Indoor Air zyxwvutsrqponmlk 1995, 5: 3-9 Frrnted in Denmark zyxwvutsrqponm . all rtghrc reserved Coavrieht zyx 0 Munksaaard 1995 zy Indoor Air ISSN 0905-6947 zyx Respiratory Symptoms zy and Infections among Children in a Day-care Center with Mold Problems Outi Koskinenl, Tuula Husman', Anne Hyvarinen', Tiina Reponen2, Aino Nevalainen' z Abstract The prevalence of irritative symptoms and the incidence of respiratory infections among children in a day-care center affected by mold were compared with those in a reference day- care center. A retrospectivepilot snrdy zyxwvut was made zyxwvu in the mold- problem day-care center. Analysis zyxwvutsrq of absenteeism records and a one-year follow-up study were made in both day-care cen- ters. In the pilot study, half of the exposed 41 children had prolonged orfieqluent symptoms and respiratory infections. In addition, the absenteeism in the mold+mblem day-care center was nearly twice as high as in the reference day-care center. After cessation of the exposure, the occurrence of respiratory symptoms decreased and no lower respiratory tract infections appeared. KEY WORDS: Mold, Children, Day-care center, Respiratory symp- toms, Infections, Absenteeism Manuscript received: 5 July 1993 Accepted for publication: 3 March 1994 A preliminary version of this paper was presented at the Indoor Air '93 Conference in Helsinki in July 1993 ' National Public Health Institute, Division of Environmental Health, P.0.B 95, SF-70701 Kuopio, Finland Kuopio Regional Institute of Occupational Health, Kuopio, Finland Introduction Microbial growth associated with building moisture causes adverse health effects, such as mucosal irri- tation, other respiratory symptoms, asthma and al- lergy. Among the symptoms reported have been nasal congestion or runny nose, shortness of breath, sore throat, cough, phlegm and wheezing (Gold- farb, 1968; Strachan and Sanders, 1989; Platt et al., 1989). There is also an association between home dampness and increased prevalence of respiratory infections (Waegemaekers et al., 1989). In buildings affected by mold, the exposure may consist of various agents, such as microorganisms and their spores and microbial metabolites such as mycotoxins and volatile organic compounds (Tobin et al., 1987). The biological mechanisms behind the association between mold exposure and adverse health effects are largely unknown, though several theories have been suggested. For example, mold spores, volatile organic compounds and toxins may cause inflammation of respiratory mucosa, cause an allergic reaction and affect the immune system, and thus promote common viral and bacterial infections in the respiratory tract (Schiefer, 1990; Flannigan et al., 1991). The purpose of this study was to describe the symptoms and infections of children attending a day-care center with mold problems. The study consisted of a pilot study and a follow-up study. The aim of the pilot study was to gain an overview of the health effects in question and to identify the es- sential parameters to be followed. The ques- tionnaire for the subsequent follow-up study was designed according to this information. The aims of the follow-up study were 1) to com- pare the children's respiratory health during the ex- posure with their health status after cessation of the exposure, 2) to compare the occurrence of respir- atory symptoms and infections among children at- tending a mold-problem day-care center with that