A damp spot appears in a ceiling after an intense rainstorm; a hose loosens from a washing machine, spilling gallons of water onto a basement floor; weeks after a moldy odor is detected, a plumber finds a slow leak behind a wall. There are over 119 million housing units in the United States and nearly 4.7 million commercial buildings (U.S. Census Bureau, 2003), and almost all of them experience leaks, flooding, or other forms of excessive indoor dampness at some time. Excessive indoor dampness is not by itself a cause of ill health, but it is a determinant of the presence or source strength of several potentially problematic exposures. Damp indoor environments favor house dust mites and microbial growth, standing water supports cockroach and rodent infestations, and excessive moisture may initiate chemical emissions from building materials and furnishings. Indoor microbial growth—especially fungal growth—has recently received a great deal of attention in the mass media. It is a prominent feature of the breakdown of dampness control; its many possible causes include a breach of the building envelope, failure of a water-use device, and excessive indoor water-vapor generation. Occupants, health professionals, and others have wondered whether indoor exposure to mold and other agents might have a role in adverse health outcomes experienced by occupants of damp buildings. Prominent among these health outcomes is acute idiopathic pulmonary hemorrhage in infants, cases of which were reported in Cleveland, Ohio in the 1990s. Residence in homes with recent water damCopyright © National Academy of Sciences. All rights reserved. This executive summary plus thousands more available at http://www.nap.edu Damp Indoor Spaces and Health http://books.nap.edu/catalog/11011.html 2 DAMP INDOOR SPACES AND HEALTH age and in homes with visible mold (including Stachybotrys chartarum) was among the risk factors identified in the case infants. Against that backdrop, 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 f
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