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Abstract
There are fewer longitudinal studies from China on symptoms as described for the sick building syndrome (SBS). Here, we performed a two-year prospective study and investigated associations between environmental parameters such as room temperature, relative air humidity (RH), carbon dioxide (CO2), nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3), particulate matter (PM10), and health outcomes including prevalence, incidence and remission of SBS symptoms in junior high schools in Taiyuan, China. Totally 2134 pupils participated at baseline, and 1325 stayed in the same classrooms during the study period (2010–2012). The prevalence of mucosal symptoms, general symptoms and symptoms improved when away from school (school-related symptoms) was 22.7%, 20.4% and 39.2%, respectively, at baseline, and the prevalence increased during follow-up (P<0.001). At baseline, both indoor and outdoor SO2 were found positively associated with prevalence of school-related symptoms. Indoor O3 was shown to be positively associated with prevalence of skin symptoms. At follow-up, indoor PM10 was found to be positively associated with new onset of skin, mucosal and general symptoms. CO2 and RH were positively associated with new onset of mucosal, general and school-related symptoms. Outdoor SO2 was positively associated with new onset of skin symptoms, while outdoor NO2 was positively associated with new onset of skin, general and mucosal symptoms. Outdoor PM10 was found to be positively associated with new onset of skin, general and mucosal symptoms as well as school-related symptoms. In conclusion, symptoms as described for SBS were commonly found in school children in Taiyuan City, China, and increased during the two-year follow-up period. Environmental pollution, including PM10, SO2 and NO2, could increase the prevalence and incidence of SBS and decrease the remission rate. Moreover, parental asthma and allergy (heredity) and pollen or pet allergy (atopy) can be risk factors for SBS.
Highlights
Non-specific symptoms associated with the indoor climate problems, often called sick building syndrome (SBS), have been reported in Western countries since the 1970s
Gender Parental allergy or asthma Ever had asthma Cat allergy Dog allergy Pollen allergy Any skin symptomsb Any mucosal symptomsc Any general symptomsd Any symptoms improved if away from schoole aDifferences tested by Chi-square test. bThe prevalence of subjects with at least one weekly symptom classified as skin. cThe prevalence of subjects with at least one weekly symptom classified as mucosal. dThe prevalence of subjects with at least one weekly symptom classified as general. eThe prevalence of subjects with at least one of the above mentioned symptoms classified as improved if away from school. doi:10.1371/journal.pone.0112933.t001
The follow-up study was restricted to those 1325 pupils (62.1%) who participated in both the initial study and the follow-up study and who stayed in the same classroom
Summary
Non-specific symptoms associated with the indoor climate problems, often called sick building syndrome (SBS), have been reported in Western countries since the 1970s. Indoor environmental factors associated with SBS include building dampness [7,8,9], low ventilation flow [10], volatile organic compounds (VOC) [11], mold and bacteria [12], microbial VOC (MVOC) [12] and room temperature [13,14,15]. It was concluded that the two most important classroom air quality problems were PM10 and CO2 levels [23] Another epidemiological study in schools in Malaysia, measuring fungal DNA, reported associations between certain microbial species (Aspergillus versicolor and Streptomyces sp) and respiratory symptoms in school children [24]. The aim was to investigate associations between measured indoor and outdoor environment and prevalence, new onset (incidence) and remission of SBS symptoms among junior high school students in schools in Taiyuan city, Shanxi province, China. The study included symptoms improved when away from the school (school-related symptom) as well as total prevalence, incidence and remission of symptoms
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