;
Potential of bed bugs to transmit pathogens; and
Bed bug gene sequencing and genomics to help progress the current research and technological approaches available in this field.
Applied research topics may include:
How human activities influence bed bug infestations and affect control;
Evaluation of existing methods for detection, prevention and control;
New methods for detection, prevention and control; and 
Integration of various methods into clear, understandable, reduced risk and reliable IPM plans.
Regardless of research questions, the workgroup suggests researchers use the following guiding principles in their work:
Serve all members of American society with appropriate control techniques;
Minimize costs while maximizing the benefits from the products of research efforts; and
Communicate results effectively and efficiently to stakeholders.
Meetings that bring researchers together could include forums for discussion of strategies for research, technology, etc., pertaining to information about bed bugs. Researchers may coordinate scientific efforts with professionals from other specialties to develop new solutions and to use methods as effectively as possible. For example, working with scientists studying related organisms could help inform approaches relevant to bed bugs. The following systems facilitate federal/academic/industrial partnerships:
   * Small Business Innovation Research: a program that enables small businesses to explore their technological potential and provides the incentive to profit from its commercialization.
   * Cooperative Research and Development Agreement: an agreement between one or more federal laboratories and one or more nonfederal parties under which the federal laboratory provides personnel, services, facilities, equipment or other resources toward the conduct of specified research or development efforts.
   * Specific Cooperative Agreement: An agreement between a federal agency and another party that describes in detail a jointly planned and executed research program or project of mutual interest between the parties where both parties contribute resources.
Measuring Progress 
Like all of the other priority areas, measuring the results from research efforts is critical to evaluating and directing research funding. Improvements in basic research can be measured by looking for increases in number of:
   * publications of research outcomes in peer-reviewed journals;
   * new patents;
   * shared resources that can be used by the bed bug research community; 
   * research projects that contribute to solutions; and
   * trained bed bug biologists.
In addition to those increases listed above, the following measurements may indicate an improvement in applied research:
Transfers of intellectual property; 
Translation of research into operational manuals and other sources of information for those who manage bed bugs;
Improved, more effective products available to the public and businesses;
Improved communication with the public and businesses;
A current baseline of the problem;
A comparison of the outcome of interventions to a baseline; and
New strategies for detection, prevention and control.
Conclusions
Integrating several methods for controlling bed bugs in response to surveillance data is likely to be more successful against bed bugs than application of any single method. Reducing bed bug populations on a community-wide basis provides an opportunity to decrease the probability of new infestations. With few exceptions, the federal government does not have a role in direct interventions against bed bugs, but it does have an important role in providing reliable information, coordinating stakeholders and providing resources for research to achieve long-term solutions. Many other stakeholders such as nongovernmental organizations, state and local governments, school associations and community coalitions have been active in efforts to manage the bed bug problem. Their input has been important in crafting this strategy.
 
Since bed bugs became a larger problem in the United States about 10 years ago, research and development has produced better products and methods for control. As improvements continue, indications are that multipronged, IPM is the best approach in most situations. Public awareness and dissemination of accurate information to individuals is helpful for earlier detection, greater chance of successful elimination of infestations, reduction of the chance of spreading infestations and more efficient use of resources.
 
This strategy advocates a logical, integrated approach to bed bug management, with a focus on cooperation among all levels of government and the community. Effective implementation of this strategy should decrease costs to the community and achieve a better level of bed bug control. Continuous measurements of success, even after the problem has been reduced to an acceptable level, will be key to efficient use of resources in the future and essential to prevent the reoccurrence of widespread infestations in the United States.

Appendix: Mission Statements for Key Federal Agencies
Centers for Disease Control and Prevention (CDC)
CDC collaborates to create the expertise, information and tools that people and communities need to protect their health  -  through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.

CDC offers live and online courses about the importance of IPM, including the biology and control of public health pests. The course trains environmental health, public health, pest management and other professionals in the principles of effective pest control, including bed bugs, and offers a special field-based exercise where participants are trained in methods to conduct a bed bug inspection of a potentially infested bedroom.

Department of Agriculture (USDA)

The USDA Research, Education, and Economics mission area agencies, the National Institute of Food and Agriculture (NIFA) and the Agricultural Research Service (ARS) provide federal leadership in creating and disseminating knowledge spanning the biological, physical, and social sciences related to agricultural research, extension, and higher education.

NIFA's mission is to lead food and agricultural sciences by supporting research, education, and extension programs in the Land-Grant University System and other partner organizations. Funding from NIFA supports bed bug researchers and extension personnel at several Land-Grant universities.  EPA's dedicated bed bug website includes science-based information on bed bugs developed by these university experts.

This work leverages other efforts in ARS on chemical ecology of insects and on development of new insecticides. This work has resulted in the discovery of new kinds of chemical attractants for bed bugs and successful new insecticides that are effective against resistant bed bugs. ARS' problem-solving orientation is capable of bringing together many scientific skills to find innovative solutions. 

Department of Defense (DOD)

DoD addresses bed bugs and their management from three different perspectives and through multiple agencies. Technical consulting, information sharing, educational efforts and control actions may involve uniformed and civilian entomologists at each of these levels:
Policy: AFPMB provides overall information and develops and provides general policies, guidance, training and consultation on pest management to other DoD elements and whomever they support.
Technical training: Preventive medicine staff members and pest management professionals (PMPs) receive routine periodic technical and certification training and guidance, as needed, by service-specific regional or national agencies.
Bed bug management: Bed bug management programs and specific actions are carried out at the local level using IPM strategies and techniques, involving all local stakeholders. Those typically include members of the affected human populations, local public health or medical authorities, facilities managers and DoD military, civilian or appropriate contracted PMPs.
The Armed Forces Pest Management Board (AFPMB) is an arm of DoD that recommends policy, provides guidance and coordinates the exchange of information on all matters related to pest management throughout the DoD. The AFPMB's mission is to ensure that environmentally sound and effective programs are available to prevent pests and disease vectors from adversely affecting DoD operations. 
 
Department of Housing and Urban Development (HUD)
HUD's mission is to "create strong, sustainable, inclusive communities and quality affordable homes for all. HUD is working to strengthen the housing market to bolster the economy and protect consumers; meet the need for quality affordable rental homes: utilize housing as a platform for improving quality of life; build inclusive and sustainable communities free from discrimination; and transform the way HUD does business."
HUD promotes a collaborative approach to bed bug management in public and Indian housing (HUD Notices PIH 2011-22, PIH 2012-17, respectively, and H 2012-5). 
While bed bug infestations are not limited to the housing sector, quality housing and strong communities are undermined by the presence of bed bug infestations. Prevention and control of bed bug infestations are enhanced by the team approach to the problem when affected and vulnerable housing providers, residents, pest management professionals, public health professionals and others focus their different perspectives and resources on the common problem. HUD is particularly concerned about effects on vulnerable populations, including underserved groups, such as elderly and disabled individuals, and owners and residents who lack the resources to effectively deal with bed bug infestations. Education of all involved parties, especially with regard to prevention methods, is a priority for HUD.
Environmental Protection Agency (EPA)
EPA's mission is to protect human health and the environment.
For bed bugs, like other pests of public health significance, EPA has a statutory charge to ensure that the pesticides with these uses are (1) safe and (2) effective against the pests on their labels. EPA's Office of Pesticide Programs works to ensure that pest management professionals and the public have access to the latest information on effective bed bug control tools. EPA realizes that certain bed bug populations in communities across the nation are becoming more resistant to many of the existing pesticides. EPA is also working to educate the general public, pest professionals and public health officials about bed bug biology and IPM, both of which are critical to long-term bed bug control. 
