"Asthma and Sick Building Syndrome are commonly reported ... (studies suggest) such symptoms in schools are related to exposures to volatile organic compounds (VOCs), molds and microbial VOCs, and allergens." (Lawrence Berkeley National Laboratory, Daisey et al, 2003)
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The Centers for Disease Control, at the request of The Center for School Mold Help (SMH), has made a number of significant updates to their online Mold and Health information. These are presented below, with a background and commentary on the process involved, as well as remaining problems. It is the opinion of SMH that the CDC is beginning their long-awaited progress in this area, while still clinging to past opinions that can continue to harm the American public. We continue to call on the CDC, to fully inform the public about all important findings by WHO (2009) and IOM (2004) related to dampness, mold, and health, at the very least.
The CDC has, next to its online logo, "The Centers for Disease Control, Your online source for credible health information." We want them to live up to that statement, when it comes to mold and health - as well as everything else! (SMH)
Highlighted areas: yellow – recent updates to CDC site; green - future areas to be updated by CDC; blue - of concern to SMH
The CDC’s NCEH is responsible for the mold info content (Dr. Howard Frumkin, Director, NCEH)
Starting in Jan., 2009, The Center for School Mold Help (SMH) began writing the Centers for Disease Control and Prevention (CDC) regarding concerns about the inaccuracies, missing information, and misleading statements within their mold information, online. Responses were received from CDC (Acting) Director, Dr. Richard E. Besser, Dr. Paul L. Garbe, Chief of the Air Pollution and Respiratory Branch (NCEH, CDC), and Dr. Howard Frumkin, Director of the National Center for Environmental Health (NCEH, CDC). A phone meeting was held with Dr. Garbe, in October, 2009. In communications during Oct. and Nov., 2009, Dr. Garbe and Dr.Frumkin agreed to update the CDC Mold website information to include the findings of the IOM Damp Indoor Spaces and Health (May, 2004) (findings missing on the CDC site since that date) and WHO Guidelines to Indoor Air Quality: Dampness and Mould (July, 2009), stating the CDC had been unaware of the latter. Ongoing notifications of these updates occurred, with letters to SMH through Dec. 10, 2009 by Dr. Frumkin.
The main updates involve five pages of the CDC Mold Information website. These are reproduced below, in their entirety. Some of the CDC updates did include health effects associated with exposure to dampness and/or mold, including those with limited or suggested evidence, by the IOM (2004), with the most prominent of these pertaining to the development of new asthma as a potential health effect. However, in other parts of these updates, the findings of the IOM related to health effects of dampness and mold were poorly represented, as in the new CDC Summary of the IOM (2004) findings, which undermines the IOM information in a confusing manner, inconsistent with the IOM self-reported conclusions. Dampness as a public health threat, a major conclusion of the IOM, is not even mentioned. Throughout the current CDC information, health effects resulting from exposures to mold and dampness are minimized, thus the CDC Mold information presents a continuing danger to the general public, and a cause for increased disease, counter to its mission.
Dr. Frumkin has promised future inclusion of the WHO Guidelines to Dampness and Mould information but has stated that the individuals who would do so are working on the pandemic at present, implying there may be a significant delay. SMH is concerned with this delay, as there is a current United States / worldwide asthma epidemic and WHO has concluded that there is enough current evidence to associate new development of asthma with indoor dampness exposures, a vital health effect to report in a timely manner – which is at this writing, 6 months overdue. In addition, dampness and its associated health effects places people more at risk for severe outcomes with the H1N1 virus.
There is, as yet, no mention of some very important WHO findings, such as, but not limited to:
The [WHO] review concludes that the most important effects are increased prevalences of respiratory symptoms, allergies and asthma as well as perturbation of the immunological system.” (WHO Abstract, p. IV)
“Indoor air pollution – such as from dampness and mould, chemicals and other biological agents – is a major cause of morbidity and mortality worldwide.” (WHO Abstract,p. XI)
Studies after 2003 show indoor dampness is (now) associated with development of new asthma. “
Studies after 2003 show indoor dampness is (now) associated with development of new asthma. “We found that there was sufficient evidence for associations between indoor dampness and four health outcomes that were not so classified or were not evaluated by the
Medicine (2004): asthma development, dyspnoea, currentasthma and respiratory infections. Asthma development is a health outcome of particular public health importance.” (WHO, p. 72)
“Exposure to microbial contaminants is clinically associated with respiratory symptoms, allergies, asthma and immunological reactions.” (WHO, Executive Summary, p. XII)
“ …for asthma exacerbation,we consider that there is almost enough evidence to meet the criteria of causality for dampness-related agents.” (WHO, p.78)
There is sufficient epidemiological evidence of associations between dampness or mould and asthma development, asthma exacerbation, current asthma, respiratory infections (except otitis media), upper respiratory tract symptoms, cough, wheeze and dyspnoea. (WHO, p. 90)
There is sufficient clinical evidence of associations between mould and other dampness-associated microbiological agents and hypersensitivity pneumonitis, allergic alveolitis and mould infections in susceptible individuals, and humidifier fever and inhalation fevers. This is the only conclusion that is based primarily on clinical evidence and also the only conclusion that refers explicitly to microbial agents, as opposed to dampness-related factors. (WHO, p. 90)
“…both atopic and nonatopic people are susceptible to adverse health effects from exposure to dampness and mould.” (WHO, p. 90)
“…both allergic and non-allergic mechanisms may be involved in the biological response.” (WHO, p. 90)
Dr. Frumkin has included a link in the Key Resources section to the WHO guidelines (2009) in its entirety, but this may not be read by many, as it is 227 pages long. However, based on the poor quality of the CDC-generated Summary of the IOM Damp Indoor Spaces and Health (2004), SMH is concerned that the quality of the future CDC-generated WHO Summary is a factor to consider. SMH feels that it is imperative to accurately represent all warnings to the public about indoor dampness and mold, along with all the health effects that might be associated for atopic and nonatopic people.
The conclusions, of the CDC-initiated study of the IOM have been, essentially, withheld from public view for five years. These have not been fully applied to health information on mold by the CDC, only now having been marginally included, at the request of The Center for School Mold Help. In fact, the conclusions have been misrepresented, as described above. Continuing to withhold vital conclusions of the IOM and WHO, minimizing the dangers of exposures to indoor dampness and mold places the public health at grave risk, in addition to its notable impact on economic and healthcare burdens in the
United States. Indeed, even the risks from the pandemic are heightened, as those with respiratory and immune-system disorders are at more risk for severe reactions. Without accurate information about the dangers of mold and dampness in indoor environments, the impetus to prevent and solve mold problems is weakened. We ask for the direct oversight and intervention by Dr. Thomas Frieden, newly appointed Director of the CDC, and President Barack Obama for the entire process of the updating of the CDC Mold information on its website and in all its literature and presentations. We invite the public and mold researchers, including those key experts for the IOM and WHO reports, to monitor the CDC Mold pages (the URL’s and current CDC content follow, in this document) and send their input to Dr. Frieden and President Obama, as well.
The public, our physicians, and the world relies on the United States Centers for Disease Control to communicate accurate, current information that protects the public health. We insist that this standard be applied to indoor mold and dampness exposure information.