Epidemiological Investigations into an Outbreak of Building-Associated Illness in Singapore

Abstract

In August 1991, the Ministry of the Environment was informed of the occurrence of illnesses suspected to be related to a modern, multi-story of fice building. Investigations revealed that 34 of the occupants on two floors of the building had non-specific ailments such as eye, throat or skin irritation which caused acute discomfort but resolved upon leaving the premises. Case-control study identified a number of factors significantly associated with the illness; viz. a personal history of allergy, asthma or sinusitis; a high level of work-related stress; and a lack of thermal comfort. One feature of the affected of fices was the numerous high partitions which tended to obstruct air movement. Adjustments of central temperature to compensate for complaints of “stuffiness” had resulted in wide fluctuations of temperature and relative humidity. Indoor air quality measurements also revealed high bacterial counts, a condition aggravated by the raised relative humidity and inadequate air movement. The problems gradually resolved following major modifications at the of fices and air-handling units. This episode confirmed the need for further studies of building-associated illness in the tropics. Asia Pac J Public Health1994;7(4):201-5.

Keywords

Building-associated illness epidemiological investigation Singapore tropics.

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References

1. Valbjorn O , Hagen H , Kukkonen E , Sundell J . Indoor climate and air quality problems: investigation and remedy. Horsholm: Danish Building Research Institute, 1990: 6–23.

2. Molina C , Pickering CAC , Valbjorn O , Bortoli MD . Sick building syndrome — a practical guide. Luxembourg: Commission of the European Communities, 1989:3–19.

3. Quinlan P , Macher JM , Alevantis LE , Cone JE . Protocol for the comprehensive evaluation of building-associated illness. Occup Med 1989; 4: 771–97.

4. Whorton MD , Larson SR , Gordon NJ , Morgan RW . Investigation and work-up of tight building syndrome. J Occup Med 1987; 29: 142–7.

5. McCarthy JF , Bearg DW , Spengler JD . Assessment of indoor air quality.In: Samet JM , Spengler JD , editors. Indoor air pollution: a health perspective. Baltimore: Johns Hopkins University, 1991:285–305.

6. Seifert B , Knoppel H , Lanting RW , Person A , Siskos P , Wolkoff P . Strategy for sampling chemical substances in indoor air. Luxembourg: Commission of the European Communities, 1989:4–28.

7. American Conference of Governmental Industrial Hygienists. Guidelines for the assessment of bioaerosols in the indoor environment. Cincinnati: ACGIH, 1989.

8. Gardner MJ , Altman DG . Statistics with confidence — confidence intervals and statistical guidelines. BMJ 1989: 28–63.

9. Glantz SA , Slinker BK . Primer of applied regression and analysis of variance. New York: McGraw Hill Inc., 1990:1–9.

10.

10. Dawson-Saunders B , Trapp RG . Basic and clinical biostatistics. London: Appleton and Lange, 1990: 116–8.

11.

11. Letz GA . Sick building syndrome: acute illness among of fice workers-the role of building ventilation, air-borne contaminants and work stress. Allergy Proc 1990; 11: 109–16.

12.

12. Weissman DN , Schuyler MR . Biological agents and allergic diseases.In: Samet JM , Spengler JD , editors. Indoor air pollution: a health perspective. Baltimore: Johns Hopkins University, 1991:285–305.

13.

13. Gammage RB , Hanson DL , Johnson LW . Indoor air quality investigations: a practitioner's approach. Environ Int 1989; 15: 503–10.

14.

14. Morey PR , Shattuck DE . Role of ventilation in the causation of building-associated illness. Occup Med 1989; 4: 625–42.

15.

15. London Hazards Centre. Sick building syndrome: causes, effects and control. London: London Hazards Centre Trust. 1990:40–64.

16.

16. Baker DB . Social and organizational factors in of fice building-associated illness. Occup Med 1989; 4: 607–24.

17.

17. Skov P , Valbjorn O , Pedersen BV . Influence of indoor climate on the sick building syndrome in an of fice environment. Scand J Work Environ Health 1990; 16: 363–71.

18.

18. Norback D , Edling C . Environmental, occupational, and personal factors related to the prevalence of the' sick building syndrome in the general population. Br J Ind Med 1991; 48: 451–62.

19.

19. Phoon WH . Outbreaks of mass hysteria at workplaces in Singapore: some patterns and modes of presentation. In: Colligan MJ , Pennebaker JW , Murphy LR , editors. Mass psychogenic illness, a social psychological analysis. Hillsdale: Erlbaum, 1982:21–31.

20.

20. Editorial. Sick building syndrome. Lancet 1991; 338: 1493–4.

21.

21. Burge S , Hedge A , Wilson S , Bass JH , Robertson A . Sick building syndrome: a study of 4373 of fice workers. Ann Occup Hyg 1987; 31: 493–504.

22.

22. Brooks BO , Utter GM , DeBroy JA , Schimke RD . Indoor air pollution: an edifice complex. Clin Toxicol 1991; 29: 315–74.

23.

23. Kreiss K . The sick building syndrome in of fice buildings — a breath of fresh air. N Engl J Med 1993; 328: 877–8.

24.

24. Potter IN . Sick building syndrome. Berkshire: The Building Services Research and Information Association, 1988:1–22.

25.

25. Burge S . Building sickness-a medical approach to the causes. In: Indoor Air 90. Ottawa: International Conference on Indoor Air Quality and Climate Inc., 1991; 5: 3–14.

26.

26. World Health Organization. Indoor air quality: report on a WHO meeting. Geneva: WHO, 1986:16–26.

27.

27. Hodgson MJ . Clinical diagnosis and management of building-related illness and the sick building syndrome. Occup Med 1989; 4: 593–606.

28.

28. Grant IWB . The sick building syndrome (letter). BMJ 1985; 290: 321.

29.

29. Liao SST , Bacon-Shone J , Kim YS . Factors influencing indoor air quality in Hong Kong: measurements in of fices and shops. Environ Technology, 1991; 12: 737–45.

30.

30. Editorial. Indoor air pollution in developing countries. Lancet 1990; 336: 1548.