THE AIRLINER CABIN ENVIRONMENT AND THE HEALTH OF PASSENGERS AND CREW

Committee on Air Quality in Passenger Cabins of Commercial Aircraft

Board on Environmental Studies and Toxicology

Division on Earth and Life Studies

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.



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The Airliner Cabin Environment and the Health of Passengers and Crew THE AIRLINER CABIN ENVIRONMENT AND THE HEALTH OF PASSENGERS AND CREW Committee on Air Quality in Passenger Cabins of Commercial Aircraft Board on Environmental Studies and Toxicology Division on Earth and Life Studies National Research Council NATIONAL ACADEMY PRESS Washington, D.C.

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The Airliner Cabin Environment and the Health of Passengers and Crew NATIONAL ACADEMY PRESS 2101 Constitution Ave., N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by Award No. DTFA0100P100P10285 between the National Academy of Sciences and the U.S. Department of Transportation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Control Number 2001099122 International Standard Book Number 0-309-08289-7 Cover photograph by Steve Cole, Photodisc Additional copies of this report are available from: National Academy Press 2101 Constitution Ave., NW Box 285 Washington, DC 20055 800–624–6242 202–334–3313 (in the Washington metropolitan area) http://www.nap.edu Copyright 2002 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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The Airliner Cabin Environment and the Health of Passengers and Crew THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A.Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A.Wulf are chairman and vice chairman, respectively, of the National Research Council.

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The Airliner Cabin Environment and the Health of Passengers and Crew COMMITTEE ON AIR QUALITY IN PASSENGER CABINS OF COMMERCIAL AIRCRAFT Members MORTON LIPPMANN (Chair), New York University School of Medicine, Tuxedo, New York HARRIET A.BURGE, Harvard School of Public Health, Boston, Massachusetts BYRON W.JONES, Kansas State University, Manhattan, Kansas JANET M.MACHER, California Department of Health Services, Berkeley, California MICHAEL S.MORGAN, University of Washington, Seattle, Washington WILLIAM W.NAZAROFF, University of California, Berkeley, California RUSSELL B.RAYMAN, Aerospace Medical Association, Alexandria, Virginia JOHN D.SPENGLER, Harvard School of Public Health, Boston, Massachusetts IRA B.TAGER, University of California, Berkeley, California CHRISTIAAN VAN NETTEN, University of British Columbia, Vancouver, British Columbia BERNARD WEISS, University of Rochester, Rochester, New York CHARLES J.WESCHLER, UMDNJ-Robert Wood Johnson Medical School-Rutgers University, New Brunswick, New Jersey HANSPETER WITSCHI, University of California, Davis, California Staff EILEEN N.ABT, Project Director ROBERTA M.WEDGE, Project Director ELLEN K.MANTUS, Program Officer NORMAN GROSSBLATT, Editor MIRSADA KARALIC-LONCAREVIC, Research Assistant LUCY V.FUSCO, Senior Project Assistant BRYAN SHIPLEY, Project Assistant Sponsor U.S. FEDERAL AVIATION ADMINISTRATION

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The Airliner Cabin Environment and the Health of Passengers and Crew BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY1 Members GORDON ORIANS (Chair), University of Washington, Seattle, Washington JOHN DOULL (Vice Chair), University of Kansas Medical Center, Kansas City, Kansas DAVID ALLEN, University of Texas, Austin, Texas INGRID C.BURKE, Colorado State University, Fort Collins, Colorado THOMAS BURKE, Johns Hopkins University, Baltimore, Maryland WILLIAM L.CHAMEIDES, Georgia Institute of Technology, Atlanta, Georgia CHRISTOPHER B.FIELD, Carnegie Institute of Washington, Stanford, California J.PAUL GILMAN, Celera Genomics, Rockville, Maryland DANIEL S.GREENBAUM, Health Effects Institute, Cambridge, Massachusetts BRUCE D.HAMMOCK, University of California, Davis, California ROGENE HENDERSON, Lovelace Respiratory Research Institute, Albuquerque, New Mexico CAROL HENRY, American Chemistry Council, Arlington, Virginia ROBERT HUGGETT, Michigan State University, East Lansing, Michigan JAMES H.JOHNSON, Howard University, Washington, D.C. JAMES F.KITCHELL, University of Wisconsin, Madison, Wisconsin DANIEL KREWSKI, University of Ottawa, Ottawa, Ontario JAMES A.MACMAHON, Utah State University, Logan, Utah WILLEM F.PASSCHIER, Health Council of the Netherlands, The Hague ANN POWERS, Pace University School of Law, White Plains, New York LOUISE M.RYAN, Harvard University, Boston, Massachusetts KIRK SMITH, University of California, Berkeley, California LISA SPEER, Natural Resources Defense Council, New York, New York Senior Staff JAMES J.REISA, Director DAVID J.POLICANSKY, Associate Director and Senior Program Director for Applied Ecology RAYMOND A.WASSEL, Senior Program Director for Environmental Sciences and Engineering KULBIR BAKSHI, Program Director for the Committee on Toxicology ROBERTA M.WEDGE, Program Director for Risk Analysis K.JOHN HOLMES, Senior Staff Officer RUTH E.CROSSGROVE, Managing Editor 1   This study was planned, overseen, and supported by the Board on Environmental Studies and Toxicology.

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The Airliner Cabin Environment and the Health of Passengers and Crew OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Arsenic in Drinking Water: 2001 Update (2001) Evaluating Vehicle Emissions Inspection and Maintenance Programs (2001) Compensating for Wetland Losses Under the Clean Water Act (2001) A Risk-Management Strategy for PCB-Contaminated Sediments (2001) Toxicological Effects of Methylmercury (2000) Strengthening Science at the U.S. Environmental Protection Agency: Research-Management and Peer-Review Practices (2000) Scientific Frontiers in Developmental Toxicology and Risk Assessment (2000) Modeling Mobile-Source Emissions (2000) Toxicological Risks of Selected Flame-Retardant Chemicals (2000) Copper in Drinking Water (2000) Ecological Indicators for the Nation (2000) Waste Incineration and Public Health (1999) Hormonally Active Agents in the Environment (1999) Research Priorities for Airborne Particulate Matter: I. Immediate Priorities and a Long-Range Research Portfolio (1998); II. Evaluating Research Progress and Updating the Portfolio (1999); III. Early Research Progress (2001) Ozone-Forming Potential of Reformulated Gasoline (1999) Risk-Based Waste Classification in California (1999) Arsenic in Drinking Water (1999) Brucellosis in the Greater Yellowstone Area (1998) The National Research Council’s Committee on Toxicology: The First 50 Years (1997) Carcinogens and Anticarcinogens in the Human Diet (1996) Upstream: Salmon and Society in the Pacific Northwest (1996) Science and the Endangered Species Act (1995) Wetlands: Characteristics and Boundaries (1995) Biologic Markers (5 reports, 1989–1995) Review of EPA’s Environmental Monitoring and Assessment Program (3 reports, 1994–1995) Science and Judgment in Risk Assessment (1994) Ranking Hazardous Waste Sites for Remedial Action (1994) Pesticides in the Diets of Infants and Children (1993) Setting Priorities for Land Conservation (1993) Protecting Visibility in National Parks and Wilderness Areas (1993) Dolphins and the Tuna Industry (1992) Science and the National Parks (1992) Assessment of the U.S. Outer Continental Shelf Environmental Studies Program, Volumes I–IV (1991–1993) Human Exposure Assessment for Airborne Pollutants (1991)

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The Airliner Cabin Environment and the Health of Passengers and Crew Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991) Decline of the Sea Turtles (1990) Copies of these reports may be ordered from the National Academy Press (800) 624–6242 or (202) 334–3313 www.nap.edu

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The Airliner Cabin Environment and the Health of Passengers and Crew Preface In 1986, a committee of the National Research Council (NRC), the principal operating arm of the National Academy of Sciences and the National Academy of Engineering, produced a report requested by Congress titled The Airliner Cabin Environment: Air Quality and Safety. That report recommended the elimination of smoking on most domestic airline flights and a number of other actions to address health and safety problems and to obtain better data on cabin air quality. In response to that report, the Federal Aviation Administration (FAA) took several actions, including the banning of smoking on all domestic flights. However, the health complaints of passengers and cabin crew continue. Their complaints tend to be broad and nonspecific and to have multiple possible causes, including air contaminants, so it is difficult to define or discern a precise illness or syndrome. As a result of continued concerns about aircraft cabin air quality and health issues raised by passengers and cabin crew, Congress directed FAA in the Wendell H.Ford Aviation Investment and Reform Act of the 21st Century, enacted in 2000, to request that the NRC perform another independent study to examine cabin air quality. In this report, the Committee on Air Quality in Passenger Cabins of Commercial Aircraft reviews what is known about air quality in passenger cabins, emphasizing studies conducted since the 1986 report. The committee specifically examined the aircraft environmental control systems, the sources of contaminants in aircraft cabins, and the toxicity and health effects associated with these contaminants; it provides a number of recommendations for potential approaches for improving cabin air quality.

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The Airliner Cabin Environment and the Health of Passengers and Crew This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purposes of this independent review were to provide candid and critical comments to assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report: Charles E.Becker (emeritus), University of California, San Francisco School of Medicine, Snow Mass Village, Colorado; Franklin D.Farrington, Boeing Company, Long Beach, California; Ashok Gadgil, Lawrence Berkeley National Laboratory, Berkeley, California; R.Richard Heppe (retired), California Lockheed, Solvang, California; Donald F.Hornig (emeritus), Brown University, Little Compton, Rhode Island; Nadia S.Juzych, Michigan Public Health Institute, Birmingham, Michigan; Roger O.McClellan (emeritus), Chemical Industry Institute of Toxicology, Albuquerque, New Mexico; James M.Melius, New York State Laborers’ Health and Safety Trust Fund, Albany, New York; Shelly Miller, University of Colorado, Boulder, Colorado; Niren L.Nagda, Energen Consulting, Inc., Germantown, Maryland; P.Barry Ryan, Emory University, Atlanta, Georgia; John C.Sagebiel, Desert Research Institute, Reno, Nevada; Calvin C.Willhite, California Environmental Protection Agency, Berkeley, California. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by John C.Bailar, III (emeritus), University of Chicago, Chicago, Illinois, and Edward C.Bishop, Parsons Engineering Science, Inc., Fairfax, Virginia. Appointed by the NRC, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution. The committee gratefully acknowledges the following for making presentations to the committee: Charles Ruehle and Thomas Nagle, FAA; Martha Waters, Elizabeth Whelan, and Kevin Dunn, National Institute for Occupational Safety and Health; Christopher Witkowski and Judith Murawski, Association of Flight Attendants; Olney Anthony, International Association of Ma-

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The Airliner Cabin Environment and the Health of Passengers and Crew chinists Union and Aerospace Workers (IAM); David Space and Richard Johnson, Boeing Corporation; Martin Dechow, Airbus Corporation; Richard Fox and George Rusch, Honeywell Corporation; Raynard Fenster, Information Overload Corporation; and Jolanda Janczewski, Consolidated Safety Services, Inc. The committee also wishes to thank the following who provided further background information: Gene Kirkendahl and Stephen Happenny, FAA; Ron Shepard, IAM; Jim McClendon, Alaska Airlines; John Downey, BAE Systems; Mac Cookson, Steve Ramdeen, and Kilisi Vailu’u, United Airlines; Sarah Knife, General Electric Aircraft Engines; Keith Morgan, Pratt & Whitney; Wayne Daughtrey, ExxonMobil Corporation; Vincent Johnston, Boeing Corporation; and Robert Wright, U.S. Air Force. The committee gives special thanks to staff at United Airlines who provided site visits of its major maintenance facilities in Oakland, California, and Indianapolis, Indiana, and provided us with additional background information: Clayton Satterlee, Yvonne Daverin, John Upchurch, Anita Davis, Roger Rube, Robert Patterson, Steve Lewis, and Rick Ransom. The committee is thankful for the useful input of Charles Schumann in the early deliberations of this study. The committee is also grateful for the assistance of the NRC staff in preparing this report. Staff members who contributed to this effort are Eileen Abt, project director; Roberta Wedge, senior program officer; Ellen Mantus, program officer; Norman Grossblatt, editor; Ruth Crossgrove, managing editor; Lucy Fusco, senior project assistant; Mirsada Karalic-Loncarevic, research assistant; and Bryan Shipley, project assistant. I would also like to thank all the members of the committee for their dedicated efforts throughout the development of this report. Finally, the committee extends its heartfelt condolences to those who lost family, friends, and colleagues in the events of September 11, 2001. These events will undoubtably have extensive repercussions on all aspects of air transportation. Although safety is always the overriding priority for air transportation, air quality in the aircraft cabin will also continue to be an important factor affecting the health of passengers and crew. The committee hopes that this report will make a long-lasting contribution to the goal of ensuring the health of all who fly aboard commercial aircraft. Morton Lippmann, Chair Committee on Air Quality in Passenger Cabins of Commercial Aircraft

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The Airliner Cabin Environment and the Health of Passengers and Crew Contents     Summary   1 1   Introduction   15     Exposures on Aircraft,   17     Regulatory Aspects of Cabin Air Quality,   21     History of Previous Cabin Air-Quality Studies,   23     Organization of the Report,   29     References,   30 2   Environmental Control   33     Environmental Conditions,   34     Environmental Control Systems,   53     Alternative Environmental Control Systems,   62     Environmental Control System Design and Operational Standards,   65     Conclusions,   69     Recommendations,   70     References,   70 3   Chemical Contaminants and Their Sources   73     Contaminants with External Sources,   73     Contaminants with Internal Sources,   93     Contaminants from Aircraft Systems,   110     Conclusions,   119

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The Airliner Cabin Environment and the Health of Passengers and Crew     Recommendations,   120     References,   121 4   Biological Agents   131     General Information on Bioaerosols,   131     Environmental Sampling on Aircraft,   138     Health Effects of Exposure to Bioaerosols,   149     Control of Exposures to Biological Agents,   163     Conclusions,   169     Recommendations,   170     References,   172 5   Health Considerations Related to Chemical Contaminants and Physical Factors   182     Flight Environment,   183     Chemical Contaminants of Concern,   190     Other Health Considerations,   208     Conclusions,   213     Recommendations,   214     References,   214 6   Health Surveillance   223     Studies of Aircraft Cabin Air Quality,   225     Other Sources of Health Effects Information,   244     Current Health-Related Data Collection Systems,   246     Conclusions,   248     Recommendations,   249     References,   250 7   Air-Quality Measurement Techniques and Applications   254     Ozone,   256     Carbon Monoxide,   259     Carbon Dioxide,   261     Relative Humidity,   263     Particulate Matter,   264     Pesticides,   267     Other Monitoring Methods,   268

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The Airliner Cabin Environment and the Health of Passengers and Crew     Sampling Locations,   268     Data Processing,   269     Conclusions,   270     Recommendations,   271     References,   272 8   Surveillance and Research Programs on Cabin Air Quality   276     Air-Quality Surveillance,   278     Health Surveillance,   278     Air-Quality Research,   281     Staging,   286     Conclusions,   288     Recommendations,   289     References,   290 Appendix A:   Biographical Information on the Committee on Air Quality in Passenger Cabins of Commercial Aircraft   293 Appendix B:   Building-Related Symptoms   297 Appendix C:   Relevant Federal Aviation Regulations   310 Appendix D:   Additional Monitoring Techniques   316 Appendix E:   Glossary   321

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