Climate Change, the Indoor Environment, and Health (2011) / Chapter Skim
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6 Infectious Agents and Pests
6 Infectious Agents and Pests
Pages 155-184
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From page 155... ...
A changing climate will thus affect human exposure to these agents. This chapter addresses indoor environmental quality concerns associated with the infectious agents and other pests that research suggests may be influenced by climate-change–induced alterations in the indoor environment.
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From page 156... ...
Respiratory Viruses Experience dating back thousands of years has taught that infectious diseases can be affected by seasonal changes; this suggests that environment plays a critical role in the modulation of disease load, spread, and susceptibility. Obvious and recurring examples are provided by the respiratory viruses, most notably influenza viruses, respiratory syncytial virus (RSV)
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From page 157... ...
However, because indoor air conditioning affects indoor temperature and humidity, these require more investigation to determine whether the critical aspects of influenza spread are determined by the indoor or outdoor environmental conditions. The different results in temperate and tropical zones may reflect differences in viral and human biology in those regions.
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From page 158... ...
Extensive work has shown that HRV is one of the most prevalent cofactors in asthma exacerbations, making their role in overall medical care critical to understand and interrupt. A few studies address the determinants of HRV transmission and prevalence in indoor environments.
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From page 159... ...
Given their close ties to the environment and their access to humans through water consumption, aerosol generation, heating, and cooling, the epidemiology of gram-negative rod infections is a window into infectious diseases in the setting of climate change. Legionella From its initial recognition as a cause of human respiratory disease, Legionella infection has been closely tied to water-droplet exposure in hotels and hospitals (Stout and Yu, 1997)
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From page 160... ...
Those infections occurred in hospitals, so they are reflections of effects of indoor environment, but they presumably reflect some changes in the outdoor environment as well. That other nosocomial pathogens, such as S
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. The combination of a stable indoor environment and increased dampness may actually decrease the transmission of some respiratory viruses and increase the survival of other pathogens on fomites, such as the ones that harbor bacteria and mold
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From page 162... ...
This may in turn lead to greater indoor penetration of pathogenic fungi contained in soil and to higher indoor exposures in the absence of enhanced HVAC filtration or settled dust removal. Invasive fungal infections are quite rare in humans and occur almost exclusively in the setting of immunocompromise, either inborn, such as some primary immunodeficiencies, or acquired, such as that acquired through transplantation or chemotherapy.
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From page 163... ...
This section summarizes the available literature on the characteristics of these pests; the health effects of exposure to the allergens and microbial agents that they produce, host, or carry; and how climate-change–induced alterations in the indoor environment -- including changes in occupant behavior -- may affect adverse exposures associated with them. House Dust Mites House dust mites are microscopic arthropods that are ubiquitous in indoor environments.
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From page 164... ...
Studies indicate that increased indoor temperature in those communities has not been accompanied by an observed increase in the dust mite population; rather, dust mites decreased (Acosta et al., 2008; Chew et al., 1999)
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FIGURE 6-1 Variations in indoor temperature and relative humidity as functions of housing type and time of year in a sample of urban residences. (Derived from data presented in Chew et al., 1999.)
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From page 166... ...
(2009) showed that evaporative coolers can increase indoor relative humidity to a point where the prevalence of patients who have asthma or allergic rhinitis with sensitization to dust mites increases.
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However, the National Cooperative Inner-City Asthma Study (NCICAS) , Childhood Asthma Management Program (CAMP)
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(TePas et al., 2006) NOTE: CAMP = Childhood Asthma Management Program, ICAS = Inner-City Asthma Study, NCICAS = National Cooperative Inner-City Asthma Study, NHANES =National Health and Nutrition Examination Survey.
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From page 169... ...
. In contrast, if the northern states experience milder winters and an increase in humidity, dust mites might become the dominant allergen and surpass cockroaches and pets as the allergen most associated with increased asthma morbidity (Chew et al., 2009)
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From page 170... ...
Extensive work in the past decade has demonstrated the presence of pesticides in urban house dust and addressed the risk of exposure to these chemicals in vulnerable groups such as pregnant women and children. Such factors as multifamily dwellings, leaky buildings that allow pests to come into the indoor environment, and home ownership influence the likelihood of pesticide use (Julien et al., 2008)
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From page 171... ...
Changes in Vector Distribution Changes in patterns of infestation in the outdoor environment may affect indoor air quality. Milder and shorter winters are expected to increase the geographic distribution of pests, such as mosquitoes and insects that attack agricultural crops (Quarles, 2007)
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Many pesticides are developed to degrade quickly in outdoor environments but sequester in indoor environments in the absence of sunlight and rain. Pesticides can pass through the blood–brain barrier and penetrate the placenta.
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Integrated Pest Management If climate change causes the spread of diseases now considered to be tropical diseases into what are now more temperate climates, the use of pesticides could increase and have the potential to degrade indoor air quality. Alternatively, the concern about rodent and insect vectors could be used to promote wider use of Integrated Pest Management (IPM)
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CONCLUSIONS Several of the key findings of the 2001 National Research Council report Under the Weather: Climate, Ecosystems, and Infectious Diseases remain pertinent and bear repeating. They are excerpted and quoted below; additional explanatory detail is available in that report.
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From page 175... ...
Locations that are hotter and drier and that have increased use of air conditioning will tend to have fewer dust mite infestations. Decreased use of heating systems in winter because of milder conditions may result in increased dust mite populations.
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2001. Reducing relative humidity is a practical way to control dust mites and their aller gens in homes in temperature climates.
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From page 177... ...
Clinical Infectious Diseases 49(6)
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2001. House dust mite and cockroach exposure are strong risk factors for positive allergy skin test responses in the Childhood Asthma Management Program.
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Nosocomial Infections Surveillance System. Clinical Infectious Diseases 29(5)
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From page 180... ...
The National Cooperative Inner-City Asthma Study. Journal of Allergy and Clinical Immunology 106(6)
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2009. Effect of evaporative coolers on skin test reactivity to dust mites and molds in a desert environment.
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From page 182... ...
Clinical Infectious Diseases 42(2)
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From page 183... ...
Current Opinion in Infectious Diseases 23(2)
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