Comparison of Mold Exposures, 

Work-related Symptoms, and 

Visual Contrast Sensitivity 

between Employees at a 

Severely Water-damaged 

School and Employees at a 

School without Significant Water 

Damage

Gregory Thomas, MD, MS

Nancy Clark Burton, PhD, MPH, CIH

Charles Mueller, MS

Elena Page, MD, MPH

Health Hazard Evaluation Report

HETA 2005-0135-3116

Alcee Fortier Senior High School

New Orleans, Louisiana

September 2010

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

Workplace

Safety and Health

 National Institute for Occupational 

Safety and Health

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific 

facility evaluated and may not be universally applicable. Any recommendations made are not to be 

considered as final statements of NIOSH policy or of any agency or individual involved. Additional HHE 

reports are available at http://www.cdc.gov/niosh/hhe/
The employer shall post a copy of this report 

for a period of 30 calendar days at or near 

the workplace(s) of affected employees. The 

employer shall take steps to insure that the 

posted determinations are not altered, defaced, 

or covered by other material during such 

period. [37 FR 23640, November 7, 1972, as 

amended at 45 FR 2653, January 14, 1980].
Health Hazard Evaluation Report 2005-0135-3116 Page i

Appendix A

Report Abbreviations.......................................................................ii

Highlights of the NIOSH Health Hazard Evaluation............ iii

Summary .............................................................................v

Introduction..........................................................................1

Assessment.........................................................................4

Results ................................................................................5

Discussion ........................................................................14

Conclusions.......................................................................16

Recommendations.............................................................17

References ........................................................................19

Contents

Tables ................................................................................33

Methods.............................................................................22

Occupational Exposure Limits and Health Effects.............27

Acknowledgments Acknowledgments and Availability of Report.....................43

Appendix C

Appendix B
Page ii Health Hazard Evaluation Report 2005-0135-3116

Abbreviations

μg/dL Micrograms per deciliter

μg/g Micrograms per gram

μm Micrometer

ACGIH® American Conference of Governmental Industrial Hygienists

AFSHS Alcee Fortier Senior High School

AIHA American Industrial Hygiene Association

ANSI American National Standards Institute

ASHRAE American Society of Heating, Refrigerating, and Air-Conditioning Engineers

BLL Blood lead level

CDC Centers for Disease Control and Prevention

CO2 Carbon dioxide

CFR Code of Federal Regulations

CFU/m3 Colony forming units per cubic meter

cpd Cycles per degree 

ERMI Environmental relative moldiness index

F.A.C.T.® Functional acuity contrast test

HHE Health hazard evaluation

HEPA High-efficiency particulate air

HUD U.S. Department of Housing and Urban Development

HVAC Heating, ventilating, and air-conditioning

IEQ Indoor environmental quality

IOM Institute of Medicine

LASIK Laser-assisted in situ keratomileusis

Lpm Liters per minute

Ls-1 Liters per second

MEA Malt extract agar

MSQPCR Mold specific quantitative polymerase chain reaction

NAICS North American Industry Classification System

NIOSH National Institute for Occupational Safety and Health

NOPS New Orleans Public School

OEL Occupational exposure limit

OSHA Occupational Safety and Health Administration

PEL Permissible exposure limit

ppm Parts per million

RH Relative humidity

U.S. EPA United States Environmental Protection Agency

VCS Visual contrast sensitivity

VOC Volatile organic compound

WHO World Health Organization

WHHS Walnut Hills High School
Health Hazard Evaluation Report 2005-0135-3116 Page iii

The National Institute 

for Occupational Safety 

and Health (NIOSH) 

received a request for a 

health hazard evaluation 

at the Alcee Fortier 

Senior High School 

(AFSHS) in New Orleans, 

Louisiana. Employees 

were concerned about 

exposures to mold and 

lead paint. The employees 

reported difficulty 

breathing, chronic 

sinusitis, and immune 

system problems.

Highlights of the

NIOSH Health

Hazard Evaluation

What NIOSH Did

● We evaluated the school in April 2005 and again in May 

2005.

● We also evaluated Walnut Hills High School (WHHS) in 

Cincinnati, Ohio, in February 2006. This school is about 

the same age as AFSHS, but has no history of water damage 

or mold contamination. We compared the two schools.

● We looked for signs of water damage and mold in both 

schools. We also reviewed industrial hygiene reports for 

both schools.

● We collected air, bulk, and surface samples for mold in the 

AFSHS and WHHS buildings. We collected bulk paint 

samples for lead at AFSHS but not at WHHS because there 

was no peeling paint.

● We looked at the ventilation systems and checked the 

moisture levels in the walls at both schools. We also 

measured carbon dioxide, temperature, and relative 

humidity levels in both schools.

● We surveyed employees at both schools. We asked about 

their work, medical history, and work-related health 

concerns.

● We conducted visual contrast sensitivity tests on employees 

at both schools.

What NIOSH Found

● We found mold and moisture problems throughout 

AFSHS. Only one area at WHHS was identified with an 

ongoing moisture problem.

● We found lead in the bulk paint samples from AFSHS.

● The carbon dioxide, temperature, and relative humidity 

levels were acceptable at AFSHS. Carbon dioxide 

measurements were elevated in some classrooms at WHHS.

● Employees at AFSHS had significantly higher prevalences 

of symptoms than employees at WHHS. These included 

rashes and nasal, lower respiratory, constitutional, and 

neurobehavioral symptoms.
Page iv Health Hazard Evaluation Report 2005-0135-3116

Highlights of the

NIOSH Health

Hazard Evalution

(continued)

● We found significantly lower visual contrast sensitivity 

test results for AFSHS compared with WHHS employees, 

indicating that mild visual changes had occurred.

What New Orleans Public School District 

Administrators Can Do

Because AFSHS is now a private school and has been renovated, 

general recommendations for maintaining good indoor 

environmental quality are provided to the New Orleans Public 

School District for use at all schools.

● Follow a routine maintenance schedule for all ventilation 

systems.

● Implement an indoor environmental quality management 

plan.

● Address existing moisture problems, and have an action plan 

to address future occurrences.

● Set up a health and safety committee with school 

administration and employees. Ensure the group has 

adequate time and money to function effectively.

What WHHS Administrators Can Do

● Make sure adequate amounts of outdoor air are supplied to 

classrooms.

● Address moisture problems in the band rooms and remediate 

existing mold contamination.

What Employees Can Do

● Report work-related health concerns to school officials.

● See an experienced occupational medicine physician if you 

have health concerns that may be related to your work.

● Become active in the safety and health committee.
Health Hazard Evaluation Report 2005-0135-3116 Page v

NIOSH investigators 

compared work-related 

symptoms and VCS 

between employees at 

a school with severe 

water damage and those 

at a school without 

significant water damage. 

Employees at the waterdamaged school had 

higher prevalences of 

work-related rashes and 

nasal, lower respiratory, 

and constitutional 

symptoms than those 

at the school without 

significant water damage. 

VCS values across all 

spatial frequencies were 

lower among employees 

at the water-damaged 

school. Further studies 

are needed to determine 

what factors could be 

responsible for the VCS 

findings and whether 

they have any clinical 

significance for affected 

individuals. The building 

problems at AFSHS 

need to be addressed; 

recommendations to 

prevent water damage and 

microbial growth and for 

remediation in NOPS and 

WHHS are provided in this 

report.

Summary

On January 18, 2005, NIOSH received a request for an HHE at 

AFSHS in New Orleans, Louisiana. Employees submitted the 

request because of concerns about exposure to mold and lead paint 

in their school building. Employees reported a variety of health 

effects, including difficulty breathing, chronic sinusitis, immune 

system problems, nosebleeds, skin rashes, irregular menses, 

headaches, irritable bowel syndrome, and nausea.

We visited AFSHS on April 18–19, 2005. During informal 

interviews, employees reported possible work-related symptoms, 

some of which were consistent with symptoms reported by people 

working in water-damaged buildings. The building had obvious 

microbial contamination, so we decided that further evaluation 

was needed. On May 23–24, 2005, we returned to New Orleans 

for a follow-up evaluation. During this visit we administered a work 

history and health symptom questionnaire. We also conducted 

VCS testing using the F.A.C.T.® handheld chart. VCS testing 

measures the subjects’ ability to determine changes in alternating 

light and dark bands of varying intensity. Performance on this test 

has been adversely associated with exposure to neurotoxins such 

as solvents and lead among many other conditions and exposures 

such as aging, certain eye conditions, alcohol and medication 

use, and depression. We used VCS testing for this evaluation to 

determine if it could serve as a biomarker of effect for occupants 

who experience adverse effects from a water-damaged building. We 

also collected environmental samples for culturable and aerosolized 

fungal spores and measured IEQ parameters (CO2, temperature, 

and RH). We performed a similar evaluation at WHHS in 

Cincinnati, Ohio, on February 27–29, 2006. WHHS had no 

history of ongoing water intrusion or mold growth.

Of 119 employees at AFSHS, 95 (80%) participated in the 

evaluation. Of 165 employees at WHHS, 110 (67%) participated. 

Participants at both schools were similar in sex, age, history of 

psychiatric disease, atopy (the predisposition to allergic disease), 

smoking history, and having mold or moisture problems in their 

homes.

Employees at AFSHS had higher prevalences of work-related 

cough, wheezing, or whistling in the chest; chest tightness; unusual 

shortness of breath; sinus problems; sore or dry throat; frequent 

sneezing; stuffy nose; runny nose; fever or sweats; aching all over; 

unusual tiredness or fatigue; headache; difficulty concentrating; 

confusion or disorientation; trouble remembering things; change 

in sleep patterns; and rash, dermatitis, or eczema on the face, neck, 
Page vi Health Hazard Evaluation Report 2005-0135-3116

Summary (continued)

Keywords: NAICS 611110 (Elementary and Secondary Schools), 

indoor environmental quality, IEQ, ERMI, mold, lead, F.A.C.T., visual 

contrast sensitivity

or arms than employees at WHHS. At each school, 13 employees 

reported currently having asthma. A significantly higher percent of 

the asthmatics at AFSHS reported their asthma was worse at work.

Monocular and binocular VCS values were significantly lower at all 

spatial frequencies among AFSHS employees. A significantly higher 

percentage of employees at AFSHS had scores that fell below the 

average performance for 90% of the population compared to the 

results found among employees at WHHS.

Actively growing Cladosporium was found on the walls of AFSHS. 

Mold was found in all three MSQPCR air samples with 

C. sphaerospermum being the most prevalent. The vacuum dust 

samples detected 32 of the 35 fungal species tested. The culturable 

air samples showed that Cladosporium and Pencillium were the most 

prevalent genera both inside and outside the school. Aspergillus

species were detected in inside samples but not in outside air samples. 

The spore trap samples showed that Cladosporium was the prevalent 

genera both inside and outside the school with the exception of 

Room 316.

No fungal growth was detected on six of eight sticky tape samples 

collected at WHHS. One had a trace of hyphae, and the other 

showed a few Aspergillus/Pencillium-like spores and a trace of hyphae. 

Both were from the band room. Air samples analyzed with MSQPCR 

showed low counts for inside samples compared to outside samples. 

The culturable and spore trap air samples collected inside and outside 

WHHS were comparable in terms of both counts and genera ranking. 

CO2 concentrations were elevated in some classrooms.

We determined that a health hazard existed at AFSHS. Employees 

had significantly higher prevalences of rashes and nasal, lower 

respiratory, and constitutional symptoms than employees at WHHS. 

The prevalences of several neurobehavioral symptoms were also 

significantly higher. VCS values across all spatial frequencies were 

lower in the employees at AFSHS. Further studies are needed to 

determine what factors could be responsible for the VCS findings 

and whether they have any clinical significance for affected 

individuals. The building problems at AFSHS need to be addressed; 

recommendations to prevent water damage and microbial growth and 

for remediation in NOPS and WHHS are provided in this report.
Health Hazard Evaluation Report 2005-0135-3116 Page 1

Introduction

On January 18, 2005, NIOSH received an employee request for an 

HHE at the AFSHS in New Orleans, Louisiana, because of concerns 

about exposure to mold and lead paint in their school building. 

Employees reported a variety of health effects, including difficulty 

breathing, chronic sinusitis, immune system problems, nosebleeds, 

skin rashes, irregular menses, headaches, irritable bowel syndrome, 

and nausea.

After review of the request and telephone consultations with the 

requestor and administrative representatives of AFSHS, an initial 

site visit was made on April 18–19, 2005. An opening conference 

was held at the AFSHS library with school administrators, school 

medical personnel, and local representatives of the NOPS teachers’ 

union. Following the opening conference, a walk-through of the 

school was conducted and confidential, open-ended interviews were 

held with AFSHS employees. In addition, preliminary environmental 

sampling (collection of tape samples for microscopic analysis for 

fungal spores, collection of bulk paint samples for lead analysis, and 

use of a moisture meter to qualitatively assess wall moisture levels) was 

performed in the school building. Among the symptoms employees 

reported were possible work-related respiratory symptoms consistent 

with symptoms reported in other water-damaged buildings. They also 

reported neurobehavioral symptoms such as difficulty concentrating, 

irritability, and trouble remembering things.

On May 23–24, 2005, we returned to New Orleans for a followup evaluation at AFSHS to administer a work and health history 

questionnaire and to conduct VCS testing. We used VCS testing 

for this evaluation to determine if it could serve as a biomarker of 

effect for occupants who experience adverse effects from a waterdamaged building. A biomarker is an indicator that signals an event 

or condition in a biological system or sample and gives a measure of 

exposure, effect, or susceptibility. A biomarker of effect is associated 

with an established or possible health impairment or disease. We also 

collected environmental samples for culturable and aerosolized fungal 

spores and measured IEQ parameters (CO2, temperature, and RH).

VCS testing has been reported as useful in “diagnosing” and 

monitoring treatment of “biotoxin-related illness” among individuals 

exposed to water-damaged buildings [Shoemaker and House 2005; 

Shoemaker and House 2006]. “Biotoxin-related illness” is not 

a generally accepted medical condition, and reportedly consists 

of multiorgan system symptoms, among which neurobehavioral 

symptoms are prominent. Interpretation of these studies is hampered 

by methodological limitations, including a nonrepresentative sample, 
Page 2 Health Hazard Evaluation Report 2005-0135-3116

Introduction 

(continued) medical conditions that often present with multiple system symptoms 

(fibromyalgia and chronic fatigue syndrome), the lack of a comparison 

group, and poor exposure characterization. These limitations could 

account for the lower VCS values in the participants of these studies, 

rather than illness from exposure to water-damaged buildings.

VCS has been documented to be adversely affected by exposure 

to toxic substances that affect the central nervous system such as 

solvents [Frenette et al. 1991; Broadwell et al. 1995; Schreiber et al. 

2002; Boeckelmann and Pfister 2003; Gong et al. 2003; Hitchcock et 

al. 2003]. Some of these studies have noted deficits in the midspatial 

frequencies [Broadwell et al. 1995; Schreiber et al. 2002] while 

others have documented deficits across all frequencies [Frenette et 

al. 1991; Gong et al. 2003]. A number of visual conditions also affect 

VCS, including cataracts, glaucoma, LASIK, retinopathy, and dry 

eye. Recently, patients with major depression have been found to 

have worse contrast discrimination than controls [Bubl et al. 2009]. 

VCS is adversely affected by aging, alcohol use, and attention deficit 

hyperactivity disorder [Pearson and Timney 1999; Nomura et al. 

2003; Bartgis et al. 2009].

We planned a third visit to New Orleans to perform similar testing 

at a local school that did not have water intrusion or mold growth. 

However, damage from Hurricane Katrina and the subsequent 

flooding prevented access to an appropriate comparison school in 

New Orleans.

We requested and were granted access to WHHS in Cincinnati, 

Ohio, for comparison. This large public school is similar in age to 

AFSHS. The school did not have a history of extensive or ongoing 

water intrusion or mold growth. We made a site visit to WHHS from 

February 27–29, 2006. An environmental evaluation was performed, 

a questionnaire was administered, and VCS testing was conducted on 

all participants at WHHS.

Facility Descriptions

Alcee Fortier Senior High School

At the time of the 2005 site visits, AFSHS was one of 130 schools in 

the NOPS district. It was an inner city high school on the western 

edge of New Orleans. The school had 119 staff members and 850 
Health Hazard Evaluation Report 2005-0135-3116 Page 3

Introduction (continued) students in the 9th through 12th grades. A school nurse was on site, 

and custodial and ventilation maintenance services were contracted 

out.

The AFSHS building was constructed in 1929 and opened in 

1930. The building was a large masonry (stone and marble) fourstory structure with a flat membrane/gravel roof. The building 

was originally designed with a natural ventilation system using 

large exterior windows and windows at the top of the interior 

walls adjacent to the hallways to provide cross-ventilation. In 2002, 

individual ventilation units (Scholar QVTM, Marvair Cordele, 

Georgia) were installed in each classroom and hallway. Each unit was 

placed on an exterior wall; the ventilation unit’s louvered outside 

air intake replaced an existing window. The ventilation systems were 

powered off during evenings and weekends to save energy. Ceiling 

fans were used in the classrooms to circulate air. The classrooms had 

hardwood floors, and the hallways had tile floors. The band room 

had a separate HVAC system.

Walnut Hills High School

WHHS was built in 1930. The main building was a stone and 

brick structure with primarily concrete floors. It had no significant 

history of water incursion or mold problems, and was chosen as 

a comparison to AFSHS based on ease of access and age of the 

building. The ventilation system consisted of steam heat in the 

winter and air conditioning for cooling. A roof leak and mold 

contamination in the library were remediated in 1995. Evidence of a 

past roof leak was seen in and around the band/music room located 

under the school patio. The art and science building, added in 1999, 

showed no evidence of moisture incursion. This building had an 

independent, ducted HVAC system.

Review of Previous IEQ Evaluations of the 

AFSHS Building

Review of reports furnished by AFSHS included citations dated from 

1997 to 2002 by the State Office of Public Health, reports from the 

State of Louisiana Department of Health and Hospitals, and the 

Orleans Parish School Board Request for Repairs and Alterations. 

These documents primarily allude to problems with extensive 

peeling paint (some of which was lead-based) on walls and ceilings, 

noninsulated pipes, mold remediation projects, and broken windows.
Page 4 Health Hazard Evaluation Report 2005-0135-3116

Medical

All employees at both schools were invited to participate in the 

evaluation. Each participant gave full informed consent and filled 

out a questionnaire about his or her age, medical history, work 

history, exposure to mold or moisture in the home, and symptoms 

experienced during the last month while working in the school. 

These included upper respiratory and mucus membrane, lower 

respiratory, constitutional, neurobehavioral, and dermal symptoms. 

If the participant reported having the symptom during the previous 

month while in the school and that it improved or went away on 

days off work, the symptom was considered work-related. VCS 

testing was conducted using the F.A.C.T. handheld chart [Ginsburg 

1993]. We also measured visual acuity with a handheld Snellen 

chart. Results from persons with visual acuity of 20/50 or less 

were removed from further analysis. The tests were conducted 

monocularly and binocularly under standard daylight illumination 

in the library of each school. A light meter was used to ensure that 

ambient illumination met the requirements specified for the F.A.C.T. 

handheld chart (between 68 and 239 candelas per square meter). 

Participants who used corrective lenses were asked to wear them 

during testing. Additional information concerning VCS and the 

statistical methods used for this report is located in Appendix A.

Environmental

During the first site visit at AFSHS on April 18–19, 2005, sticky 

tape samples from surfaces were collected throughout the school 

for microscopic fungal analysis. Vacuum dust samples were analyzed 

for the presence of fungal species using a DNA-based method called 

MSQPCR [Haugland et al. 2002]. A nondestructive moisture meter 

was used to qualitatively assess the interior wall moisture levels. To 

address requestors’ concerns over the potential for lead exposures 

from peeling paint, paint samples were collected and analyzed for 

lead.

During the second site visit to AFSHS, a more detailed 

environmental evaluation was conducted. Air samples for culturable 

fungi were collected using Andersen N-6 samplers (Thermo 

Electron Corporation, Waltham, Massachusetts) with MEA 

agar plates. Spore trap samples were collected using Air-o-Cell® 

samplers (Zefon International, Inc., Ocala, Florida). Measurements 

of CO2, temperature, and RH, as indicators of comfort, were 

Assessment
Health Hazard Evaluation Report 2005-0135-3116 Page 5

Assessment (continued) taken throughout the workday. Additional sticky tape samples 

were collected for microscopic fungal analysis, and one additional 

paint sample was collected and analyzed for lead. A more detailed 

description of the sampling methods can be found in Appendix A. 

Information on OELs and health effects for IEQ, mold, and lead is 

provided in Appendix B.

A similar environmental protocol for mold testing was used for the 

WHHS evaluation. Environmental samples collected included sticky 

tape samples for microscopic fungal analysis and air samples for 

culturable fungi, MSQPCR, and spore trap analyses. Measurements 

of CO2, temperature, and RH were made throughout the workday. 

Additional information concerning the sampling protocol is given in 

Appendix A.

Of 119 AFSHS employees, 95 (80%) participated in the evaluation; 

65 were teachers or teaching aides. The rest were administrative 

personnel, food service staff, janitorial staff, security staff, nurses, 

counselors, and speech therapists. Of 165 WHHS employees, 

110 (67%) participated; 73 were teachers, 21 were administrative 

personnel, and the rest were food service staff, janitorial staff, security 

staff, nurses, counselors, and speech therapists. Participants at both 

schools were similar in sex, age, history of psychiatric disorder, atopy 

(the predisposition to allergic disease), smoking history, and having 

mold or moisture problems in their home. A significantly higher 

percentage of AFSHS employees had hypertension, which may 

adversely affect VCS. A significantly higher percentage of WHHS 

employees reported head injuries. The median number of alcoholic 

drinks among WHHS employees was higher than those at AFSHS. 

Alcohol intake and head injuries may also adversely affect VCS. 

The prevalence of current asthma was very similar between schools. 

Demographic information is presented in Table 1.

Results
Page 6 Health Hazard Evaluation Report 2005-0135-3116

Results (continued)

Employees at AFSHS had higher prevalences of work-related 

rash and lower respiratory, upper respiratory, constitutional, 

and neurobehavioral symptoms compared to WHHS employees 

(Table 2). All but dry or irritated eyes, nosebleeds, irritability, and 

depression were statistically significantly higher. Thirteen employees 

at each school reported currently having asthma, but 69% of the 

asthmatics at AFSHS reported their asthma was worse at work, 

compared to 23% at WHHS (P=0.02). We removed employees with 

current asthma from our analyses for lower respiratory symptoms 

and found that AFSHS employees still had significantly higher 

prevalences of work-related cough (P<0.01), wheezing or whistling in 

the chest, (P<0.01), chest tightness (P<0.01), and unusual shortness 

of breath (P<0.01). In previous studies we have used the presence 

of work-related wheezing or whistling in the chest, or two of the 

following three symptoms: cough, chest tightness, or unusual 

Table 1. Selected characteristics of participants, by school

Variable AFSHS

n=91–95*

WHHS

n=98–109*

Age (mean) 46 years 48 years

Tenure (median) 4 years 8 years

Number of alcoholic beverages in the past 30 days (median) 0 3

number (%) number (%)

Female 49 (52) 59 (55)

Mold or moisture problem at home 6 (6) 9 (8)

Ever had asthma 20 (21) 13 (12)

Physician diagnosed asthma 19 (20) 12 (11)

Currently have asthma 13 (14) 13 (12)

Atopy† 69 (73) 75 (69)

Diabetes 8 (8) 4 (4)

Hypertension 37 (39) 28 (26)

Physician-diagnosed anxiety 15 (16) 15 (14)

Physician-diagnosed depression 15 (16) 17 (16)

Physician-diagnosed obsessive compulsive disorder 1 (1) 2 (2)

Physician-diagnosed bipolar disorder 3 (3) 1 (1)

History of eye surgery 3 (3) 10 (9)

History of head injury 10 (11) 23 (21)

Ever smoked cigars, cigarettes, or pipes 32 (34) 35 (33)

*Denominators vary due to missing information

†

Atopy is a self-reported history of asthma, allergic rhinitis or hay fever, or eczema. Atopy signifies a 

predisposition to allergic disease.
Health Hazard Evaluation Report 2005-0135-3116 Page 7

Results (continued) shortness of breath to define symptoms consistent with workrelated asthma. Excluding those who reported current, physiciandiagnosed asthma, 20 employees at AFSHS met the definition of 

symptoms consistent with work-related asthma and, therefore, may 

have undiagnosed or unrecognized asthma.

Table 2. Prevalence of work-related symptoms in the last month, by school

Symptom AFSHS

n= 81–88*

WHHS

n=102–107*

Prevalence Ratio

(95% Confidence 

Interval)

P value

number (%) number (%)

Lower Respiratory

Cough 35 (43) 11 (10) 4.16 (2.26, 7.68) <0.01

Wheezing or whistling in chest 19 (23) 2 (2) 12.13 (2.91, 50.62) <0.01

Chest tightness 22 (27) 0 +inf (7.69, +inf) † <0.01

Unusual shortness of breath 19 (24) 4 (4) 6.22 (2.20, 17.56) <0.01

Upper Respiratory

Sinus problems 27 (33) 14 (13) 2.44 (1.37, 4.35) <0.01

Dry or irritated eyes 16 (20) 12 (11) 1.72 (0.86, 3.44) 0.12

Nosebleeds 3 (4) 1 (1) 3.70 (0.53, 47.02) 0.33

Sore or dry throat 21 (24) 13 (13) 1.95 (1.04, 3.67) 0.03

Frequent sneezing 17 (20) 4 (4) 5.23 (1.83, 14.96) <0.01

Stuffy nose 25 (29) 10 (10) 3.09 (1.57, 6.07) <0.01

Runny nose 22 (25) 7 (7) 3.87 (1.73, 8.62) <0.01

Constitutional 

Fever or sweats 14 (16) 4 (4) 4.10 (1.40, 12.01) <0.01

Aching all over 12 (14) 4 (4) 3.71 (1.24, 11.08) 0.01

Unusual tiredness or fatigue 25 (31) 18 (17) 1.78 (1.04, 3.03) 0.03

Headache 30 (35) 21 (20) 1.74 (1.08, 2.81) 0.02

Neurobehavioral

Difficulty concentrating 15 (18) 4 (4) 4.63 (1.60, 13.44) <0.01

Confusion or disorientation 8 (10) 2 (2) 5.05 (1.25, 29.56) 0.02

Trouble remembering things 15 (17) 5 (5) 3.59 (1.36, 9.47) <0.01

Irritability 19 (22) 15 (14) 1.51 (0.82, 2.80) 0.18

Depression 6 (7) 2 (2) 3.74 (0.87, 20.82) 0.14

Change in sleep patterns 16 (19) 4 (4) 4.99 (1.73, 14.37) <0.01

Rash, dermatitis, or eczema (on face, 

 neck, arms, or hands)

12 (14) 4 (4) 3.70 (1.24, 11.06) 0.01

*Denominators vary because of missing information.

†

Positive infinity or undefined
Page 8 Health Hazard Evaluation Report 2005-0135-3116

Results (continued) Fifteen individuals were excluded from analyses of VCS because of 

conditions that could affect their VCS such as glaucoma, cataract, 

LASIK surgery, or retinal surgery (4 from AFSHS and 11 from 

WHHS). Eighteen left eyes (8 from AFSHS and 10 from WHHS) 

and 19 right eyes (8 from AFSHS and 11 from WHHS) were 

excluded because near visual acuity was > 20/50. Three individuals 

were excluded from analyses because their binocular near visual 

acuity was > 20/50 (two from AFSHS and one from WHHS). Near 

monocular and binocular visual acuity did not differ significantly 

between the remaining WHHS and AFSHS employees who were 

included in the analyses. Monocular and binocular VCS values were 

significantly lower at all spatial frequencies among AFSHS employees 

(P<0.01). We repeated the analyses excluding diabetics, and results 

were similar. We compared VCS values between schools among only 

hypertensives, and again among only nonhypertensives. We found 

lower values at all frequencies among AFSHS employees in both 

groups, although the differences were not statistically significant 

among the hypertensives at spatial frequencies 1.5 cpd (P=0.12) or 18 

Table 3. Prevalence of visual contrast sensitivity scores below 90% of the population

AFSHS

n=80

number (%)

WHHS

n=81

number (%)

P value

Left Eye (cpd)

1.5 10 (13) 1 (1) <0.01

3 11 (14) 1 (1) <0.01

6 23 (29) 4 (5) <0.01

12 23 (29) 3 (4) <0.01

18 22 (28) 2 (3) <0.01

Right Eye (cpd)

1.5 7 (9) 0 (0) <0.01

3 10 (13) 1 (1) <0.01

6 21 (26) 2 (3) <0.01

12 22 (28) 4 (5) <0.01

18 23 (29) 6 (7) <0.01

Both Eyes (cpd) n=86 n=95

1.5 0 (0) 0 (0) NA

3 2 (2) 0 (0) 0.22

6 11 (13) 1 (1) <0.01

12 10 (12) 2 (2) 0.01

18 11 (13) 1 (1) <0.01
Health Hazard Evaluation Report 2005-0135-3116 Page 9

Results (continued) cpd (P=0.07) in the left eye or spatial frequencies 12 cpd (P=0.12) and 

18 cpd (P=0.16) binocularly among nonhypertensives. A significantly 

higher percentage of employees at AFSHS had scores at all spatial 

frequencies in the both the right eye and left eye that fell below the 

average performance for 90% of the population (i.e., in the lower 10th

percentile) than employees at WHHS (Table 3).

Because some people with allergies and asthma report a variety 

of neurobehavioral symptoms, including fatigue, sleepiness, poor 

concentration, poor work or school performance, and irritability, 

and studies have found objective evidence of cognitive impairment in 

these persons, we assessed whether VCS decrements were associated 

with upper or lower respiratory symptoms (Table 4). We combined 

work-related symptoms into the following symptom complexes: upper 

respiratory (sinus problems, dry or irritated eyes, nosebleeds, sore 

or dry throat, frequent sneezing, stuffy nose, or runny nose) and 

lower respiratory (cough, wheezing or whistling in the chest, chest 

tightness, or unusual shortness of breath). Persons reporting one or 

more symptom in a given symptom complex were considered to have 

that work-related symptom complex. Persons reporting one or more 

lower respiratory symptom had significantly lower mean VCS values 

at all spatial frequencies than those reporting no lower respiratory 

symptoms.

Table 4. Comparison of binocular VCS values between those with and without the symptom complex

Work-related Symptom Complex Spatial Frequency

(cycles per degree)

Both Schools*

(P value)

n=159–164

 1.5 <0.01

 3 <0.01

Upper Respiratory 6 0.07

 12 0.15

 18 0.09

 1.5 <0.01

 3 <0.01

Lower Respiratory 6 <0.01

 12 <0.01

 18 <0.01

*Indicates all findings in anticipated direction (i.e., mean VCS scores were lower for those with symptom 

complex)
Page 10 Health Hazard Evaluation Report 2005-0135-3116

Results (continued)

Aureobasidium pullulans, Cladosporium cladosporioides-1, Cladosporium 

sphaerospermum, and Eurotium (Asp.) amstelodami were found in all 

three MSQPCR air samples with C. sphaerospermum being the most 

prevalent genus (Table C2). The MSQPCR air sample field blank 

contained no positive hits for fungal spores.

The vacuum dust samples detected 32 of the 35 fungal species tested. 

The five most prevalent species were Aspergillus sydowii, Aspergillus 

unguis, Aureobasidium pullulan, Cladosporium cladosporioides-1, and 

Cladosporium sphaerospermum (Table C3). The analysis of dust samples 

by MSQPCR from a national survey of homes conducted by HUD 

has produced the ERMI for U.S. homes [Vesper et al. 2007]. The 

ERMI is the result of the analysis for 26 Group 1 mold species 

Environmental

Alcee Fortier Senior High School

Of the sixteen sticky tape samples, 15 showed the presence of actively 

growing Cladosporium in numerous to massive amounts of growth 

on the walls of the school at the time of the site visits (Table C1). 

Cladosporium, a known allergen, is one of the most common genera 

found worldwide. Widespread evidence of mold contamination in 

the school is further illustrated in Figure 1 (fourth floor hallway) and 

Figure 2 (fourth floor classroom).

Figure 1. Picture of mold growing along fourth floor hallway 

cieling at AFSHS
Health Hazard Evaluation Report 2005-0135-3116 Page 11

Results (continued)

associated with water damage and 10 Group 2 or common species 

not associated with water damage [Meklin et al. 2004; Vesper et al. 

2006]. The ERMI scale ranges from about –10 to 20, lowest to highest 

[Vesper et al. 2007]. The closer to 20, the greater is the mold burden, 

indicating likely significant water damage in that environment. The 

results of the ERMI analysis (Table C3) indicate a high mold burden 

in AFSHS and that all the dust samples came from highly waterdamaged environments.

Lead levels in the peeling paint chips collected in seven rooms ranged 

from 11 to 1730 μg lead/g total dust (Table C4). The sampling was 

done to determine whether lead was present in the paint. There are 

no specific regulations or guidelines for bulk paint samples; however, 

HUD and U.S. EPA have issued clean-up guidelines for lead on 

surfaces that can be found in Appendix B.

The culturable air samples for fungi show that Cladosporium and

Pencillium were the most prevalent genera both inside and outside 

the school (Table C5). Aspergillus species were detected in the inside 

air samples but not in the outside air samples. Air samples from two 

classrooms with open windows had similar genera and fungal counts 

to the outside samples.

The spore trap samples showed that Cladosporium was the prevalent 

genus both inside and outside the school with the exception of Room 

Figure 2. Picture of fourth floor classroom wall and ceiling showing 

active mold growth at AFSHS
Page 12 Health Hazard Evaluation Report 2005-0135-3116

Results (continued) 316, which had Aspergillus/Pencillum-like spores as the most prevalent 

genera (Table C6). The spore counts in the two rooms with closed 

windows were lower than in the two rooms with open windows and 

in the outside air sample.

Condensation was observed in classrooms near the top of walls and 

in the adjacent hallways. The fourth floor had visible evidence of 

water damage. Room 403 had broken and missing ceiling tiles and 

holes in the plaster walls. Rooms 407, 408, and 409 had visible water 

damage on the ceiling and rust on the metal light fixtures. The fourth 

floor hallway ceiling showed that a large roof leak had been repaired, 

but the interior damage had not been fixed. The exterior wall on the 

fourth floor also had a large crack. The moisture readings for May 

2005 showed the following: hallway outside Room 208: 10%–12%, 

interior walls of the third floor stairwell: 30%, exterior walls of the 

third floor stairwell: 70%–90%, fourth floor exterior wall near the 

stairwell: about 80%, and fourth floor hallway: 25%–30%. These 

readings indicated recent water intrusion problems in the third floor 

stairway and the exterior fourth floor of AFSHS.

Classrooms contained numerous windows, many of which were open 

during the two site visits in 2005. In April 2005, spot checks for 

IEQ parameters were made in five classrooms, the teachers’ lounge, 

and the second floor hallway. CO2 concentrations ranged from 

465 ppm to 744 ppm, temperatures ranged from 73.6°F to 78.1°F, 

and RH levels ranged from 39.8% to 52.4% indoors. These IEQ 

parameters were within accepted ANSI/ASHRAE guidelines [ANSI/

ASHRAE 2004; ANSI/ASHRAE 2007]. In May 2005, spot checks 

in four classrooms found that CO2 concentrations ranged from 530 

ppm to 576 ppm. When windows are open, the CO2 concentrations 

usually reflect the conditions outdoors, not what is happening 

in the indoor environment. Temperatures ranged from 67.8°F to 

79.8°F, and RH levels ranged from 48.3% to 76%. Outside the front 

door of the school in the morning, the CO2 level was 422 ppm, the 

temperature was 90.7°F, and the RH was 49.2%. The May 2005 IEQ 

measurements for temperature and relative humidity were higher 

than the ANSI/ASHRAE recommended guidelines [ANSI/ASHRAE 

2004; ANSI/ASHRAE 2007]. Additional information on the ANSI/

ASHRAE guidelines can be found in Appendix B.
Health Hazard Evaluation Report 2005-0135-3116 Page 13

Results (continued) Walnut Hills High School 

Eight sticky tape samples were collected at WHHS. No fungal growth 

was detected in six of the samples. Two of the samples collected 

in Room 102 showed some evidence of fungal growth – one had a 

trace of hyphae, and the other showed a few Aspergillus/Pencilliumlike spores and a trace of hyphae (Table C7). Air samples analyzed 

with MSQPCR showed low counts for the four inside samples when 

compared to the outside samples (Table C8). The culturable and 

spore trap air samples collected inside and outside WHHS were 

comparable in terms of both counts and genera ranking (Tables C9 

and C10).

Rooms 102 and 103, located under a concrete patio, had a history of 

water leakage. The library had undergone mold remediation several 

years prior after a leaking roof had been repaired. Some areas of the 

oldest school building showed evidence that leaks had been repaired 

but lacked visual evidence of ongoing water intrusion or microbial 

growth.

In March 2006, IEQ measurements in six classrooms found that 

CO2 concentrations ranged from 615 to 1967 ppm, temperatures 

ranged from 68.9°F to 76.6°F, and RH ranged from 15.7% to 30.8%. 

Outside the front door of the school, the CO2 level was 449 to 

482 ppm, the temperature was 53.6°F to 59.2°F, and the RH was 

49.2%. The rooms with the highest CO2 concentrations were fully 

occupied and located in the oldest school building. The elevated CO2

concentrations indicated a problem with the amount of outdoor air 

being introduced into the space. Additional information concerning 

CO2 concentrations can be found in Appendix B.
Page 14 Health Hazard Evaluation Report 2005-0135-3116

Some AFSHS employees reported work-related symptoms shown 

to be associated with occupancy in damp and/or moldy buildings, 

including upper and lower respiratory symptoms and possibly 

development of asthma. Twenty AFSHS employees without current, 

physician-diagnosed asthma met our case definition of work-related 

asthma, and AFSHS employees who reported current asthma were 

significantly more likely to report that their asthma was worse at work 

than were WHHS employees with asthma. Compared to WHHS 

participants, those at AFSHS had significantly elevated prevalences 

of constitutional symptoms such as fever, body aches, and unusual 

tiredness, which, along with cough and shortness of breath, could 

indicate a history of hypersensitivity pneumonitis.

ERMI scores were high, and epidemiologic studies indicate that 

higher ERMI values increase the likelihood of asthma/wheeze and 

rhinitis in children in the home [Vesper et al. 2006; Vesper et al. 

2007]. Although the ERMI scale was developed for homes in the 

United States, finding a very high ERMI value in a school or office 

would also be strongly suggestive of a water-damaged environment. 

The dampness and mold in AFSHS were verified by additional 

environmental sampling including the use of a moisture meter and 

surface and air samples.

VCS testing is part of a panel of neurobehavioral tests recommended 

by the Agency for Toxic Substances and Disease Registry for use in 

community studies of residents exposed to neurotoxins [Amler et al. 

1996; Sizemore and Amler 1996]. The adult panel has 12 tests, and 

the pediatric panel has 15 tests. The Agency for Toxic Substances 

and Disease Registry selected these tests to assess different aspects 

of central nervous system functions. These include sensation, motor 

control, cognition, and affect. The Agency for Toxic Substances and 

Disease Registry notes that these neurobehavioral tests are for use as 

nonspecific screening tools that require follow up of positive findings 

with “appropriate focused tests to characterize more completely 

any neurotoxic effects that may be present and their relationship 

to putative exposures” [Amler et al. 1996]. The Agency also states 

there is no evidence that the tests will identify past exposures 

to neurotoxins, but they “will detect, without specificity, subtle 

neurobehavioral changes that may be consequent to many insults” 

[Amler et al. 1996].

As noted in the introduction, VCS testing has been used in 

“diagnosing” and monitoring treatment of “biotoxin-related illness” 

among individuals exposed to water-damaged buildings [Shoemaker 

Discussion
Health Hazard Evaluation Report 2005-0135-3116 Page 15

Discussion (continued) and House 2005; Shoemaker and House 2006]. Of particular interest 

here is that the studies of individuals exposed to water-damaged 

buildings had several methodologic problems that limit their validity, 

including nonrepresentative participants, inclusion of persons with 

specific medical conditions that often present with multiple system 

symptoms (fibromyalgia and chronic fatigue syndrome), lack of a 

comparison group, and poor exposure assessment.

We attempted to address some of those issues in this evaluation. 

We compared VCS scores and symptoms of employees in the damp, 

moldy school to those of employees in a school without significant 

dampness or fungal contamination. All employees were asked to 

participate. Participation was relatively high at both schools, so that 

not only persons who had significant health issues made up our study 

population. We conducted a thorough building evaluation at both 

schools and documented extensive fungal contamination throughout 

AFSHS, and the lack of significant fungal contamination at WHHS.

Our VCS findings may be due to some factor other than the 

extensive water damage and mold contamination in AFSHS. We 

did not examine all possible exposures that may be present in 

damp buildings, and it is still unclear exactly what exposures in 

damp buildings are responsible for health effects [WHO 2009]. In 

addition to mold, dust mites, bacteria, and chemical emissions can 

be present. We postulated that upper and lower respiratory symptoms 

and their potential treatment may have led to constitutional and 

neurobehavioral symptoms and lower VCS scores among these 

employees. Studies have clearly demonstrated that some persons 

with allergic rhinitis or asthma complain of fatigue, sleepiness, poor 

concentration, poor work or school performance, poor sleep, and 

irritability [Bender 2005; Leander et al. 2009; Williams et al. 2009]. 

In addition, objective evidence of cognitive impairment (impaired 

mood, decreased reaction time, attention, and memory) has been 

demonstrated in persons with allergic rhinitis and asthma [Fitzpatrick 

et al. 1991; Weersink et al. 1997; Bender 2005]. No studies were 

located of VCS testing in subjects with allergic diseases such as 

rhinitis and asthma.

We do not recommend using VCS testing in a clinical setting to 

diagnose illness in occupants of water-damaged buildings because of 

its nonspecificity. We were able to detect significant differences in 

VCS between these two groups of employees, but most employees at 

AFSHS had normal contrast sensitivity, i.e., that which would be seen 

in 90% of the population. VCS testing has not been validated as a 
Page 16 Health Hazard Evaluation Report 2005-0135-3116

Discussion (continued) standalone test for diagnosing neurobehavioral deficits in individuals, 

but is used by the Agency for Toxic Substances and Disease Registry 

as part of a panel for assessing populations.

It is possible that the use of a comparison school from a different 

region of the country could have biased our study. The racial 

distributions of Cincinnati and New Orleans are very different. In 

2000, Cincinnati was 84% white and 13% black; while New Orleans 

was 55% white and 37% black [CensusScope 2010]. We did not 

collect information on race or education for our participants because 

we planned to use another school in the NOPS as our comparison 

until Hurricane Katrina hit New Orleans. The salaries for teachers in 

the NOPS District ranged from $25,439 to $41,478 in 2002–2003, 

while those of Cincinnati Public School teachers ranged from 

$34,888 to $69,609 in 2003–2004 [US Cities 2009]. This implies a 

lower socioeconomic status for the employees of AFSHS, which may 

be associated with poorer health overall and perhaps substandard 

housing, which may be more prone to leaks and subsequent mold 

growth. However, a similar proportion of employees at both schools 

reported mold or moisture problems at home (6%–8%). Lead 

paint was present in AFSHS. It should have been present in both 

schools based on the age of the two buildings, but no peeling paint 

was observed at WHHS, so we did not test for it at WHHS. Lead 

exposure has been documented to adversely affect VCS. Finally, 

the cross-sectional nature of our evaluation does not allow for 

determination of cause-effect relationships.

We found that a health hazard existed at AFSHS. Employees 

had significantly higher prevalences of rashes and nasal, lower 

respiratory, and constitutional symptoms than employees at WHHS. 

The prevalences of several neurobehavioral symptoms were also 

significantly higher. VCS values across all spatial frequencies were 

lower in the employees at AFSHS. Further studies are needed to 

determine what factors could be responsible for the findings.

Conclusions
Health Hazard Evaluation Report 2005-0135-3116 Page 17

Because AFSHS is no longer part of the NOPS district, the following 

recommendations are offered to the NOPS District to maintain good 

IEQ and prevent problems for staff. Additional recommendations are 

provided to address the issues identified for WHHS.

1. Implement an IEQ Management Plan for the NOPS to address 

IEQ issues. An IEQ manager or administrator with clearly 

defined responsibilities, authority, and resources should be 

selected. This individual should have a good understanding 

of the building’s structure and function, and should be able 

to effectively communicate with occupants. Although no 

comprehensive regulatory standards specific to IEQ have been 

established, guidelines have been developed by organizations 

such as ASHRAE, NIOSH, and the U.S. EPA. An employee 

representative should be included in the program. The 

U.S. EPA Indoor Air Quality Tools for Schools program 

may be helpful for developing and implementing the IEQ 

management plan. The U.S. EPA has a website specifically for 

IEQ issues in schools at http://www.epa.gov/iaq/schools/. 

Information on consultants is available from the AIHA’s 

“Guidelines for Selecting an Indoor Air Quality Consultant”.

2. Develop a comprehensive program for the NOPS District to 

immediately address and fix moisture incursion problems 

when they occur.

3. Clean up mold contamination when identified in NOPS 

District buildings using appropriate techniques as outlined 

in the U.S. EPA document “Mold Remediation in Schools 

and Commercial Buildings” at http://www.epa.gov/mold/

mold_remediation.html and the New York City Department 

of Health and Mental Hygiene guidelines at http://www.nyc.

gov/html/doh/html/epi/moldrpt1.shtml.

4. Reassess the existing preventive maintenance program for the 

HVAC units in NOPS District buildings to make sure that it 

meets current needs. Ventilation units in the schools should 

provide at least the minimum amount of outdoor air according 

to current ASHRAE guidelines [ANSI/ASHRAE 2007]. 

Temperature and RH should be measured to determine if 

current guidelines are being met [ANSI/ASHRAE 2004].

5. Establish a forum, such as a health and safety committee, for 

all employees to communicate their health concerns to the 

NOPS District.

Recommendations
Page 18 Health Hazard Evaluation Report 2005-0135-3116

Recommendations

(continued) 6. Evaluate and remediate lead paint in the NOPS District 

buildings to meet federal and state current guidelines. 

Additional information on lead paint regulations for the State 

of Louisiana can be found at http://www.deq.louisiana.gov/

portal/tabid/2884/Default.aspx.

7. Encourage employees with health concerns related to their 

workplace to seek evaluation and care from a physician who 

is residency trained and/or board certified in occupational 

medicine and is familiar with the types of exposures employees 

may have had and their health effects. The Association of 

Occupational and Environmental Clinics (http://www.

aoec.org) and the American College of Occupational and 

Environmental Medicine (http://www.acoem.org) maintain 

lists of their members.

8. Evaluate the ventilation systems at WHHS to determine if the 

amount of outdoor air being provided is in accordance with 

current ANSI/ASHRAE guidelines [ANSI/ASHRAE 2007].

9. Reseal the patio over the band rooms at WHHS and 

monitored for leaks routinely. The mold contamination in the 

band rooms should be remediated.
Health Hazard Evaluation Report 2005-0135-3116 Page 19

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BL, Olsen KL [1996]. Selective approaches to basic neurobehavioral 

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visual contrast sensitivity. Environ Health Perspect 110(7):655–664.

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syndrome: chronic, biotoxin-associated illness from exposure to waterdamaged buildings. Neurotoxicol Teratol 27(1):29–46.

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Page 22 Health Hazard Evaluation Report 2005-0135-3116

Visual Contrast Sensitivity 

Contrast sensitivity testing was conducted with the F.A.C.T. handheld chart [Ginsburg 1993]. This 

instrument consists of a calibrated rod with a card holder at one end and cheek pads at the other end that 

are held tightly against the face to maintain a constant viewing distance between the eyes and the test card 

(Figure 3).

Figure 3: Visual contrast sensitivity test using F.A.C.T. chart.

VCS testing has been used to document subclinical neurobehavioral effects in persons exposed to 

neurotoxicants and has recently been reported to be affected by exposure to water-damaged buildings. VCS 

tests are considered superior to visual acuity tests for detecting visual loss. Visual acuity tests (similar to 

the tests done by optometrists when ordering eyeglasses) generally detect refractive disorders, whereas VCS 

tests may detect visual changes due to chemical exposures even though visual acuity is normal (e.g., 20/20) 

[Regan 1989]. VCS can be affected by a number of factors including age, hypertension, diabetes, head 

injury, alcohol consumption; and various eye conditions such as cataract, glaucoma, LASIK and other eye 

surgery [Atkin et al. 1979; Sokol et al. 1985; Trick et al. 1988; Roquelaure et al. 1995; Pearson and Timney 

1998; Hammond et al. 2004; Shamshinova et al. 2007].

The F.A.C.T. sine-wave grating chart tests five spatial frequencies (1.5, 3, 6, 12, 18 cycles per degree) and 

nine levels of contrast.

Appendix A: Methods
Health Hazard Evaluation Report 2005-0135-3116 Page 23

Appendix A: Methods (continued)

Cycles per degree refers to the number of alternating light and dark bands within one degree of visual 

angle. Contrast refers to the difference in intensity (expressed as a percent) between the light and dark 

bands, with white to black having a 100% contrast. The last grating seen for each spatial frequency 

row, assessed by a correct reporting of the orientation of the grating (right, up, or left), is plotted on a 

contrast sensitivity curve. Test results produce a visuogram that indicates sensitivity at each of the five 

spatial frequencies tested. Because high levels of visual sensitivity for spatial form are associated with low 

contrast thresholds, a reciprocal measure (1/threshold), termed the contrast sensitivity score, is computed. 

Measures of visual contrast sensitivity, rather than measures of refractory visual acuity, have been presented 

as better appraisals of visual dysfunction resulting from chemical exposures. However, if visual acuity is 

poor, then performance on the F.A.C.T. will also be poor. Therefore, we also measured visual acuity with 

a handheld Snellen chart. Results from persons with visual acuity of 20/50 or less were removed from 

further analysis.

The tests were conducted monocularly and binocularly under standard daylight illumination in the library 

of each school. A light meter was used to ensure that ambient illumination met the requirements specified 

for the F.A.C.T. handheld chart (between 68 and 239 candelas per square meter). Participants who used 

corrective lenses were asked to wear them during testing. Using a preprinted recording form, the test 

results indicate where the subject being tested falls in the range of average performance for 90% of the 

population [Ginsburg 1993].

Environmental Sampling

During the first site visit at AFSHS on April 18–19, 2005, 14 sticky tape samples for microscopic fungal 

analysis were collected throughout the school. Five vacuum dust samples were collected using a filter 

“sock” with a HEPA vacuum in Rooms 317, 321, 322, 400, and 426. Three air samples were collected 

in Room 213, Room 416, and the teachers’ lounge with an SKC Inhalable ButtonTM Sampler (SKC 

Inc., Eighty Four, Pennsylvania) with a 2.0-μm pore size polycarbonate filter at a flow rate of 3.5 Lpm. 

These eight samples were analyzed via a DNA-based method called MSQPCR [Haugland et al. 2002]. 

MSQPCR identifies 36 species of fungi commonly associated with water-damaged indoor environments 

using established procedures for preparing conidial suspensions from fungal cultures, extracting DNA, 

and performing MSQPCR analyses [Haugland et al. 2002; Brinkman et al. 2003; Haugland et al. 2004]. 

All primer and probe sequences, as well as known species comprising the assay groups, were published 

at http://www.epa.gov/microbes/moldtech.htm. A TRAMEX Moisture Encounter meter (Tramex Ltd., 

Littleton, Colorado) was used to qualitatively assess the interior wall moisture levels. To address requestors’ 

concerns over the potential for lead exposures from peeling paint, paint samples were collected in six 

rooms in April 2005 and one room in May 2005 and analyzed for lead according to NIOSH Method 7300 

using inductively coupled plasma atomic emission spectrometry [NIOSH 2010].

During the second site visit to AFSHS, a more detailed environmental evaluation was conducted. Air 

sampling using Andersen N-6 samplers (Thermo Electron Corporation, Waltham, Massachusetts) with 

MEA agar plates at a flow rate of 28.3 Lpm was performed in four classrooms (Rooms 205, 316, 420, 

and 427) and one outdoor location. A sampling time of 5 minutes was used. All N-6 samples were 
Page 24 Health Hazard Evaluation Report 2005-0135-3116

Appendix A: Methods (continued)

collected in triplicate. All sampling pumps were pre- and post-calibrated with a DryCal (Bios International 

Corporation, Butler, New Jersey).

Spore trap samples were collected with Air-o-Cell® samplers (Zefon International, Inc., Ocala, Florida) at a 

flow rate of 15 Lpm in the same sampling locations. A sampling time of 5 minutes was used. All spore trap 

samples were collected in triplicate. Measurements of CO2, temperature, and RH were made throughout 

the workday using TSI Q-TrakTM Indoor Air Quality monitors (TSI Incorporated, Shoreview, Minnesota). 

Two additional sticky tape samples were collected for microscopic fungal analysis. One additional paint 

sample was collected and analyzed for lead using NIOSH Method 7300 [NIOSH 2010].

A similar environmental protocol was used for the WHHS evaluation, except for lead paint sampling. 

Eight sticky tape samples were collected and submitted for microscopic fungal analysis. The sampled areas 

were Band Room 102 (three samples), Band Room 103 (two samples), library (two samples), and Room 

333 (one sample). Air sampling using Andersen N-6 samplers with MEA agar plates at a flow rate of 28.3 

Lpm was performed in four classrooms and the library (Rooms 102, 260, 333, and 334) and one outdoor 

location. A sampling time of 5 minutes was used. All N-6 samples were collected in triplicate. All sampling 

pumps were pre- and post-calibrated with a DryCal. Area air samples were collected in the same locations 

using a 0.3 μm pore-size 37-millimeter polytetrafluoroethylene filter at a flow rate of 2 Lpm. The six area 

air samples were analyzed for fungal species via MSQPCR.

Spore trap samples were collected with Air-o-Cell samplers at a flow rate of 15 Lpm in the same sampling 

locations. A sampling time of 5 minutes was used, and all spore trap samples were collected in triplicate. 

Measurements of CO2, temperature, and RH were made throughout the workday using TSI Q-Trak Indoor 

Air Quality monitors.

Statistical Analysis

SAS Version 9.1.3 software (SAS Institute, Cary, North Carolina) and StatXact Version 6 software (Cytel 

Software Corporation, Cambridge, Massachusetts) were used for the statistical analyses. Results with 

P values ≤ 0.05 were considered statistically significant. Chi square or Fisher’s exact tests were used to 

compare the prevalence of symptoms, certain demographic characteristics, and percent of abnormal VCS 

scores between schools. To examine the relationship between work-related symptoms and VCS values, 

we combined the symptoms into the following symptom complexes: upper respiratory (sinus problems, 

dry or irritated eyes, nosebleeds, sore or dry throat, frequent sneezing, stuffy nose, or runny nose); lower 

respiratory (cough, wheezing or whistling in the chest, chest tightness, or unusual shortness of breath); 

and neurobehavioral (difficulty concentrating, trouble remembering things, confusion or disorientation, 

irritability, depression, or change in sleep patterns). The Wilcoxon two-sample test was used to compare 

alcohol intake and VCS values between schools, and to examine the relationship between symptom 

complexes and VCS values. Mold concentration data having a minimum detection limit of 1 cell per 

milligram dust were treated as left-censored data with appropriate statistical methods applied [Helsel 

2005]. Procedurally, nondetections were set at half the minimum detection limit, and given equal and 

lowest rank for nonparametric rank-based analyses [Helsel 2005].
Health Hazard Evaluation Report 2005-0135-3116 Page 25

Appendix A: Methods (continued)

References 

Atkin A, Bodis-Wollner I, Wolkstein M, Moss A, Podos SM [1979]. Abnormalities in central contrast 

sensitivity in glaucoma. Am J Ophthalmol 88(2):205–211.

Brinkman NE, Haugland RA, Wymer LJ, Byappanahalli M, Whitman RL, Vesper SJ [2003]. 

Evaluation of a rapid, quantitative real-time PCR method for cellular enumeration of pathogenic 

Candida species in water. Appl Environ Microbiol 69(3):1775–1782.

Ginsburg AP [1993]. Functional Acuity Contrast Test F.A.C.T.® Instructions for use. Chicago, IL: Stereo 

Optical Company, Inc.

Hammond SD Jr, Puri AK, Ambati BK [2004]. Quality of vision and patient satisfaction after LASIK. Curr 

Opin Ophthalmol 15(4):328–332.

Haugland RA, Brinkman NE, Vesper SJ [2002]. Evaluation of rapid DNA extraction methods for the 

quantitative detection of fungal cells using real time PCR analysis. J Microbiol Meth 50(3):319–323.

Haugland RA, Varma M, Wymer LJ, Vesper SJ [2004]. Quantitative PCR of selected Aspergillus, Penicillium

and Paecilomyces species. Sys Appl Microbiol 27(2):198–210.

Helsel DR [2005]. Nondetects and data analysis, statistics for censored environmental data. Wiley and 

Sons Inc. Hoboken, NJ.

NIOSH [2010]. NIOSH manual of analytical methods (NMAM®). 4th ed. Schlecht PC, O’Connor PF, 

eds. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for 

Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) 

Publication 94–113 (August, 1994); 1st Supplement Publication 96–135, 2nd Supplement Publication 

98–119; 3rd Supplement 2003–154. [http://www.cdc.gov/niosh/nmam/]. Date accessed: August 2010.

Pearson P, Timney B [1998]. Effects of moderate blood alcohol concentrations on spatial and temporal 

contrast sensitivity. J Stud Alcohol 59(2):163–173.

Regan D [1989]. Human brain electrophysiology. New York: Elsevier, p. 672.

Roquelaure Y, Gargasson LE, Kupper S, Girre C, Hispard E, Dally S [1995]. Alcohol consumption and 

visual contrast sensitivity. Alcohol Alcohol 30(5):681–685.

Shamshinova AM, Arakelian MA, Rogova SIu, Adasheve TV, Silakova OL [2007]. Classification of the 

forms of hypertensive retinopathy on the basis of estimation of the bioelectrical retinal potential and 

contrast sensitivity. Vestn Oftalmol 123(1):24–28.
Page 26 Health Hazard Evaluation Report 2005-0135-3116

Appendix A: Methods (continued)

Sokol S, Moskowitz A, Skarf B, Evans R, Molitch M, Senior B [1985]. Contrast sensitivity in diabetics with 

and without background retinopathy. Arch Ophthalmol 103(1):51–54.

Trick GL, Burde RM, Gordon MO, Santiago JV, Kilo C [1988]. The relationship between hue discrimination and 

contrast sensitivity deficits in patients with diabetes mellitus. Ophthalmology 95(5):693–698.
Health Hazard Evaluation Report 2005-0135-3116 Page 27

Microbial Contamination 

Exposure to microbes is not unique to the indoor environment. No environment, indoors or out, 

is completely free from microbes, not even a surgical operating room. Remediation of microbial 

contamination may improve IEQ conditions even though a specific cause-effect relationship is not 

determined. NIOSH investigators routinely recommend the remediation of observed microbial 

contamination and the correction of situations that are favorable for microbial growth and bioaerosol 

dissemination.

Mold 

The types and severity of symptoms related to exposure to mold in the indoor environment depend in 

part on the extent of the mold present, the extent of the individual’s exposure, and the susceptibility of 

the individual (for example, whether he or she has preexisting allergies or asthma). In general, excessive 

exposure to fungi may produce health problems by several primary mechanisms, including allergy or 

hypersensitivity, infection, and toxic effects. Additionally, molds produce a variety of VOCs, the most 

common of which is ethanol, that have been postulated to cause upper airway irritation. However, as 

discussed above, potential irritant effects of VOCs from exposure to mold in the indoor environment are 

not well understood. Evidence also shows that exposure to fungal fragments that can contain allergens, 

toxins, and (1→3)-β-D-glucan may occur [Górney et al. 2002; Brasel et al. 2005; Reponen et al. 2006].

Allergic responses are the most common type of health problem associated with exposure to molds. These 

health problems may include sneezing; itching of the nose, eyes, mouth, or throat; nasal stuffiness and 

runny nose; and red, itchy eyes. Repeated or single exposure to mold or mold spores may cause previously 

nonsensitized individuals to become sensitized. Molds can trigger asthma symptoms (shortness of breath, 

wheezing, cough) in persons who are allergic to mold. In the 2004 report, “Damp Indoor Spaces and 

Health,” the IOM found sufficient evidence of an association between mold or dampness indoors and 

nasal and throat symptoms, asthma symptoms in sensitized asthmatics, wheeze, cough, and hypersensitivity 

pneumonitis in susceptible persons [IOM 2004]. The IOM found limited or suggestive evidence of an 

association between lower respiratory illness in healthy children and damp indoor spaces. Evidence was 

inadequate or insufficient to determine whether an association exists between dyspnea, airflow obstruction 

in healthy persons, mucous membrane irritation, skin symptoms, chronic obstructive pulmonary 

disease, asthma development, inhalation fevers in nonoccupational settings, fatigue, cancer, reproductive 

effects, neuropsychiatric effects, lower respiratory illness in healthy adults, gastrointestinal problems, 

rheumatologic or immune problems, or acute idiopathic pulmonary hemorrhage in infants. No health 

conditions met the level of evidence for causation. In 2009, WHO published guidelines for protection of 

public health from mold and other exposures in damp buildings [WHO 2009]. Based on its review of the 

scientific literature for this report, the WHO concluded that there was sufficient epidemiologic evidence 

that occupants of damp buildings are at risk of developing upper and lower respiratory tract symptoms 

(including cough, wheeze, and dyspnea), respiratory infections, asthma, and exacerbation of asthma. The 

WHO also concluded that limited evidence suggests an association between bronchitis and allergic rhinitis 

Appendix B: Occupational Exposure Limits and Health Effects
Page 28 Health Hazard Evaluation Report 2005-0135-3116

Appendix B: Occupational Exposure Limits and Health Effects (continued)

and damp buildings. It noted clinical evidence that exposure to mold and other microbial agents in damp 

buildings is associated with hypersensitivity pneumonitis.

People with weakened immune systems (immune-compromised or immune-suppressed individuals) may be 

more vulnerable to infections by molds. For example, Aspergillus fumigatus is a fungal species that has been 

found almost everywhere on every conceivable type of substrate. It has been known to infect the lungs of 

immune-compromised individuals after inhalation of the airborne spores [Wald and Stave 1994; Brandt et 

al. 2006]. Healthy individuals are usually not vulnerable to infections from airborne mold exposure.

No exposure guidelines for mold in air exist, so it is not possible to distinguish between “safe” and 

“unsafe” levels of exposure. Nevertheless, the potential for health problems is an important reason to 

prevent indoor mold growth and to remediate any indoor mold contamination. Moisture intrusion, 

along with nutrient sources such as building materials or furnishings, allows mold to grow indoors, so 

it is important to keep the building interior and furnishings dry. NIOSH concurs with the U.S. EPA’s 

recommendations to remedy mold contamination in indoor environments (http://www.epa.gov/iaq/

molds /mold_remediation.html) [Redd SC 2002; U.S. EPA 2001a]. Additional information on health 

effects and mold remediation can be found in the CDC document “Mold Prevention Strategies and 

Possible Health Effects in the Aftermath of Hurricanes and Major Floods” at http://www.cdc.gov/mmwr/

preview/mmwrhtml/rr5508a1.htm.

No standards specific to the nonindustrial indoor environment exist. Measurement of indoor 

environmental contaminants has seldom proved helpful in determining the cause of symptoms except 

where there are unusual sources, or a proven relationship between specific exposures and disease. With few 

exceptions, concentrations of frequently measured chemical substances in the indoor work environment 

fall well below the recommended OELs published by NIOSH [NIOSH 2005], ACGIH [ACGIH 2010], 

and AIHA [AIHA 2010], and the mandatory PELs set by OSHA [29 CFR 1910 (general industry)]. ANSI/

ASHRAE has published recommended building ventilation and thermal comfort guidelines [ANSI/

ASHRAE 2004; ANSI/ASHRAE 2007]. The ACGIH and AIHA have also developed a manual of 

guidelines for approaching investigations of building-related symptoms that might be caused by airborne 

living organisms or their effluents [ACGIH 1999; AIHA 2008]. Other resources that provide guidance for 

establishing acceptable IEQ are available through U.S. EPA at http://www.epa.gov/iaq, especially the U.S. 

EPA Indoor Air Quality Tools for Schools (http://www.epa.gov/iaq/schools/), and the joint U.S. EPA/

NIOSH document, Building Air Quality, A Guide for Building Owners and Facility Managers (http://www.epa.

gov/iaq/largebldgs/baqtoc.html).

Heating, Ventilating, and Air-Conditioning

One of the most common deficiencies in the indoor environment is the improper operation and 

maintenance of ventilation systems and other building components [Rosenstock 1996]. NIOSH 

investigators have found correcting HVAC problems often reduces reported symptoms. Most studies of 

ventilation rates and building occupant symptoms have shown that rates below 10 Ls-1/person (which 
Health Hazard Evaluation Report 2005-0135-3116 Page 29

Appendix B: Occupational Exposure Limits and Health Effects (continued)

equates to 20 cubic feet per minute per person) are associated with one or more health symptoms 

[Seppanen et al 1999]. Moreover, higher ventilation rates, from 10 Ls-1/person up to 20 Ls-1/person, have 

been associated with further significant decreases in the prevalence of symptoms [Seppanen et al. 1999]. 

Thus, improved HVAC operation and maintenance, higher ventilation rates, and comfortable temperature 

and RH can all potentially serve to improve symptoms without ever identifying any specific cause-effect 

relationships. When conducting an IEQ evaluation, NIOSH investigators often measure ventilation and 

comfort indicators, such as CO2, temperature, and RH to provide information relative to the functioning 

and control of HVAC systems.

Carbon Dioxide

CO2 is a normal constituent of exhaled breath and is not considered a building air pollutant. It can be 

used as an indicator of whether sufficient quantities of outdoor air are being introduced into an occupied 

space for acceptable odor control. However, CO2 is not an effective indicator of ventilation adequacy if the 

ventilated area is not occupied at its usual occupant density at the time the CO2 is measured. ASHRAE 

notes in an informative appendix to standard 62.1 that indoor CO2 concentrations no greater than 700 

ppm above outdoor CO2 concentrations will satisfy a substantial majority (about 80%) of visitors with 

regard to odor from sedentary building occupants (body odor) [ANSI/ASHRAE 2007]. Elevated CO2

concentrations suggest that other indoor contaminants may also be increased. If CO2 concentrations 

are elevated, the amount of outdoor air introduced into the ventilated space may need to be increased. 

When CO2 concentrations are used as an indicator to determine outdoor air requirements, ventilation 

system designs that rely on duct-mounted CO2 sensors should have some form of ventilation efficiency 

documentation that relates concentration values observed at the duct location with those observed within 

the breathing zone of the occupied space.

Temperature and Relative Humidity 

Temperature and RH measurements are often collected as part of an IEQ evaluation because these 

parameters affect the perception of comfort in an indoor environment. The perception of thermal comfort 

is related to one’s metabolic heat production, the transfer of heat to the environment, physiological 

adjustments, and body temperature [NIOSH 1986]. Heat transfer from the body to the environment is 

influenced by factors such as temperature, humidity, air movement, personal activities, and clothing. 

The ANSI/ASHRAE Standard 55-2004: Thermal Environmental Conditions for Human Occupancy, 

specifies conditions in which 80% or more of the occupants would be expected to find the environment 

thermally acceptable [ANSI/ASHRAE 2004]. Assuming slow air movement and 50% RH, the operative 

temperatures recommended by ANSI/ASHRAE range from 68.5oF to 76oF in the winter and from 75oF to 

80.5oF in the summer. The difference between the two is largely due to seasonal clothing selection. ANSI/

ASHRAE also recommends that RH be maintained at or below 65% [ANSI/ASHRAE 2007]. Excessive 

humidity can promote the excessive growth of microorganisms and dust mites.
Page 30 Health Hazard Evaluation Report 2005-0135-3116

Appendix B: Occupational Exposure Limits and Health Effects (continued)

Lead in Surface Dust and Soil 

Lead is ubiquitous in U.S. urban environments because of the widespread use of lead compounds in 

industry, gasoline, and paints during the past century. Occupational exposure to lead occurs via inhalation 

of dust and fume and via ingestion through contact with lead-contaminated hands, food, cigarettes, and 

clothing. Absorbed lead accumulates in the body in the soft tissues and bones [ATSDR 1990]. Lead is 

stored in bones for decades, and may cause health effects long after exposure as it is slowly released in the 

body.

Lead-contaminated surface dust represents a potential source of lead exposure, particularly for young 

children. This may occur either by direct hand-to-mouth contact, or indirectly from hand-to-mouth contact 

with contaminated clothing, cigarettes, or food. Previous studies have found a significant correlation 

between resident children’s BLLs and house dust lead levels [Farfel and Chisholm 1990].

In the workplace, generally there is little or no correlation between surface lead levels and employee 

exposures because ingestion exposures are highly dependent on personal hygiene practices and available 

facilities for maintaining personal hygiene. No current federal standard provides an exposure limit for lead 

contamination of surfaces in the workplace. The OSHA lead standard requires maintaining all surfaces as 

free as practicable of accumulations of lead. Additionally, OSHA has stated in its Compliance Directive 

CPL 02-02-058-29 CFR 1926.62, Lead Exposure In Construction; Interim Final Rule: Inspection and 

Compliance Procedures (12/13/1993), that it recommends the use of HUD’s recommended level for 

acceptable decontamination of 200 μg/ft2 for floors in evaluating cleanliness of change areas, storage 

facilities, and lunchrooms/eating areas and would not expect that surfaces should be any cleaner than this 

level [OSHA 1993].

The U.S. EPA currently recommends meeting the following clearance levels for surface lead loading after 

residential lead abatement or interim control activities: floors, 40 μg/ft2; interior window sills, 250 μg/ft2; 

window troughs, 400 μg/ft2 [U.S. EPA 2001b]. These levels have been established as achievable through 

lead abatement and interim control activities. They are not based on projected health effects associated 

with specific surface dust levels. The Louisiana Department of Environmental Quality has a website 

containing state specific information about lead-based paint at http://www.deq.louisiana.gov/portal/

tabid/2884/Default.aspx.

References

ACGIH [1999]. Bioaerosols: assessment and control. Cincinnati, OH: American Conference of 

Governmental Industrial Hygienists.

ACGIH [2010]. 2010 TLVs® and BEIs®: threshold limit values for chemical substances and physical 

agents and biological exposure indices. Cincinnati, OH: American Conference of Governmental 

Industrial Hygienists.
Health Hazard Evaluation Report 2005-0135-3116 Page 31

Appendix B: Occupational Exposure Limits and Health Effects (continued)

AIHA [2008]. Recognition, evaluation, and control of indoor mold. Prezant B, Weekes DM, Miller JD eds. 

Fairfax, VA: American Industrial Hygiene Association.

AIHA [2010]. 2010 Emergency response planning guidelines (ERPG) & workplace environmental 

exposure levels (WEEL) handbook. Fairfax, VA: American Industrial Hygiene Association.

ANSI/ASHRAE [2004]. Thermal environmental conditions for human occupancy. American 

National Standards Institute/ASHRAE standard 55-2004. Atlanta, GA: American Society for Heating, 

Refrigerating, and Air-Conditioning Engineers, Inc.

ANSI/ASHRAE [2007]. Ventilation for acceptable indoor air quality. American National Standards 

Institute/ASHRAE standard 62.1-2007. Atlanta, GA: American Society of Heating, Refrigerating, and AirConditioning Engineers, Inc.

ATSDR [1990]. Toxicological profile for lead. Atlanta, GA: U.S. Department of Health and Human 

Services, Agency for Toxic Substances and Disease Registry. DHHS (ATSDR) Publication No. TP–88/17.

Brandt M, Brown C, Burkhart J, Burton N, Cox-Ganser J, Damon S, Falk H, Fridkin S, Garbe P, 

McGeehin M, Morgan J, Page E, Rao C, Redd S, Sinks T, Trout D, Wallingford K, Warnock D, Weissman 

D [2006]. Mold prevention strategies and possible health effects in the aftermath of hurricanes and major 

floods. MMWR 55(RR-8):1–27.

Brasel TL, Martin JM, Carriker CG, Wilson SC, Straus DC [2005]. Detection of airborne Stachybotrys 

chartarum macrocyclic trichothecene mycotoxins in the indoor environment. Appl Environ Microbiol 

71(11):7376–7388.

CFR. Code of Federal Regulations. Washington, DC: U.S. Government Printing Office, Office of the 

Federal Register.

Farfel MR, Chisholm JJ [1990]. Health and environmental outcomes of traditional and modified practices 

for abatement of residential lead–based paint. Am J Pub Health 80(10):1240–1245.

Górny RL, Reponen T, Willeke K, Schmechel D, Robine E, Boissier M, Grinshpun SA [2002]. Fungal 

fragments as indoor air biocontaminants. Appl Environ Microbiol 68(7):3522–3531.

IOM [2004]. Human health effects associated with damp indoor environments. In: Damp indoor spaces 

and health. Washington, DC: Institute of Medicine, National Academy Press, pp. 183–269.

NIOSH [1986]. Criteria for a recommended standard: occupational exposure to hot environments, revised 

criteria. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control, 

National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 86–13.
Page 32 Health Hazard Evaluation Report 2005-0135-3116

Appendix B: Occupational Exposure Limits and Health Effects (continued)

NIOSH [2005]. NIOSH pocket guide to chemical hazards. Cincinnati, OH: U.S. Department of Health 

and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational 

Safety and Health, DHHS (NIOSH) Publication No. 2005–149. [http://www.cdc.gov/niosh/npg/]. Date 

accessed: August 2010.

OSHA [1993]. Occupational Safety and Health Administration Instruction CPL 02-02-058-29 CFR 

1926.62, Lead Exposure in Construction; Interim Final Rule: Inspection and Compliance Procedures 

(12/13/1993).

Redd SC [2002]. State of the science on molds and human health. Statement for the Record Before the 

Subcommittee on Oversight and Investigations and Housing and Community Opportunity, Committee 

on Financial Services, United States House of Representatives. Atlanta, GA: U.S. Department of Health 

and Human Services, Centers for Disease Control and Prevention.

Reponen T, Seo S-C, Iossifova Y, Adhikari A, Grinshpun SA [2006]. New field-compatible method for 

collection and analysis of β-glucan in fungal fragments. Abstracts of the International Aerosol Conference, 

St. Paul, Minnesota, p. 955.

Rosenstock L [1996]. NIOSH Testimony to the U.S. Department of Labor on indoor air quality. Applied 

Occupational and Environmental Hygiene 11(12):1365–1370.

Seppanen OA, Fisk WJ, Mendell MJ [1999]. Association of ventilation rates and CO2 concentrations with 

health and other responses in commercial and institutional buildings. Indoor Air 9(4):226–252.

U.S. EPA [2001a]. Mold remediation in schools and commercial buildings. Washington, DC: United 

States Environmental Protection Agency, Office of Air and Radiation, Indoor Environments Division. 

EPA Publication No. 402–K–01–001.

U.S. EPA [2001b]. Lead; identification of dangerous levels of lead. Washington, DC: United States 

Environmental Protection Agency. 40 CFR Part 745 [http://www.epa.gov/fedrgstr/EPA-TOX/2001/

January/Day-05/t84.pdf]. Date accessed: August 2010.

Wald P, Stave G [1994]. Fungi. In: Physical and biological hazards of the workplace. New York: Van 

Nostrand Reinhold, p. 394.

WHO [2009]. WHO guidelines for indoor air quality: dampness and mould. Geneva, Switzerland: World 

Health Organization. [http://www.euro.who.int/document/e92645.pdf]. Date accessed: August 2010.
Health Hazard Evaluation Report 2005-0135-3116 Page 33

Table C1. Microscopic sticky tape sample results for AFSHS

Sample location Genera Amount of 

growth*

 April 19, 2005

2nd floor hallway across from 

teachers’ lounge

Cladosporium spores, hyphae, conidiophores Numerous

Room 217 under window sill – 

water-damaged

None

Room 213 wall with dark pattern 

near door 

Cladosporium spores, hyphae, conidiophores Numerous

Room 213 – next to window by 

teacher’s desk

Cladosporium spores, hyphae, conidiophores Numerous

3rd floor hallway across from Room 

313

Cladosporium spores, hyphae, conidiophores Numerous

3rd floor hallway across from Room 

317

Cladosporium spores, hyphae, conidiophores Numerous

Room 313 – wall over chalkboard Cladosporium spores, hyphae, conidiophores Massive

4th floor hallway across from Room 

400

Cladosporium spores, hyphae, conidiophores Massive

Room 416 – wall over chalkboard Cladosporium spores, hyphae, conidiophores Many

4th floor hallway black pattern on 

ceiling

Cladosporium spores, hyphae, conidiophores Massive

3rd floor hallway outside of library Cladosporium spores, hyphae, conidiophores Numerous

3rd floor faculty women’s restroom Cladosporium spores, hyphae, conidiophores Massive

Room 312A ceiling Cladosporium spores, hyphae, conidiophores Massive

Room 316 wall Cladosporium spores, hyphae, conidiophores Massive

May 24, 2005

2nd floor hallway by Room 208 Cladosporium spores, hyphae, conidiophores Numerous

Room 205 wall Cladosporium spores, hyphae, conidiophores Massive

*Massive>numerous>many>a few>trace

Appendix C: Tables
Page 34 Health Hazard Evaluation Report 2005-0135-3116

Appendix C: Tables (continued)

Table C2. Fungal spore equivalents in air identified by MSQPCR in the AFSHS on April 19, 2005

Sample locations 2nd Floor Teachers’ 

Lounge Room 213 Room 416

Sampling time 9:34 a.m. – 

3:42 p.m.

9:42 a.m. – 

3:34 p.m.

9:46 a.m. – 

3:37 p.m.

Fungal ID (SE/m3)*

Aspergillus fumigatus 0 0 10

Aspergillus niger 5 4 0

Aspergillus penicillioides 54 21 0

Aspergillus unguis 2 0 0

Aspergillus versicolor 29 0 0

Aureobasidium pullulans 2 2 5

Cladosporium cladosporioides-1 212 757 426

Cladosporium cladosporioides-2 8 0 1

Cladosporium sphaerospermum 52 29 33

Epicoccum nigrum 0 0 41

Eurotium (Asp.) amstelodami 89 1 4

Mucor amphibiorum group 1 0 0

Penicillium brevicompactum 6 0 0

Penicillium crustosum (group 2) 0 0 19211

Penicillium variabile 0 0 3

Rhizopus stolonifer 0 1 0

Scopulariopsis brevicaulis/fusca 0 0 154

Wallemia sebi 0 3 147

*Spore equivalent per cubic meter of air
Health Hazard Evaluation Report 2005-0135-3116 Page 35

Appendix C: Tables (continued)

Table C3. Fungal spore equivalents in dust using MSQPCR and ERMI analysis AFSHS on April 19, 2005

Fungal species Room 321 wall 

by teacher’s 

desk

Room 317 

by teacher’s 

desk

Room 426 

Top of filing 

cabinet

Room 322 

Choir Room 

chairs

Room 400 

window 

Group 1 sill

Aspergillus flavus 6 5 31 7 1

Aspergillus fumigatus 14 3 94 13 7

Aspergillus niger 9 2 16 7 22

 Aspergillus ochraceus 1 1 1 1 1

Aspergillus penicillioides 743 211 351 47 55

Aspergillus restrictus 1 1 63 1 1

Aspergillus sclerotiorum 76 38 196 104 1

Aspergillus sydowii 1174 214 67 1 113

Aspergillus unguis 4504 237 375 52 2631

Aspergillus versicolor 1 1 1 1 1

Aureobasidium pullulans 754 1273 5036 431 2288

Chaetomium globosum 49 2 21 14 51

Cladosporium sphaerospermum 2464 1758 2647 578 1119

Eurotium Group 512 409 762 173 224

Paecilomyces variotii 31 11 174 82 148

Penicillium brevicompactum 39 14 48 1 1

Penicillium corylophilum 1 1 1 1 36

Penicillium Group 2 1 1 1 1 1

Penicillium purpurogenum 1 1 1 1 3

Penicillium spinulosum 1 1 1 1 1

Penicillium variabile 12 4 37 16 95

Scopulariopsis brevicaulis 4 18 2 1 10

Scopulariopsis chartarum 1 1 1 1 1

Stachybotrys chartarum 1 1 11 1 1

Trichoderma viride 10 5 16 135 64

Wallemia sebi 75 43 250 42 57

Sum of the logs group 1 32.66 29.32 39.05 27.88 33.39

Group 2

Acremonium strictum 1 1 4 1 1

Alternaria alternata 1 22 841 72 159

Aspergillus ustus 252 62 88 138 392

Cladosporium cladosporioides-1 611 502 1820 556 453

Cladosporium cladosporioides-2 19 3 12 6 17

Cladosporium herbarum 36 12 619 42 86

Epicoccum nigrum 20 16 499 19 95

Mucor Group 25 6 8 3 7

Penicillium chrysogenum Type 2 112 114 37 43 400

Rhizopus stolonifer 7 21 45 1 21

Sum of the logs group 2 13.62 14.24 19.93 14.05 18.1

ERMI values 19.0 15.1 19.1 13.8 15.3
Page 36 Health Hazard Evaluation Report 2005-0135-3116

Appendix C: Tables (continued)

Table C4. Bulk paint/matrix lead results for AFSHS

Sample location Pb (μg/g)* LOD (μg/g) LOQ (μg/g)

April 19, 2005

Room 403 under window sill 68.1 0.51 1.71

4th floor hallway outside wall 904.0 0.18 0.603

4th floor stairwell (even side) 11.4 0.37 1.24

Room 325 wall under window 1670 1.2 4.11

Room 325 window sill 1410 1.3 4.20

Room 321 wall by teacher’s desk 1660 0.56 1.86

May 24, 2005

Room 205 loose ceiling paint 1730 1.0 3.47

*Micrograms per gram total weight

 
Health Hazard Evaluation Report 2005-0135-3116 Page 37

Appendix C: Tables (continued)

Table C5. Culturable fungi in air sampling results for AFSHS

Sample location Air volume per 

replicate (liters)

Average colony 

count (CFU/m3)*

Fungal identification,

by rank

Room 420 141.5 246 Cladosporium

Penicillium

Basidiomycetes

yeasts

sterile fungi

Alternaria alternata

Botrytis cinerea

Aspergillus glaucus

Tritirachium

Room 316 141.5 321 Cladosporium

Penicillium

Aspergillus niger

Aspergillus versicolor

Aspergillus ochraceus

Syncephalastrum|

sterile fungi

yeasts

Rhizopus stolonifer| |

Room 427 141.5 1000 Cladosporium

Penicillium

Alternaria alternata

Epicoccum nigrum

sterile fungi

yeasts

Basidiomycetes

Aspergillus fumigatus

Aspergillus sp.

Fusarium

Room 205 141.5 888 Cladosporium

Penicillium

Aspergillus sp.

Basidiomycetes

sterile fungi

yeasts

Curvularia

Epicoccum nigrum

Outside main entrance 141.5 1179 Cladosporium

Penicillium

Alternaria alternata

sterile fungi

yeasts

Epicoccum nigrum

Aureobasidium pullulans

Fusarium

*Colony forming units per cubic meter (average of three replicates)
Page 38 Health Hazard Evaluation Report 2005-0135-3116

Appendix C: Tables (continued)

Table C6. Fungal spores in air using spore traps for AFSHS

Sampling 

location

Sample 

volume

(liters)

Average 

total fungal 

structure

(count/m3)*

Fungal identification by rank

Room 420 75 98 Cladosporium>Basidiospores>Aspergillus/Pencilliumlike>Ascospores>Hyphal Fragments> Ganoderma

Room 316 75 338 Aspergillus/Pencillium like>Cladosporium> Basidiospores>Asc

ospores>Mxyomycetes>Hyphal Fragments>Ulocladium

Room 427 75 1911 Cladosporium>Aspergillus/Pencillium-like> 

Basidiospores>Ascospores>Hyphal Fragments>

Ganoderma>Epicoccum>Myxomycetes>Alterneria>Torula>Cur

vularia>Cercospora>Piuthomyces> Bipolaris/Dreschlera

Room 205 75 1311 Cladosporium>Basidiospores>Aspergillus/Pencilliumlike>Ascospores>Hyphal Fragments> Myxomycetes> 

Alterneria>Ganoderma> Bipolaris/Dreschlera

Outside 

main 

entrance

75 4000 Cladosporium>Ascospores>Basidiospores>

Alterneria>Aspergillus/Pencillium like>Hyphal Fragments>Epic

ocuum>Myxomycetes>Ganoderma>Cercospora>Periconia>Pi

thomyces>Polythrincium>Curvularia>Pestalotiopsis>Bipolaris/

Dreschlera> Chaetomium>Curvularia

*Count per cubic meter of air
Health Hazard Evaluation Report 2005-0135-3116 Page 39

Appendix C: Tables (continued)

Table C7. Microscopic sticky tape sample results for WHHS

Sample location Genera Amount of 

growth*

Room 102 – back wall in closet – evidence 

of chronic leakage

None N/A†

Room 102 – back wall in closet – evidence 

of chronic leakage

Hyphae – unidentified genera Trace

Room 102 – back wall in closet – evidence 

of chronic leakage

Aspergillus/Penicillium-like spores

Hyphae – unidentified genera

A Few

Trace

Room 103 – side wall in classroom – 

evidence of chronic leakage

None N/A

Room -103 – rug sample – chronic leak 

pattern

None N/A

Library – window leak None N/A

Library – shelving that had mold 

remediation completed

None N/A

Room 333 – evidence of roof leak None N/A

*Massive>numerous>many>a few>trace

†Not applicable
Page 40 Health Hazard Evaluation Report 2005-0135-3116

Appendix C: Tables (continued)

Table C8. Fungal spore equivalents in air identified by MSQPCR for WHHS

Sample locations Room 102 Room 103 Library Room 271 Outside

Sampling time 8:28 a.m. – 

2:09 p.m.

8:42 a.m. – 

2:11 p.m.

8:58 a.m. – 

2:14 p.m.

9:32 a.m. – 

2:23 p.m.

9:40 a.m. – 

2:26 p.m.

Fungal ID (SE/m3)*

Aspergillus fumigatus ND† ND 34 ND 35

Aspergillus niger ND ND 7 ND ND

Cladosporium 

cladosporioides-1

1 4 ND ND ND

Eurotium (Asp.) 

amstelodami‡

ND 61 20 ND 210

Penicillium 

brevicompactum

ND ND ND 23 13

Penicillium chrysogenum ND ND 5 ND ND

*Spore equivalent per cubic meter of air

†

None detected

‡

Detected in field blank
Health Hazard Evaluation Report 2005-0135-3116 Page 41

Appendix C: Tables (continued)

Table C9. Culturable air sample results for WHHS

Sample location Air volume per 

replicate (liters)

Average colony 

count (CFU/m3)*

Fungal identification,

by rank

Room 333 85 92 Cladosporium

Penicillium

Epicoccum nigrum

Aureobasidium pullalans

Room 334 85 103 Basidiomycetes

Cladosporium

Penicillium

Yeasts

Aspergillus niger

Aspergillus sydowii

Aspergillus versicolor

Chrysosoporium pannorum

Epicoccum nigrum

Library 85 159 Basidiomycetes

Penicillium

sterile fungi

yeasts

Aspergillus versicolor

Fusarium sp.

Phoma sp.

Rhodotorula mucilaginosa

Room 102 85 8 Cladosporium

Aspergillus caesitosus

Room 260 85 12 Sterile fungi

Yeasts

Outside main entrance 85 140 Basidiomycetes

Cladosporium

Penicillium

yeasts

sterile fungi

Alternaria alternata

Aspergillus fumigatus

Aspergillus nidulans

Aspergillus versicolor

Epicoccum nigrum

*Colony forming units per cubic meter (average of three replicates). Sample results corrected for multiple 

impacts.
Page 42 Health Hazard Evaluation Report 2005-0135-3116

Appendix C: Tables (continued)

Table C10. Fungal spores in air using spore traps for WHHS

Sampling 

location

Sample 

volume

(liters)

Total fungal 

structure

(count/m3)*

Fungal identification by rank

Room 333 75 187 Cladosporium> Aspergillus/Pencillium-like> 

Hyphal Fragments> Basidiospores> Pithomyces> 

Mxyomycetes>Rusts

Room 334 75 373 Aspergillus/Pencillium-like> Basidiospores> Epicocuum> 

Ganoderma>Mxyomycetes>Hyphal Fragments

Library 75 253 Aspergillus/Pencillium-like> Basidiospores>Hyphal 

Fragments> Myxomycetes>Cladosporium> Curvularia

Room 102 75 27 Basidiospores> Hyphal Fragments

Room 260 75 93 Aspergillus/Pencillium-like> Basidiospores> Pithomyces 

Outside Main 

Entrance

75 520 Basidiospores> Aspergillus/Pencillium-like> Ascospores> 

Cladosporium>Hyphal Fragments>Pollen

*Count per cubic meter of air
Health Hazard Evaluation Report 2005-0135-3116 Page 43

Acknowledgments and

Availability of Report

The Hazard Evaluations and Technical Assistance Branch (HETAB) 

of the National Institute for Occupational Safety and Health 

(NIOSH) conducts field investigations of possible health hazards 

in the workplace. These investigations are conducted under the 

authority of Section 20(a)(6) of the Occupational Safety and Health 

Act of 1970, 29 U.S.C. 669(a)(6) which authorizes the Secretary of 

Health and Human Services, following a written request from any 

employer or authorized representative of employees, to determine 

whether any substance normally found in the place of employment 

has potentially toxic effects in such concentrations as used or found. 

HETAB also provides, upon request, technical and consultative 

assistance to federal, state, and local agencies; labor; industry; and 

other groups or individuals to control occupational health hazards 

and to prevent related trauma and disease.

The findings and conclusions in this report are those of the authors 

and do not necessarily represent the views of NIOSH. Mention of any 

company or product does not constitute endorsement by NIOSH. In 

addition, citations to websites external to NIOSH do not constitute 

NIOSH endorsement of the sponsoring organizations or their 

programs or products. Furthermore, NIOSH is not responsible for 

the content of these websites. All Web addresses referenced in this 

document were accessible as of the publication date.

This report was prepared by Gregory Thomas, Nancy Clark Burton, 

Charles Mueller, and Elena Page of HETAB, Division of Surveillance, 

Hazard Evaluations and Field Studies. Industrial hygiene field 

assistance was provided by Srinivas Durgam, Andrea Markey, Rob 

McCleery, and Perianan Periakaruppan. Medical field assistance was 

provided by Judith Eisenberg and Marilyn Radke. Analytical support 

was provided by Ronnee N. Andrews, Chemical Exposure Monitoring 

Branch, Division of Applied Research and Technology, and EMLab 

P&K Laboratories, Cherry Hill, New Jersey. Assistance with the 

ERMI analysis was provided by Steven Vesper, U.S. Environmental 

Protection Agency. Health communication assistance was provided by 

Stefanie Evans. Editorial assistance was provided by Ellen Galloway. 

Desktop publishing was performed by Robin Smith.

Copies of this report have been sent to employee and management 

representatives at the New Orleans Public School District, Walnut 

Hills High School, the state health department, and the Occupational 

Safety and Health Administration Regional Office. This report is 

not copyrighted and may be freely reproduced. The report may be 

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Below is a recommended citation for this report:

NIOSH [2010]. Health hazard evaluation report: comparison of mold exposures, 

work-related symptoms, and visual contrast sensitivity between employees at a 

severely water-damaged school and employees at a school without significant 

water damage, New Orleans, LA. By Thomas G, Burton NC, Mueller C, Page 

E. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for 

Disease Control and Prevention, National Institute for Occupational Safety and 

Health, NIOSH HETA No. 2005-0135-3116.

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