Going out of town this winter? Traffic, blizzards or spending a long weekend with your crazy uncle may put a damper on the seasonal cheer, but in your haste to come home, make sure you're not transporting six-legged souvenirs: bed bugs.

A decade ago bed bugs were still the vermin of lore--blood-sucking creepy-crawlies laid to waste by the amazingly effective (and toxic) pesticide DDT.

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These pesky insects have made quite the stateside comeback lately. This year bed bug outbreaks have been reported everywhere from homes to office buildings, hotels, stores, schools and hospitals. No less than former president Bill Clinton's Manhattan offices suffered an outbreak.

Although the exact cause remains a mystery, the Centers for Disease Control and Prevention and the U.S. Environmental Protection Agency chalk up the resurgence of these tiny terrors to "increased resistance of bed bugs to available pesticides, greater international and domestic travel, lack of knowledge regarding control of bed bugs due to their prolonged absence, and the continuing decline or elimination of effective vector/pest control programs at state and local public health agencies."

Translation: Bed bugs are great travelers. Every region of the country has been besieged, with bed bugs hitchhiking rides in handbags, the folds of clothes, luggage, planes, trains, cars--even ambulances.

While every major metropolis has reported infestations in 2010 (as well as a rapidly increasing number of smaller towns), some cities have been harder hit than others. We tapped the nation's two largest pest exterminators, Orkin LLC and Terminix, to find the cities with the worst bed bug infestations. Each company has 400 offices nationwide and compiled a list of the hardest-hit metros, based on the number of calls they've received and bed bug jobs performed relative to population. From their lists of the 15 cities with the worst bed bug problems, we then focused in on 13 cited by both.

"This list is based on our experience, and it's not to say that other cities might not be as bad," stresses Ron Harrison, Orkin entomologist and director of technical services.

Bob Young, Division Service Manager for the Northeast and Mid-South Divisions at Terminix, explains his company's methodology like this: "We based it on sheer number of calls that come into our service centers...plus the services that we perform...basically total that and measure the increase that we've been seeing, and it's been growing exponentially over the years."

The results? Bustling densely populated urban epicenters with high turnovers of tourists and business travelers are among the worst sufferers. Those cities include New York City, Chicago, Los Angeles and Washington, D.C.

The state most afflicted by bed bugs is a bit of a surprise: Ohio. Three of the Buckeye state's cities--Cincinnati, Columbus and Dayton--are on the exterminators' bed bug-infested lists.

"At this point we don't know, nor does anyone know, why cities in Ohio seem to have a much higher influx of bed bugs per capita than larger cities," says Orkin's Harrison.

One possibility is that Ohio citizens may simply be more willing to seek help rather than let infestations worsen (a common and harmful response, given the stigma of bed bugs and cost of eliminating them).

The National Pesticide Information Center, which offers information about pesticides and related topics, tracks bed bugs by state, based on the calls it receives. Its data parallels the pest management companies', with the most inquiries coming from New York, California, New Jersey, Ohio and Pennsylvania.

NPIC Project Coordinator Kaci Buhl says the center has also been receiving bed bug-related calls this year from new states like Oregon, which now claims a weekly presence in the inquiry logs.

Getting rid of bed bugs is complex. It can take up to several visits and treatments. Some states have introduced bed bug related legislation. New York now requires landlords to tell new tenants whether a property has experienced past outbreaks; Pennsylvania, whose largest city Philadelphia makes our list, is considering legislation that would clarify whether a landlord or tenant is financially responsible for an infestation.

Edwin Rajotte, professor of entomology and IPM coordinator at Penn State University, says the good news is that bed bugs don't carry diseases and are physiologically the same everywhere.

"There aren't super bugs in Detroit or something like that," he explains. "The main defense against bed bugs is education and awareness because everybody has a role to play in managing bed bugs, and it's much easier to manage if you catch it early."

Both Rajotte and Buhl stress a proactive approach when traveling this holiday season. Check the space you are sleeping in, whether it's a hotel or the home of a loved one.

"Look everywhere, bring a flashlight and inspect the box spring, seam along the mattress, under tags on the bed, even the headboards," instructs Buhl.

If possible, leave your luggage in the bathroom since the apple-seed-shaped insects aren't prone to migrating there. Inspect your luggage before bringing it into your house (Harrison stores his suitcases in the garage to be safe).

Once home, launder your clothes and dry them on high heat for at least 30 minutes to kill all life stages of the potential hitchhikers.

If you spot them in your home or experience bites, do not wait to call in an exterminator. The infestation will only worsen and become more costly and challenging to treat.

Follow these simple steps and you have a good chance of sleeping tight, and not letting the bed bugs bite.


Five of America's Worst Bed Bug-Infested Cities

Cincinnati, Ohio
Orkin ranking: 1
Terminix ranking: 4

Chicago
Orkin ranking: 3
Terminix ranking: 5

Detroit
Orkin ranking: 5
Terminix ranking: 3

New York
Orkin ranking: 7
Terminix ranking: 1

Columbus, Ohio
Orkin ranking: 2
Terminix ranking: 7