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Latestfindingsonwaterdamageandmouldinbuildings

CONFERENCEPAPER·AUGUST2014

DOI:10.13140/2.1.1324.1600

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1AUTHOR:

CedricDCheong

EndeavourCollegeofNaturalHealth

58PUBLICATIONS31CITATIONS

SEEPROFILE

Availablefrom:CedricDCheong

Retrievedon:23October2015

Latest findings on water damage

and mould in buildings

Cedric Cheong

Cedric Cheong

• Lecturer

• Endeavour College of Natural Health

• Murdoch University

• Notre Dame University

• Speaker / Trainer

• Local government, facility

management, mining

• Qualifications

• MSc. B. Env Sci

• Cert IV TAE, WHS

• IICRC – mould & water damage

• Certified Asbestos assessor

• Certified Environmental Practitioner

• Memberships

• Australian College of Nutritional and

Environmental Medicine

• Global Indoor Health Network

• Air Pollution Health Network

• Healthy Hotels Advisory

Topics• Current state of mould research evidence

• Why focus on indoor mould?

• Exposure limits for mould

• Health impacts

• Mechanism of illness

• Damp housing and health

• Summary of responses from Management of Mould

Workshop re guidelines for EHOs

IEQ, Fungi and Health

• IEQ and Mould

– Exposure to damp / water damaged indoor environments is the main factor associated with many adverse health effects*

2,3

– In Australia, 1 in 3 homes are water damaged and

have mould and costs hundreds of millions of dollars in repair bills every year*

5

– In the US, 1 in 2 homes are reported to have dampness and mould issues*

4

Fungi and Health• Majority of healthy

individuals – exposure to fungi in indoor

environments would not normally cause any reactions or health effects

• In most cases, occupants report musty or damp odours

– Do not take much more notice

than that, due to the natural defences of the human body

Fungi and Health• For certain susceptible individuals

• Impaired or immature immunological

or respiratory systems

• very young or the elderly,

• individuals with predisposed genetic predisposition

• Even short-term low level exposure to fungi could lead to or exacerbate medical health conditions

• Susceptibility to fungal exposure – varies with genetic predisposition, age, health status,

and concurrent exposures

Why Focus on Indoor Mould?

• Unlike bacteria and viruses

Mould do not have to be alive to cause

adverse health effects

• Every part can cause a reaction

–Spore, cell wall components

–Allergen

–Protein

–Broken hyphae

–Mycotoxins, MVOCs

Mould Remediation = Physical removal

• Physical removal of all mould

–including active mould growth, mould laden

dust, physical components, mycotoxins and

fungal propagules.

• Structure of fungi, has an epoxide ring,

which makes non-viable fungal spores,

fragments and mycotoxins extremely hard to

destroy

Current Research Evidence• Credible research & cognizant health authorities

have confirmed links between health problems

(asthma & upper respiratory problems) & indoor

dampness & mould

– World Medical Association (WMA) – October 2013

– American Industrial Hygiene Association (AIHA), March 2013

– ASHRAE, January 2013

– National Collaborating Centre for Environmental Health

(NCCEH), July 2012

– National Institute for Occupational Safety and Health (NIOSH) &

Centre for Disease and Prevention (CDC), November 2012

– Global Indoor Health Network (GIHN), December 2012

– New York State (Mould Task Force), 2010

– World Health Organisation (WHO), 2009

– Institute of Medicine (IOM), 2004

Cheong, C. 2013, ACNEM Journal Vol 32, No 3, pp 10-16.

Exposure Limits for Mould

• There are no recommended quantitative /

numerical, health-based microbial exposure

guidelines or thresholds

–Previously published but many retracted

• Current acceptable approach

–Visible mould growth indoors, regardless of

species or amount, is inappropriate and needs to

be removed.

Health effects

Mechanism of illness

Damp housing

Indoor dampness

• Defined as the presence of unwanted

and excessive moisture (or even liquid

water) in buildings.

Scientifically verified symptoms

associated with WDB mould exposure

• Asthma exacerbation

• New onset asthma

• Upper respiratory tract

– sore throat

– conjunctivitis

– allergic rhinitis

– nasal congestion

– runny nose

• Cough, wheeze

• Hypersensitivity

pneumonitis

– in sensitive people

• Dyspnea

– shortness of breath

• Respiratory infections

• Bronchitis

• Eczema

• Common cold

• Allergy / atopy

Mechanism of illness

• Allergic & inflammatory responses (Allergens)

– Asthma (new onset & exacerbations), allergic rhinitis,

hypersensitivity pneumonitis & allergic pulmonary

aspergillosis (ABPA)

• Systemic Infections (Pathogens)

– pulmonary inflammatory disease, immune suppression

and modulation, subcutaneous mycosis,

histoplasmosis, aspergillosis

• Acute and Chronic toxicity (Toxins)

– Mitochondrial toxicity, carcinogenicity, renal toxicity,

neurotoxicity, Mycotoxicosis, poisoning

Routes of Exposure• Airborne exposure (inhalation) is the most

significant exposure route in water damaged

indoor environments

–Respirable particles (2.5 microns)

• Hyphae, spores, fungal fragments,

mycotoxins (macrocyclic

trichothecenes, T2 mycotoxins)

–Fungal fragments released at 320 x

higher

– Increased reactivity – smaller (< 1.0

micron, penetrate deeper)

Routes of Exposure• Transdermal / Absorption

–Contact with mycotoxin contaminated items,

spores

–Cross contamination

• Bring belongings to new locations

• Continual exposure despite leaving

contaminated environment

• Foodborne / Ingestion

• Spores, mycotoxins, hyphae

Mechanism of illness

• Illness or injury triggered by exposure and

mediated by oxidative stress

–Imbalance between reactive oxygen species

and biological system’s ability to detoxify or

repair damage

–Production of peroxides and free radicals

• Damage components of cells, proteins, lipids, DNA

–Development of cancer

Oxidative stress in WDB

• Oxidative stress is a significant mechanism

of illness from exposure to water damaged

buildings (WDB)

–Ochratoxin A (OTA) found in elevated levels

in persons in WDB

Neurocognitive Damage

• Exposure to WDB and toxigenic moulds

–Affects neurological tissues – IQ & cognitive

–Study in Poland of children exposed to indoor mould

for > 2 years

• Statistically significant reduction of 10

points in IQ

• Longer exposure tripled the risk for

low IQ scores

Neurocognitive Damage

• Exposure to WDB and toxigenic moulds

–Strong association with Depression

• Independent of individual & housing

characteristics

• Dysregulate emotions through a hypo-

activation of the frontal cortex

• Compounded by stress of chronic illness (from

mould) and the stress of dealing with mould

• Perception of control over health and physical

health

Neurocognitive Damage

• Common behavioural symptoms

–Difficulty concentrating

–Fatigue

–Dizziness

–Impaired memory

–Thinking slowly

–Problems following

instructions

–Headaches

–Increased frustration

–Difficulty dealing with

people

Neurocognitive Damage

• Impairment of brain function

–Reaction time

–Balance

–Colour vision

–Visual fields

–Strength (grip)

–Memory

–Attention span

–Electrical conduction

–Cognitive test

abnormalities

Housing & Health

• Housing problems & residents

emotional problems

–Strong association

• Housing quality with psychological

distress and depression

–Over crowding, noise, indoor air

quality, housing type, floor level

Damp housing & Health

• Studies using both objective and subjective

measures of dampness & mould showed

associations with depression and reports of

emotional distress

–Also reported problems with physical

energy, sleep and social isolation

Damp housing & Health

• Possible reasons

1.Psychological & financial stress of “keeping

a house clean” in the face of recurrent

mould outbreaks

2.Housing linked to perception of control

• People faced with high demands but low

control experience elevated risk of

anxiety & depression

Damp housing & Health

• Living in a damp & mouldy dwelling is

linked with poor physical health outcomes

1. Respiratory problems

2. Asthma (new onset & exacerbation)

3. Diarrhoea

4. Nausea

5. Headaches

• Never ending cycle of illness

leading to anxiety and depression

Latest Research

• More research needed :

–Depressed individuals tend to their home in a

manner that allows mould to grow

–Individuals in emotional dire straits drift

towards poor housing

Development of Guidelines

• Department of Health have begun preliminary

work on the development of guidelines for the

management of mould in properties.

–Currently conducting research and background work

–Will develop a draft guideline

–Will be sending out a draft for feedback from relevant

stakeholders including EHOs, real estate, inspectors,

remediators and industry experts

Received feedback from EHOs at Monday’s workshop for inclusion in guidelines

–Tenants/Occupants/Owner’s requirements /

responsibilities for keeping a property maintained

and preventing conditions that will lead to water

damage and mould growth.

–Limits or guidelines for when the property is to be

deemed not habitable.

–Methodology for inspecting and sampling for water

damage and mould

–Methodology for the proper remediation of water

damage and mould

–Requirements for clearance testing

Contact: - Endeavour College of Natural Health

- Dept: Biosciences and Social Sciences

- cedric.cheong@endeavour.edu.au- (08) 9225 2919

Questions