CDC Correspondance

[Guest guest]

Dear Correspondant for the CDC,

My husband received this email in response to an inquiry about the efforts the

CDC is making to further the understanding of mycotic diseases in relationship

to exposure to excessive fungi in an indoor environment.

There was no name attached as the author of this email. Could you please be so

kind as to provide the name of a knowledgeable contact person should we have

further inquiries?

We and many others across the US are gravely concerned about this issue. We

would like to know who at the CDC is the best person to address our concerns.

I am pasting a copy of a letter that was included in a packet that was hand

delivered to Congressmen and Senators in Washington DC, this past week. We are

a bit confused by the varying responses and study interpretations we have

received from the CDC and would greatly appreciate further clarification.

Sincerely,

Sharon Kramer

Exerpts from Congressional Packets:

Mold Awareness Coalition

P.O. Box

676327

Rancho Santa Fe,

California 92067

September 20, 2004

Dear Member of Congress,

On May 25, 2004, a committee of the Institute of Medicine issued a summary

report of their two year study of illnesses that are resultant of Damp Indoor

Spaces. Based on the medical research that was the foundation of this study, it

was concluded that exposure to indoor molds can cause asthma and allergies in

previously healthy people.

Many of the peer reviewed research documents that were made available to the

IOM committee were not included in this study. The charge of the committee was

to study only the non-infectious diseases acquired by fungal exposure.

Documentation of the more serious infectious illnesses, that many from across

the US are currently experiencing, were not considered in this preliminary study

and not addressed in this preliminary report.

The Institute of Medicine, Damp Indoor Spaces Committee urged that further

understanding of the matter should be of the high priority. We strongly agree.

Many families and many lives are literally being destroyed by mycotic

illnesses, illnesses which are caused by fungi. Although there are many known

viable treatments available, America’s physicians are not being taught how to

recognize, diagnose or treat mycotic illnesses. Early detection, diagnosis and

treatment is the key to lessoning the severity of these illnesses.

Within this packet is a small sampling of personal accounts that best

represent what is occurring all across the United States from this devastating

situation. Also included, is a small sampling of medical research documents

illustrating the known serious conditions caused by fungal exposure. There are

vast numbers more of such documents.

Many are gravely ill from mold exposure in our homes, schools and places of

work. As the leaders of our nation, we urge you to take immediate action to stop

this emerging health crisis.

We urge you to call for emergency appropriations to teach our physicians,

make our schools environmentally safe and help those families who have currently

lost everything, including their health, to indoor molds. Please support

legislation that will bring this unnecessary national tragedy to an end.

Sincerely,

Sharon Noonan Kramer,

on behalf of the

Mold Awareness Coalition

***************************************************************Project Title:

Damp Indoor Spaces and Health

Project Identification Number:HPDP-H-00-06-A

Project Scope: January 01, 2002

The Institute of Medicine will conduct comprehensive review of the

scientific literature regarding the relationship between damp or moldy indoor

environments and the manifestation of adverse health effects, particularly

respiratory and allergic symptoms. The review will focus on the non-infectious

health effects of fungi, including allergens, mycotoxins and other biologically

active products. In addition, it will make recommendations or suggest

guidelines for public health interventions and for future basic science,

clinical, and public health research in these areas.

Institute of Medicine Damp Indoor Spaces Report, May 25, 2004

Executive Summary Page 12, paragraphs two and three

Concentrations of organic dust consistent with the development of organic dust

toxic syndrome are very unlikely to be found in homes or public buildings.

However, clinicians should consider the syndrome as a possible explanation of

symptoms experienced by some occupants of highly contaminated indoor

environments.

Greater research attention to the possible role of damp indoor environments

and the agents associated with them in less well understood disease entities is

needed to address gaps in scientific knowledge and concerns among the public.

Testimony of Dr. Redd

Chief, Air and Respiratory Branch, accompanied by Tom Sinks both of CDC's

National Center for Environmental Health Before the

House Financial Services Housing and Community Opportunity and Oversight and

Investigations Subcommittees

July 18, 2002

“We do not know whether molds cause other adverse health effects, such as

pulmonary hemorrhage, memory loss, or lethargy. We also do not know if the

occurrence of mold-related illnesses is increasing. Other than surveillance for

hospital-acquired infections, there is no system to track the public’s

exposure to and the possible health effects of mold.â€

In a message dated 8/2/2004 1:42:55 PM Pacific Daylight Time, aprhb@...

writes:

You inquired about a mold-related study. It is in the planniing stages prior to

protocol development and has a long approval process ahead. It is sufficiently

early in the process that there is not yet a timeline.

P. Boss, MPH, PhD

CDC, MS E-17

1600 Clifton Rd., N.E.

Atlanta, GA 30333

--------------------------------------------------------------------------------

Subj: Fwd: CDC's activities regarding mold

Date: 9/24/2004 11:35:03 AM Eastern Daylight Time

From: MAKramer

SNK 1955

Response from CDC

--------------------------------------------------------------------------------

Subj: CDC's activities regarding mold

Date: 9/24/2004 9:31:01 AM Eastern Daylight Time

From: " APRHB-Public Inquiries " <aprhb@...>

" APRHB-Public Inquiries " <aprhb@...>

Thank you for your inquiry about CDC’s efforts regarding mold.

CDC is a public health research and education agency, not a policy or

enforcement agency. CDC does not have authority to set laws, regulations, or

policy regarding mold. That role is largely filled by local and state health

and housing authorities, and, to a lesser extent, federal authorities. However,

CDC has taken a leading role in those areas that do fall within our purview,

including:

· developing plans to strengthen state, local, and tribal capacity to

respond to mold-related issues, including (1) determining the extent to which

state programs establish coordinated responses to indoor mold exposures; (2)

working with federal and other organizations to coordinate plans related to

indoor air and mold; (3) developing a coordinated public response strategy; and

(4) identifying resources for developing and implementing responses.

· continuing to work with state health departments to identify risk

factors associated with acute idiopathic pulmonary hemorrhage in infants and

producing the following reports:

o Acute Idiopathic Pulmonary Hemorrhage Among Infants Recommendations from

the Working Group for Investigation and Surveillance. MMWR March 12,

2004;53(RR02)1-12. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5302a1.htm)

o Case Definition for Acute Idiopathic Pulmonary Hemorrhage in Infants

(http://www.cdc.gov/nceh/airpollution/mold/AIPHIcasedef.htm)

o Investigation of Acute Idiopathic Pulmonary Hemorrhage Among

Infants—Massachusetts, December 2002-June 2003. MMWR September 10,

2004;53(35)817-820. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5335a4.htm)

· beginning a 5-year initiative on work-related asthma in offices and

schools, with an emphasis on moisture and mold exposures. CDC’s National

Institute for Occupational Safety and Health (NIOSH) is leading this initiative.

· assisting states in responding to mold-related issues, including

offering technical assistance with assessment, cleanup efforts, and prevention

of further mold growth and unnecessary exposure.

· Maintaining a Mold Web site

(http://www.cdc.gov/nceh/airpollution/mold) which provides information on molds

and health and links to resources.

· Creating, in conjunction with the Council of State and Territorial

Epidemiologists, an inventory of state indoor air quality programs, which is

available at http://www.cdc.gov/nceh/airpollution/indoor_air.htm.

· Commissioning an Institute of Medicine (IOM) report

(http://www.nap.edu/books/0309091934/html/), which is a part of CDCs plan to

develop an agenda for research, service, and education related to mold. The

report provides information on the relationship between damp or moldy indoor

environments and the manifestation of adverse health effects. It also provides

recommendations for future research, which CDC and others will follow. The IOM

committee concluded that excessive indoor dampness is a public-health problem

and that the prevention or reduction of potentially problematic damp indoor

environments is a public health goal. However, they note serious challenges

associated with achieving that goal as there is insufficient information on

which to base quantitative recommendations for either the appropriate level of

dampness reduction or the “safe†level of exposure to dampness-related

agents. It is thus not possible to objectively rank dampness-related health

problems within the larger context of threats to the public’s health because

there is insufficient information available to confidently quantify the overall

magnitude of the risk resulting from exposures in damp indoor environments. The

IOM also concluded:

· Excessive indoor dampness does not cause ill health by itself

· Growth of fungi and other microbial agents is one consequence of indoor

dampness. Damp indoor environments also favor house dust mites, standing water

supports cockroach and rodent infestations, and excessive moisture may initiate

chemical emissions from building materials and furnishings.

· Mold spores are found in indoor air and on surfaces and materials—no

indoor space is free of them.

· The availability of moisture is the primary factor that controls mold

growth indoors, since the nutrients and temperature range they need are usually

present.

· The lack of knowledge regarding the role of microorganisms in the

development and exacerbation of diseases found in occupants of damp indoor

environments is due to the lack of valid quantitative exposure-assessment

methods and knowledge of which specific microbial agents may primarily account

for the presumed health effects.

· The validity for exposure assessment in the indoor environment is often

not known and few biomarkers of exposure or dose of biologic agents have been

identified.

· There are no generally accepted health-based standards for acceptable

concentrations of fungal spores, hyphae, or metabolites in the air or on

surfaces.

· Damp indoor spaces may also facilitate the growth of bacteria that can

have toxic and inflammatory effects.

The IOM recommended that animal studies be initiated to evaluate the effects of

long-term (chronic) exposures to mycotoxins via inhalation. Such studies should

establish dose-response, lowest-observed-adverse-effect levels, and

no-observed-adverse-effect levels for identified toxicologic endpoints in order

to generate information for risk assessment that is not available from

presently-available studies of acute, high-level exposures.

The IOM committee found:

· sufficient evidence of an association between exposure to damp indoor

environments and some respiratory health outcomes: upper respiratory tract

(nasal and throat) symptoms, cough, wheeze, and asthma symptoms in sensitized

asthmatic persons. Epidemiologic studies also indicate that there is sufficient

evidence to conclude that the presence of mold (otherwise unspecified) indoors

is associated with upper respiratory symptoms, cough, wheeze, asthma symptoms in

sensitized asthmatic persons, and hypersensitivity pneumonitis (a relatively

rare immune-mediated condition) in susceptible persons.

· limited or suggestive evidence for an association between exposure to

damp indoor environments and shortness of breath, respiratory illness in

otherwise healthy children, and the development of asthma in susceptible

persons. The specific exposure (fungi, bacteria, their constituents and

emissions, other exposures related to damp indoor environments, such as dust

mites and cockroaches, or to some combination) remains unclear.

· limited or suggestive evidence of an association with respiratory

illness in otherwise healthy children for the presence of mold indoors

· inadequate or insufficient information to determine whether damp indoor

environments or the agents associated with them are related to a variety of

other health outcomes, including acute idiopathic pulmonary hemorrhage in

infants.

The committee considered whether any of the health outcomes listed above met the

definitions for the categories “sufficient evidence of a causal

relationship†and “limited or suggestive evidence of no association†and

concluded that none did.

We hope this information is useful to you.