Author:

Edited by Aino Nevalainen and Lidia Morawska. April 2009

Date: 15 July 2009

Abstract:

PrefaceThe earliest publication of WHO addressed mycotoxins in No.11 of theEnvironmental Health Criteria Series in 1979, updated for selected mycotoxins in1990 in Environmental Health Criteria No. 105. In 1990 WHO also published a reporton a WHO meeting entitled ‘Indoor air quality: biological contaminants’.After the publication of the second edition of the ‘Air Quality Guidelines for Europe’and the first globally applicable ‘Guidelines for Air Quality’ in 2000 the idea emergedto develop guidelines or guidance for biological agents in the indoor environment.After initial deliberations between WHO and various experts in January 2000 eightbackground papers on the health aspects of exposure to fungi, mould spores,mycotoxins, endotoxins, house dust mite allergens, and microbial volatile organiccompounds were commissioned, including also interactions between biological agentsand air pollutants and practical considerations in remediation of infected houses.These background papers were discussed in a meeting of the WHO SteeringCommittee which was convened back to back to the Healthy Building 2000conference, in Espoo, Finland on 4 August 2000. A report of the meeting waspublished in late 2000.As a primary objective of a guidance document the Steering Committee identified theprovision of information to decision makers and building operators on biologicalagents present in non-manufacturing indoor environments. The focus of the documentwas envisaged to be on the:a) Protection of building occupants from potential adverse health effects frombiological agents; andb) Provision of advice to decision makers and building operators on management ofbiological agents in indoor environments.It was the consensus of the Steering Committee that mould spores (funga; fungi);bacteria; mites; animal allergens; cockroach allergens; pollen; and microbial toxinsincluding endotoxins, MVOCs, etc., metabolites and fragments should be consideredin terms of evaluation of exposure; health risk evaluation; recommended guidelinevalue; relation to building moisture; and practical aspects of management and control.The Steering Committee agreed that the guideline document should recognise thelimits of current science and provide, for many biological agents, only generalqualitative advice, with minimal numerical exposure-response relationships andhealth-based guideline values. There was also consensus that practical management ofbiological agents in indoor air is an important issue worldwide. The ‘guidelines’ wereenvisaged to provide general advice on management of biological agents based onexperience mainly in developed countries, but the general principles should hopefullybe applicable for buildings world-wide including those in developing countries. The‘guidelines’ were also envisaged to clarify research needs and emphasise the need toharmonise biological agents indicators in future epidemiological studies.The Steering Committee also finalised the outline of the guideline document,identified the contributors and reviewers of the various chapters, and recommendedthe participation of important agencies in the United States and Canada.The first draft of the ‘guideline’ document was completed mid of 2001 and sent to thereviewers. After receiving the reviewers’ comments WHO convened an expertmeeting in Berlin, 22-26 April 2002, to which all contributing experts were invited.This meeting was convened although it was recognized that not all the required ordesired data were yet available. The meeting was held in collaboration with theUnited States Environmental Protection Agency, Washington DC and the NationalInstitute for Occupational Health and Safety, Morgantown, WV.In this meeting the objective of the Expert Group was to consider the state ofknowledge about exposure-response relationships of and the potential derivation ofguideline values for biological agents in the indoor environment, with respect to theimpact of these agents on the health and well-being of building occupants. It was felt,however, that there was only rudimentary information available on the quantitativeexposure-response relationships for biological agents, which would not allow thederivation of appropriate guideline values to protect the whole population or at leastthe most susceptible groups from the impact of biological agents in the indoorenvironment. The document summarized the knowledge in the area of biologicalagents indoors as of 2002, described the principles of their assessment and control,and also presented a list of recommendations that can be drawn on the basis of thecurrent understanding.Editorial meetings were held during the Indoor Air 2002 conference, 1-4 July 2002,Monterey and in a meeting in Sosnowiec, 5-8 January 2003.The ‘guideline’ document was intended to provide a clear stand of WHO with respectto the biological agents issue and a meaningful procedure for exposure andepidemiological studies which would be of value to the international scientificcommunity. Harmonisation of biological agent indicators and monitoring andinstrumental procedures would be beneficial for world-wide inter-comparison ofstudy results and optimal spending of spare funds. However, the work of the SteeringCommittee proved that deriving to a set of recommendations acceptable to the wholegroup was a very challenging task, considering the many gaps in knowledge stillavailable in this field. This was causing delays in finalization of some of thedocument’s sections.In the mean time, the development of health-based guidelines for indoor air qualitywas recommended to WHO by the working group for Global Update of WHOGuidelines for Air Quality, in 2005. The planning meeting for this task, organized inBonn in October 2006, recommended addressing indoor air quality issues under threesub categories of which on was dampness and mould in indoor air, and was closelyrelated to the document in progress.At that point, it was decided that the parts of the document on biological factors inindoor air which were completed, including the chapters that provided a generalintroduction to biological agents in indoor environments, and those that discussed thehealth effects of biological agents, as well as assessment methods and interactions ofbiological agents with other air pollutants, would be useful supplementary material tothe guidelines on dampness and mould. Professors Lidia Morawska and AinoNevalainen (members of the Steering Committee for the document) were entrusted arole of brining the chapters together, ensuring that the literature references were up todate and that all the necessary editorial corrections were conducted. This document isa product of this work, and it is made available as a technical report supplementingscientific evidence for WHO guidelines on dampness and mould.Dr Dietrich Schwela (WHO, Retired)Michal Krzyzanowski (WHO, European Centre for Environment and Health)

Link to DOI

Download the full article (Disclaimer)

This manuscript library of ~16,000 articles (1729-2024) related to Aspergillus and aspergillosis is intended for individual study only, and is provided as contribution to global understanding of the topic. Please refer to the publisher’s guidance about any other usage.

I understand (click to accept and view download link)

---