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2	Weekly World News 1/22/02
3	Project Partners: Environmental Health Watch Cuyahoga Metropolitan Housing Authority (CMHA) – Bruce Haber Greater Cleveland Asthma Coalition – Norman Robbins USDA Research Station, Gainesville – Rick Brenner, David Milne Johns Hopkins Allergy and Asthma Center – Ed Horowitz
4	Project to explore improved methods for: Safer and more effective elimination of cockroach infestation Assessment of cockroach allergen contamination More effective cleanup/ decontamination of cockroach allergen
5	Cockroach allergen A potent, pervasive and persistent asthma trigger for low-income, inner-city populations National Cooperative Inner-City Asthma Study [1997]: 37% of children allergic, High levels in 50% of homes, Sensitivity + exposure associated with morbidity measures
6	Exposure to cockroach allergen associated with: “exacerbation of asthma in sensitive individuals” (“sufficient evidence of a causal relationship”) “development of asthma” (“limited or suggestive evidence of an association”) [Committee on the Assessment of Asthma and Indoor Triggers of the Institute of Medicine, 2000]
7	Study setting Multi-family complexes operated by the public housing authority in Cleveland. 18 housing units enrolled. Live roaches observed in 11 units and dead roaches in 16 units.
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9	General design Confirmation of roach infestation Elimination by IPM methods Pre-cleaning allergen measurement Cleaning interventions Post-cleaning allergen measurement Occupant education Follow-up allergen measurement
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11	Roach reduction by IPM USDA precision-targeted IPM Roaches flushed with a hot air gun and captured with a HEPA vacuum Gel baits and borate powders placed in harborages identified by the flushing Occupants educated to reduce food debris and clutter
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13	Roach allergen is persistent Elimination of infestation alone found not sufficient to reduce exposure below clinically relevant level in several studies. Recent study [Arbes 2004] found significantly lowered allergen from infestation reduction.
14	Cockroach allergen measurement Vacuum sample of settled dust 1 m² area of floor vacuumed for two minutes, using canister vacuum with sample collection sleeve Vacuum samples from the kitchen, bedroom and one other room Sampled pre-cleaning, post-cleaning and follow-up
15	Ordinary cleaning Occupant or professional house cleaning not found effective. Allergens were missed or concentrated into hot spots
16	Cleaning intervention Based on the HUD protocol for cleanup of lead dust on hard surfaces HEPA vacuuming Wet mopping and rinsing HEPA vacuuming
17	Cleaning intervention Two modifications to the standard lead cleaning protocol were tested, wet vacuum rather than a mop to pick up dirty wash and rinse water substituting bleach/detergent cleaner for the detergent-only cleaner
18	Cleaning treatment differences
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23	Summary of changes in cockroach allergen concentration pre-post cleaning and at follow-up
24	Bla g 1 values greater than or equal to 2 U/g
25	Maximum Bla g 1 at pre-cleaning, post-cleaning and at follow-up (U/g)
26	Why was Lead Clean better? Better performance of standard lead cleaning may be due to the increased mechanical abrasion from additional mopping in this treatment as compared to the other two.
27	Why continued decline post-cleaning to follow-up? No continuing input of allergenic material from roach infestation Reservoirs cleaned, e.g., rugs, upholstered furniture and bulk debris, which could have contributed to recontamination But some reservoirs were not treated, e.g., bedding, clothes, and wall voids Occupants continued cleaning
28	Why low pre-cleaning allergen levels Large amount of allergenic material removed prior to the first sampling for cockroach allergen: Pre-cleaning sampling done after the initial IPM work had been completed Flushing and HEPA vacuuming removed large numbers of cockroaches and a considerable amount of roach debris
29	Overall, the combination of cockroach infestation reduction through precision-targeted IPM (including hot air flushing and HEPA vacuuming), a one-time professional cleaning based on the HUD lead dust cleaning protocol, occupant education and occupant on-going cleaning effort was able to reduce cockroach allergen to near proposed levels of sensitization
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