Some of the top destinations for summer vacations are included on the list of the 50 most bed bug-infested cities in 2019 released Monday at the start Bed Bug Awareness Week. The annual list was put together by Terminix and ServiceMasters, which wage war on the blood-sucking creatures with products and services.

The ranking is based on the number of times Terminix was called out in 2018 to wipe out bed bugs. They’re hitchhikers, and bum rides in travelers’ suitcases, purses, jackets and other personal belongings. Though bed bugs are associated with bedding and mattresses, they also hide in upholstered furniture and behind baseboards.

“Bed bugs continue to pose concerns for public health, as their presence is felt across the country, in cities large and small,” Matthew Stevenson, president of Terminix Residential, said in a statement, saying the nearly decade-old ranking has “helped bring awareness to an epidemic that can lead to a variety of negative physical health, mental health and financial consequences.”

About one-fifth, or 22 percent, of Americans have had a bed bug encounter, according to a national poll of 1,516 randomly selected U.S. adults conducted in March by the market research company Maru/Blue. The number of children who have had bed bug encounters was higher, at 35 percent.

The top 10 cities for bed bug infestations are:

Ohio dominated the list with six cities in the top 50, followed by Florida with five. Philadelphia last appeared at the top of the list in 2017, and Cleveland fell to No. 7 after two years as the No. 1 bed bug-infested city.

The Maru/Blue research also showed that nearly half (48 percent) of U.S. travelers don’t know what precautions to take to protect themselves against bed bugs. Some things to keep in mind:

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