Moldy Claims - Stachybotrys and the Centers for Disease Control reports
Moldy Claims - Toxicity
Much of the present alarm over indoor mold exposure can be traced to a 1993-1994 series of cases of pulmonary hemorrhage among infants in Cleveland, Ohio. Those cases were investigated by the Centers for Disease Control and Prevention (CDC) and the initial reports did not suggest any cause for the cases studied. Later, these investigators suggested that the cause had been the presence of a particular mold, Stachybotrys chartarum, in the infants' homes. Because no illness was seen in adults and other children living in the same homes, they also suggested that very young infants might be unusually vulnerable. See CDC, Update: pulmonary hemorrhage/hemosiderosis among infants – Cleveland, Ohio, 1993-1996, MMWR Morb. Mortal Wkly. Rep. 49(9):180-184 (2000); CDC, Update: pulmonary hemorrhage/hemosiderosis among infants--Cleveland, Ohio, 1993-1996, MMWR Morb. Mortal Wkly. Rep. 46(2):33-35 (1997); CDC, Acute pulmonary hemorrhage/hemosiderosis among infants – Cleveland, January 1993-November 1994, MMWR Morb. Mortal Wkly. Rep. 43(48):881-883 (1994); Etzel, R.A. et al., Acute pulmonary hemorrhage in infants associated with exposure to Stachybotrys atraand other fungi, Arch. Pediatr. Adolesc. Med. 152(8):757-62 (1998); Montana, E. et al., Environmental risk factors associated with pediatric idiopathic pulmonary hemorrhage and hemosiderosis in a Cleveland community, Pediatrics 99(1):1-8 (1997).
In the immediate aftermath, despite the intense national attention to these cases in Cleveland, no new clusters and only a few additional isolated case reports have been published by independent investigators, See Elidemir, O. et al., Isolation of Stachybotrys from the lung of a child with pulmonary hemosiderosis, Pediatrics 104(4 Pt 1):964-966 (1999); Flappan, S.M. et al., Infant pulmonary hemorrhage in a suburban home with water damage and mold (Stachybotrys atra), Environ. Health Perspect. 107(11):927-930 (1999); Novotny, W.E. and Dixit, A., Pulmonary hemorrhage in an infant following 2 weeks of fungal exposure, Arch. Pediatr. Adolesc. Med. 154(3):271-75 (2000); Tripi, P.A. et al., Acute pulmonary haemorrhage in an infant during induction of general anaesthesia, Paediatr. Anaesth. 10(1):92-94 (2000). although the original investigators continue to add to their case series. See Dearborn, D.G. et al., Clinical profile of 30 infants with acute pulmonary hemorrhage in Cleveland, Pediatrics 110(3):627-637 (2002).
Nation-wide surveillance by the CDC has failed to identify either clusters or isolated cases that meet the CDC’s definition of “acute idiopathic pulmonary hemorrhage in infants” (AIPHI). See Brown, C.M., Medical Epidemiologist, Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, E-mail message to Hardin, B.D., Subject: AIPHI (May 15, 2003); CDC, Availability of case definition for acute idiopathic pulmonary hemorrhage in infants, MMWR Morb. Mortal. Wkly. Rep. 50(23):494-495 (2001).
When questions arose regarding the validity of the suggestion that exposures in the home to Stachybotrys caused the Cleveland cluster of AIPHI cases, the CDC conducted a detailed internal reevaluation of the original data and also convened a panel of outside experts to evaluate the original study and its conclusions. These re-evaluations led the CDC to publish a statement that Stachybotrys had not been shown to be the cause of the series of pulmonary hemorrhages in Cleveland, See CDC (2000)., and other reviewers have also concluded that the available scientific evidence does not establish Stachybotrys (or other indoor mold) as the cause of AIPHI. See Hardin, B.D. et al., Adverse human health effects associated with molds in the indoor environment, J. Occup. Environ. Med. 45(5):470-78 (2003); Kuhn and Ghannoum, supra note 28; Page and Trout, supra note 28; Sudakin, D.L., Stachybotrys chartarum: current knowledge of its role in disease, MedGenMed :E11 (2000).
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