SMH Letters to the CDC 2009-2010

Letters that have flowed between The Center for School Mold Help and CDC on the topic of mold and health from Jan., 2009 – Jan., 2010 have influenced the Centers for Disease Control to begin updating their online Mold and Health info(in Nov. and Dec. 2009, on website www.cdc.gov/mold). These are reproduced below, in the interest of public information, public interest, transparency and truth. The first letter was sent to HHS Secretary-Nominee Thomas Daschle, in Jan. 2009. Similar letters and copies of these, below, have been sent to President Obama, the United States Surgeon General, and various members of the US Congress, among other key individuals. These letters appear in chronological order. If a .pdf is desired, please click the .pdf icon n the top right of the body of this article. This article may be shared freely, citing The Center for School Mold Help. (SMH)

“How wonderful it is that nobody need wait a single moment before starting to improve the world.” ~Anne Frank

SMH Note: Please note that the letters below are reproduced as closely as possible via electronic means.

The Center for School Mold Help
P.O. Box 3422
La Mesa, CA 91944-3422

January 30, 2009

The Honorable Secretary-Nominee Thomas Daschle

Honorable Secretary Daschle:

I am writing, as the Executive Director of The Center for School Mold Help, to explain and offer help for a here-to-fore unaddressed and largely unrecognized environmental health problem that is causing extensive illness in the American population. In my capacity as director of an educational, 501c3 nonprofit that monitors these problems and their solutions on a national basis, I would like to share with you what I have learned, in order to improve the health of Americans and strengthen our nation.

I am particularly concerned about American schools, as 1/5 of our population occupies school buildings on any given week during the school year, either as a student or staff member. At least half of America’s schools are damp, leaky, and often, contaminated with toxic molds and bacteria that sicken many students and staff. Our schools have become the vectors for related chronic illnesses and diseases (such as asthma and immune system disorders) for, virtually, the entire nation.

The public must be made aware of the dangers of dampness in our buildings and action must be taken to provide healthcare solutions for the large number of ill people and to prevent and solve dampness problems. Laws can be readily devised to protect the public. All of these will dramatically improve the health of the nation and our economy.

The problem is complex, but perhaps can best be described as the following: dampness and mold in our buildings are making Americans sick, in an unprecedented manner. Mold poisonings are occurring, through exposure to mycotoxins and other powerful toxic substances emitted by many common, toxigenic molds and bacteria found in water-damaged and damp buildings. This can now be demonstrated through medical tests.

Dampness and mold are caused by defective designs (including those created to conserve energy), use of new types of materials that grow mold readily – even prior to use in construction, construction methods that create mold in buildings, lack of adherence to ASHRAE standards for HVAC’s, and poor maintenance. In schools, the above problems are exponential, due to a variety of factors, including lack of accountability and ignorance about mold prevention at the local level.

Physicians are largely uninformed or misinformed of the causes or protocols for treatment for environmental exposures such as those found in damp or moldy buildings. They need immediate, current training on the latest methodologies and research, not yet been made available through the CDC.

There are effective treatment protocols that are relatively unknown that must be made available to our nation’s physicians.

The recent GAO Audit on Mold suggests better coordination by government agencies. This is needed, desperately. The EPA is one of the better sources of information on this topic, at the government level, but even they fall short in describing the health problems mold causes. The CDC has consistently played politics with the issue of mold exposure and health, without adequately warning the general public, nor educating our physicians properly. Conflicts of interest with business abound within the government sector, with one of the most recent, alarming developments being the possibility that environmental pediatric clinics be utilized for school environmental problems, staffed by physicians with ties to occupational clinics that previously have been in the business of denying environmental exposures. We need effective solutions through education and public outreach.

I would like to discuss the problem of school mold as well with you, if possible. I ask that you would inform President Obama of these concerns, and advise him to take decisive, informed action to assure that Americans and their physicians become educated on the dangers of mold exposure, with federal directives to ensure that our school (and other) buildings become healthy places to work, learn and live in.

Sincerely,
Susan Brinchman, Director

The Center for School Mold Help

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service
Centers for Disease Control and Prevention (CDC)
Atlanta, GA 30333

[undated, postmarked Feb. 23, 2009]

Ms. Susan Brinchman
Executive Director
The Center for School Mold Help
P.O. Box 3422
La Mesa, California 91944-3422

Dear Ms. Brinchman:

Former Secretary Nominee Thomas Daschle has asked me to thank you for your letter regarding health problems related to indoor mold exposure. He has asked me to respond directly to you. The Centers for Disease Control and Prevention (CDC) has done significant research and understands the potential health effects of indoor mold.

Unfortunately, like other policy or enforcement government agencies, 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. However, CDC is taking a leading role in mold
research and education, including:

* Developing mold prevention strategies to be used to counter possible health effects in the aftermath of hurricanes and major floods http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5508a1.htm June 9, 2006 / 55(RR08);1-27; including population-specific recommendations for protection from exposure to mold (http://emergency.cdc.gov/disasters/mold/report/pdf/2005_moldtable5.pdf)
* Commencing a 5-year initiative on work-related asthma in offices and schools, with an emphasis on moisture and mold exposures, led by CDC’s National Institute for Occupational Safety and Health;
* Assisting states in responding to mold-related issues, including offering techincal assistance with assessment, cleanup efforts, and prevention of further mold growth and unnecessary exposure;
* Educating public health professionals, physicians, and the public using a mold website that provides information on molds and health as well as links to resources (http://www.cdc.gov/mold/);
* Maintaining an inventory of state indoor air quality programs in conjunction with the Council of State and Territorial Epidemiologists (this is available at http://www.cdc.gov/nceh/airpollution/indoor_air.htm).

CDC also commissioned an Institute of Medicine (roM) report. This tepo11 provides information on the relationship between dampor moldy indoor environments and the

Page 2 – Ms. Susan Brinchman

manifestation of adverse health effects. The 10M committee concluded that excessive indoor dampness is a public-health problem and that the prevention and reduction of potentially problematic damp indoor environments should be a public health goal. However, they note serious challenges associated with achieving that goal because 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. Therefore, it is not possible to objectively rank dampness-related health problems within the larger contex(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 to damp and moldy indoor environments. I encourage you to read the full 10M report detailing its findings and recommendations at http://www.nap.edulbooks/0309091934/html/.

CDC appreciates your commitment to the education and research of mold in schools and its potential health effects on the nation’s children. I hope this information is helpful to you. For more information on CDC’s mold activities, please visit http://www.cdc.gov/mold.

Sincerely,
Richard E. Besser, M.D.
Acting Director, Centers for Disease Control and Prevention,
and Acting Administrator, Agency for Toxic Substances and Disease Registry

Ms. Susan Brinchman
Executive Director
The Center for School Mold Help
P.O. Box 3422
La Mesa, California 91944-3422

Dr. Richard E. Besser,
Acting Director, Centers for Disease Control and Prevention
Acting Administrator, Agency for Toxic Substances and Disease Registry
Centers for Disease Control
Atlanta, GA 30333

April 24, 2009

Dear Dr. Besser,

Thank you for your letter of March, 2009, in response to former Secretary Nominee Daschle’s request to reply to The Center for School Mold Help’s concerns about national health problems related to indoor mold exposure. In that letter, it states, “The Centers for Disease Control and Prevention has done significant research and understands the potential health effects of indoor mold”, describing actions the CDC has undertaken, chief among these, the CDC informational website on mold (www.cdc.gov/mold), used to educate the public and professionals.

I am writing, as Director of The Center for School Mold Help, in this letter, to comment on the CDC’s current stance on mold, per the CDC website. I will respond in another letter to the other CDC actions you described, specifically. I appreciate this opportunity to open an ongoing dialogue with you, as Acting Director of the The Centers for Disease Control and Prevention, on the topic of mold, one that directly impacts the health and productivity of millions of Americans. I will be very direct and specific with my comments, with suggestions for how the CDC might improve its information, as applicable. The above will be offered in the interest of encouraging information that will best protect and serve the health of the American public, including, but not limited to, American school children and school staff, who constitute 20% of our entire population on any given school day (EPA).

In general, the CDC, via its website, as of today’s date (4/24/09) informs the public re: mold and health:

“There is always some mold everywhere – in the air and on many surfaces. Molds have been on the Earth for millions of years. Mold grows where there is moisture.

Mold and Your Health

Exposure to damp and moldy environments may cause a variety of health effects, or none at all. Some people are sensitive to molds. For these people, molds can cause nasal stuffiness, throat irritation, coughing or wheezing, eye irritation, or, in some cases, skin irritation. People with mold allergies may have more severe reactions. Immune-compromised people and people with chronic lung illnesses, such as obstructive lung disease, may get serious infections in their lungs when they are exposed to mold. These people should stay away from areas that are likely to have mold, such as compost piles, cut grass, and wooded areas.

A link between other adverse health effects, such as acute idiopathic pulmonary hemorrhage among infants, memory loss, or lethargy, and molds, including the mold Stachybotrys chartarum (Stachybotrys atra), has not been proven. Further studies are needed to find out what causes acute idiopathic hemorrhage and other adverse health effects. (http://www.cdc.gov/mold/dampness_facts.htm)

This key web page, above, is the evidence that the CDC fails to warn the public sufficiently, including our state and local health departments, physicians and other health professionals, about the extent of the impact of molds on health. It minimizes the health impacts to a very serious degree. Further, it is misleading, barely mentioning adverse health effects associated with indoor exposures to toxic (or toxigenic) molds, and then, only to imply that these do not exist. The focus of this CDC section called Mold and Your Health focuses on those people with mild sensitivities, resulting in “irritation”, with references to allergies and serious infections within specific, seemingly minor populations (those with mold allergies, chronic lung disease – ex. COPD, or immuno-compromise). Further, these populations are merely advised to stay away from outdoor sources of mold. Later in this web page, the CDC briefly covers mold issues in the home, noting that (in our country) an acceptable standard of mold has not been determined, that reactions may vary among individuals, with a bit of advice on how to prevent and control mold.

Based on the above, which does not mention indoor mold sources at all, and states that mold has been with us always, one might logically conclude that ill health effects for the vast majority of the population are not likely. Indeed, this is what the nation’s physicians do conclude, based directly on CDC information. Toxic molds or mold toxins are not mentioned, save for one reference to stachybotrys, which is used to deny a link between other adverse health effects, such as idiopathic pulmonary hemorrhage, memory loss, or lethargy, (ie. “has not been proven” and that further studies are needed). Nowhere is Sick Building Syndrome mentioned; nowhere are the well-known, multiple organ-system adverse health effects to mycotoxins mentioned. Nowhere is the Precautionary Principle applied. Nowhere is the charge of The Centers for Disease Control and Prevention, to protect the public from emerging diseases, observed. Rather, quite frankly, this web information prevents protection.

One might readily conclude, as do our state and local health departments, the nation’s physicians and other health professionals, based on the CDC’s statements, that it is virtually impossible for the general public to become sickened by indoor molds. One might conclude that healthy people will not become ill from mold. One might conclude that moldy, damp buildings are unlikely to cause health effects except for very minor problems for a very few individuals, those with an identifiable pre-existing condition, such as allergies, lung, or immuno-compromise. One might conclude that it would only be in the interest of a few people, who are already ill, to improve indoor air quality. In fact, since indoor air quality is not mentioned in the Mold and Your Health section, one would conclude that there are no ill health effects to indoor mold, but only to outdoor molds, and for only very specific populations. The CDC’s advice in that section is for only these named populations, to avoid certain outdoor activities or sources of mold.

To put it bluntly, this entire section fails to protect the public health from emerging disease. It is completely inadequate, reading as if it was designed by defense interests in legal torts, which, indeed, is possible, given revelations about key individuals within the CDC who have moved on to lucrative positions within the mold-defense cottage industry.

This information directly endangers the health of every American and prevents them from receiving appropriate diagnosis and medical assistance when sickened by molds, through misinforming health professionals. It does not even summarize what the limited efforts of the IOM has found regarding damp buildings (ie., that an association has been found linking damp buildings and mold with development of respiratory disease in formerly healthy individuals), nor the conservative warnings for populations exposed to flooding that were designed by the CDC, the warnings issued by other federal agencies, the World Health Organization, or the thousands of related, independent, legitimate medical research studies. This failing is supported by the findings of the US GAO Audit on Mold (Oct., 2008).

The CDC information is grossly inadequate and misleading, causing millions of Americans to suffer, losing their health or lives, and in many cases, their productivity (ability to work), their homes, financial security, and all belongings – rendering many homeless, hopelessly disabled, ill, with shortened life spans, no health insurance, bankrupt. Some die from all of the above and this is not even tracked, nor is the illness derived from toxic mold exposures.

The failure of the CDC to adequately inform the public about the dangers of molds is contributing significantly to the economic hardships and health problems for millions of Americans and the nation as a whole. This misinformation and minimizing of the health effects of indoor molds endangers school children and staff in America’s overwhelmingly damp schools, which have become major, national vectors for disease. It prevents any interest in legislation that might improve the health and productivity of the nation, protecting Americans from indoor mold exposures. The CDC’s misinformation about Mold and Health is the direct source of the deterioration of the health of millions of people in the United States and threatens our very existence as a nation, given the vast, well-documented exposures to mold and dampness in our homes, commercial buildings and workplaces.

It is not necessary to have a flood to become exposed to high levels of toxic mold. American building practices are known to produce indoor molds in both new and aging buildings, supported by extensive research on these topics. Low levels of toxins have not been proven to be safe, and in fact, there is increasing scientific consensus that low levels of toxic chemicals can cause harmful health effects in both children and adults. Levels of chemical exposure are suspect in the sudden exponential surge of cancers, asthma, inflammatory disease, and autism, to name but a few catastrophic 21st century illnesses that Americans suffer from.

With the current attitude, evidenced in the CDC’s Mold and Health section, it is obvious that there has been little political will to address the real problems of the public health threats related to indoor molds, though the CDC is charged with doing so. The time is long overdue to address the problem of mold and health, informing the public on what is known, and taking precautionary approaches that protect children and the general public.

I ask that you and the incoming, future Director of the Centers for Disease Control take strong, immediate action to correct the public information in the Mold and Health section of your website, to protect the health of the public and allow them to receive appropriate diagnosis and medical assistance when exposed to indoor mold infestations, as well as their ability to remain productive. I ask that I be allowed to review the information to be revised, and offer suggestions. That will be a step in the right direction.

It is also noteworthy that our nation is the sole developed nation in the world that has not issued a conservative and protective standard for indoor mold exposure for the public. This, too, must immediately change.

I will write again, to address many of the other actions the CDC has taken, and those it has not taken, with regard to mold.

I am placing President Obama and key members of Congress on copy, as I hope that they will insist, as they are doing with other agencies, that the health and welfare of the American public is put first, that scientific findings are not politicized, and that the public is protected from harm.

I am concerned for the public health and welfare of every child, citizen, and resident of our nation. This is an urgent need. I hope that you are, as well, and that the future CDC Director will be, to the extent that the mold information problems above will be properly and swiftly rectified. Our organization is in possession of information on mold and health, on our website, www.schoolmoldhelp.org, that can protect the public, should you care to review this. The nation needs The Centers for Disease Control and Prevention’s help and leadership in an informed, proactive manner, regarding mold and health, on a federal basis. The CDC can do much better to provide leadership to protect our school children’s health and welfare, as well as that of all citizens.

I thank you for this opportunity to directly communicate with you and the CDC on this most important topic.

Sincerely,
Susan Brinchman,
Executive Director
The Center for School Mold Help
PO Box 655
La Mesa, CA
91944-0655
[phone]

The Center for School Mold Help
P.O. Box 655
La Mesa, California 91944-0655

September 15, 2009

Kathleen Sebelius, HHS Secretary
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Secretary Sebelius,

I am writing to ask your assistance to ensure that the American public and our nation’s physicians are adequately warned about the dangers and health effects of mold and dampness. Currently, this is not the case. The CDC website information is extremely limited and falls short of all other United States and world authorities regarding the health effects of mold.

As Director of The Center for School Mold Help, a national, 501c3 educational nonprofit that provides scientific information to the public on the topic of school mold, I know that it is well-documented that dampness and mold are a major public health threat in America. I have requested that the Centers for Disease Control update their information on the CDC website to include the World Health Organization’s recent findings, along with a description of and link to WHO Guidelines for Indoor Air Quality: Dampness and Mould (July 16, 2009). The CDC is viewed as our national authority on health, causing confusion on this topic, by the statements on their website. Please see my letter to Dr. Frieden, attached.

We also need all of our nation’s physicians trained, immediately, on the problem of mold and dampness, with the most up-to-date information. Every physician in America should read the WHO Guidelines, which confirm that mold is a public health threat for the general population, not just the immuno-compromised, a change from the misinformation of the past. Every physician in America should include questions about exposures to dampness and/or mold in their patient workups and histories. There is an upcoming Mold & Moisture workshop for clinicians in Atlanta (October 25, 2009) http://oehc.uchc.edu/clinser/NEPHC_Atlanta_2009.pdf, that health care providers may wish to attend. I suggest that this workshop be videotaped and offered as a free webinar, indefinitely, with updates, on the related CDC and HHS sites. I encourage you to review the Guidance for Clinicians on the Recognition of Health Effects Related to Mold Exposure and Moisture Indoors (2004)(http://www.oehc.uchc.edu/clinser/MOLD%20GUIDE.pdf, the basis for this workshop. This document is essentially in agreement with the public health threat described in the WHO Guidelines, though the information by the WHO is broader and more recent. Our organization’s article about the WHO Guidelines for Indoor Air Quality: Dampness and Mould (7/09), with links to this document and press releases, is located at http://www.schoolmoldhelp.org/content/view/1705/1/ .

I am certain that the vast majority of the millions of people now impacted by mold and dampness see indoor dampness as little threat to their health, as do their physicians. Thus, prevention and solutions for mold are not proactively pursued. This has led to extensive illness, a burden on our healthcare system, and major economic consequences that could be avoided with the simple changes I propose on the CDC site.

I hope you can help end the extensive, silent epidemic of mold and dampness-related health conditions in America.

Sincerely,
Susan Brinchman,
Director, The Center for School Mold Help
www.schoolmoldhelp.org

The Center for School Mold Help
P.O. Box 655
La Mesa, CA 91944-0655

September 15, 2009

Dr. Thomas Frieden
Director, Centers for Disease Control and Prevention
Centers for Disease Control
Atlanta, Georgia 30333

Dear Dr. Frieden,

I am writing to ask you to help facilitate my request that the CDC update its public information on mold (located on the CDC website), a vital necessity, especially in light of the public health threats described within the WHO Guidelines for Indoor Air Quality: Dampness and Mould, released in July, 2009. I recently sent the following letter, below, on this topic to the CDC Info Administrator. I ask for your assistance in improving the information provided to the general public, which is most important, as the CDC sets the tone of the nation with regard to prevention of mold problems and resulting health impacts.

Sincerely,
Susan Brinchman
Director, The Center for School Mold Help
La Mesa, CA

My email of 9/8/09:

Subject: URGENT request for CDC to update mold and health info re: WHO mold info
Date: 9/8/2009 11:37:35 A.M. Pacific Daylight Time

From: Nomoreschoolmold@aol.comThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it
To: cdcinfo@cdc.govThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Dear CDC Info Administrator,

I am writing, as the Director of The Center for School Mold Help, a national, 501c3, educational nonprofit, to request that the Centers for Disease Control website information on mold and health be updated to correspond with and include the WHO guidelines for indoor air quality: dampness and mould (July 16, 2009).

Millions of Americans are unnecessarily subjected to and sickened by dampness and mold, without help or recognition of the environmental illnesses that often develop. School children suffer in moldy, leaky, damp schools throughout the United States – chronically sickened while trying to obtain an education. The school staff suffer and may die from exposures within these buildings. Homeowners and renters alike find their health and finances destroyed by preventable mold exposures. Physicians, health departments, and the public are misinformed by your current information, which is dated and inaccurate – the CDC is, sadly, the primary source of the poor information.

This misinformation, in turn, helps overwhelm our healthcare system and damages our nation’s economy and productivity by causing millions to be sickened by a preventable cause. Now that the WHO has provided the vital planning and improved information regarding the very harmful health effects and mortality caused by mold and dampness, this should be included in an improved, updated informational section on mold and health on your website. The CDC must not continue to downplay this public health threat. The CDC must fully inform and warn physicians and the public about the health effects of mold and dampness.

The US GAO Audit on Mold (Sept., 2008) found that the US gov’t health agencies were not consistent in their information on mold. In fact, the US EPA and Federal OSHA both warn the public far more about the health effects of dampness and mold. This report, a year ago, has not yet improved your website information. I trust that the WHO Guidelines will assist in providing that which is missing, going beyond what any of our United States agencies have provided.

Mold and Your Health (from your website today)

Exposure to damp and moldy environments may cause a variety of health effects, or none at all. Some people are sensitive to molds. For these people, molds can cause nasal stuffiness, throat irritation, coughing or wheezing, eye irritation, or, in some cases, skin irritation. People with mold allergies may have more severe reactions. Immune-compromised people and people with chronic lung illnesses, such as obstructive lung disease, may get serious infections in their lungs when they are exposed to mold. These people should stay away from areas that are likely to have mold, such as compost piles, cut grass, and wooded areas.

A link between other adverse health effects, such as acute idiopathic pulmonary hemorrhage among infants, memory loss, or lethargy, and molds, including the mold Stachybotrys chartarum (Stachybotrys atra), has not been proven. Further studies are needed to find out what causes acute idiopathic hemorrhage and other adverse health effects. (CDC, Mold)

Note the contrast with the WHO information, below:

WHO guidelines for indoor air quality: dampness and mould published July, 2009

From the WHO Foreward

“Indoor air pollution – such as from dampness and mould, chemicals and other biological agents – is a major cause of morbidity and mortality worldwide.”

“The guidelines were developed and peer reviewed by scientists from all over the world, and the recommendations provided were informed by a rigorous review of all currently available scientific knowledge on this subject.”

From the WHO Executive summary
X I I I
“Exposure to microbial contaminants is clinically associated with respiratory symptoms, allergies, asthma and immunological reactions.”

“There is strong evidence regarding the hazards posed by several biological agents that pollute indoor air; however, the WHO working group convened in October 2006 concluded that the individual species of microbes and other biological agents that are responsible for health effects cannot be identified. This is due to the fact that people are often exposed to multiple agents simultaneously, to complexities in accurately estimating exposure and to the large numbers of symptoms and health outcomes due to exposure. ”

“The presence of many biological agents in the indoor environment is due to dampness and inadequate ventilation. Excess moisture on almost all indoor materials leads to growth of microbes, such as mould, fungi and bacteria, which subsequently emit spores, cells, fragments and volatile organic compounds into indoor air. Moreover, dampness initiates chemical or biological degradation of materials, which also pollutes indoor air. Dampness has therefore been suggested to be a strong, consistent indicator of risk of asthma and respiratory symptoms e.g. cough and wheeze). The health risks of biological contaminants of indoor air could thus be addressed by considering dampness as the risk indicator.”

“Sufficient epidemiological evidence is available from studies conducted in different countries and under different climatic conditions to show that the occupants of damp or mouldy buildings, both houses and public buildings, are at increased risk of respiratory symptoms, respiratory infections and exacerbation of asthma. Some evidence suggests increased risks of allergic rhinitis and asthma. Although few intervention studies were available, their results show that remediation of dampness can reduce adverse health outcomes. There is clinical evidence that exposure to mould and other dampness-related microbial agents increases the risks of rare conditions, such as hypersensitivity pneumonitis, allergic alveolitis, chronic rhinosinusitis and allergic fungal sinusitis.”

“Toxicological evidence obtained in vivo and in vitro supports these findings, showing the occurrence of diverse inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites and components.”

“Microbial growth may result in greater numbers of spores, cell fragments, allergens, mycotoxins, endotoxins, β-glucans and volatile organic compounds in indoor air. The causative agents of adverse health effects have not been identified conclusively, but an excess level of any of these agents in the indoor environment is a potential health hazard.”

“Microbial interactions and moisture-related physical and chemical emissions from building materials may also play a role in dampness-related health effects.”

“The authors conclude that occupants of damp or mouldy buildings, both private and public, have up to a 75% greater risk of respiratory symptoms and asthma. The guidelines recommend the prevention or remediation of dampness- and mould-related problems to significantly reduce harm to health…In damp conditions, hundreds of species of bacteria and fungi grow indoors and emit spores, cell fragments and chemicals into the air. Exposure to these contaminants is associated with the incidence or worsening of respiratory symptoms, allergies, asthma and immunological reactions. Children are particularly susceptible.” (WHO Press Release, 7/16/09)

This World Health Organization report, published July 16, 2009, verifies that which suffering millions and The Center for School Mold Help have been reporting, which the United States Centers for Disease Control, health departments, and most US physicians have downplayed and denied – that mold and dampness cause serious health problems, including respiratory and immunological. The WHO emphasizes that mold should be avoided as a major health risk, explains how to prevent and address indoor mold, and points out that building owners have the responsibility to provide healthy indoor air. This document will begin the changes needed to rescue the world population from the devastating impact of indoor mold (mould) and dampness, especially within our schools and homes. We expect that the United States Centers for Disease Control will quickly follow with a position on mold and dampness, in step with the WHO. There is no more doubt – mold and dampness harms and can kill. We cannot tolerate this in our schools and buildings.

I would like to be informed about your plans to update your mold and health information, on an urgent basis.

Sincerely,
Susan Brinchman
Founder and Executive Director,
The Center for School Mold Help
P.O. Box 655
La Mesa, CA 91944
director@schoolmoldhelp.orgThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it
www.schoolmoldhelp.org

[phone]

Cc: President Barack Obama; Kathleen Sebelius, Secretary of HHS; Dr. Steven K. Galson, US Surgeon General; Senator Barbara Boxer

In a message dated 9/24/2009 9:41:05 P.M. Pacific Daylight Time, CDCINFO@cdc.govThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it writes:

Thank you for your inquiry to CDC-INFO. We are sorry for the delay in responding to your email. We are awaiting guidance from the CDC program.

We will be back in touch with you when we have more information.

CDC-INFO is a service of the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR). This service is provided by Vangent, Inc. under contract to CDC and ATSDR.

9/24/09

Dear CDC Info Administrator,

Thank you for your reply. I see that I am corresponding with Vangent, Inc., under contract to the CDC and ATSDR (as below). What directions, specifically, has Vangent, Inc. been given with regards to the content in the Mold and Health section of the website, in the past?

Sincerely,
Susan Brinchman
Director, The Center for School Mold Help

Subj: CDC-INFO e-mail inquiry – Advocacy Organization – Inquiry rgd school mold – Priority Normal
Date: 9/25/09
From: EHHEinq@cdc.govThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it
To: Nomoreschoolmold@aol.comThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Dear Ms. Brinchman:

Thank you for bringing the WHO report to our attention.

We will review the report in light of our own findings, which are based in part on the 2004 review, Damp Indoor Spaces and Health, conducted by the Institute of Medicine (http://www.nap.edu/openbook.php?isbn=0309091934).

For your further reference, federal response to the GAO report you reference is being coordinated by the Committee on Indoor Air Quality, which is chaired by the U.S. Environmental Protection Agency.

EHHEinq
Division of Environmental Hazards and Health Effects
National Center for Environmental Health
Centers for Disease Control and Prevention

Service Record: SR No. 1-91067036

email sent in reply to EHHEinq@cdc.govThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

9/25/09

Dear Sirs/Ms.,

I would like to write to a specific person, if the name and contact information, including phone numbers, could be provided, that would be most helpful.

In response to your reply to my concerns about the outdated Mold and Health information on the CDC website that is causing millions not to receive adequate recognition and treatment for health effects from mold and dampness indoors:

1. I am glad to bring the WHO Guidelines on Indoor Air Quality: Mould and Dampness to your attention, but surely the Centers for Disease Control Division of Environmental Hazards and Health Effects was aware of it?
2. I am concerned that the Institute of Medicine findings from 2004, though now outdated, are not reflected in the CDC website Mold and Health section, and there have been five years to post these.
3. The US GAO Audit on Mold (Sept., 2008) finding that the US gov’t health agencies were not consistent in their information on mold does not prevent the CDC itself from moving forward in preventing environmental health hazards, particularly in light of the fact that the IOM findings are not highlighted on your site in a manner that would fully inform the public.
4. A year has now passed since the GAO Audit on Mold and the CDC still has inaccurate, hazardous information on its Mold and Health site, contributing in a major way to negatively impacting public health, which is not the mission of the CDC.

My question is: what is the CDC waiting for? The information exists, from the IOM study and now, from the WHO Guidelines. Let’s slow down the asthma epidemic, the upper respiratory ailments, the immunologic diseases, and all the other health ailments associated with damp buildings and mold by informing the public and our nation’s physicians, so that the public does not lose complete faith in the Centers for Disease Control and Health and Human Services.

This could be done overnight. The information is already generated, we do not need more studies to do so. Read it, summarize it, post it, reference it. This is do-able with the political will to prevent illness.

Sincerely,
Susan Brinchman
Director, The Center for School Mold Help

email sent back to me, 9/28/09:

Dear Ms. Brinchman:

In response to you most recent request below, you may address your inquiry to:

Paul L.Garbe, DVM, MPH
Chief, Air Pollution and Respiratory Health Branch
Division of Environmental Hazards and Health Effects
National Center for Environmental Health
Centers for Disease Control and Prevention
4770 Buford Highway, Building 106, Mail Stop F-58
Chamblee, Georgia 30341-3717

We hope this information is helpful to you.

EHHEinq
Division of Environmental Hazards and Health Effects
National Center for Environmental Health
Centers for Disease Control and Prevention

The Center for School Mold Help
P.O. Box 655
La Mesa, CA 91944-0655

Paul L.Garbe, DVM, MPH
Chief, Air Pollution and Respiratory Health Branch
Division of Environmental Hazards and Health Effects
National Center for Environmental Health
Centers for Disease Control and Prevention
4770 Buford Highway, Building 106, Mail Stop F-58
Chamblee, Georgia 30341-3717

Oct. 6, 2009

Dear Dr. Garbe:

I am writing, as the Director of The Center for School Mold Help, a national, 501c3, educational nonprofit, to request that the Centers for Disease Control website information on mold and health be updated to correspond with and include the WHO guidelines for indoor air quality: dampness and mould (http://www.euro.who.int/document/E92645.pdf) (July 16, 2009).

Millions of Americans are unnecessarily subjected to and sickened by dampness and mold, without help or recognition of the environmental illnesses that often develop. School children suffer in moldy, leaky, damp schools throughout the United States – chronically sickened while trying to obtain an education. The school staff suffer and may die from exposures within these buildings. Homeowners and renters alike find their health and finances destroyed by preventable mold exposures. Physicians, health departments, and the public are misinformed by your current information, which is dated and inaccurate – the CDC is, sadly, the primary source of the poor information.

This misinformation, in turn, helps overwhelm our healthcare system and damages our nation’s economy and productivity by causing millions to be sickened by a preventable cause. Now that the WHO has provided the vital planning and improved information regarding the very harmful health effects and mortality caused by mold and dampness, this should be included in an improved, updated informational section on mold and health on your website. The CDC must not continue to downplay this public health threat. The CDC must fully inform and warn physicians and the public about the health effects of mold and dampness.

The US GAO Audit on Mold (Sept., 2008) found that the US gov’t health agencies were not consistent in their information on mold. In fact, the US EPA and Federal OSHA both warn the public far more about the health effects of dampness and mold. This report, a year ago, has not yet improved your website information. I trust that the WHO Guidelines will assist in providing that which is missing, going beyond what any of our United States agencies have provided.

Mold and Your Health (from your website today)

Exposure to damp and moldy environments may cause a variety of health effects, or none at all. Some people are sensitive to molds. For these people, molds can cause nasal stuffiness, throat irritation, coughing or wheezing, eye irritation, or, in some cases, skin irritation. People with mold allergies may have more severe reactions. Immune-compromised people and people with chronic lung illnesses, such as obstructive lung disease, may get serious infections in their lungs when they are exposed to mold. These people should stay away from areas that are likely to have mold, such as compost piles, cut grass, and wooded areas.

A link between other adverse health effects, such as acute idiopathic pulmonary hemorrhage among infants, memory loss, or lethargy, and molds, including the mold Stachybotrys chartarum (Stachybotrys atra), has not been proven. Further studies are needed to find out what causes acute idiopathic hemorrhage and other adverse health effects. (CDC, Mold)

Note the contrast with the WHO information, below:

WHO guidelines for indoor air quality: dampness and mould (http://www.euro.who.int/document/E92645.pdf) published July, 2009

From the WHO Foreward “Indoor air pollution – such as from dampness and mould, chemicals and other biological agents – is a major cause of morbidity and mortality worldwide.”

“The guidelines were developed and peer reviewed by scientists from all over the world, and the recommendations provided were informed by a rigorous review of all currently available scientific knowledge on this subject.”

From the WHO Executive summary X I I I
“Exposure to microbial contaminants is clinically associated with respiratory symptoms, allergies, asthma and immunological reactions.”

“There is strong evidence regarding the hazards posed by several biological agents that pollute indoor air; however, the WHO working group convened in October 2006 concluded that the individual species of microbes and other biological agents that are responsible for health effects cannot be identified. This is due to the fact that people are often exposed to multiple agents simultaneously, to complexities in accurately estimating exposure and to the large numbers of symptoms and health outcomes due to exposure.”

“The presence of many biological agents in the indoor environment is due to dampness and inadequate ventilation. Excess moisture on almost all indoor materials leads to growth of microbes, such as mould, fungi and bacteria, which subsequently emit spores, cells, fragments and volatile organic compounds into indoor air. Moreover, dampness initiates chemical or biological degradation of materials, which also pollutes indoor air. Dampness has therefore been suggested to be a strong, consistent indicator of risk of asthma and respiratory symptoms (e.g. cough and wheeze). The health risks of biological contaminants of indoor air could thus be addressed by considering dampness as the risk indicator.”

“Sufficient epidemiological evidence is available from studies conducted in different countries and under different climatic conditions to show that the occupants of damp or mouldy buildings both houses and public buildings, are at increased risk of respiratory symptoms, respiratory infections and exacerbation of asthma. Some evidence suggests increased risks of allergic rhinitis and asthma. Although few intervention studies were available, their results show that remediation of dampness can reduce adverse health outcomes. There is clinical evidence that exposure to mould and other dampness-related microbial agents increases the risks of rare conditions, such as hypersensitivity pneumonitis, allergic alveolitis, chronic rhinosinusitis and allergic fungal sinusitis.”

“Toxicological evidence obtained in vivo and in vitro supports these findings, showing the occurrence of diverse inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites and components.”

“Microbial growth may result in greater numbers of spores, cell fragments, allergens, mycotoxins, endotoxins, β-glucans and volatile organic compounds in indoor air. The causative agents of adverse health effects have not been identified conclusively, but an excess level of any of these agents in the indoor environment is a potential health hazard.”

“Microbial interactions and moisture-related physical and chemical emissions from building materials may also play a role in dampness-related health effects.”

“The authors conclude that occupants of damp or mouldy buildings, both private and public, have up to a 75% greater risk of respiratory symptoms and asthma. The guidelines recommend the prevention or remediation of dampness – and mould-related problems to significantly reduce harm to health…In damp conditions, hundreds of species of bacteria and fungi grow indoors and emit spores, cell fragments and chemicals into the air. Exposure to these contaminants is associated with the incidence or worsening of respiratory symptoms, allergies, asthma and immunological reactions. Children are particularly susceptible.” (_WHO Press Release, 7/16/09_
(http://www.euro.who.int/mediacentre/PR/2009/20090715_1) )

This World Health Organization report, published July 16, 2009, verifies that which suffering millions and The Center for School Mold Help have been reporting, which the United States Centers for Disease Control, health departments, and most US physicians have downplayed and denied – that mold and dampness cause serious health problems, including respiratory and immunological. The WHO emphasizes that mold should be avoided as a major health risk, explains how to prevent and address indoor mold, and points out that building owners have the responsibility to provide healthy indoor air. This document will begin the changes needed to rescue the world population from the devastating impact of indoor mold (mould) and dampness, especially within our schools and homes. We expect that the United States Centers for Disease Control will quickly follow with a position on mold and dampness, in step with the WHO. There is no more doubt – mold and dampness harms and can kill. We cannot tolerate this in our schools and buildings.

I would like to be informed about your plans to update the CDC’s mold and health information, on an urgent basis.

Sincerely,
Susan Brinchman
Executive Director,
The Center for School Mold Help
director@schoolmoldhelp.orgThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it
nomoreschoolmold@aol.comThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it
[phone]

Cc: President Barack Obama, Dr. Thomas Frieden, Senator Barbara Boxer

Several emails ensued between Dr. Garbe and S. Brinchman to set up a date/time for a phone meeting on the topic of our concern.

The phone meeting was held on Oct. 9, 2009, with Dr. Paul Garbe calling S. Brinchman, lasting 50 minutes.

The Center for School Mold Help
P.O. Box 655
La Mesa, CA 91944-0655

Paul L.Garbe, DVM, MPH
Chief, Air Pollution and Respiratory Health Branch
Division of Environmental Hazards and Health Effects
National Center for Environmental Health
Centers for Disease Control and Prevention

10/23/09

Dear Dr. Garbe:

Thank you for meeting with me on Oct. 9, 2009, regarding my concerns relating to the information the your division of the CDC is disseminating on mold and health. During that fifty minute discussion, the following was determined, according to my notes:

1. The Centers for Disease Control Air Pollution and Respiratory division, of which you are Chief, is responsible for what appears on the CDC web site with regard to indoor air pollution and mold.
2. Information from the IOM Damp Indoor Spaces and Health (2004) has been shared with the public via the website, on a very limited and selective basis. For instance, I brought to your attention that the IOM findings related to health effects associated with mold and/or (indoor) dampness, such as development of (new) asthma and lower respiratory disease in otherwise healthy children DO NOT appear on the Mold and Health section of the CDC website – yet the minor associated health effects did, such as skin irritation, wheezing, etc.. You agreed. The IOM report link was “buried” under many layers of information in the web site, where most would never look. You agreed.
3. Your division was unaware of the 250 page WHO Guide to Indoor Air Quality: Dampness and Mould (July 16, 2009) because there is “no coordination whatsoever” with WHO on this topic of mold and dampness. You said you were glad to learn of its publication and will include a link to it, with summary of the WHO findings on the CDC web site, with permissions as needed from WHO.
4. You will be contacting your web designers to adjust the Mold and Health information to include all the important associated effects of mold (IOM) and the WHO findings, immediately.
5. You expressed concern that you are not given even “a dollar” for mold per se, and do not have “unlimited webspace”.

I was very pleased that we were able to speak and clarify all of the above. I have to say that I am disappointed in the performance of the CDC, to date, on this important health topic that impacts the entire American population, healthcare industry, and economy, ultimately. I believe that this is an important area of accountability and prioritizing that needs to be delved into further. We need the CDC to be current, transparent, science-based, and non-political regarding disease prevention.

The changes in the CDC information on Mold and Health, described above, will help prevent mold and dampness-related illness and chronic disease in millions of Americans. It is imperative that, without need for further research or passage of time for any reason, these current scientific findings are published prominently on the Mold and Health section of the web site. As of today, the old, inaccurate information still appears, two weeks after our phone conversation. Further, it is very hard to find the Mold and Health section.

The reason I am being so persistent on this matter is that I see a direct connection to the lack of current, comprehensive information by the CDC and the illness of many tens of millions. This is, quite definitely, a failure to protect the public and can readily be remedied, overnight, if the political will exists. The information is already published by the most authoritative sources, all CDC has to do is share it prominently and start applying this information in all its programs related to asthma, respiratory, and immunological disease prevention.

Our nation’s school children and staff (20% of the US population) are frequently exposed to indoor mold and dampness, with much misunderstanding about the health effects – thus, school districts, health departments, state and local lawmakers do not make it a priority to provide dry and sanitary buildings. Physicians often deny the health effects described in the IOM and WHO documents, as they are unaware, getting their information, ultimately, from that which the CDC publishes on its website and emphasizes in its communications. This is something that can be fixed immediately, within our easy reach.

I thank you for taking the time to speak with me, and for your promise to correct the matter.

I would like to be notified of the changes to the CDC Mold and Health web site, on an urgent basis.

Sincerely,
Susan Brinchman
Executive Director,
The Center for School Mold Help
director@schoolmoldhelp.orgThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it
nomoreschoolmold@aol.comThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

www.schoolmoldhelp.org

[phone]

[cell]

Cc: President Barack Obama; Dr. Thomas Frieden; Senator Barbara Boxer; Rep. Bart Gordon, Committee on Science and Technology

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Agency for Toxic Substances and Disease Registry
Atlanta, GA 30333

October 29,2009

Ms. Susan Brinchman
The Center for School Mold Help
P.O. Box 655
La Mesa, California 91944

Dear Ms. Brinchman:

Thank you for your letter of September 15,2009.

I understand that you have spoken with Dr. Paul Garbe, Chief of the Air Pollution and Respiratory Health Branch at the National Center for Environmental Health. As Dr. Garbe stated, the CDC recognizes the importance of mold as a public health concern, particularly for vulnerable individuals, such as individuals with asthma and other respiratory diseases or with other underlying conditions. We appreciate that you share this concern, and thank you for bringing your specific suggestions to our attention.

As Dr. Garbe explained on your October 9 call, we are reviewing the new World Health Organization (WHO) guidelines on indoor air quality, dampness, and mold to determine if those findings are at significant variance with the Institute of Medicine (lOM) review/ Damp Indoor Spaces and Health that CDC sponsored in 2004. We feel the WHO authors’ conclusions and their recommendation for “prevention or remediation of dampness and mold-related problems to significantly reduce harm to health” are in agreement with the 10M report and with what we have posted on our website. We are still reviewing the evidence for WHO’s characterization of mold as a “major cause of morbidity and mortality” and will adjust our recommendations as needed based on that review.

In the meantime, we have provided a link to the WHO report on our mold website, www.cdc.gov/mold, as a “Key resource” (on the right side of the page), and as a “Nonfederal” resource on our mold “resources” page (http://www.cdc.gov/moldllinks.htm). as you suggested. Also, in response to one of your emails on this matter, we have clarified some of the recent redesign of our website to improve our links to the 10M report. Thank you for bringing this oversight to our attention. We are reviewing how to more clearly represent the 10M findings related to exposures and health effects. In particular we will review our presentation of the 10M findings regarding “Limited or suggestive evidence” and “Sufficient evidence of an association”.

Page 2 – Ms. Susan Brinchman

I would also like to respond to two additional concerns you have raised.
1. The US Government Accountability Office (GAO) Audit on Mold, found inconsistencies among federal agencies addressing mold. This problem is being addressed by the Federal Interagency Committee on Indoor Air Quality (CIAQ), which is chaired by the U.S. Environmental Protection Agency. Inquiries on the CIAQ process should be addressed to the CIAQ. You may contact the CIAQ at the following address; Philip Jalbert, Executive Secretary, Federal Interagency Committee on Indoor Air Quality (CIAQ) U.S. EPA, lndoor Environments Division (66091), 1200 Pennsylvania Avenue, N.W., Washington, D.C. 20460 or via email at ciaq@epa.gov.This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
2. You asked about email correspondence from Vangent Inc. CDC has used Vangent Inc. to assist with public inquiry response since 2005. The information provided by Vangent in response to question about is prepared by the CDC’s Air Pollution and Respiratory Health Branch.

Again, thank you for sharing your concerns with us.

Sincerely,
Howard Frumkin, M.D., Dr.P.H.
Director, National Center for Environmental Health!
Agency for Toxic Substances and Disease Registry

DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Atlanta, GA 30333

November 5, 2009

Ms. Susan Brinchman
Founder and Executive Director
The Center for School Mold Help
P. O. Box 655
La Mesa, California 91944-0655

Dear Ms. Brinchman:

Thank you for your letter of October 23, 2009, to Dr. Paul Garbe, Chief of our Air Pollution and Respiratory Health Branch.

Per your conversation with Dr. Garbe and our letter to you dated October 29, 2009, we are reviewing the new World Health Organization (WHO) guidelines on indoor air quality, dampness, and mold to determine if those findings are at significant variance with the Institute of Medicine (lOM) review Damp Indoor Spaces and Health that CDC sponsored in 2004. We will adjust our recommendations as needed based on that review.

In addition, we have provided a link to the WHO report on our mold website, www.cdc.gov/mold,asa “Key resource” (on the right side of the page), and as a “Nonfederal” resource on our mold “resources” page (http://www.cdc.gov/mold/links.htm) as you suggested.

Also, in response to one of your emails on this matter, we have clarified some of the recent redesign of our website to improve our links to the 10M report. Finally, we are reviewing how to more clearly represent the 10M findings related to exposures and health effects. In particular we will review our presentation of the 10M findings regarding “Limited or suggestive evidence” and “Sufficient evidence of an association.”

I appreciate your interest and hope this information is helpful.

Howard Frumkin, M.D., Dr.P.H.
Director, National Center for Environmental Health
Agency for Toxic Substances and Disease Registry

Howard Frumkin, M.D., Dr.PH
Director, National Center for Environmental Health/
Agency for Toxic Substances and Disease Registry
Atlanta, GA 30333
November 11, 2009

Dear Dr. Frumkin,

I am in receipt of your letter of October 29, 2009, responding to my letter of September 15, 2009 to Dr. Thomas Frieden, Director, Centers for Disease Control and Prevention, expressing my concern about the poor quality of information available on the CDC website regarding Mold and Health. Also, you have indicated you are aware that I participated in a phone meeting on Oct. 9th with CDC Director Paul Garbe, of the Air Pollution and Respiratory Branch, responsible for the CDC website information in the above-noted section. Thank you for your reply.

I must be quite frank in this reply to your letter, as the public health and the welfare of our nation itself is at stake. As Director of The Center for School Mold Help, a national, educational 501c3 nonprofit, I am writing for the benefit of the public health.

I appreciate hearing that the inclusion of a more prominent link with the IOM Damp Indoor Spaces and Health (2004) report has been made. Also, that the World Health Organization Guide to Indoor Air Quality: Dampness and Mould (2009) is now provided with a link within two sections – one, prominently. I understand, from your letter, that the CDC is now reviewing the WHO’s findings, including that the World Health Organization considers mold to be “a major cause of morbidity and mortality” and that CDC’s recommendations will be adjusted based on that review. The exact quote from the WHO Guide is, “Indoor air pollution – such as from dampness and mould, chemicals and other biological agents – is a major cause of morbidity and mortality worldwide”[1]. I hope all the WHO statements related to health effects will be carefully and swiftly reviewed, as well. I have summarized many of these, below.

I note that in your letter of Oct. 29th, you state that Dr. Garbe explained to me that CDC was reviewing the new WHO guidelines to determine if those findings were at significant variance with the IOM review. Dr. Garbe did not explain this to me, as he had just become aware of the WHO guidelines from my letter to the CDC of Sept. 15th. He did not tell me that CDC was looking to see if the findings were at variance. But it is obvious that the variance will occur, as the WHO report takes into consideration NEWER findings from studies not yet in the scientific literature. I hope that CDC does not only look at its own reports, nor dated ones, which the IOM now is.

You have also stated that the CDC is reviewing its presentation of the IOM findings “related to exposures and health effects”, regarding “limited or suggestive evidence and “sufficient evidence of an association”. I do not find the limited or suggestive evidence of an association anywhere on your site now. The WHO notes that many studies have improved the literature since mid-2003, the time period that ended the IOM’s research review. The IOM findings and subsequent findings by researchers and the WHO are prominently listed in the WHO Guide (2009) with an in-depth discussion. It would be fair to the public to summarize, perhaps for the first time, the IOM findings, fully, as they pertain to all possible health effects associated with dampness and mold, and then to add in those the WHO found in the international literature – as WHO has done. Citing just the CDC/IOM study will not do the subject justice.

I would like to know how promptly the CDC will accomplish this review and revision of its Mold and Health statements. Promptness is called for, as the findings are very serious and the need is immediate. For your convenience and to speed this process up, I am providing an extensive, footnoted list of the health effects found in both studies that need inclusion on the CDC website.

I would now like to see all pertinent content and findings related to health effects from both of these large reviews summarized and placed on the CDC Mold and Your Health section, rather than what now appears there (see below).

Current CDC information as of today, November 11, 2009:

Mold and Your Health

(http://www.cdc.gov/mold/dampness_facts.htm)

“Exposure to damp and moldy environments may cause a variety of health effects, or none at all. Some people are sensitive to molds. For these people, molds can cause nasal stuffiness, throat irritation, coughing or wheezing, eye irritation, or, in some cases, skin irritation. People with mold allergies may have more severe reactions. Immune-compromised people and people with chronic lung illnesses, such as obstructive lung disease, may get serious infections in their lungs when they are exposed to mold. These people should stay away from areas that are likely to have mold, such as compost piles, cut grass, and wooded areas.

A link between other adverse health effects, such as acute idiopathic pulmonary hemorrhage among infants, memory loss, or lethargy, and molds, including the mold Stachybotrys chartarum (Stachybotrys atra), has not been proven. Further studies are needed to find out what causes acute idiopathic hemorrhage and other adverse health effects.”[2]

Physicians and the public are misinformed by the above information about the health effects of mold and dampness. The above paragraphs are inadequate, misleading, and dated – minimizing the health effects of mold and dampness, contrasting starkly with the evidence and findings from the CDC-sponsored Institute of Medicine findings of 2004 and the World Health Organization, 2009.

This lack of warning for the American public constitutes misinformation given, by the CDC, related to a major public health threat. This misinformation is causing millions to be unnecessarily exposed to dampness, mold with the resultant development of serious, chronic health conditions whose causes are not properly diagnosed and may have been avoided. This is causing personal tragedies including loss of health and life, as well as economic disaster for those who can no longer work, lose health insurance coverage, savings accounts are emptied, and homes are lost, undoubtedly contributing to homelessness, home foreclosures and bankruptcies in America. I have personally communicated with a large number of people who have experienced many of these problems following dampness and mold-related exposures, especially in our nation’s schools, where 20% of the United States population spend each week. Our children, most vulnerable of all, become sickened for life in damp schools and homes.

This, in turn, harms our economy, with billions of dollars in lost productivity and costs of healthcare, while contributing on a large scale to the costs of our healthcare system, overwhelming it with unnecessary dampness-related conditions and illnesses.[3] This cannot be considered an oversight, given the fact that the CDC sponsored the Institute of Medicine Damp Indoor Spaces and Health review, costing millions of tax-payer dollars and several years of time, receiving it in 2004.

The following is submitted by the Center for School Mold Help, based on the above two broad reports, with strong suggestion that the CDC improve its Mold and Health information, above, immediately, to include all of the health effects mentioned below.

Indoor Dampness, Mold, and Health

Dampness and mold have been found to be a public health threat by numerous national and international researchers and authoritative bodies, including the IOM [4] and WHO[5]. Several major reports have recently identified significant public health problems associated with exposure to indoor dampness and mold and have formulated guidelines to protect the public health. The first was a CDC sponsored report produced by The Institute of Medicine (IOM), Damp Indoor Spaces and Health (2004), which studied “the relationship between damp or moldy indoor environments and the manifestation of adverse health effects, particularly respiratory and allergic symptoms”, focusing on “the non-infectious health effects of fungi, including allergens, mycotoxins and other biologically active products”. [6] In 2009, following review of improved studies, the World Health
Organization (WHO) issued the WHO Guidelines for Indoor Air Quality: Dampness and Mold, covering the main health risks due to dampness, the associated microbial growth and contamination of indoor spaces, and to formulate guidelines for the protection of public health…the review covers not only mould (mold) but … other biological agents, such as bacteria associated with excess moisture in indoor environments…[7] Health effects studied by WHO included those reported for “dampness, mould, and other dampness related agents, combining the conclusions of large previous reviews with newly reviewed findings for selected health outcomes.[8] The review focuses on selected categories of the outcomes included in the

Institute of Medicine review (upper respiratory tract symptoms, cough, wheeze, dyspnoea, asthma symptoms in people with asthma, asthma development) and several additional categories (current asthma, respiratory infections, bronchitis, wheeze, allergic rhinitis and allergy or atopy). It excludes outcomes on which limited research has been reported (e.g. effects related to skin, eyes, fatigue, nausea, headache, insomnia, mucous membrane irritation and sick-building syndrome).[9]

Health effects:

The findings of the IOM (2004) for indoor dampness and/or mold are as follows – an association (sufficient; limited or suggestive*) is found for the following health effects: upper respiratory tract symptoms, wheeze, cough, asthma symptoms in sensitized people, hypersensitivity pneumonitis; lower respiratory illness in otherwise healthy children*, dyspnoea (shortness of breath)*, asthma development*

The findings of the WHO (2009) for dampness-related agents are as follows – an association (sufficient; limited or suggestive*) is found for the following health effects: asthma exacerbation, upper respiratory tract symptoms, cough, wheeze, asthma development, dyspnoea (shortness of breath), current asthma respiratory infections; bronchitis*, allergic rhinitis*

The (WHO) review concludes that the most important effects are increased prevalences of respiratory symptoms, allergies and asthma as well as perturbation of the immunological system.[10] The WHO report states, “the overall evidence shows that …dampness is consistently associated with a wide range of respiratory health effects, most notably, asthma, wheeze, cough, respiratory infections, and upper respiratory symptoms.[11]

The WHO report differs with the IOM report in several important areas.

WHO found that there was sufficient evidence for associations between indoor dampness and four health outcomes that were not so classified or were not evaluated by the Institute of Medicine (2004): asthma development, dyspnoea, current asthma and respiratory infections. Asthma development is a health outcome of particular public health importance.[12] The IOM concluded that there was limited or suggested association for development of asthma, whereas

WHO concluded in 2009, with information provided by new studies, that there was sufficient evidence for an association. WHO notes a strong study by Pekkanen et al, 2007, showing that dampness or mould in the main living area of a house was related in a dose-response fashion to asthma development in infants and children. WHO further mentions that there is a body of generally consistent findings that dampness-related exposure is not only associated with, but may cause, asthma in infants and children. WHO has settled on dampness as the risk indicator, the common denominator in buildings associated with the above occupant health problems.

IOM notes, in its chapter on Toxic Effects of Fungi and Bacteria, that nonallergic responses are caused by bacteria and mold and that “respiratory and other effects that resemble allergic responses occur in nonatopic persons”[13]. Further, in this chapter, it is stated that nervous system effects, suppression of the immune response, hemorrhage in the mucous membranes of the intestinal and respiratory tracts, rheumatoid disease, and loss of appetite, have been reported in people who work or live in buildings that have microbial growth.”[14]

WHO notes there is some evidence (Kercsmar et al. (2006) to suggest a causal association between indoor dampness or mould (mold) and respiratory morbidity in children with asthma.[15] Indeed, WHO states, in its abstract, that mold is included as a major cause of morbidity and mortality, worldwide.[16] Bronchitis, altered lung function, allergy or atopy, and “asthma, ever”, were found to be reported by researchers, but the small number of studies precluded drawing conclusions at this date.

Protection of the public health calls for full transparency of the CDC, with use of the current body of scientific knowledge available, exercising public health ethics, and the use of the precautionary principle. Protection of the public in the case of exposures to mold and dampness requires that the CDC list all known associated and reported health effects as noted above, and beyond, so that physicians and the public may become fully aware of these possible health effects.

The CDC is charged with protection of health in America. The goals set for the CDC include prevention and provision of health information to accomplish that mission.

The dampness and mold health effects should be incorporated extensively into the CDC website, where the public may easily access them. These should be fully communicated clearly to all American physicians and clinicians, directly, and immediately. Asthma prevention materials should be revised to inform the public on how to prevent and address environmentally caused asthma, associated with dampness and mold.

I am aware of the US GAO Audit on Mold, prompted by complaints to Senator Kennedy’s office related to how the US agencies, including the CDC, were communicating inaccurate mold information. I am aware of the current findings of federal inconsistencies about the mold and health information and want to be assured that the current CDC’s misinformation does not become the rule for all other agencies. We need to move forward, utilizing scientific knowledge that is readily available today.

I understand, from your letter and Dr. Garbe’s statement, that the company contracted by CDC to respond to public inquiry, Vangent, is not responsible for the content of the Mold and Health information on the CDC website, that it is, according to Dr. Garbe, his branch’s responsibility for what has been provided to the public on this topic, and that CDC provides the information to the website managers and contracted companies.

I have written Dr. Garbe on October 23rd, as a follow-up to our phone meeting, but have not yet received a reply.

I have to say that I am deeply concerned and disappointed by the very limited, poor information about mold and health that has been provided to the public, to date, and for the past five years, given the ready access to the IOM findings and now, the WHO review. As noted above, this is undoubtedly harming America in a profound manner and may be corrected by immediately and completely updating the Mold and Health section of your website and all content related to the above health conditions to include all known and reported health effects for occupants of damp and moldy buildings.

Sincerely,
Susan Brinchman
Executive Director, The Center for School Mold Help

Cc: President Barack Obama; Dr. Thomas Frieden, CDC Director; Dr. Paul L. Garbe, Chief, CDC Air Pollution and Respiratory Branch; Committee on

Sci and Tech: Congressman Brad Miller, Congressman Bart Gordon; Senator Barbara Boxer

[1] WHO Guidelines for Indoor Air Quality: Dampness and Mould (2009), p. xi
[2]CDC website http://www.cdc.gov/mold/dampness_facts.htm
[3] Public health and economic impact of dampness and mold (Mudarri & Fisk, 2007)
[4] IOM Damp Indoor Spaces and Health (2004) p.14
[5] WHO Guidelines p. xii, xiii
[6] IOM Damp Indoor Spaces and Health (2004) p.2
[7] WHO Guidelines for Indoor Air Quality: Dampness and Mould (2009) p.3
[8] WHO Guidelines p.63
[9] WHO Guidelines p.64
[10] WHO Guidelines Abstract (p.6, .pdf version)
[11] WHO Guidelines p.70
[12] WHO Guidelines p.72
[13] IOM Damp Indoor Spaces and Health (2004), Toxic Effects of Fungi & Bacteria, p. 125
[14] IOM Damp Indoor Spaces and Health (2004), Toxic Effects of Fungi & Bacteria, p. 125
[15] WHO Guidelines p.72
[16] WHO Guidelines p.xi

Dr. Thomas Frieden

Director, Centers for Disease Control and Prevention
Centers for Disease Control
Atlanta, Georgia 30333

Dear Dr. Frieden,

I am attaching a copy of my communication, today, with Dr. Howard Frumkin of the CDC, related to his letter to me of Oct. 29th, mentioning that the CDC has started to improve the CDC information on Mold and Health to include specific, important findings of the IOM (2004) and the WHO (2009). I am concerned that the CDC is still sounding as if it is not going to fully inform the public.

As the recently appointed Director of the Centers for Disease Control, I ask you that assist in monitoring this situation, as there has been, historically, evidence of resistance within the CDC to inform the public fully about the problem of dampness, mold and health, on the part of the CDC. The public health depends on full disclosure.

With your oversight, I am sure that this can be corrected swiftly.

Thank you for your assistance in this matter.

Sincerely,

Susan Brinchman, Director
The Center for School Mold Help
DEPARTMENT OF HEALTH & HUMAN SERVICES

Ms. Susan Brinchman, Founder and Executive Director
The Center for School Mold Help
P. O. Box 655
LaMesa, California 91944-0655

Dear Ms. Brinchman:

Public Health Service
Centers for Disease Control
and Prevention (CDC)
Atlanta, GA 30333

December 10, 2009

Thank you for your letter of November 11 concerning our review of information available on the Centers for Disease Control and Prevention (CDC) website regarding mold and health.

My letter to you dated October 29, was sent in response to both your letter of September 15 to Dr. Thomas Frieden, CDC Director, and your letter of October 23 to Dr. Paul Garbe, Chief of the Air Pollution and Respiratory Health Branch in CDC’s National Center for Environmental Health. These two letters raised substantially the same issues. Your letter of September 15 to Health and Human Services Secretary Kathleen Sebelius is also addressed by both this current letter and my letter of October 29.

CDC’s website features reports on our past investigations of incidents of potential health effects of exposure to mold and damp indoor environments, fact sheets developed based on those reports, and on work we have commissioned to be done by others, such as the Institute of Medicine’s (10M) 2004 report Damp Indoor Spaces and Health. The 10M characterized their findings on the parameters of “Sufficient evidence of an association,”"Limited or suggestive evidence of an association,” and “Inadequate or insufficient information of an association” for both “Exposure to Damp Indoor Environments” and”Presence of Mold (Otherwise Unspecified) Indoors.” We have created a revised fact sheet that more clearly uses these headings to present the 10M findings. You can find a link to this presentation at http://www.cdc.gov/mold in the “Key resources” bar on the right side of the page.

As noted in my letter of October 29, CDC has been reviewing the 2009 World Health Organization (WHO) Guide to Indoor Air Quality: Dampness and Mould since October 9th, when you brought this matter to Dr. Garbe’s attention. We are not able to complete our review immediately because the individuals with expertise in this area are among the

Page -2 Ms. Brinchman

hundreds at CDC staff taking part in our response to H1Nl influenza. This response has been declared a national emergency by President Obama. We plan to complete our review of the WHO report by early 2010. We cannot promise at this time that CDC will adopt 100% of WHO’s findings without comment or dissent. You may track the release of this review, or any other air quality-related document, by going to our “What’s New” page at htlp://www.cdc.gov/nceh!airpollution/whatsnew.html and clicking on “Get email updates” in the top left side of the page, and following the
instructions to subscribe.

I appreciate your interest and hope this information is helpful.

Sincerely,
Howard Frumkin, M.D., Dr.P.H.
Director, National Center for Environmental Health
Agency for Toxic Substances and Disease Registry

Howard Frumkin, M.D., Dr.PH
Director, National Center for Environmental Health/
Agency for Toxic Substances and Disease Registry
Atlanta, GA 30333

January 6, 2010

Dear Dr. Frumkin,

I am in receipt of your letter of December 12, 2009, and wish to thank you for your continued communications regarding the updating of the CDC’s Mold and Health information. Today, I am writing to provide feedback related to these and pending updates.

RE: the latest additions to CDC Mold info:

* The two new paragraphs in Mold and Your Health do improve the public information by including the IOM finding related to associated, limited, and suggestive evidence for health effects from dampness and/or mold.
* More is urgently needed, including similarly accurate paragraphs summarizing the main points of the WHO Guide to Indoor Air Quality: Dampness and Mould (2009).
* The first half of the new “CDC Summary” of the IOM Damp Indoor Spaces and Health (2004) is, unfortunately, very misleading and poorly written.

It should be removed and rewritten accurately or removed entirely. An explanation and suggestions are included, below.

I do, respectfully, wish to point out that my letters are far from repetitive and are quite pertinent to public health issues that have not been properly addressed by the CDC in recent years, causing massive illness, impacting the economy and health of the United States. Over the past year, I have expressed concern about the CDC’s Mold and Health information falling short of current scientific knowledge, thus inadequately warning the public[1] and medical practitioners about the health effects that may result from (indoor) damp building and mold exposures. I represent our Board of Directors and thousands of concerned parents, teachers, and community members whose health or the health of loved ones has been destroyed in damp, moldy schools, in addition to many researchers and physicians frustrated by lack of accurate mold information at the CDC level. I am writing to all stakeholders in order to keep them informed and ask for their help, including those who oversee the CDC.

I wrote your employee, Dr. Paul Garbe, Chief of the Air Pollution and Respiratory Branch, on Oct. 23, 2009 to confirm what he and I discussed during a 50 minute mutual phone conference on October 9, 2009, which included his acknowledgment that the CDC was not displaying the IOM Damp Indoor Spaces and Health findings for the American public and that he had not been aware of the WHO Guide to Indoor Air Quality: Dampness and Mould (2009), but would, at my request, include both of these in a revision of the public info on the CDC website, shortly.

I am pleased that a process has begun to accomplish the promises made by both you and Dr. Garbe, in your communications of Oct – Dec., 2009, despite the trying times the CDC is in with respect to the current demands of the H1N1 pandemic. I do wish to point out that the current, alarming epidemic of asthma in the United States must far exceed the cost, mortality rate, and chronic illness derived from this worrisome pandemic. Therefore, the addition of the WHO findings to the CDC Mold information must not wait for the pandemic to end.

Today, I offer more specific recommendations for additional improvements to the new CDC public information about mold. I ask for your patience and understanding, asmy communications are made in the interest of preventing disease and the protection of the public health. I will be specific and direct as I continue to evaluate and suggest improvements. As a lifelong educator and Director of The Center for School Mold Help, a national, 501c3 nonprofit, I want the CDC to provide the best information possible, in order to provide the impetus to prevent and address health problems related to indoor dampness and mold, now epidemic in our nation’s schools, workplaces, and homes. These publicly presented health effects will then provide impetus to the use of prevention and establishment of solutions for dampness and mold – for both the human beings and the buildings. We must not lose sight of the fact that people are being sickened by the millions, particularly in our schools, and that people must be the focus of all the health agencies – not the buildings alone.

In this interest, please find, below, commentary and quotes from the IOM and WHO that might help shorten the work necessary to accomplish your new, ongoing task.

RE: WHO Guidelines info to be included in CDC Mold info

I understand, from your letter of December 10th, that the CDC has been reviewing the WHO guidelines for dampness and mold, which are more current than the IOM review that focused on a limited number of non-infectious mold and dampness studies that pertained to respiratory and allergic symptoms (see below) through mid-2003, with most publications it reviewed issued prior to that year.[2]

“The Institute of Medicine will conduct a 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.” [3]

I note that World Health Organization findings are cited 1,960 times on the CDC website, normal for the CDC. Therefore, without passing personal judgment, I ask that, as a part of your public information, you inform the public about the WHO guidelines for dampness and mold by including an accurate summary prominently placed in the Mold and Your Health section. You have recently included a link to the WHO Guide to Indoor Air Quality: Dampness and Mould (2009) as a Key Resource, therefore it should follow that the WHO findings are also deserving of at least several key paragraphs in the CDC section called Mold and Your Health. I suggest inclusion of the following in these paragraphs, quoted verbatim or summarized from the WHO guidelines, covering all points:

The scope of the WHO review:

“…to identify the main health risks due to dampness, the associated microbial growth and contamination of indoor spaces and to formulate relevant guidelines for the protection of public health… The review covers not only mould but also covers to some extent other biological agents, such as bacteria associated with excess moisture in indoor environments.” [4]

This review combines the conclusions of a review by the Institute of Medicine (2004), covering the literature up to mid-2003, those of a quantitative meta-analysis of findings up to 2007 on dampness, mould and respiratory health effects (Fisk, Lei-Gomez, Mendell, 2007) and a new assessment of more recent published studies on selected outcomes. The review focuses on selected categories of the outcomes included in the Institute of Medicine review (upper respiratory tract symptoms, cough, wheeze, dyspnoea, asthma symptoms in people with asthma, asthma development) and several additional categories (current asthma, respiratory infections, bronchitis, wheeze, allergic rhinitis and allergy or atopy.[5]

In a key summary paragraph, WHO states:

“Microbial pollution is a key element of indoor air pollution. It is caused by hundreds of species of bacteria and fungi, in particular filamentous fungi (mould), growing indoors when sufficient moisture is available. This document provides a comprehensive review of the scientific evidence on health problems associated with building moisture and biological agents. The review concludes that the most important effects are increased prevalences of respiratory symptoms, allergies and asthma as well as perturbation of the immunological system.[6] (emphasis in italics by SMH – a vital statement to report to the public)

Important finding of WHO: The association of new asthma with exposures to dampness:

At least one new paragraph is needed to communicate that the World Health Organization has now stated it has determined that sufficient evidence exists to associate dampness with development of new cases of asthma. That is a major finding that I expect to see in the CDC Mold and Your Health section. This takes the mystery out of the new cases of asthma seen in our nation – and needs to be included in all information coming out of the CDC (in addition to the website) about asthma prevention and control. WHO says, additionally, that poor indoor air quality is a major source of morbidity and mortality, worldwide. The CDC should immediately and prominently report these carefully drawn, current, scientifically-based, international findings without further delay.

RE: IOM Damp Indoor Spaces and Health findings and CDC Summary:

I commend your office for the two new paragraphs found in Mold and Your Health, which appear to be well written and represent the IOM’s important evidence-based findings, though the overall information still falls short, not adequately warning the public about the threat of dampness to the public health, even though the IOM stated this on page 14 of its report.

I also note, sadly, a poorly written, misleading, new CDC Summary of the IOM Damp Indoor Spaces and Health, as a pdf, located under the IOM section in Key Resources. I do see that in both the Mold and Your Health paragraphs and within the CDC Summary important major statements by the IOM, with regard to mold, dampness and health have been left out, and I ask that these will be included, promptly. The chart within appears accurate, in the latter part of the document.

My suggestions are as follows, for the CDC Summary of the IOM study:

#1. The CDC needs to identify the author(s) of the CDC Summary on that document, as it might be confused with an official IOM summary by the public. No mention is made of who produced it.

#2. The scope of the IOM study needs to be more accurately represented, per the IOM statement itself:

“…the Centers for Disease Control and Prevention

(CDC) asked the Institute of Medicine to convene a committee of experts.

CDC provided the following charge to that committee:

The Institute of Medicine will conduct a 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.”
[IOM Damp Indoor Spaces and Health (2004), Executive Summary p. 2]

#3. The (dark) bulleted items bear little, if any, resemblance to the main points determined by the IOM Damp Indoor Spaces and Health (2004) study (see attachments). These statements appear to focus on bacterial overgrowth and minimize the presence of mold, as evidenced in the statement:

* Mold spores are found in indoor air and on surfaces and materials. No indoor space is free of them.

That item might mislead the reader into thinking that mold is everywhere and harmless as if this was a major conclusion of the IOM related to health effects, which it most certainly is not. It is now universally, scientifically accepted that mold growing within a building and indoor dampness are highly undesirable, due to numerous associated health effects. The IOM reiterates this throughout their report. Revision of your bulleted items is necessary to reflect the most prominent conclusions of the IOM, pertaining to health, especially, in their own words, to better inform the public (white bulleted items are my suggestions, with citation):

* “On the basis of its review of the scientific papers and other information … the committee concludes that excessive indoor dampness is a public

health problem.” (p. 14) (this is a major statement)

* “The appropriate public health goal should thus be to prevent or reduce the incidence of potentially problematic damp indoor environments, that is environments that may be associated with undesirable health effects, particularly in vulnerable populations.” (p. 14)

(this is a major statement)

* “Bacteria and Fungi can cause allergic responses, non-allergic, toxic and inflammatory effects.” (p. 7) (a broad, major statement)

* Mold and bacterial growth produce undesired health effects. (mentioned throughout)

* “The term dampness has been applied to a variety of moisture problems in buildings that include high relative humidity, condensation, and signs of excess moisture or microbial growth.” (p. 185)

#4 I further suggest that all of the white-bulleted items cited above be summarized or directly quoted in additional paragraphs of the Mold and Your Health section of the CDC website, as these are strong, informative statements by the IOM, in addition to their evidentiary findings.

I am concerned that the information found on the Mold and Health section be openly presented in a forthright, neutral, scientific manner, not selected on the basis of past individual or collective belief systems nor conflicts of interest, in accordance with President Obama’s position on science.

Millions are currently sick and dying from preventable exposures in this nation, due to inaccurate CDC information about dampness and mold. It is time to completely and swiftly correct that problem, fully informing the public regarding the health hazards of dampness and mold. This information should then go out to every physician, health department, and health practitioner in the nation, so they will be on the alert for damp-building-related illnesses. Our legislators should be informed, so the public might be protected. All agencies and health departments of the United States should be receive the new information, in order to align their presentations about asthma, mold, dampness, etc. Indoor dampness is a major health threat, now rampant in the United States. There is no time to be lost.

People with respiratory and immunological problems are more susceptible to the H1N1 virus and many other health concerns. There is no time like the present to continue to correct the CDC information and assist the public in its quest for health.

The CDC needs to reestablish trust with the general public, something that has been lost in recent years. This would be a good start to repair that damage and simultaneously assist Americans to begin on the road to improved health.

I will continue to write until the mold and health information is kept current, comprehensive, and accurate, and then will monitor it, along with many other concerned members of the American public. These actions will drastically improve public health, as people are made aware that “Exposure to microbial contaminants is clinically associated with respiratory symptoms, allergies, asthma and immunological reactions (WHO). ”[7] In America, we all know it is imperative to place the emphasis on prevention of disease, to relieve our overburdened healthcare system and government of the cost of reduced productivity, chronic illness, and disabilities. Indeed, the CDC is charged with that mission.

The public health is at stake, here, and nothing less than excellence in educational information will be acceptable. As an educator yourself, I am sure you would agree. I appreciate your continuing understanding, collaboration, assistance and understanding, regarding this vital matter.

Sincerely,

Susan Brinchman
Director, The Center for School Mold Help

Attachments (to above letter)
From the CDC website, today:

CDC – Mold – General Information – Facts About Mold and Dampness

http://www.cdc.gov/mold/dampness_facts.htm

Mold and Your Health

Exposure to damp and moldy environments may cause a variety of health effects, or none at all. Some people are sensitive to molds. For these people, molds can cause nasal stuffiness, throat irritation, coughing or wheezing, eye irritation, or, in some cases, skin irritation. People with mold allergies may have more severe reactions. Immune-compromised people and people with chronic lung illnesses, such as obstructive lung disease, may get serious infections in their lungs when they are exposed to mold. These people should stay away from areas that are likely to have mold, such as compost piles, cut grass, and wooded areas.

In 2004 the Institute of Medicine (IOM) found there was sufficient evidence to link indoor exposure to mold with upper respiratory tract symptoms, cough, and wheeze in otherwise healthy people; with asthma symptoms in people with asthma; and with hypersensitivity pneumonitis in individuals susceptible to that immune-mediated condition. The IOM also found limited or suggestive evidence linking indoor mold exposure and respiratory illness in otherwise healthy children.

In addition, in 2004 the IOM found sufficient evidence to link exposure to damp indoor environments in general to upper respiratory tract symptoms, cough, and wheeze in otherwise healthy people and with asthma symptoms in people with asthma. The IOM also found limited or suggestive evidence linking exposure to damp indoor environments in general to shortness of breath, to respiratory illness in otherwise healthy children and to potential development of asthma in susceptible individuals. (emphasis in bold by SMH, these are the two new paragraphs added by CDC in late Dec.

‘09/Jan. ’10)

A link between other adverse health effects, such as acute idiopathic pulmonary hemorrhage among infants, memory loss, or lethargy, and molds, including the mold Stachybotrys chartarum (Stachybotrys atra), has not been proven. Further studies are needed to find out what causes acute idiopathic hemorrhage and other adverse health effects.

Key resources (*added by CDC in Nov., 2009)

http://www.cdc.gov/mold/default.htm

*Damp Indoor Spaces and HealthExternal Web Site Icon [PDF, 608 KB]
Executive Summary of Institute of Medicine report. Summary [DOC, 35 KB] Also see the Full Report.External Web Site Icon

Mold Cleanup Fact Sheet [PDF, 114 KB]
After a flood, mold will grow in your house.

*WHO Guidelines for Indoor Air Quality: Dampness and MouldExternal Web Site Icon [PDF, 2.5 MB]
World Health Organization review of scientific evidence on health problems associated with building moisture and biological agents.

Summary of 2004 IOM Report: Damp Indoor Spaces and Health

(added by CDC in Dec. 2009)

In 2003, the Centers for Disease Control and Prevention (CDC) asked the Institute of Medicine (IOM) to review all scientific studies to date about the possible connection between damp or moldy indoor places and problems with breathing or allergies. [see commentary #2] In its report Damp Indoor Spaces and Health, released in May 2004, IOM concluded the following:

* The growth of some bacteria (germs) and molds is one effect of indoor dampness. Damp indoor environments also benefit house dust mites.

Standing water supports cockroach and rodent (rats and mice) problems as well. Too much moisture may cause toxic chemicals to be released from building materials and furnishings.
* Mold spores are found in indoor air and on surfaces and materials. No indoor space is free of them.
* Damp indoor spaces may also allow the growth of bacteria that can cause negative health effects.
* Controlling moisture is the main way to control indoor mold growth.

After reviewing the studies, IOM determined that potential health effects of exposure to either damp indoor environments or to mold indoors could be classified in one of three ways: 1) “sufficient evidence of an association” between the exposure and the health effect, 2) “limited or suggestive evidence” of an association, or 3) “inadequate or insufficient information” to determine if an association exists. The following tables summarize these findings. The full report can be read here [linked to IOM report].

Table 1. Evidence supporting an association between exposure to damp indoor environments and certain health effects.

Sufficient evidence

· upper respiratory tract (nasal and throat) symptoms

· cough

· wheeze

· asthma symptoms in sensitized asthmatic persons

Limited or suggestive evidence

· shortness of breath

· respiratory illness in otherwise healthy children

· development of asthma in susceptible persons

Inadequate or insufficient information

· a variety of other health outcomes, including acute idiopathic pulmonary hemorrhage in infants

Table 2. Evidence supporting an association between the presence of mold (otherwise unspecified) indoors and certain health effects.

Sufficient evidence

· upper respiratory symptoms

· cough

· wheeze

· asthma symptoms in sensitized asthmatic persons

· hypersensitivity pneumonitis (a relatively rare immune-mediated condition) in susceptible persons

Limited or suggestive evidence

· respiratory illness in otherwise healthy children

Inadequate or insufficient information

· a variety of other health outcomes, including acute idiopathic pulmonary hemorrhage in infants

[1] Confirmed by US GAO Mold Audit 2008
[2] IOM Damp Indoor Spaces and Health (2004) p. 183
[3] IOM Damp Indoor Spaces and Health (2004), Executive Summary p. 2
[4] WHO Indoor Air Quality: Dampness and Mould, Intro, p. 3
[5] WHO Indoor Air Quality: Dampness and Mould, Chapter 4. Health effects associated with dampness and mould, p. 63-64
[6] WHO Indoor Air Quality: Dampness and Mould, Abstract
[7] WHO Guide to Indoor Air Quality: Dampness and Mould, Intro, p.1
(END)

We, at The Center for School Mold Help strongly encourage our site visitors to write President Obama about your mold concerns. We also encourage you to write Dr. Thomas Frieden, Dr. Howard Frumkin, and Dr. Paul Garbe at the CDC, w/ President Obama and your state legislators on copy, about your professional or person indoor mold and dampness findings and concerns.

For a copy of these letters in pdf format click “HERE”

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