Producing a Science-Based Policy Statement (California) on Indoor Dampness, Mold, and Health

1. Producing a Science-Based
Policy Statement (California)
on Indoor Dampness,
Mold, and Health
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
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2. This presentation will describe the
background to a CDPH statement
on dampness, mold, and health in California
CA Toxic Mold
Protection Act The mandate for a mold policy
of 2001
What we know now
“CDPH has concluded that the presence of water damage,
dampness, visible mold, or mold odor in … indoor
environments is unhealthy
What we did
We recommend against measuring indoor microorganisms ...”
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3. 1990s: Great public concern about
indoor molds and health, but
limited scientific knowledge
“My Toxic
Mold Story”
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4. Dampness, Mold, and Health — Policies
• 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%20U
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5. 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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6. D, M, H — How do we know?
• 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)
• Available online at EHP
http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1002410?
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7. D, M, H — How do we know?
• Evident dampness or • Measured microbiologic
mold (any) factors (50+ metrics)
 Visible water damage  In air or dust
• Total culturable fungi
 Visible moisture
• Specific culturable fungi
 Leaks (now or past)
• Mold spore counts
 Visible mold • 1-3-beta glucans
 Mold odor • Total culturable bacteria
• Endotoxin, etc, etc
= qualitative = quantitative
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8. D, M, H — What do we know about risk?
• Qualitative dampness/mold exposures and
health
 NO documented “causal” relationships
 Documented “associations” (i.e., sufficient evidence)
o Asthma development* o Respiratory infections*
o Current asthma* o Dyspnea*
o Asthma exacerbation o Wheeze
o Cough
evidence
strongly
o URT symptoms
suggestive of
* new conclusion since 2004 IOM review
causation
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9. D, M, H — What do we know about risk?
• Quantitative microbial exposures !
Paradox
 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!
!
Paradox  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
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10. D, M, H — What can we do?
• 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
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11. D, M, H — What we know SUMMARY
• Health effects associated with evident
dampness or mold (qualitative)
 Asthma development, exacerbation, and current asthma
 Respiratory infections
 Upper and lower respiratory symptoms
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12. D, M, H — What we know SUMMARY
• 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
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13. 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
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14. CDPH Statement on Building Dampness,
Mold, and Health (September 2011)
• 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
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15. In summary, CDPH has made a science-based
recommendation to the public
about dampness and mold
Assess dampness and mold these ways:
Not this way:
Questions?
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