Publications

Review of health hazards and prevention measures for response and recovery workers and volunteers after natural disasters, flooding, and water damage: mold and dampness

Johanning E, Auger P, Morey PR, Yang CS, Olmsted E.

Abstract

Health problems and illnesses encountered by unprotected workers, first-responders, home-owners, and volunteers in recovery and restoration of moldy indoor environments after hurricanes, typhoons, tropical storms, and flooding damage are a growing concern for healthcare providers and disaster medicine throughout the world. Damp building materials, particularly cellulose-containing substrates, are prone to fungal (mold) and bacterial infestation. During remediation and demolition work, the airborne concentrations of such microbes and their by-products can rise significantly and result in an exposure risk. Symptoms reported by unprotected workers and volunteers may relate to reactions of the airways, skin, mucous membranes, or internal organs. Dampness-related fungi are primarily associated with allergies, respiratory symptoms or diseases such as dermatitis, rhinosinusitis, bronchitis, and asthma, as well as changes of the immunological system. Also, cognitive, endocrine, or rheumatological changes have been reported. Based on the consensus among experts at a recent scientific conference and a literature review, it is generally recommended to avoid and minimize unnecessary fungal exposure and use appropriate personal protective equipment (PPE) in disaster response and recovery work. Mycologists recommend addressing any moisture or water intrusion rapidly, since significant mold growth can occur within 48 h. Systematic source removal, cleaning with "soap and water," and "bulk removal" followed by high-efficiency particulate air vacuuming is recommended in most cases; use of "biocides" should be avoided in occupied areas. Public health agencies recommend use of adequate respiratory, skin, and eye protection. Workers can be protected against these diseases by use of dust control measures and appropriate personal protective equipment. At a minimum, a facial dust mask such as the National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirator should be used for mold remediation jobs. For any large-scale projects, trained remediation workers who have medical clearance and use proper personal protection (PPE) should be employed.

Environ Health Prev Med. 2014 Mar;19(2):93-9. doi: 10.1007/s12199-013-0368-0.Epub 2013 Nov 20.

Eckardt Johanning, M.D. , M.Sc., Manfred Gareis, DVM (BAFF-Kulmbach, FRG), Wayne Gordon (MSMC, New York, USA)
Occupational and Environmental Life Science Fungal Research Group Foundation, Albany, N.Y.

Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment

E Johanning 1, R Biagini, D Hull, P Morey, B Jarvis, P Landsbergis

Abstract

There is growing concern about adverse health effects of fungal bio-aerosols on occupants of water-damaged buildings. Accidental, occupational exposure in a nonagricultural setting has not been investigated using modern immunological laboratory tests. The objective of this study was to evaluate the health status of office workers after exposure to fungal bio-aerosols, especially Stachybotrys chartarum (atra) (S. chartarum) and its toxigenic metabolites (satratoxins), and to study laboratory parameters or biomarkers related to allergic or toxic human health effects. Exposure characterization and quantification were performed using microscopic, culture, and chemical techniques. The study population (n = 53) consisted of 39 female and 14 male employees (mean age 34.8 years) who had worked for a mean of 3.1 years at a problem office site; a control group comprised 21 persons (mean age 37.5 years) without contact with the problem office site. Health complaints were surveyed with a 187-item standardized questionnaire. A comprehensive test battery was used to study the red and white blood cell system, serum chemistry, immunology/antibodies, lymphocyte enumeration and function. Widespread fungal contamination of water-damaged, primarily cellulose material with S. chartarum was found. S. chartarum produced a macrocyclic trichothecene, satratoxin H, and spirocyclic lactones. Strong associations with exposure indicators and significant differences between employees (n = 53) and controls (n = 21) were found for lower respiratory system symptoms, dermatological symptoms, eye symptoms, constitutional symptoms, chronic fatigue symptoms and several enumeration and function laboratory tests, mainly of the white blood cell system. The proportion of mature T-lymphocyte cells (CD3%) was lower in employees than in controls, and regression analyses showed significantly lower CD3% among those reporting a history of upper respiratory infections. Specific S. chartarum antibody tests (IgE and IgG) showed small differences (NS). It is concluded that prolonged and intense exposure to toxigenic S. chartarum and other atypical fungi was associated with reported disorders of the respiratory and central nervous systems, reported disorders of the mucous membranes and a few parameters pertaining to the cellular and humoral immune system, suggesting a possible immune competency dysfunction.

Int Arch Occup Environ Health 1996;68(4):207-18. doi: 10.1007/BF00381430.