• Journal of Environmental Health Sciences
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• v.42 no.6
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• pp.365-374
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• 2016

Objectives: Studies are needed to examine the characteristics of health effects reported by people who used humidifier disinfectant (HD), including the distribution of victims. Methods: We analyzed the distribution of health effects including lung injury that were asserted by a total of 699 individuals who registered with the first through third national programs to determine health effects associated with the use of HD. Results: We found that HD-associated lung injury (HDLI) occurred every year from 2002 through 2011, and in 2011 for 37.2% (n=96) of the total of 258 clinically evaluated HDLI victims. More than half of the victims responded that they were victimized between 2010 and 2011. This was consistent among all classifications by sex, age, HD brand and HD chemical ingredient. Conclusion: This study assumed that the major reason for the outbreak of the health effect between 2010 and 2011 could be the variations in concentrations and physical properties related to polyhexamethylene guanidine (PHMG). Further studies are necessary to examine if some factors related to the chemical disinfectants contained in HD brands may have caused the massive outbreak of health effects including HDLI.

• Journal of Environmental Health Sciences
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• v.44 no.2
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• pp.107-114
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• 2018

Objectives: The objectives of this study are to describe strategy for exposure assessment of humidifier disinfectant (HD) used in the national program to associate the use of HD with lung injury. Methods: Strategy and method employed to evaluate HD use characteristics were developed to associate health effects including HD associated with lung injury (HDLI). We developed HD-specific questionnaire to assess potential HD exposure, which was consistently used in the national program. Trained environmental health scientists visited the residences of registered subjects and investigated HD use characteristics. Results: Major HD exposure related variables were type of HD brand/s used; HD volume added to the humidifier, frequency of HD addition, and time spent in room/s with the humidifier; duration of HD use in the household in average months/year, weeks/month, and days/week; average sleeping hours in a room with an operating humidifier containing a disinfectant; number of HD brands used and type of HD; average distance of the bed from the humidifier in meters. Conclusions: We concluded that estimated airborne HD concentration was significantly associated with the risk of HDLI.

• Journal of Environmental Health Sciences
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• v.43 no.5
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• pp.349-359
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• 2017

The objective of this study is to review the safety and health information displayed on containers of humidifier disinfectants (HD). We summarized not only general characteristics related to the marketing and manufacturing of HD, such as the duration sold and the name of the company, but also the safety and health information, such as identification of disinfectants, recommended use volume, and precautions. All of this information was reviewed by HD brand. We collected safety and health information from 31 HD brands. We found that companies that sold and manufactured HD brands differ. Two companies were found to sell their HD without permission after 2011 when the health effects caused by HD were widely known. The name of the disinfectants were not identified on the container of HD. The recommended volumes were found not to be based on toxicological evidence and set without consideration of the level of susceptibility of users. Most companies displayed phrases such "this HD is safe for humans, even children" on the front of the container. No inhalation and skin toxicity precautions were provided. In conclusion, most HD did not properly display information related to safety and health to protect the health of HD users. There has been no official investigation to evaluate the risks posed by HD, such as the sales volume by HD, identification of chemical disinfectants, or their concentration, nor have there been actions to control the chemical quality of HD. In addition, government actions to punish the malicious practices of companies that manufactured and sold HD were found to inappropriate.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.25.1-25.9
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• 2016

Objectives After the initial investigations by the Korea Centers for Disease Control in 2011, over 1000 suspicious cases of humidifier disinfectant (HD) victims were subsequently reported by 2015, and numbers are still increasing dramatically in 2016 in the midst of the prosecutors' office investigation. This study attempts to summarize the current understandings of the related health effects of HD based upon a systemic review of published epidemiologic studies and toxicology investigations. Methods Published studies of HDs were searched through PubMed and TOXLINE under the search words 'humidifier disinfectant,' and related reports were identified from the references and published report list of regulatory agencies including the Korean National Institute of Environmental Research, US Environmental Protection Agency, and EU European Chemicals Agency. Results Case reports and epidemiologic studies have reported the clinical features of severe forms of HD lung damage, together with epidemiologic findings of seasonal occurrence and demographic variations, including the heightened susceptibility of young children. Toxicological studies have reported inhalation toxicities together with positive findings of in vitro genotoxicity studies. Conclusions This study examined unsolved issues based on cases of upper respiratory diseases and diseases of other organs, including cancers, among suspected victims of HDs. These issues should be clarified in future research for the management and prevention of health effects from HDs and chemicals of other related household products.

• Journal of Environmental Health Sciences
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• v.49 no.3
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• pp.159-168
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• 2023

Background: An ongoing environmental exposure assessment of humidifier disinfectants (HDs) has been conducted since November 2011 among individuals who experienced HD exposure-related adverse health effects. It is being performed in order to determine and quantify exposure to humidifier disinfectants in victims and their families. To date, the assessment has encompassed Cycles I-to-V. There is no report summarizing the characteristics of the subjects from the overall cycles. Objectives: We intended to examine the individual characteristics related to demographics, HD usage, and HD exposure using integrated data from Cycles I-to-V of the environmental exposure assessment of HDs and the changes with the cycles. Methods: We included 7,543 individuals who participated in Cycles I-to-V of the environmental exposure assessment of HDs. We summarized the participants' characteristics regarding their demographics (e.g., sex, education level, and age), HD usage history (e.g., product name, ingredient, and frequency of HD use), and HD exposure (e.g., daily time of HD use, cumulative time of HD use, and exposure intensity). In addition, their characteristics were compared across the cycles of the exposure assessment. Results: Among the 7,543 participants from Cycles I-to-V, there were more male participants than females (51.05% overall), except for Cycles I and III. Across all cycles, a higher proportion of survivors was observed than deceased individuals. While PHMG was the most prevalent ingredient in HDs throughout all the cycles, its proportion gradually decreased over the course of the examination cycles. Participants in Cycle I reported longer daily times of HD use compared to those in the subsequent cycles. On the other hand, cumulative time of HD use was shorter in the earlier cycles than in the later cycles. Conclusions: Using the integrated data from the full cycles of the environmental exposure assessment, this study identified changes in demographic characteristics as well as the HD exposure characteristics between the participants across different cycles.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.14.1-14.4
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• 2016

A total of 221 patients were evaluated to be humidifier disinfectant associated with lung injury (HDLI) through two rounds of programs through April 2015. The humidifier disinfectant (HD) brands most often associated with HDLI were found to be Oxy (n=151, 68 %) and Cefu (n=26, 17 %). Polyhexamethylene guanidine used for disinfectant for four types of HD brands including Oxy was found to be associated with the highest number of HDLI cases (n=188). Further programs are operating to identify various health effects including lung injury which may be associated with the use of HD. Not only national agencies, but also pertinent environmental health societies should cooperate in the necessary investigations so that this tragedy can be properly addressed and future incidents concerning chemicals and chemical-containing products can be prevented.

• Journal of Environmental Health Sciences
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• v.47 no.3
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• pp.193-204
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• 2021

Objectives: In January 2021, the former heads of the manufacturer SK Chemical and the vendor Aekyung were acquitted for manufacturing and selling humidifier disinfectant (HD) containing 5-chloro-2-methylisothiazol-3(2H)-one/2-methylisothiazol-3(2H)-one (CMIT/MIT). In this article, we analyzed the rationale used in this judgement in the light of scientific consideration. Methods: The sentencing document for the judgements was obtained from the Korea Supreme Court Service. In particular, the judgements made by the court related to the toxicological and individual association with HD perspectives were discussed based on scientific evidence. Results: The ruling stated that the necessary conditions for causality between CMIT/MIT and such diseases were not met based on the fact that asthma and lung damage were not found in the inhalation exposure animal experiments. The judgment overlooked the inevitable limitations of using animal experiments for verifying health effects in humans, which are often inconsistent with the observations in animals. Among 11 governmentaffirmed lung injury cases with CMIT/MIT usage, three patients' humidifier disinfectant-associated lung injury (HDLI) pathology proved that CMIT/MIT could cause lung injury similar to that caused by PHMG and PGH. In addition, five children showed decreased lung function related to damage caused by humidifier disinfectant exposure. Conclusions: We conclude that there is sufficient evidence supporting the assertion that HDs containing CMIT/MIT cause lung injuries, including asthma, contrary to the court's decision.

• Journal of Environmental Health Sciences
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• v.47 no.4
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• pp.303-309
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• 2021

Background: Humidifier disinfectant is a biocidal product used in the water tanks of humidifiers to prevent the growth of microorganisms. Although there are a huge number of cases of reported humidifier disinfectant-related health effects across the entire Korean population, their numbers are distributed differently depending on the region. Objectives: This study aimed to investigate the regional distribution of enrollment cases who reported humidifier disinfectant-related health effects. Methods: This study used data on 6,240 subjects who experienced humidifier disinfectant-related health effects and who enrolled their cases which is conducted by the Korea Ministry of Environment. We examined the regional distribution of the enrolled cases based on sixteen administrative divisions and assessed the: 1) crude number; 2) proportional rate; and 3) age-standardized proportional rate of enrollment by region. Results: When we examined the crude number of enrollments by region, the highest number were in Gyeonggi-do Province (n=1,896), followed in order by Seoul (n=1,405), Incheon (n=436) Busan, Daegu, Gyeongsangnam-do Province, Daejeon, Chungcheongnam-do Province, Gyeongsangbuk-do Province, Jeollabuk-do Province, Gwangju, Chungcheongbuk-do Province, Gangwon-do Province, Jeollanam-do Province, Ulsan, and Jeju-do. When we examined proportional rate of the regional enrollment (cases per 100,000 population), Daejeon (n=16.2) was the region with the highest rate, followed in order by Gyeonggi-do Province (n=16.1), Incheon-do Province (n=15.9), Seoul, Daegu, Gwangju, Jeollabuk-do Province, Chungcheongnam-do Province, Busan, Chungcheongbuk-do Province, Gangwon-do Province, Gyeongsanbuk-do Province, Gyeongsangnam-do Province, Ulsan, Jeju-do, and Jeollanam-do Province, which is inconsistent with the order in terms of crude numbers. However, when we examined the age-standardized proportional rate of regional enrollment (cases per 100,000 population), their ranked distribution is consistent with the crude rate. Conclusions: This study observed that the regional distribution of the enrolled cases who reported humidifier disinfectant-related health effects is inconsistent with the regional distribution of the proportional rate of enrollment cases, which may be caused in part by the volume of the inherent population of each region.

• Journal of Nutrition and Health
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• v.50 no.6
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• pp.543-551
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• 2017

Purpose: The objective of the present study was to determine whether fermentation can increase the protective effects of blueberry liquid in a high-fat diet-induced obese mice model. Methods: Male C57BL/6J mice were fed a high-fat diet (HD, 60% fat, w/w,), HD supplemented with 10 ml/kg BW/day of blueberry liquid (BHD, blueberry high-fat diet), or HD supplemented with 10 ml/kg BW/day of fermented blueberry liquid (FBHD, fermented blueberry high-fat diet) for 10 weeks. Results: There were significant decreases in the body, epididymal adipose tissue, and liver weights of blueberry-fed groups compared to HD, whereas there were no significant differences in food intake among the groups. Furthermore, blueberry liquid groups, especially fermented blueberry liquid, significantly attenuated the contents of hepatic triglycerides and total cholesterol induced by HD. Serum LDL-cholesterol was significantly lower in the BHD and FBHD-fed groups, whereas FBHD significantly increased the serum HDL-cholesterol level compared to the control. Concentrations of aspartate transaminase, alanine transaminase, and leptins in serum were also reduced by blueberry liquid supplementation. The mRNA expression of hepatic acetyl CoA carboxylase was significantly reduced in both the BHD and FBHD groups compared to HD. Furthermore, FBHD altered the mRNA expression level of hepatic lipolysis genes. Conclusion: In conclusion, these results suggest that blueberry, especially fermented blueberry liquid, may improve obesity-related abnormalities.

• Journal of Environmental Health Sciences
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• v.47 no.4
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• pp.310-319
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• 2021

Background: Humidifier disinfectant exposure is an ongoing issue, and there is still considerable related controversy. Various approaches are needed to secure scientific evidence on the extent of the victims' damages and for the determination of appropriate compensation. Objectives: The purpose of this study was to assess the association between humidifier disinfectant (HD) use and academic achievement in Korean children. Methods: This study used data from the 8th Panel Study on Korean Children in 2015. For the final study, 1,598 cases were used. T-tests and multiple linear regression analyses were conducted to determine whether the use of humidifier disinfectant is a factor that affects academic ability. Results: Children in groups using humidifier disinfectant showed statistically significantly lower scores in all areas of language, including reading, speaking and writing, and statistically lower scores in all areas of mathematics, including counting, addition and subtraction. In the multiple regression analysis results, which control for the effects of various demographic/social variables, the use of humidifier disinfectants showed statistically significant beta coefficients (β: -0.357, p<0.001), negatively affecting children's language ability. As for the 'math' variable, which was created by combining counting, addition, and subtraction scores, the use of humidifier disinfectants as independent variables also showed statistically significant beta coefficients (β: -0.200, p<0.001), negatively affecting children's math ability. Conclusions: The results of the study showed that depending on whether or not humidifier disinfectants were used, there are differences in children's language abilities, such as reading, speaking, and writing, as well as in their mathematical abilities, such as counting, adding, and subtracting numbers. These findings are thought to serve as a scientific basis for extending the perspective from health effects to more diverse areas of demographic and social impact related to humidifier disinfectant damage and compensation.