Friends kept telling Janet Moore that her three-year-old daughter was constantly getting sick from exposure to the other children she played with in nursery school.

"They kept saying, 'It's because she's started nursery school. It's the normal stuff that kids pass around,'" Moore explained. But that theory didn't seem to be quite right to the mother and Key Biscayne resident.

"The thing was, Cindy had been at the nursery school for a camp the entire summer, so you'd think that if she were getting sick from exposure to children because she'd never been around other children before, that it would have happened during camp," she said.

Parent's nightmare

Moore kept that thought in the back of her head for the next two years, during which time Cindy's illnesses became more frequent and serious.

"As time went on, it went from being just little sneezes and runny noses to a health condition--major illnesses--that interfered with her quality of life," she explained.

A pediatrician suggested Cindy had a mild case of asthma, which seemed reasonable since husband Chris Moore's family medical history included allergies. "It made sense and we didn't think too much about it," Moore said.

The Moores began using an aerosol machine that helps clear nasal passages for children too young to blow their noses. They had purchased the device when Cindy had bronchiolitis at six months old. Their family doctor also prescribed mild dosages of a respiratory medication as well as saline solution to open the air passages. The machine became a constant fixture in the family's life.

But the nightmare had only begun. The Moore's next child, Meghan, developed the same types of ailments as her older sister, only Meghan's health problems did not take three years to set in.

"By two weeks old she had what we thought was a cold that became basically chronic and progressively worse and at seven weeks old we ended up rushing her to Children's Hospital," Moore said.

At Children's, Meghan was treated for respiratory syncytial virus (RSV). Doctors performed a painful spinal tap on the infant to rule out the possibility of meningitis.

Eight months later, the Moore family was a regular visitor to local hospitals, shuttling Meghan and Cindy to the emergency room for treatment of a variety of ailments.

"I would say it was a 10-week period where we were at the hospital every two weeks," Moore said.

During that time, Cindy had fevers spiking as high as 103 and 104 degrees on the family's thermometer. The Moores alternated visits between Key Biscayne general practitioner Dr. Suzel Vazquez and her sister, Gladys, a Kendall pediatrician. "Within an eight-day period prior to [sending Cindy to] the hospital, we were in one of their offices every day or two and we were on the phone in between," Moore said.

A few weeks later, the child spent two days in the hospital, where she was given intravenous medication for sinusitis.

"It was a situation where normally they would have put Cindy into the hospital sooner but because they were monitoring her so carefully they let us keep her out of the hospital and instead we altered the antibiotics and the medication for the aerosol machine," Janet Moore explained.

It was after that spell of health problems that Dr. Gladys Vazquez decided to refer the Moores to Dr. Mark Young, an allergist, and Dr. Kunjana Mavunda, a pediatric pulmonologist. "Both of them independently came to the conclusion that it was an environmental problem," Moore said.

The doctors, thinking the problem may be an allergic reaction to dust mites--microscopic organisms which live in carpeting, mattresses, upholstery, pillow and linens and whose feces and urine cause an allergic reaction in some humans--ordered the Moores to turn off their ceiling fans, remove books, stuffed animals and other knick knacks from shelves, encase their mattresses and pillows and wash their sheets, linens and curtains more regularly.

The family followed the doctors' directives, ridding their home of several items and spending $125 at a Fort Lauderdale specialty shop for mattress and bed coverings.

But nothing changed. "There was no noticeable difference," Moore said.

In fact, the children's health got worse. Two days before Christmas of last year and one year after she had been diagnosed with one year after she had been diagnosed with RSV, Megan became so ill that "the only way to get her to breathe was to hold her upright," Moore said. The child would scream and cry whenever Moore laid her down to change her diaper.

Paramedics rushed the one-year-old to Children's Hospital. After an examination, emergency staff told the anxious parents that they were baffled at the child's symptoms. They gave the child an aerosol treatment of breathing medication at 5 a.m. and sent the family home.

"They couldn't come up with anything. They basically looked at me like I was nuts. They basically said, 'There nothing wrong with this kid,'" Moore explained.

The next day, Meghan's pediatrician determined she had an ear infection and the beginning of sinusitis. Two weeks later, the Moores took the infant to Baptist Hospital, where doctors gave her IVs of glucose for several hours to build her strength to combat a flu and sent her home.

Meghan next came down with sinusitis combined with a stomach flu. She would eat and then about 20 minutes later "she would cough so hard that she would throw up her meal--the breast milk--and along with it would be phlegm the size of two cupped hands," Moore recalled.

"I would say that was six or eight ounces of phlegm. A baby's stomach holds seven ounces," she added.

Meanwhile, doctors tested Cindy for serious respiratory disorders. "They tested Cindy for cystic fibrosis. That's how bad it was," Moore said.

Revelation

At the end of March, the Moores returned to Dr. Mavunda, who personally reviewed both children's medical histories. In passing, Moore revealed information that would bring the family's life back to normal.

"I mentioned to her that we had had hurricane repairs done in July through October 1994," she said, adding that she had told Mavunda that one spot in their home had been leaking continuously. Mavunda picked up the clue.

"What happened to some of the houses during the hurricane is that there might have been leaks in the ducts and because of the humidity you get mildew and mold that grow there and then as you turn the air on, those things will go through the house and they are quite allergenic," said Mavunda, who recently received a master's degree in public health and wrote a paper on sick building syndrome.

And then it dawned on Moore: When the Moores first moved into the house, then two-month-old Cindy was "perfectly healthy. The only time she went to the doctor was to get one of the shots or checkups they require for little kids."

Then there was the time that the Moores moved out of the house while contractors were making hurricane repairs because Janet Moore was pregnant with Meghan. "We moved back in and Cindy immediately got sick," she recalled.

Things were starting to make sense.

Mavunda referred the Moores to Raul Garcia, an industrial hygienist with the University of Miami School of Medicine. Garcia came to the Moore home, shined a flashlight into the air duct and said, "I can tell you what's wrong," Moore recalled.

Moore looked inside the duct, which should have been lined with a beige-colored fiberglass. "The stuff was absolutely black. The duct itself was absolutely covered with mold and spores and gunk," she said.

"It was bad. In their case, the contamination took place due to water damage to the ducts," Garcia said.

He said the problem was that water was continuously getting into the duct work in the home. "Repeated insults--that's what causes microbial contamination," Garcia explained.

Garcia offered a simple solution. "What he said to me is, 'Turn your air conditioning off now. Don't run it," Janet Moore remembered.

About a week later, a Florida Power & Light inspector confirmed Garcia's findings. "He said it was the dirtiest system he'd ever seen," Moore recalled.

It was early April, a time of year when South Floridians normally begin using their air conditioning systems after a short winter of open windows. But the Moores followed Garcia's recommendation and saw immediate improvement in Meghan and Cindy.

"We turned it off Saturday and by Tuesday Meghan was almost completely better and by Wednesday there was no sign that she had a runny nose at all. She was like a new child. And both kids have been completely healthy since we turned it off," Moore said.

Moore recalled one incident when during an ambulance visit to the house, a paramedic--probably thinking Cindy was having an allergic reaction to something outside--told the Moores to close all their windows and run their AC constantly.

"It was the worst thing we could do. Without realizing it, I was probably doing them more damage on days when I probably could have let them get fresh air," she said.

Mavunda said the doctors who were previously treating the Moore children gave them proper treatment. "They were put on appropriate medications but because of the continuing exposure they continued to have symptoms. The fact that they needed the medicines to control the symptoms was a little worrisome," she explained. A month after the air conditioning was turned off, Janet took Cindy to Dr. Gladys Vazquez for a chicken pox vaccination, which the child was finally healthy enough to receive.

"I said to the pediatrician, 'This is the first time in two years that we put her through the 'Well Children' door and she laughed because she said, 'Janet, your child's got strep throat,'" Moore recalled, adding that the child picked up strep throat from another child.

"We were so used to them having these serious respiratory problems that we didn't even pick up on the strep throat because she's so much better than when she was suffering from all these other problems that we didn't notice it," she explained.

In June, the Moores moved out of their house for two and a half weeks so that environmental experts in special suits and oxygen masks could remove the old duct, install a new one made of galvanized metal and completely remove any traces of the harmful mold and spores.

The process was a complicated one. Enviro Team Inc. staff set up a contaminant work area in the home and put it under negative air pressure so the contamination wouldn't spread. They then removed all duct work and the air handler section of the system. They were hermetically sealed before they were removed from the house. The entire Moore home was then vacuumed with a HEPA (high efficiency particulate air) device that can filter down to 99.97 percent of all airborne particulates.

Enviro Team also lowered part of the ceiling to accommodate a new air handler. The containment areas were dismantled as they were cleaned and air scrubbers were placed throughout the home for two days.

Michael Rhodes, Enviro Team co-owner, said the duct cleaning is not the only answer to improving indoor air quality.

"Instead of just shooting from the hip and saying, 'It's got to be duct cleaning and spending all this money...it's better to find the source of what's causing the problem and correct it rather than start throwing money in different directions because you may have two or three sources of contamination and if you take care of one and not the other you may be recontaminating," Rhodes said, adding that he could not say for sure whether all of the Moores' indoor air quality problems were caused by damage from Hurricane Andrew.

The job cost $15,500 and the Moores' insurance company--Herald Fire Insurance, which wrote a wind policy on the Moores' home--reopened their Hurricane Andrew damage claim and covered 40 percent, or $6,800 of the cleanup costs.

"I think they fulfilled the original insurance contract, which required replacement of losses," Moore said.

But the Moores also paid $600 for professional drawings of the new system, $190 to board their dog at the veterinarian's office, $100 for packing materials, $600 to send Cindy to camp while the family was packing and $600 for hired help to assist with packing.

If a friend hadn't donated several boxes from her business, the family would be out another $200 to buy those.

Life is starting to get back to normal for the Moores. They haven't been to a hospital since early February. They go out with their friends once in awhile. "We had hardly socialized for two years because we couldn't rely on anything because the kids were always sick," she said.

But the healing process is a long one. Garcia told the Moores to be patient. "What he said was, 'You'll probably see for the first year after the repairs is that the kids may still have illnesses but they'll gradually minimize over the year. Don't think just because you're doing this it's going to completely go away,'" Moore said.

In fact, Cindy recently caught a cold from another child in swim class. But it's just a cold. "The severity is much less than what we experienced before," Moore explained.

Dr. Mavunda said the Moore children have stopped using medication in the last couple of months, although they still use nasal sprays, aerosol treatments and antihistamines. The doctor has not seen Cindy and Meghan since the spring.

"That's the kind of results I like," Mavunda said.

Reality check

The Moore family is not likely to be the only family on the Key that has experienced health problems due to moisture build-up in the home as a direct result of Hurricane Andrew.

Janet Moore, whose two young daughters were seriously ill for two years, said she hopes Key Biscayne residents will check into the air quality of their homes. "My main intention is if there are other kids or even adults suffering from similar problems as our family did that they should take a look at their air conditioning system," Moore explained.

"This is something that everyone on the Key should be doing on a regular basis," she added.

Raul Garcia-Casariego, the industrial hygienist who discovered the mold in the Moores' air ducts, agreed. "The first thing we need to do is learn a little bit more about how we can improve the environment in our homes," he said.

Cost estimates for an indoor air quality assessment range from $500-2,000, according to Patrick O'Donnell of Enviro Team, the company that replaced the ducts in the Moore home. O'Donnell said cleanups can range from $500-10,000, depending upon what work needs to be done.

Moore said the poor indoor air quality in her home is probably not unusual for a home on an island that was heavily damaged by Hurricane Andrew. "How do you get interior cracks in your living room and bedroom ceilings without it also putting enough force to pull the air duct system apart?" she said.

Moore said she has noticed several other children on the Key who have been consistently sick as were her children.

Still, Dr. Kunjana Mavunda, the pediatric pulmonologist who keyed into the source of the Moores' problem, said there is not an epidemic of children's respiratory problems on the island.

At the time she was treating the Moore children, Mavunda was also seeing children from two other Key families who suffered respiratory. She wondered if there was outside air pollution on the island.

"The other kids are fine now so it was probably just a coincidence," she said, adding that symptoms for younger children include frequent runny nose, ear infections and cough and, for older children, include snoring at night and frequent sore throats. Mavunda said there is an increasing national trend of children with allergies and asthma but that those affected were already susceptible.

"Most of the kids that we're seeing with respiratory problems have a family history of asthma and allergies so they have the genetic background," Mavunda said.

"On top of that, if they inhale irritants, then they get a lot of airway inflammation that can make their symptoms worse," she explained.

How to improve indoor air quality

* Change air filters monthly

* Use filters that fit your AC system

* Have a professional clean your system twice a year

* Make sure the system's drain pan is flushing

* Make sure the void beneath the air handler is clear of dust and debris

* Make sure air supply vents do not have condensation or black or greenish growth (mold)

* Don't let leaks go--get them fixed immediately

* Replace damaged fiberglass ducts--they cannot be cleaned

Source: Raul Garcia-Casariego, industrial hygienist

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