WEHA-BEOH Damp Buildings Sept09

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Why Do People Get Sick in Damp Buildings? The joint conference of the Wisconsin Environmental Health Association and the Bureau of Environmental and Occupational Health (Wisconsin Department of Health Services).

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WEHA-BEOH Damp Buildings Sept09

  1. 1. Presented by: Wane A. Baker, P.E., CIH IAQ Division Manager MICHAELS ENGINEERING Email: wab@MichaelsEngineering.com (608) 785-1900 Why Do People Get Sick in Damp Buildings?
  2. 2. Agenda <ul><li>What have you heard? </li></ul><ul><li>Microbiological contaminants </li></ul><ul><li>Health effects of microbiological contaminants </li></ul><ul><ul><li>Fungi and bacteria ( and chemistry) </li></ul></ul><ul><ul><li>Partial review: Micro 101 (next time?) </li></ul></ul><ul><ul><li>Infection, irritation, allergy </li></ul></ul><ul><ul><li>We will not discuss “toxic black mold” </li></ul></ul><ul><li>Damp buildings and human health </li></ul><ul><ul><li>NORDDAMP, EUROEXPO, Mudarri & Fisk </li></ul></ul>
  3. 3. Agenda (cont’) <ul><li>Oft-cited publications </li></ul><ul><ul><li>CDC: Dr. Redd’s Statement for the record </li></ul></ul><ul><ul><li>ACOEM: Evidence-based statement </li></ul></ul><ul><ul><li>Texas Medical Association </li></ul></ul><ul><li>The National Academies </li></ul><ul><ul><li>Institute of Medicine </li></ul></ul><ul><ul><li>Causation vs. Association </li></ul></ul><ul><li>WHO Guidelines for IAQ: Dampness and Mould </li></ul>
  4. 4. Microbiological Contaminants
  5. 5. “ Killer mold” and the lay press From the comic strip “Rex Morgan, MD” (August 6, 2001)
  6. 6. “ Killer mold” and the lay press (cont’) From the comic strip “Rex Morgan, MD” (August 13, 2001)
  7. 7.
  8. 8. Damp buildings and health: NORDDAMP <ul><li>“ Dampness in Buildings and Health” </li></ul><ul><li>Nordic Interdisciplinary Review of the Scientific Evidence on Associations between Exposure to “Dampness” in Buildings and Health Effects (NORDDAMP) </li></ul><ul><li>Bornehag, C.G., et al, (2001) Indoor Air , 11:72-86 </li></ul><ul><li>The International Journal of Indoor Environment and Health </li></ul><ul><li>Peer-reviewed articles based on epidemiological studies </li></ul><ul><li>Strong evidence of a “causal association” between dampness and health effects </li></ul><ul><li>Differences in how ‘dampness’ is defined (humidity, condensation, visible mold, odors) were unimportant </li></ul>
  9. 9. <ul><li>“ Dampness in Buildings and Health” (cont’) </li></ul><ul><li>Nordic Interdisciplinary Review of the Scientific Evidence on Associations between Exposure to “Dampness” in Buildings and Health Effects (NORDDAMP) </li></ul><ul><li>Bornehag, C.G., et al, (2001) Indoor Air , 11:72-86 </li></ul><ul><li>The International Journal of Indoor Environment and Health </li></ul><ul><li>Increased risk for cough, wheeze, asthma (OR 1.4-2.2; n>100,000) </li></ul><ul><li>Association with fatigue, headache, respiratory infections </li></ul><ul><li>Mechanisms are unknown (chemical, biological) </li></ul><ul><li>Recognized an important factor: dust mites </li></ul>NORDDAMP (cont’)
  10. 10. <ul><li>Centers for Disease Control and Prevention (CDC), Stephen C. Redd, MD: </li></ul><ul><ul><li>“… molds can cause illness when people are exposed to extensive mold growth indoors .” </li></ul></ul><ul><ul><li>“… airborne fungal allergens were most often associated with allergic diseases…” </li></ul></ul><ul><ul><li>“ In its 2000 report…[the] IOM 1 concluded that there is sufficient evidence of an association between exposure to mold and exacerbations of asthma .” </li></ul></ul><ul><li>“ State of the Science on Molds and Human Health”, Statement for the Record, U.S. House of Representatives, July 18, 2002 </li></ul><ul><li>1 Clearing the Air: Asthma and Indoor Air Exposures </li></ul>Centers for Disease Control
  11. 11. Centers for Disease Control (cont’) <ul><li>Centers for Disease Control and Prevention (CDC), Stephen C. Redd, MD: (cont’) </li></ul><ul><ul><li>In a 5-year CDC initiative on work-related asthma in offices and schools, significant relationships have been found between: </li></ul></ul><ul><ul><ul><li>Respiratory disease, and visual assessment of water and mold damage </li></ul></ul></ul><ul><ul><ul><li>Respiratory symptoms, and endotoxin and ultra-fine particles </li></ul></ul></ul><ul><ul><ul><li>Respiratory symptoms, and indicators of mold in chair and floor dust </li></ul></ul></ul><ul><li>“ State of the Science on Molds and Human Health”, Statement for the Record, U.S. House of Representatives, July 18, 2002 </li></ul>
  12. 12. <ul><li>Centers for Disease Control and Prevention (CDC), Stephen C. Redd, MD: (cont’) </li></ul><ul><ul><li>“ We do not know whether molds cause…pulmonary hemorrhage, memory loss, or lethargy.” </li></ul></ul><ul><ul><li>“… measures should be taken to prevent mold growth indoors because some people are, or may become, allergic to it .” </li></ul></ul><ul><ul><li>“ Linkages between indoor airborne exposures to molds and…bleeding from the lung, or memory loss, have not yet been scientifically substantiated .” </li></ul></ul><ul><li>“ State of the Science on Molds and Human Health”, Statement for the Record, U.S. House of Representatives, July 18, 2002 </li></ul>Centers for Disease Control (cont’)
  13. 13. Institute of Medicine 2004 <ul><li>“ Damp Indoor Spaces and Health” (2004) </li></ul><ul><ul><li>See http://www.iom.edu/report.asp?id=20223  </li></ul></ul><ul><ul><li>Or, http://www.nap.edu/catalog/11011.html  </li></ul></ul><ul><ul><li>Read the entire book FREE on-line </li></ul></ul><ul><ul><li>29 page summary available as PDF </li></ul></ul><ul><ul><li>Refer to Tables ES-1 and ES-2 </li></ul></ul><ul><li>(Refer to text) </li></ul>
  14. 14. Damp buildings and health: EUROEXPO <ul><li>“ Dampness in Buildings as a Risk Factor for Health Effects” </li></ul><ul><li>EUROEXPO: a multidisciplinary review of the literature (1998-2000) on dampness and mite exposure in buildings and health effects </li></ul><ul><li>Bornehag, C.G., et al, (2004) Indoor Air , 14:243-257 </li></ul><ul><li>The International Journal of Indoor Environment and Health </li></ul><ul><li>Updates NORDDAMP , include dust mite exposure </li></ul><ul><li>Mites explain some but not all health problems </li></ul><ul><li>Dampness is a risk factor among atopics and non-atopics </li></ul><ul><li>Both domestic and public environments </li></ul>
  15. 15. EUROEXPO (cont’) <ul><li>“ Dampness in Buildings as a Risk Factor for Health Effects” (cont’) </li></ul><ul><li>EUROEXPO: a multidisciplinary review of the literature (1998-2000) on dampness and mite exposure in buildings and health effects </li></ul><ul><li>Bornehag, C.G., et al, (2004) Indoor Air , 14:243-257 </li></ul><ul><li>The International Journal of Indoor Environment and Health </li></ul><ul><li>True association between dampness and health </li></ul><ul><li>Dampness approximately doubles the risk of health effects </li></ul><ul><li>Causative factors are not known </li></ul><ul><li>Remediate damp buildings, avoid mite exposure </li></ul>
  16. 16. Mudarri and Fisk 2007 <ul><li>“ Public Health and Economic Impact of Dampness and Mold” </li></ul><ul><li>D. Mudarri and W. J. Fisk (2004) Indoor Air , 17: 226–235 </li></ul><ul><li>The International Journal of Indoor Environment and Health </li></ul><ul><li>Based on meta-analysis, including research since IOM 2004 report </li></ul><ul><li>Estimated public health risk and economic impact of dampness and mold </li></ul><ul><li>Exposures was assessed using current asthma as a health endpoint </li></ul><ul><li>Data from two prior studies were updated to 2004 </li></ul>
  17. 17. Mudarri and Fisk 2007 (cont’) <ul><li>“ Public Health and Economic Impact of Dampness and Mold” </li></ul><ul><li>D. Mudarri and W. J. Fisk (2004) Indoor Air , 17: 226–235 </li></ul><ul><li>The International Journal of Indoor Environment and Health </li></ul><ul><li>21% of US current asthma cases are attributable to dampness and mold exposure (95% CI, 12–29%) </li></ul><ul><li>National annual cost of asthma that is attributable to dampness and mold exposure in the home is estimated to be $3.5 billion ($2.1 – $4.8 billion) </li></ul><ul><li>Poses significant public health and economic risks in the USA. </li></ul><ul><li>These findings are compatible with public policies and programs that help control moisture and mold in buildings. </li></ul>
  18. 18. World Health Organization 2009 <ul><li>“ WHO Guidelines for Indoor Air Quality: Dampness and Mould” </li></ul><ul><li>WHO Regional Office for Europe, Copenhagen, Denmark </li></ul><ul><li>§ 4.4 Synthesis of available evidence on health effects </li></ul><ul><ul><li>The epidemiological evidence is not sufficient to conclude causal relationships between indoor dampness or mould and any specific human health effect </li></ul></ul><ul><ul><li>There is sufficient epidemiological evidence of associations between dampness or mould and asthma development, asthma exacerbation, current asthma, respiratory infections, upper respiratory tract symptoms, cough, wheeze and dyspnoea. </li></ul></ul>
  19. 19. World Health Organization 2009 (cont’) <ul><li>“ WHO Guidelines for IAQ: Dampness and Mould” </li></ul><ul><li>WHO Regional Office for Europe, Copenhagen, Denmark </li></ul><ul><li>§ 4.4 Synthesis of available evidence on health effects (cont’) </li></ul><ul><ul><li>The mechanisms by which non-infectious microbial exposures contribute to adverse health effects associated with indoor air dampness and mould [remain] largely unknown . </li></ul></ul><ul><ul><li>It is clear…that no single mechanism can explain the wide variety of effects associated with dampness and mould. </li></ul></ul><ul><ul><li>… studies have demonstrated diverse inflammatory, cytotoxic and immunosuppressive responses after exposure to the spores, metabolites and components of microbial species found in damp buildings </li></ul></ul>
  20. 20. World Health Organization 2009 (cont’) <ul><li>“ WHO Guidelines for IAQ: Dampness and Mould” </li></ul><ul><li>WHO Regional Office for Europe, Copenhagen, Denmark </li></ul><ul><li>§ 4.4 Synthesis of available evidence on health effects (cont’) </li></ul><ul><ul><li>Many dampness-associated conditions are likely to involve inflammation </li></ul></ul><ul><ul><li>These include histamine release by mechanisms other than those mediated by IgE , indicating a plausible mechanism for the occurrence of allergy-like symptoms even in non-sensitized people . </li></ul></ul><ul><ul><li>Dampness-associated asthma, allergic sensitization and associated respiratory symptoms may result from repeated activation of the immune defences, exaggerated immune responses, prolonged production of inflammatory mediators and tissue damage, leading to chronic inflammation and inflammation-related diseases, such as asthma . </li></ul></ul><ul><ul><li>See: “Critical Care: Applying Genomics to Inflammation Outcomes”, Environmental Health Perspectives , v113, n12, Dec. 2005 </li></ul></ul>
  21. 21. World Health Organization 2009 (cont’) <ul><li>“ WHO Guidelines for IAQ: Dampness and Mould” </li></ul><ul><li>WHO Regional Office for Europe, Copenhagen, Denmark </li></ul><ul><li>§ 4.4 Synthesis of available evidence on health effects (cont’) </li></ul><ul><ul><li>The observed increase in the frequency of respiratory infections associated with damp buildings might be explained by the immunosuppressive effects of damp building-associated microbes …which impair immune defences and thus increase susceptibility to infections. </li></ul></ul><ul><ul><li>Various microbial agents…are present simultaneously with other airborne compounds, inevitably resulting in interactions in indoor air . Such interactions may lead to unexpected responses, even at low concentrations. </li></ul></ul><ul><ul><li>Therefore, the detection of individual exposures , such as certain microbial species, toxins or chemical agents, cannot always explain any associated adverse health effects . </li></ul></ul>
  22. 22. World Health Organization 2009 (cont’) <ul><li>“ WHO Guidelines for IAQ: Dampness and Mould” </li></ul><ul><li>WHO Regional Office for Europe, Copenhagen, Denmark </li></ul><ul><li>§ 4.4 Synthesis of available evidence on health effects (cont’) </li></ul><ul><ul><li>The synergistic interactions among microbial agents present in damp buildings suggest that the immunotoxic effects of the fungal and bacterial strains typically found can be potentiated during concomitant exposure, leading, for instance, to increased cell death or cytotoxic or inflammatory effects. </li></ul></ul><ul><ul><li>Such interactions can give rise to unexpected responses…so that it is difficult to detect and implicate specific exposures in the causation of damp building-associated adverse health effects </li></ul></ul>
  23. 23. World Health Organization 2009 (cont’) <ul><li>“ WHO Guidelines for IAQ: Dampness and Mould” </li></ul><ul><li>WHO Regional Office for Europe, Copenhagen, Denmark </li></ul><ul><li>§ 4.4 Synthesis of available evidence on health effects (cont’) </li></ul><ul><ul><li>The available estimates…suggest that dampness-related risk factors are associated with a large proportion of human respiratory disease . </li></ul></ul><ul><ul><li>These estimates, for imprecisely defined risk factors, cannot indicate true causal relationships and must be interpreted with caution, but they suggest that some dampness-related risk factors contribute substantially to the burden of human respiratory disease . </li></ul></ul>
  24. 24. Information on mold & bacteria <ul><li>Sources of reliable information </li></ul><ul><li>CDC, National Center for Environmental Health: “Mold” </li></ul><ul><li>http://www.cdc.gov/mold/default.htm  </li></ul><ul><li>AIHA: “The Facts About Mold” </li></ul><ul><li>http://www.aiha.org/Content/AccessInfo/consumer/factsaboutmold.htm  </li></ul><ul><li>California Dept. Health Services: “Mold-Related Links” </li></ul><ul><li>http://www.cal-iaq.org/cal-iaq%20moldinformation.htm  (**WOW!**) </li></ul>
  25. 25. <ul><li>Wisconsin Department of Health Services: “ Mold: Frequently Asked Questions ” </li></ul><ul><li>http://dhs.wisconsin.gov/eh/HlthHaz/fs/MoldFAQs.htm  </li></ul><ul><li>Minnesota Department of Health: “Mold in Homes” </li></ul><ul><li>http://www.health.state.mn.us/divs/eh/indoorair/mold/index.html  </li></ul><ul><li>“ Fungal glossary” at University of Minnesota , DEHS </li></ul><ul><li>http://www.dehs.umn.edu/iaq_fib_fg_gloss.htm  </li></ul>Information on mold & bacteria (cont’)
  26. 26.
  27. 27. Questions? <ul><li>Thank you! </li></ul><ul><li>Wane A. Baker, P.E., CIH </li></ul><ul><li>MICHAELS ENGINEERING </li></ul><ul><li>La Crosse, Milwaukee, Green Bay and St. Paul </li></ul><ul><li>608/785-1900 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Website: www.MichaelsEngineering.com </li></ul>

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