Environmental & Occupational Disease Epidemiology.

EODE is all about looking after the health and safety of New Yorkers. EODE helps to look after the environment where New Yorkers work, rest and play and contributes to protecting them from the potential dangers of contaminants that can develop from man made and natural materials that trigger illness and disease. The (DOH) Department of Health and the (HRA) Human Resources Administration in New York City alongside the Mt. Sinai Occupational Health Clinic assembled a highly knowledgeable panel to investigate Stachybotrys atra (greenish black mold) conditions in inside areas. The whole reason behind the assembly was to address the contamination caused by Stachybotrys atra (full name Stachybotrys Chartarum) in medical and environmental terms. In New York City during the 1990's reports of several buildings contaminated with mold growth brought awareness of this problem to the attention of health professionals. Guidelines were placed and a document was drafted, however these have all being revised to include the dangers of all types of mold and fungi. The document focus's on the comments and content made by experts on the review panel that include top people from health sciences and microbiology The intention of the document was initially for health professionals, building managers, engineers, environmental consultants but is now also for anyone concerned about stachybotrys atra contamination. The document that has been produced is a guideline and not a legal document; so far there are no proper regulations in place through the USA Federal, New York City or New York State for the health effects caused by the contamination of fungi/mold and the remediation. The guideline focus's on the contamination of buildings caused by mold especially through the ventilation systems, air conditioning units, fans, filters and support beams. Other household elements like bathrooms, cleaning products, aerosols, moisture from condensation and out of date food are also included in the concerns. People should take special notice to food and discard any out of date, or old food produce! The document outlines the potential effects of fungal contamination, to include medical assessments, procedures for remediation, risk communication, and environmental issues. It has been separated into 4 units that include health and environmental issues, hazard communication and remediation

The guidelines are now going to include all related problems to fungi because of these reasons: Fungi comes in many harmful species like Memnoniella, Fusarium, Trichoderma, and the cultures Penicillium and Aspergillosis and alongside Stachybotrys atra can develop highly dangerous mycotoxins. These are actually recognized as fungal toxic components that cause health problems so therefore Stachybotrys atra can't be singled out as the only indoor potent toxic problem. A variety of fungi can contain spores, fragments and metabolite compounds that when inhaled can encourage immunologic reactions, trigger allergies, develop infections and cause toxic effects. Anyone involved in the cleaning or repairing of fungal problems or renovating buildings are at a high risk of exposure to (ODTS) Organic Dust Toxic Syndrome or open to (HP) Hypersensitivity Pneumonitis which causes inflammation of the lungs from breathing in these foreign particles. ODTS can actually come on very quickly after being open to any of these potent particles and will begin with flu like symptoms. The difference between HP and ODTS is that HP usually occurs after continuous exposure and failure to use adequate protection against the allergen and it can also lead to major lung damage and in some cases this can become permanent. ODS is caused by a variety of toxic components including common fungi/mold. Allergic reactions are a common cause of exposure to fungi with symptoms being either a cough, nasal congestion, itchy eyes, runny nose, dermatiits and aggravated asthma. Unfortunately some form of fungi is found in many areas inside and outside. These health complaints caused by fungi are recorded, however evidence suggests that most problems were caused by eating contaminated foods. Exposure to inhalation in some agricultural environments was recorded at quite a high level while during the performance of remedial work levels were quite low. The common complaints from the inside environments were, headaches, fatigue, eye problems, runny nose, coughs and aggravated asthma. Reports have also been made from offices, where workers have been exposed to fungi from neglected surfaces, the same applies to residential buildings. Again symptoms of respiratory complaints, eye problems, nausea and fatigue were typical of cases affected by exposure to contaminated dust.

Infectious disease from fungi is really a worry for those with particularly low immune systems and people recuperating after surgery. Aspergillosis is the most common health complaint among these people and can become quite severe. The component Aspergillus found in some fungi can cause various types of this disease, the most common being fumigatus. In a normal healthy person this type of mold should not have an effect.

In children the symptoms can be much more severe, especially in babies under 6 months old. It has been reported that exposure to SC could be a probable cause for Pulmonary Hemorrhaging (bleeding of the lungs). It is not known for sure why this happens, but cIT ould be because it existed alongside other factors, like smoking, water damage, and other fungal components associated with SC. If a child under 6 months lives in a damp environment and experiences breathing problems or nosebleeds they should get a medical assessment straight away and a screening for alveolar hemorrhage. Air testing should be carried out in order to establish if the home is healthy enough for a child of this age.

Remedial work must start straight away if fungi is noticed in a building to maintain a healthy environment. Repairs of any kind regarding water leaks, added moisture levels and high condensation levels should be dealt with immediately. Speed is of the essence to make these repairs, however proper specific fungal remedies should be used. The document states what methods of remediation to use and how to assess mold damage. To prevent contamination when entering a moldy environment gloves must be worn, and full face protection for the respiratory system and eyes must be used . For large works like air conditioning or ventilation systems where people may occupy the space then the need for specialist health and safety people experienced in remediating building maintenance should assess the safety levels and carry out repairs. The original source of the cause needs to be addressed as soon as possible to prevent further mold damage and higher levels of contamination. People who persistently have allergic reactions like wheezing, sensitive eyes, shortness of breath or tightness in the chest and asthma and rhinitis sufferers will increase their health problems if they spend time in fungi infested buildings. Anyone feeling increased symptoms after exposure to fungi should see a medical specialist who is trained in environmental or occupational medicine. The results of an expert will decide whether a place is habitable, and unless the fungal contamination is widespread or linked with any of these medical complaints evacuation is usually not necessary.

Testing. If fungi is found through assessment or sample results then it does not automatically mean it will cause harm to your health. The spores, metabolites or fragments must be in the air and then inhaled, be eaten or touched. The nature of the fungi determines whether a human would be infected and also the initial health of the person. The material is important also as it can either cause allergic, infectious or toxic reactions. In general it is impossible to test the safe and unsafe levels of exposure as each individual has a different genetic marker. Unfortunately tests that can evaluate the time, place, and source of the exposure are not yet available. Although exposure can be detected in the body, it cannot tell us any more information! Before evacuating a building it must be checked by an environmental/occupational health expert, who will carry out a level assessment. They will check for smells, damaged materials, water damage, and the obvious presence of spores. The growth of mold spores usually indicates some water damage. Air conditioning and ventilation systems should be checked and cleaned. Other culprits are wallboard, paper, cardboard, leather, and ceiling tiles. Moisture meters can be quite useful as can boroscopes to help find hidden problems. Samples only really need to be taken to test for specific components for medical purposes if someone has been experiencing symptoms of fungal exposure. The samples will be scraped from the exposed mold and placed in a clean plastic bag, or by using a swab and stripping the area with clear tape. Normally the method of remediation can be selected through a visual examination but on occasion air sampling is done but this has proven unreliable in testing contamination. It will probably be carried out if someone has been diagnosed with a fungi related illness like Pulmonary Hemorrhage or Aspergillosis. Air sampling is an important factor if a ventilation or air conditioning system is suspected or proved to have dust contamination. If there is a musty smell yet no visual proof of fungi then air sampling can be useful as it can help to locate the source, like behind walls for example.

Analysis of Samples. Any samples taken will be identified in a laboratory by microscopic methods under the expertise of an environmental science specialist. The results of any surface or air samples will be analyzed and documented accordingly. The AIHA (American Industrial Hygiene Association has authorized microbial laboratories to participate in efficient testing every quarter known as EMPAT (Environmental Microbiology Proficiency Testing Program). Very few surface samples found or traces of spores will be recorded as background, however any evidence higher than this that contains (hyphae and conidiophores could mean fungal growth near the area the sample was taken from. Air samples should be compared between 30 separate sample taken inside and outside and by fungal species. In an unaffected building the inside and outside samples should be similar, so different levels could mean excessive moisture caused by fungal presence that could become a problem.

Basic Rules. If the building is classed as problematic then remediation should take place within 48 hours and include removal of any mold damaged materials, a total clean up and location of the source of the problem. There are some basic rules to removing and repairing fungal/mold damage while making sure the workers are protected while performing the job. Any non-porous items like glass, plastics and metal should not be effected, but should be thoroughly cleaned. Any semi-porous material like wood that has becoe moldy but not damaged can be cleaned with a detergent and reused. All porous materials should be discarded! A fungal expert should be able to measure the contamination and determine what materials can be saved and what can't. All reusable items and materials should be mold free and dry. Continuous inspections should be carried out regularly to inspect the remediation process. During remediation it is advised not to use aerosols or vapor-phased products as it is unknown what effect they may have on the people returning to use the area. For further information on this subject see the document of The American Conference of Governmental Industrial Hygienists concerning Bio aerosols

Assessment and Control. Remediation should be carried out by trained people that can be part of a program in accordance with OSHA (Occupational Safety and Health Administration) training. This would be an ideal option for building maintenance staff. It is usually not necessary to totally vacate a building but if there are children or people with low immune systems, people who suffer from asthma or anyone with chronic lung problems it is advisable for these people to leave the area. Misting surfaces before starting remediation is recommended to suppress dust. All damaged materials and items that cannot be saved should be placed in a plastic bag. After removing all damaged goods and the area has been cleaned with a detergent it should be HEPA vacuumed and left to dry completely. Its always advisable to get advise from a professional associated with microbial testing and investigations before remediation. To comply with OSHA, personnel carrying out the remediation should be equipped with full face respirators, gloves and be trained in dealing with hazardous materials. All the areas surrounding the problematic area should be protected and secured with plastic sheeting, ventilation and grills should be switched off and sealed and the rest of the areas should be free of people.

When large areas of mold growth are discovered then the building management, employers and owner should inform all the occupants especially those in and around the contaminated areas. There should be an official remediation plan, meetings should be held regarding remediation plans, and in some cases HVAC manufacturers, and system installers should be contacted in order to ensure the correct cleaning products are used. Anyone seeking medical attention as a result of the contamination should have a full inspection document to give to their doctor or specialists. The overall conclusion is to repair the original source of the contamination, and in all cases any water related problems should be dealt with in the first instance. Repairing any damaged area promptly will prevent the growth of the mold and further damage to materials. Before allowing people to occupy a once contaminated area, the air quality should be monitored to ensure the problem is solved. For any information regarding the guideline document contact the New York City Department of Health at (212) 788-4290 / 4288.