Overview of the GAO Report on Mold

[Guest guest]

Dear All,

Below is my synopsis of what I found most relevant within the Federal GAO

Report " Indoor Mold: Better Coordination of Research on Health Effects and More

Consistent Guidance Would Improve Federal Efforts "

_http://www.gao.gov/products/GAO-08-980_

(http://www.gao.gov/products/GAO-08-980)

1. It is a Federally endorsed acknowledgment that many of the symptoms of

ill health being reported by US citizens after their exposure to microbial

contaminants in water damaged buildings are plausible to be occurring as a

result of the exposure; and

2. even with inconclusive gaps in the scientific data available, enough is

known that it is important to warn the public of possible/plausible ill health

effects in a consistent, coordinated manner; and

3. better Federal inter-agency coordination is required to properly warn the

public, to properly educate health agencies and to effectively advance the

scientific understanding of cause and symptoms of mycotic and related disease.

Excerpts from the GAO Report:

Although not all guidance documents need to provide a comprehensive list of

all of the potential health effects of exposure to indoor mold, the

information provided should be sufficient to alert the public about potential

adverse

health effects of exposure to indoor mold, highlight specific populations

that are particularly vulnerable to such exposure, and not conflict among

documents.

Finally, most of the documents warn that certain populations may be more sens

itive to mold than others, but only two provide specific recommendations

about the varying levels of protective clothing and equipment (such as gloves,

respirators, and eye and skin protection) that such populations should use

under various circumstances. As a result of some of these omissions and

inconsistencies, the public may be at risk of unnecessary exposure to indoor

mold.

Plausibility of Toxicosis

The Institute of Medicine reported in 2004 that (1) exposure to mycotoxins

can occur via inhalation, contact with the skin, and ingestion of contaminated

food and (2) research on Stachybotrys chartarum (a species of indoor mold

that can produce mycotoxins) suggests that effects in humans may be

biologically plausible.

Plausibility of a Causal Link to Asthma

In addition, the association between indoor mold and exacerbation of asthma

symptoms is a particularly significant public health concern because asthma

is the most common chronic illness among children in the United States and one

of the most common chronic illnesses overall, according to the Institute of

Medicine’s 2000 report, Clearing the Air: Asthma and Indoor Air

Exposures....The American Academy of Pediatrics stated in its 2006 report that

epidemiologic studies consistently support causal relationships between

exposure to mold

and upper respiratory tract symptoms and exacerbation of pre-existing

asthma.

Association of Lower Respiratory in Prior Healthy People

In addition to these more established health effects, this report also found

limited or suggestive evidence of an association between indoor mold and

lower respiratory illness (for example, bronchitis and pneumonia) in otherwise

healthy children.

Casual Relationship to Hypersensitivity Pneumonitis

The American Academy of Pediatrics also said that epidemiologic studies

support a causal relationship between exposure to mold and hypersensitivity

pneumonitis in susceptible persons.14 Moreover, a 2007 meta-analysis15

sponsored

by EPA and DOE found that building dampness and mold are associated with

increases of 30 percent to 50 percent in a variety of health outcomes, such as

upper respiratory tract symptoms, wheeze, and cough. The authors concluded that

these associations strongly suggest these adverse health effects are caused

by dampness-related exposures.16

Plausible Link to Idiopathic Pulmonary Hemorraging in Infants

For example, the American Academy of Pediatrics concluded in 2006 that a

plausible link exists between acute pulmonary hemorrhage in infants and

exposure to certain toxins that some molds produce.

Areas of Concern Regarding Systematic Research and Public Warnings

While the information on research activities relating to the health effects

of exposure to indoor mold provides some insight into the extent to which

federal agencies are addressing scientific data gaps identified by the

Institute

of Medicine in 2000 and 2004, the extent to which these ongoing research

activities will effectively advance scientific knowledge in these areas is not

clear. Specifically, the research is not guided by an overarching strategic

plan or entity that would help agencies work together to identify their

research priorities on the health effects of mold. Instead, agencies generally

determine independently which research activities they will support using a

variety of criteria. This lack of clearly articulated, common research goals is

exacerbated by the limited intra- and inter-agency planning and coordination of

research activities among federal agencies....

Overall, the federal guidance documents we reviewed that provide information

to the general public about the health effects of exposure to indoor mold,

ways to minimize mold growth, and safe and effective methods for cleaning up

provide generally useful information. However, some documents do not

sufficiently advise the general public about some potentially serious health

effects,

and others provide inconsistent information about cleaning agents and

appropriate protective gear. Regarding protective gear, some documents do not

provide information about how populations that are particularly vulnerable to

adverse health effects should protect themselves. In fact, populations with

certain immunosuppression conditions should avoid exposure to mold but many

guidance documents do not state this. As a result, the public may not be

sufficiently aware of the health risks they or their family members may face,

and they

may also be confused about how to approach cleaning up mold in their homes.

Recommended Action

An existing interagency committee—the Federal Interagency Committee on

Indoor Air Quality—could provide an effective vehicle for enhancing the

coordination of research activities. As the executive secretary and co-chair,

EPA

guides the activities of this committee, which was established in response to

congressional direction to, among other things, coordinate federal indoor air

quality research and foster information sharing among, for example, federal

agencies and the public

We recommend that the Administrator, EPA, use the Federal Interagency

Committee on Indoor Air Quality to accomplish the following two actions.

• Help articulate and guide research priorities on indoor mold across

relevant federal agencies, coordinate information sharing on ongoing and

planned

research activities among agencies, and provide information to the public on

ongoing research activities to better ensure that federal research on the

health effects of exposure to indoor mold is effectively addressing research

needs

and efficiently using scarce federal resources.

• Help relevant agencies review their existing guidance to the public on

indoor mold—considering the audience and purpose of the guidance

documents—to

better ensure that it sufficiently alerts the public, especially vulnerable

populations, about the potential adverse health effects of exposure to indoor

mold and educates them on how to minimize exposure in homes. The reviews

should take into account the best available information and ensure that the

guidance does not conflict among agencies.

Sharon Noonan Kramer

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