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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?

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• 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?

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• 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

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• 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

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• 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: