damp mold-hlth+policy hb-2012-jm
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Mark J. Mendell (Mark.Mendell@cdph.ca.gov)
Janet M. Macher (Janet.Macher@cdph.ca.gov)
Kazukiyo Kumagai
Jed Waldman
Indoor Air Quality Section, EHLB
California Department of Public Health (CDPH)
2012 July
Producing a Science-Based Policy Statement (California) on Indoor Dampness, Mold, and Health
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The mandate for a mold policyCA Toxic Mold Protection Act
of 2001
This presentation will describe the
background to a CDPH statement on dampness, mold, and health in California
What we know now
What we did“CDPH has concluded that the presence of water damage, dampness, visible mold, or mold odor in … indoor environments is unhealthy
We recommend against measuring indoor microorganisms ...”
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1990s: Great public concern about
indoor molds and health, but limited scientific knowledge
“My Toxic Mold
Story”
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• CA Toxic Mold Protection Act, 2001 (SB 732, ) CDPH mandated to assess feasibility of setting health-
protective limits for mold exposure, analogous to chemicals
If feasible, to set exposure limits with consideration of technological and economic feasibility
• No funding provided
• CDPH response, 2005 Not feasible to set measured “mold” limits Insufficient scientific evidence available
No standards set• http://www.cdph.ca.gov/programs/IAQ/Documents/SB732-LegReport-Final.pdf
• http://www.cdph.ca.gov/programs/IAQ/Documents/SB%20732%20Implementation%20Update%20July%202008.htm
Dampness, Mold, and Health — Policies
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D, M, H — Background
What was known about dampness, mold, and health?
• Long-recognized effects of mold Allergy in susceptible persons
Respiratory sensitization, at high occupational levels
Infections, in immunocompromised individuals
• Recent research and multiple reviews 2004–2011 Expand and clarify what we know
Evidence links dampness/mold to a wider range of respiratory health effects, including non-allergic ones
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• What is the scientific basis of what we now know about d,m,h? Two expert panel reviews —
• Institute of Medicine (IOM) 2004 (www.nap.edu/openbook.php?isbn=0309091934 )
• World Health Organization (WHO) 2009 (http://www.euro.who.int/__data/assets/pdf_file/0017/43325/E92645.pdf)
Mendell, Mirer, Cheung, Tong, and Douwes, Environ Health Perspect 2011*
• Updated WHO review
• Summarized 145 studies with two kinds of exposure metrics Evident indoor dampness or mold (qualitative)
Measured microbiologic factors (quantitative)
D, M, H — How do we know?
• Available online at EHP http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1002410?
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• Evident dampness or mold (any)
Visible water damage
Visible moisture
Leaks (now or past)
Visible mold
Mold odor
• Measured microbiologic factors (50+ metrics)
In air or dust
• Total culturable fungi
• Specific culturable fungi
• Mold spore counts
• 1-3-beta glucans
• Total culturable bacteria
• Endotoxin, etc, etc
D, M, H — How do we know?
= qualitative = quantitative
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• Qualitative dampness/mold exposures and health NO documented “causal” relationships
Documented “associations” (i.e., sufficient evidence)
* new conclusion since 2004 IOM review* new conclusion since 2004 IOM review
o Asthma development*
o Current asthma*
o Asthma exacerbation
o Respiratory infections*
o Dyspnea*
o Wheeze
o Cough
o URT symptomsevidence strongly
suggestive of causation
D, M, H — What do we know about risk?
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• Quantitative microbial exposures
NO documented “causal” relationships
NO documented “associations”
“Limited/suggestive” associations —
NONE with air, but several with microbial compounds in dust Few studies available
Both increased and decreased risks!
Recently, DNA-based assay (PCR index) of fungi in house dust predicted asthma, but this is the only strong study
• Quantified microbial exposures not consistently associated with adverse health effects
Paradox!Paradox!
Paradox!Paradox!
D, M, H — What do we know about risk?
101010
• Expert review on housing remediation (Krieger et
al., 2010) Combination of
• Elimination of moisture intrusion and leaks and
• Removal of moldy items
• Sufficient evidence of effectiveness for reducing respiratory symptoms from asthma and allergies, and
• Ready for widespread implementation
D, M, H — What can we do?
111111
• Health effects associated with evident
dampness or mold (qualitative)
Asthma development, exacerbation, and current asthma
Respiratory infections
Upper and lower respiratory symptoms
D, M, H — What we know SUMMARY
121212
• Specific causal agent(s) have not been identified
The inconsistent associations with measured microbial factors are not yet understood
• Best current public health strategy
Prevention / remediation of evident dampness or mold
Not decisions based on microbiologic measurements
To provide guidance, CDPH released a
“Statement on Dampness, Mold, and Health”See full 2-page statement at: www.cal-iaq.org
http://www.cal-iaq.org/phocadownload/statement_on_building_dampness_mold_and%20health2011.pdf
D, M, H — What we know SUMMARY
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CDPH Statement on Building Dampness, Mold, and Health (September 2011)
• The presence of water damage, dampness, visible mold, or mold odor in schools, workplaces,
residences, and other indoor environments is
unhealthy
• We recommend against
Measuring indoor microorganisms
Using the presence of specific microorganisms to
determine the level of health hazard or the need for urgent remediation
141414
• We strongly recommend addressing water damage,
dampness, visible mold, and mold odor
Identify and correct the source of water that may
allow microbial growth or contribute to other problems
Rapidly dry or remove damp materials
Clean or remove mold and moldy materials, as
rapidly and safely as possible, to protect the health and
well-being of building occupants, especially children
CDPH Statement on Building Dampness, Mold, and Health (September 2011)
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Questions?
Assess dampness and mold these ways:
In summary, CDPH has made a science-based recommendation to the public about dampness and mold
Not this way:
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