Fungal Exposure in NYC Homes Damaged by Hurricane Sandy and Respiratory Outcomes

在纽约市（NYC），住宅霉菌污染一直是公共卫生官员最关注的问题之一，也是飓风桑迪过后居民最常见的投诉之一。一般来说，霉菌问题在城市家庭中很常见，对有利于霉菌生长的条件控制较少的低收入家庭影响更大。在城市环境中，哮喘儿童可能特别容易受到与灾难性水害后真菌暴露有关的不利健康影响。2004年医学研究所的一份报告和几项荟萃分析得出结论，霉菌和室内潮湿因素与哮喘症状有关。然而，这些证据大多是基于潮湿或可见霉菌的报告，而不是基于真菌暴露的测量，这限制了这些研究无法证明1)真菌暴露是致病因子，2)哪种真菌与健康结果相关，以及3)特异性过敏致敏是否是哮喘相关发病率的病因途径。从历史上看，评估国内霉菌暴露的传统方法的局限性阻碍了这些联系的建立，包括微观鉴定形态上不可识别的孢子和霉菌培养所需的物种特异性生长条件，以及生物测定法对霉菌缺乏特异性。最近，聚合酶链反应方法的进展将允许表征与水损害相关的真菌谱，能够监测修复工作的效果和国内真菌谱的长期变化，并可能有助于阐明真菌暴露与呼吸健康不良之间的关系。本提案将测试以下假设：与未受影响的纽约市房屋相比，遭受飓风桑迪相关水损害的纽约市房屋在修复前后将具有不同的真菌物种特征，并且房屋中的真菌浓度将与哮喘症状、气流阻塞和哮喘儿童的气道炎症有关。居住在纽约市被飓风桑迪破坏的房屋中的参与者将从一个独特的公私合作伙伴关系中招募，该合作伙伴关系为2000所房屋提供免费的霉菌修复服务。一组生活在纽约市非受影响家庭的7 - 11岁哮喘儿童将被用来比较受影响家庭和这些家庭中的哮喘儿童的暴露和呼吸结果。该提案将在纽约市卫生和心理卫生部（DOHMH）、哥伦比亚大学、NIOSH和私营企业的研究人员和公共卫生从业人员之间建立合作，并具有互补的专业知识和技能，以回答应对这场毁灭性自然灾害的重要公共卫生研究问题。如果成功，这一建议将导致对城市社区自然灾害（如飓风桑迪）后家庭真菌暴露和儿童哮喘发病率相关增加的重要认识。纽约市卫生部和其他机构将利用这些知识来应对未来的自然灾害，特别是澄清哮喘儿童的风险。

DESCRIPTION (provided by applicant): Project summary In New York City (NYC), domestic mold contamination has been one of the greatest concerns for public health officials and most common complaints of residents in the aftermath of Hurricane Sandy. Mold problems are common in urban homes in general and disproportionately affect lower-income families who have less control over conditions conducive to mold growth. In urban settings, asthmatic children could be particularly susceptible to adverse health effects related to fungal exposures following catastrophic water damage. A 2004 Institute of Medicine report and several meta-analyses have concluded that mold and home dampness factors are associated with asthma symptoms. However, a majority of this evidence is based on report of dampness or visible mold and not on measured fungal exposure, limiting these studies from demonstrating 1) that fungal exposure was the causative agent, 2) which species of fungi were associated with the health outcomes and 3) whether specific allergic sensitization is an etiological pathway to the asthma-related morbidity. Historically, making these connections was impeded by limitations of traditional methods for assessing domestic mold exposure, including the microscopic identification of morphologically indiscernible spores and species-specific growth conditions required for mold culture and a lack of specificity for mold with bioassays. Recently, advances in polymerase chain reaction methodologies will allow for characterization of fungal profiles associated with water damage, enable monitoring the efficacy of remediation efforts and long-term changes in domestic fungal profiles, and may aid in elucidating the association between fungal exposure and poor respiratory health. This proposal will test the hypotheses that NYC homes with Hurricane Sandy-related water damage will have different fungal species profiles both pre- and post- remediation as compared with NYC homes that were not impacted and that fungal concentrations in homes will be associated with asthma symptoms, airflow obstruction and airway inflammation among asthmatic children. Participants living in NYC homes damaged by Hurricane Sandy will be recruited from a unique public-private partnership that is providing services for free mold remediation for 2,000 houses. An established cohort of seven-eleven year-old asthmatic children living throughout NYC in non-impacted homes will be used to compare exposures and respiratory outcomes with impacted homes and the asthmatics children living in those homes. This proposal will establish collaboration between researchers and public health practitioners at the NYC Department of Health and Mental Hygiene (DOHMH), Columbia University, NIOSH and private industry with complementary expertise and skills to answer important public health research questions in response to this devastating natural disaster. If successful, this proposal will lead to important knowledge about domestic fungal exposure following a natural disaster like Hurricane Sandy in urban communities and the associated increase in asthma morbidity in children. This knowledge will be used by the NYC DOHMH and others to inform the response to future natural disasters, particular to clarify the risks to asthmatic children.