Agenda• Introductions – Mary Lou Fleissner,

Dr.PH.• NIOSH Update – Terri Pearce, Ph.D.• UConn Update – Eileen Storey, M.D.• Questions and Answers

August 2004 Survey25 Sigourney Street

Terri A. Pearce, Ph.D. – Project Officer

National Institute for Occupational Safety and Health

Division of Respiratory Disease Studies Field Studies Branch

Morgantown, West Virginia

Questions about 25 Sigourney Street

• Has health improved?• Has the environment

improved?• What happens next?

Overall Summary• There is evidence of improvement in

symptoms reported in the 12 months prior to the 2004 survey

• Some occupants of 25 Sigourney Street continue to have ongoing respiratory illness

• Previous water damage is likely to have contributed to the health complaints

• Ongoing health surveys are required to assess the effectiveness of dampness remediation

NIOSH Investigation

• Union health hazard evaluation request in response to employee reports of physician-diagnosed diseases and symptoms

• Became a joint request when management learned of the concerns

NIOSH 2001 and 2002 Surveys

• September 2001 - Health questionnaire survey offered to everyone in the building

• April 2002 – Environmental sampling• June 2002 – Offered medical testing

to some employees

2001 and 2002 Findings

• Two to three times the expected number of employees with asthma or wheezing

• Persons reporting symptoms or respiratory diagnoses frequently had abnormal lung test results or asthma medication use

• Mold and endotoxin levels in dust were associated with respiratory and skin symptoms

Building Repairs• Exterior repairs to correct balcony

drainage, brick failure, window leaks, roof replaced

• Interior replacement of water and mold damaged sheetrock

• Interior repairs to bathroom core• Replacement of carpeting on some

floors• Vacuuming of carpets, chairs, and

partitions

Has the health improved?

2004 Post-Repair Survey

• 7-8 months after roof repair• 3-4 months after post-repair cleaning• Health Assessment – Questionnaires

and medical testing • Building Assessment – Dust sampling

and real-time monitoring

Participation

• 888 people in 2001 and 771 in 2004• About 70% for both surveys

481 290407

2001 2004

New Diagnoses from January 2003 to August

2004• In employees hired 2003-2004

1 asthma diagnosis

• In employees hired before 2003 6 asthma diagnoses 1 hypersensitivity pneumonitis diagnosis* 1 sarcoidosis diagnosis

* also diagnosed with asthma

Respiratory Illness - 2004

ConditionDRS (%)

DSS (%)

Current asthma 13.7 15.5

Hypersensitivity pneumonitis

2.1 0.3

Sarcoidosis 0.4 1.4

One or more symptoms in the

last 12 months - 2004

0

10

20

30

40

50

60

70

80

90

100

Lower Respiratory Upper Respiratory

Per

cen

t o

f P

arti

cip

ants

DRS

DSS

One or more symptoms each week for the last 4 weeks -

2004

0

10

20

30

40

50

60

70

80

90

100

Lower Respiratory Upper Respiratory

Pe

rce

nt

of

Pa

rtic

ipa

nts

DRS

DSS

Non-Respiratory Symptoms - 2004

In Last 12 months and 4 Weeks

0

10

20

30

40

50

60

70

80

90

100

HypersensitivityPneumonitis-like

Sick Buildingsymptoms

Itchy Skin

Per

cen

t o

f P

arti

cip

ants

Last 12 months

Weekly in last 4 weeks

Summary of 2004 questionnaire survey

• DRS and DSS similar for physician diagnoses and respiratory symptoms

• About half of participants reported lower and non-respiratory symptoms and 30% reported skin symptoms

• More upper than lower respiratory symptoms

Has the percent of symptomatic employees

changed between the 2001 and 2004 surveys?

• We compared the results for the 481 employees who participated in both surveys

2001Percent

2004Percent

Wheeze 26 18

Shortness of breath (SOB)

18 13

Chest tightness 20 14

Cough attack 30 15

Awakened by breathing difficulty

10 6

Asthma-like symptoms in the last 12 months, but not in the

last 4 weeks

2001Percent

2004Percent

Wheeze 12 17

Shortness of breath (SOB)

15 15

Chest tightness 18 16

Cough attack 22 22

Awakened by breathing difficulty

7 7

Asthma-like symptoms weekly in the last 4 weeks

Have you had symptoms that you think may be related to the building?

Comparison between 2001 and 2004 surveys

0

10

20

30

40

50

60

70

80

90

100

DRS DSS

Pe

rce

nt

of

Pa

rtic

ipa

nts

2001

2004

Summary of comparison2001/2002 to 2004

• There were decreases in the percent of employees reporting symptoms in the last 12 months but not occurring in the last 4 weeks

• There were no decreases in the percent of employees reporting symptoms occurring weekly in the last 4 weeks

• Decrease for DRS when asked: Have you had symptoms that you think

may be related to the building?

Did medical testing results change?

• Lung function test results show similar relationships with symptom status in 2002 and 2004

• Positive allergy skin tests have decreased for all symptom groups

• Persons with post-occupancy asthma continue to have fewer positive skin allergy tests than persons with pre-occupancy asthma

Abnormal Lung Function Tests – 2002 and 2004

Subgroup June 2002 August 2004

Respiratory Case Group

39% (44/114) 36% (26/72)

Fewer Symptoms Group

29% (16/55) 16% (8/50)

Comparison Group 11% (4/37) 18% (5/28)

The participants in the 2002 and 2004 surveys were not all the same people

Has the environment improved?

Median Dust Levels

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

2002 2004

Survey Year

Gra

ms

pe

r s

qu

are

me

ter

Building

DRS

DSS

Median Fungi Levels

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

2002 2004 IICRC SuggestedBackground Level

Co

lon

y F

orm

ing

Un

its

pe

r S

qu

are

Me

ter

BuildingDRSDSS

Median Cat Allergen Levels

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

2002 2004

Survey Year

Mic

rog

ram

s p

er

Sq

ua

re M

ete

r

BuildingDRSDSS

Have the dust levels changed?

• Amounts of dust in the carpet are somewhat higher than measured in 2002

• Amounts of culturable fungi and endotoxin in floor dust are also slightly higher than in 2002

• Amounts of cat and dog allergen are lower than in 2002

Real-time Monitoring

• Temperature and relative humidity were within the recommended ranges

• Some carbon dioxide measurements on 15th floor were above the recommended level

• Water activity of some carpets could support microbial growth

Have we answered the questions?

• There were decreases in the percent of employees reporting symptoms in the last 12 months but not occurring in the last 4 weeks

• There were no decreases in the percent of employees reporting symptoms occurring weekly in the last 4 weeks

• Dust levels were similar with fungi and endotoxin levels being somewhat higher in carpets with cat and dog allergen being somewhat lower

What happens next?

Next Steps• August health and environmental

surveys• Follow-up for new employees• Building systems evaluation

Overall Summary• There is evidence of improvement in

symptoms reported in the 12 months prior to the 2004 survey

• Some occupants of 25 Sigourney Street continue to have ongoing respiratory illness

• Previous water damage is likely to have contributed to the health complaints

• Ongoing health surveys are required to assess the effectiveness of dampness remediation

NIOSH - Morgantown

1-800-232-2114

Terri Pearce, Ph.D. – Project Officer