1. Introduction

Overview

1.1
Mould is a naturally occurring type of fungi that can be found throughout the environment, both indoors and outdoors. Mould produces airborne particles called spores, which have the potential to cause health issues if inhaled by susceptible individuals.1 In particular, mould may impact the health of people with allergies, asthma, weakened immune systems and/or other health conditions.2
1.2
In addition to these established health impacts of mould, the prevalence of a condition referred to as Chronic Inflammatory Response Syndrome (CIRS) has been described in Australia and internationally as a biotoxin-related illness.
1.3
In some instances, CIRS and biotoxin-related illnesses have been reported to be associated with exposure to biotoxins such as mould in buildings arising from excessive moisture build-up from water damage. Buildings can become water-damaged after events such as leaks, heavy rain and flooding, and moisture can also enter a building through incoming air or through a buildup of condensation.3 Certain building and construction practices may also increase the amount of condensation within a building. While water damage can occur in any building, tenants in rental properties and public housing may face particular challenges related to having water damage issues resolved.
1.4
A variety of methods can be used for the assessment and remediation of a property for mould and/or water damage. The effectiveness of different methods is contested4, and there is limited guidance in the form of agreed standards or regulation.5
1.5
Biotoxin-related illnesses and CIRS are not widely recognised medical conditions among the Australian medical profession. The Department of Health stated that ‘biotoxin-related illnesses are not captured within the National Notifiable Diseases Surveillance System’ and that data is not retained on their frequency or distribution.6 Further, there are no clinical guidelines for the diagnosis and treatment of CIRS.7
1.6
A number of inquiry participants described symptoms of biotoxin-related illnesses and the effect these symptoms had on their daily lives, and also linked these symptoms with the presence of mould in their homes or workplaces. The symptoms described ranged from mild to severe, with commonly described symptoms including fatigue, pain, memory and concentration problems, disorientation, insomnia, gastrointestinal issues, sinus issues, fever, headaches, and respiratory issues.
1.7
The Department of Health stated that, at this stage, ‘the scientific evidence is not sufficient … to accept the assertion that exposure to environmental biotoxins is causing [CIRS].’8 The Department of Health also emphasised the importance of providing patients who present with multiple unexplained symptoms with a comprehensive and multidisciplinary clinical evaluation.9

Terminology

1.8
Inquiry participants used a variety of terms to describe and discuss the effects of biotoxin-related illness and CIRS. In many instances, terms were used interchangeably, such as:
CIRS;
CIRS-Water Damaged Building;
biotoxin-related illness; and
mould illness.
1.9
The Royal Australasian College of Physicians preferred to use the phrase ‘people with multiple not-readily-explained symptoms’.10

About the Inquiry

Objectives and Scope

1.10
On 21 June 2018, the Minister for Health, the Hon Greg Hunt MP, referred the Inquiry into Biotoxin-related Illnesses in Australia (the inquiry) to the Standing Committee on Health, Aged Care and Sport (the Committee).
1.11
As part of the inquiry, the Committee reviewed the prevalence, diagnosis and treatment of biotoxin-related illnesses such as CIRS. The Committee, in particular, focused on:
the potential health impacts of exposure to dampness and/or mould, particularly in indoor environments;
the prevalence of CIRS and biotoxin-related illnesses in inquiry participants; and
the current medical process of identifying CIRS and biotoxin-related illnesses and available treatments.
1.12
The Committee received a number of personal accounts from people who identified as having CIRS or a biotoxin-related illness and also outlined the symptoms associated with these illnesses and the effect they had on daily life.
1.13
While the Committee does not have the power to intervene in, or investigate, personal circumstances, Members appreciate the time and effort taken by individuals experiencing CIRS, as well as their friends and family, to participate in the inquiry. These personal accounts provided the Committee with a valuable insight into the health, financial and wellbeing impacts associated with this condition.
1.14
The Committee also received personal accounts from inquiry participants who suffer from Chronic Fatigue Syndrome and tick-bite related conditions (Lyme Disease). The Committee considered that these illnesses were comprehensively examined by the Committee’s predecessor in 2016, and that further investigation in this area was not warranted for this inquiry. The Committee’s predecessor in the 44th Parliament, the Standing Committee on Health, conducted the Inquiry Into Chronic Disease Prevention and Management in Primary Health Care, which included an examination of Myalgic Encephalomyelitis (Chronic Fatigue Syndrome) and Tick-Borne and LymeLike Diseases.11

Inquiry Conduct

1.15
On 21 June 2018, the Committee issued a media release announcing the inquiry, calling for submissions to be received by 2 August 2018. The Committee also invited submissions from: government agencies, advocacy groups, medical bodies and academics.
1.16
The inquiry received 142 submissions and 39 exhibits, which are listed at Appendix A and B respectively. The Committee also received a form letter from six participants, which used an identical structure.
1.17
The Committee subsequently held two public hearings as outlined in the table below. A list of witnesses and organisations who attended these public hearings is at Appendix C.
Table 1.1:  Public Hearings Held
Date
Place
9 August 2018
Canberra, ACT
12 September 2018
Canberra, ACT

Report Structure

1.18
Chapter 2 discusses mould and its potential health effects, including an outline of biotoxin-related illnesses. The prevalence and possible sources of indoor mould growth is also discussed, as well as methods for testing and remediation of buildings with mould issues.
1.19
Chapter 3 outlines diagnostic and treatment options that have been put forward for CIRS. Chapter 3 also presents personal accounts of individuals who have reported as experiencing CIRS, or CIRS-attributed symptoms.

  • 1
    Department of Health, Submission 56, p. 2.
  • 2
    Government of Victoria, Mould and Your Health,
    www.betterhealth.vic.gov.au/health/conditionsandtreatments/mould-and-your-health, Accessed 23 August 2018.
  • 3
    World Health Organization, Guidelines for Indoor Air Quality: Dampness and Mould, 2009, p. xiv.
  • 4
    Australian Institute of Occupational Hygienists, Submission 50, p. 6.
  • 5
    Greencap, Submission 138, p. 9.
  • 6
    Department of Health, Submission 56, p. 2.
  • 7
    Royal Australasian College of Physicians, Submission 142, p. 3.
  • 8
    Professor Brendan Murphy, Chief Medical Officer, Department of Health, Official Committee Hansard, Canberra, 12 September 2018, p. 1.
  • 9
    Professor Brendan Murphy, Department of Health, Official Committee Hansard, Canberra, 12 September 2018, p. 1.
  • 10
    Royal Australasian College of Physicians, Submission 142, p. 2.
  • 11
    Standing Committee on Health, Inquiry into Chronic Disease Prevention and Management in Primary Health Care, www.aph.gov.au/Parliamentary_Business/Committees/House/Health/Chronic_Disease
    , Accessed 29 August 2018.

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