ATLANTA, Ga – Orkin, the Atlanta-based pest control company, released its annual list of top 50 bed bug cities on Tuesday, and the company’s hometown has moved up in the rankings.

Atlanta ranks 16th on the list, up three slots from last year. The list is based on the number of bed bug treatments Orkin performed in each metro area from Dec. 1, 2015 through Nov. 30, 2016.

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Baltimore tops this year’s top 50 bed bug cities list.

In the six years Orkin has released the bed bug city rankings, this is the first time Baltimore has made the top five, moving up nine spots since last year. Four metro regions — Las Vegas, Portland, Salt Lake City and Greensboro-High Point-Winston Salem — made the list for the first time this year.

Here’s the top 20:

  1. Baltimore
  2. Washington, D.C.
  3. Chicago
  4. New York
  5. Columbus, OH
  6. Los Angeles
  7. Detroit
  8. Cincinnati
  9. Philadelphia
  10. San Francisco-Oakland-San Jose
  11. Richmond-Petersburg, Va.
  12. Raleigh-Durham, N.C.
  13. Cleveland-Akron-Canton, Ohio
  14. Indianapolis
  15. Dallas-Ft. Worth
  16. ATLANTA
  17. Houston
  18. Buffalo, N.Y.
  19. Charlotte, N.C.
  20. Norfolk-Portsmouth-Newport News, Va.

“We have more people affected by bed bugs in the United States now than ever before,” says Ron Harrison, Orkin entomologist, adding that bed bugs are a growing issue. “They were virtually unheard of in the U.S. 10 years ago,” he says.

According to a 2015 “Bugs without Borders Survey” by the National Pest Management Association, nearly all (99.6 percent) of pest professionals nationwide have treated bed bugs in the past year, up from five, 10 and 15 years ago.

“Anyone can get bed bugs in their home. They are not a sign of uncleanliness. Bed bugs only need blood to survive. We have treated for bed bugs in everything from million dollar homes to public housing,” Harrison says.

Bed bugs can be difficult to detect and treat because of their small size and ability to survive up to a year without feeding. They are about the size of an apple seed when fully grown, and can hide around seams of a mattress, behind headboards and in cracks and crevices, usually within a five-foot radius of the bed. The first signs of a bed bug infestation are often the bed bugs themselves or small dark stains bed bugs can leave behind.

“People may have bed bugs and not know it, because many people have no physical reaction to bed bug bites,” Harrison says. “That’s why it’s important for people everywhere to inspect for bed bugs regularly.”