DAMPNESS - World Health Organization

1 WHO guidelines FOR indoor AIR QUALITYWHO guidelines FOR indoor AIR quality : DAMPNESS AND MOULDDAMPNESSAND moulds cherfi gsvej 8, DK-2100 Copenhagen , DenmarkTel.: +45 39 17 17 17. Fax: +45 39 17 18 18 E-mail: site: Health OrganizationRegional Offi ce for EuropeWhen sufficient moisture is available, hundreds of species of bacteria and fungi particularly mould pollute indoor air. The most important effects of exposure to these pollutants are the increased prevalence of respiratory symptoms, allergies and asthma, as well as disturbance of the immune system. Prevent-ing (or minimizing) persistent DAMPNESS and microbial growth on interior surfaces and building structures is the most important means of avoiding harmful effects on Health . This book provides a comprehensive overview of the scientific evidence on the Health problems associated with this ubiquitous pollution and provides WHO guidelines to protect public Health .

2 It also describes the conditions that determine the presence of mould and provides measures to control its growth indoors. WHO guidelinesfor indoor air quality : DAMPNESS and mouldKeywords AIR POLLUTION, indoor - adverse effects - prevention and control FUNGIHUMIDITY - adverse effects - prevention and controlENVIRONMENTAL EXPOSURERISK ASSESSMENTGUIDELINESISBN 978 92 890 4168 3 Address requests for publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen , DenmarkAlternatively, complete an online request form for documentation, Health information, or for permission to quote or translate, on the Regional Office web site ( ). World Health Organization 2009 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full.

3 The designations employed and the presentation of the material in this publication do not imply the ex-pression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fron-tiers or boundaries. Where the designation country or area appears in the headings of tables, it covers countries, territories, cities and areas. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are en-dorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital World Health Organization does not warrant that the information contained in this publication is complete or correct and shall not be liable for any damages incurred as a result of its use.

4 The views ex-pressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health by: Elisabeth Heseltine and Jerome Rosen. Cover photos (from top): Heger/M ller, Szewzyk, UBA, picture taken by design: Sven Lund. Printed in Germany by Druckpartner guidelinesfor indoor air quality : DAMPNESS and mouldAbstractMicrobial pollution is a key element of indoor air pollution. It is caused by hun-dreds 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.

5 The document also summarizes the available information on the conditions that determine the presence of mould and measures to control their growth indoors. WHO guide-lines for protecting public Health are formulated on the basis of the review. The most important means for avoiding adverse Health effects is the prevention (or minimization) of persistent DAMPNESS and microbial growth on interior surfaces and in building structures. Contributors vii Acknowledgements x Foreword xi Executive summary xii1. Introduction 1 Background 1 Scope of the review 3 Preparation of the guidelines 5 guidelines and indoor air quality management 62. Building DAMPNESS and its effect on indoor exposure to biological and non-biological pollutants 7 Frequency of indoor DAMPNESS 7 Effects of DAMPNESS on the quality of the indoor environment 9 DAMPNESS -related indoor pollutants 13 Exposure assessment 20 Summary and conclusions 293.

6 Moisture control and ventilation 31 Introduction 31 Sources of moisture 34 Mould and mites as indicators of building performance 37 Ventilation performance 41 Ventilation systems 42 Outdoor and other sources of pollution related to ventilation 49 Ventilation and spread of contaminants 51 Moisture control in buildings 55 Measures to protect against damage due to moisture 58 Conclusions and recommendations 61 Cont ents4. Health effects associated with DAMPNESS and mould 63 Review of epidemiological evidence 63 Clinical aspects of Health effects 78 Toxicological mechanisms 84 Synthesis of available evidence on Health effects 895. Evaluation of human Health risks and guidelines 93 Summary 93 Conditions that contribute to Health risks 93 guidelines 946.

7 References 97 Annex 1. Summary of epidemiological studies 133 Annex 2. Summary of in vitro and in vivo studies 215 VIIP articipants in the working group meeting in Bonn, 17 18 October 2007 Alireza Afshari Danish Building Research Institute, Copenhagen, DenmarkHugh Ross Anderson1 St George s Hospital Medical School, University of London, London, England Aaron Cohen1 Health Effects Institute, Boston, United States of AmericaEduardo de Oliveira Institute of Mechanical Engineering, Fernandes Faculty of Engineering, University of Porto, Porto, PortugalJeroen Douwes Centre for Public Health Research, Massey University, Wellington, New ZealandRafal G rny Institute of Occupational Medicine and Environmental Health , Sosnowiec, PolandMaija-Riitta Hirvonen National Public Health Institute, Helsinki.

8 FinlandJouni Jaakkola Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, United KingdomS verine Kirchner1 Centre Scientifique et Technique du B timent, Marne la Vall e FranceJarek Kurnitski University of Technology, Helsinki, FinlandHal Levin Building Ecology Research Group, Santa Cruz, United States of AmericaMark Mendell Lawrence Berkeley National Laboratory, Berkeley, United States of AmericaLars M lhave1 Department of Public Health , University of Aarhus, Aarhus, DenmarkLidia Morawska International Laboratory for Air quality and Health , Queensland University of Technology, Brisbane, AustraliaAino Nevalainen1 National Public Health Institute, Helsinki, FinlandCo ntributorsVIIIWHO guidelines FOR indoor AIR quality : DAMPNESS AND MOULDM alcolm Richardson University of Helsinki, Helsinki, FinlandPeter Rudnai National Institute of Environmental Health , Budapest, HungaryHans W.

9 Schleibinger Institute for Research in Construction, National Research Council of Canada, Ottawa, CanadaPer E. Schwarze Norwegian Institute of Public Health , Oslo, NorwayBernd Seifert1 Consultant, Berlin, GermanyTorben Sigsgaard University of Aarhus, Aarhus, DenmarkWeimin Song Fudan University, Shanghai, ChinaJohn Spengler1 Harvard School of Public Health , Boston, United States of AmericaRegine Szewzyk Federal Environment Agency, Berlin, GermanySadras Panchatcharam Sri Ramachandra University, Chennai, IndiaThyagarajanGiulio Gallo European Commission, Brussels, Belgium Manfred Giersig (observer) European Chemical Industry Council (CEFIC) and Bayer Material Science AG, Leverkusen, GermanyCo-authors who did not participate in the working group meeting Jakob B nl kke University of Aarhus, Aarhus, DenmarkKerry Cheung Centre for Public Health Research, Massey University, Wellington, New ZealandAnna G.

10 Mirer Lawrence Berkeley National Laboratory, Berkeley, United States of AmericaHarald W. Meyer Hiller d Hospital, Hiller d, DenmarkMarjut Roponen National Public Health Institute, Helsinki, Finland1 Steering Group member IXCO NTRIBUTORSR eviewers who did not participating in the working group meetingOlaf Adan Eindhoven University of Technology and Netherlands Organization for Applied Scientific Research (TNO), Eindhoven, NetherlandsGwang Pyo Ko Seoul National University, Seoul, Republic of KoreaWHO Regional Office for EuropeMatthias BraubachOtto H nninenMichal Krzyzanowski (project leader)Secretariat: Andrea Rhein, Deepika SachdevaNone of the people listed declared any conflict of of the guidelines was supported by funds received by the WHO Eu-ropean Centre for Environment and Health (Bonn Office) from the German Federal Environment Ministry and from the United Kingdom Department of Health , which are gratefully acknowledged.