• Journal of Environmental Health Sciences
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• v.43 no.1
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• pp.1-22
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• 2017

'The worstest environment disaster', 'World's first biocide massacre', 'Home-based Sewol ferry disaster' are all phrases attached to the recent humidifier disinfectant disaster. In the spring of 2011, four of 8 pregnant women including 1 adult man passed away at a university hospital in Seoul due to breathing failure. Epidemiologic investigation conducted by the Korean CDC soon revealed the inhalation of humidifier disinfectant, which had been widely used in Korea during the winter, to be responsible for the disease. As well as lung fibrosis hardening of the lungs, other diseases including asthma, rhinitis, skin disease, liver disease, fetal disease or cancers have been researched for their relation with exposure to the products. By February 9, 2017, 5,342 cases had registered for health problems and 1,131 of them were already dead (20.8% mortality rate). Based on studies by government agencies and a telephone survey of the general population by Seoul National University and civic groups, around 20% of the general public of Korea has used these products. Since the market release of the first product by SK Chemical in 1994, over 7.1 million items from around 20 brands were sold up to 2011. Most of the products were manufactured by well-known large conglomerates such as SK, Lotte, Samsung, Shinsegye, LG, and GS, as well as some European companies including UK-based Reckitt Benckiser and TESCO, the German firm Henkel, the Danish firm KeTox, and an Irish company. Even though this disaster was unveiled in 2011 by the Korean government, the issue of the victims was neglected for over five years. In 2016, an unexpected but intensive investigation by prosecutors found that Reckitt Benckiser manipulated and concealed animal tests for its own brand and brought several university experts and company employees to court. The matter was an intense social issue in Korea from May to June with a surge in media coverage. The prosecutor's investigation and a nationwide boycott campaign organized by victims and environmental groups against Reckitt Benckiser, whose product had been used by more than 70% of victims, led to the producer's official apology and a compensation scheme. A legislative investigation organized after the April 2016 national election revealed the producers' faults and the government's responsibility, but failed to meet expectations. A special law for the victims passed the National Assembly in January 2017 and a punitive system together with a massive environmental epidemiology investigation are expected to be the only solutions for this tragedy. Sciences of medicine, toxicology and environmental health have provided decisive evidence so far, but for the remaining problems the perspectives of social sciences such as sociology and jurisprudence are highly necessary, similar to with the Minamata disease and Wonjin Rayon events. It may not be easy to follow this issue using unfamiliar terminology from medical and chemical science and the long, complicated history of the event. For these reasons the author has attempted to write this article in a question and answer format to render it easier to follow. The 17 questions are: Q1 What is humidifier disinfectant? Q2 What kind of health problems are caused by humidifier disinfectant? Q3 How many victims are there? Q4 What is the analysis of the 1,112 cases of death? Q5 What is the problem with the government's diagnostic criteria and the solution? Q6 Who made what brands? Q7 Has there been a recall? What is still on sale? Q8 Was safety not checked by any producers? Q9 What are the government's responsibilities? Q10 Is it true that these products were sold only in Korea? Q11 Why and how was it unveiled only in 2011 after 17 years of sales? Q12 What delayed the resolution of the victim issue? Q13 What is the background of the prosecutor's investigation in early 2016? Q14 Is it possible to report new victim cases without evidence of product purchase? Q15 What is happening with the victim issue? Q16 How does it compare with the cases of Minamata disease and Wonjin Rayon? Q17 Are there prevention measures and lessons?

• Health Policy and Management
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• v.30 no.4
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• pp.444-450
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• 2020

Background: In this study, we compared the incidents of humidifier disinfectants and incidents of mild hepatitis in Japan to highlight the differences in government response in the health care field in terms of "chain of responsibility". Methods: We examined whether the three mechanisms of action and the chain of responsibility hypothesis were applied to compare the cases of Korea and Japan. The incident of Japan occurred in 1987 in Misawa city, Aomori prefecture. In the 1990s, the safety of blood products increased dramatically. However, relief for infected victims was neglected. Green Cross did not notify the parties. In Korea, in the spring of 2011, a number of lung disease patients were accidentally admitted to a hospital in Seoul, and a female patient with respiratory failure symptoms expired. The Korea Centers for Disease Control and Prevention conducted animal tests and the Ministry of Health and Welfare issued an order for forced collection of humidifier disinfectants. Results: In the case of Japan, the Ministry of Health and Welfare had to take responsibility for follow-up measures such as the investigation of the cause, so it was tied to a "chain of responsibility". However, in the case of Korea, the Ministry of Health and Welfare was free from the chain. Conclusion: Through the comparison between the cases of Japan and Korea, we confirmed that whether or not a government organization chooses to conceal responsibility depends on its past behavior, which is whether it is free from the chain of responsibility or not. Therefore, it was reaffirmed that an organization (ministry or department) free from the chain of responsibility must exist within the government.

• Journal of Environmental Health Sciences
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• v.48 no.3
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• pp.183-194
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• 2022

Background: No study has examined the regulatory factors associated with fatal health problems due to the use of humidified disinfectants (HD) in South Korea. Objectives: This study aimed to identify and discuss the deficiencies and limitations found in the Toxic Chemical Control Acts (TCCA) that failed to prevent the health risk of chemicals in HD products. Methods: The South Korean TCCA was reviewed focusing on acts in operation from 1994 through the end of 2011, the period when HD was allowed in manufacturing and marketing. Results: The TCCA was the act intended to regulate the toxicity of chemicals in HD products. We found the TCCA to lack three key legal clauses which would have been essential to controlling the health risk of HD. First, there was the exemption of toxic and hazard testing for existing chemicals, including chloromethylisothiazolinone (CMIT), methylisothiazolinone (MIT), and benzalkonium chloride (BKC). Secondly, there were no articles requiring industry to provide animal inhalation test result for polymers such as polyhexamethylene guanidine (PHMG) and Oligo(2-)ethoxyethoxyethyl guanidine chloride (PGH). Finally, there was a lack of articles on examining the risk of products as well as on addressing changes in the usage of products. These articles were found to be generally provided in the US Toxic Substance Chemical Act (TSCA) and the EU Registration, Evaluation and Authorization of Chemicals (REACH). Conclusions: In conclusion, the Ministry of Environment of South Korea had not updated key articles for regulating hazardous chemicals, causing large-scale health problems due to HD which had been fundamentally addressed in chemical-related acts in other countries.

• Journal of Environmental Health Sciences
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• v.42 no.3
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• pp.147-159
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• 2016

In South Korea, many cases of humidifier disinfectant-associated lung injury (HDLI) have been reported among people who used humidifier products containing humidifier disinfectant (HD). The objective of this study is to characterize exposure to HD among a total of 221 HDLI patients who used HD. Information and data on the HDs used were collected through a structured questionnaire and home environmental investigations. The conditions of these 221 HDLI patients were clinically confirmed to be caused by the use of HD. Children aged under 5 years old made up the highest proportion of HDLI cases (n=125, 56.6 %), followed by pregnant women (n=35, 15.8%). Forty-three percent (n=95) of the victims died. There were three cases of fetuses and 35 pregnant women among the victims. The number of HDLI patients who used only the Oxy Saksak brand of HD was found to be 85 (38.5%), followed by the HD brands Cefu (n=24, 10.9%), Lottemart Wiselect (n=9, 4.1%) and Aekyung (n=3). Patients who exclusively used HD brands containing polyhexamethylene guanidine phosphate (PHMG) (n=13, 55.7%) as an active ingredient made up the largest share, followed by those who exclusively used HD containing only oligo(2-(2-ethoxy) ethoxyethyl guanidinium (PGH) (n=24, 10.9%) and by those who only used a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (n=3, 1.4%). HD products containing PHMG were found to be the most commonly used among the confirmed HDLI patients. Three exposed fetuses who never used HD after birth developed lung injuries, indicating a probability of exposure to HD during gestation. All HDLI patients responded that they used HD while sleeping and for longer than 10 hours per day. In conclusion, the development of HDLI was clinically found to be associated with the use of several HD products containing PHMG, PGH and CMIT/MIT.

• Bulletin of the Korean Chemical Society
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• v.34 no.6
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• pp.1708-1714
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• 2013

Polyhexamethylene guanidine (PHMG) polymers used as an active ingredient in an antibacterial humidifier disinfectant were reported to cause harm to the human health when inhaled, although physical contact with this material was known to present low toxicity to humans. It is therefore necessary to develop an optimal analysis method which enables detection and analysis of PHMG polymers. MALDI-TOF investigations of PHMG are performed with a variety of matrices, and it is found that CHCA and 2,5-DHB are excellent matrices which well reflects the polymer population even at high mass. For the provided PHMG sample, the number-average ($M_n$) and weight-average ($M_w$) molecular masses were determined to be 744.8 and 810.7, respectively, when the CHCA was used as a matrix. The rank of the matrices in terms of averaged molecular weight was CHCA ~2,5-DHB > 5-NSA > DHAP, THAP > ATT > IAA ~ super-DHB ~ HABA. In addition, PSD of the PHMG oligomer ions exhibited a few unique fragmenation characteristics. The formation of a- and c-type fragments was the major fragmentation pathway, and the 25-Da loss peaks generally accompanied a- and c-type fragments.

• Tuberculosis and Respiratory Diseases
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• v.80 no.4
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• pp.351-357
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• 2017

In 2011, a cluster of peripartum patients were admitted to the intensive care unit of a tertiary hospital in Seoul with signs and symptoms of severe respiratory distress of unknown etiology. Subsequent epidemiological and animal studies suggested that humidifier disinfectant (HD) might represent the source of this pathology. Epidemiological studies, animal studies, and dose-response analysis demonstrated a strong association between HD use and lung injuries. The diagnostic criteria for HD-associated lung injury (HDALI) was defined on the basis of the clinical, pathological, and radiological attributes of the patients. The clinical spectrum of HDALI appears to range from asymptomatic to full-blown acute respiratory failure, and some patients have required actual lung transplantation for survival. The overall mortality of the exposed population was not significant, although peripartum patients and children who were admitted to the intensive care unit did show high mortality rates. Persistent clinical findings such as diffuse ill-defined centrilobular nodules and restrictive lung dysfunction were observed in some of the survivors. The findings of this review emphasize the importance of assessment of the level of toxicity of chemical inhalants utilized in a home setting, as well as the need to identify and monitor afflicted individuals after inhalational injury.

• Journal of Environmental Health Sciences
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• v.45 no.4
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• pp.321-325
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• 2019

The recent humidifier disinfectant disaster has caused a great change in our society and lead the Korean people to lose faith in the government and corporations. To overcome this mistrust, the government and corporations have undertaken certain efforts, including a voluntary agreement on consumer product safety. All the ingredients of a consumer product should be disclosed according to this voluntary agreement. There were also unexpected benefits occuring from this process. We found that the concept of corporate responsibility for product safety differed greatly among the various actors in Korean society. Corporations believed that a product could be considered safe if it contained no regulated substances. We have come to believe that this may be an important cause of the humidifier disinfectant disaster. The Korean government, corporations, and civil organizations have reached a consensus that it is a corporation's responsibility to evaluate the risks of products before they are introduced to the market. However, the limitations of these voluntary efforts are clear, and the legal system needs to be improved. We suggest that the concept of extreme recklessness should be introduced into regulations on product safety.

• Journal of Environmental Health Sciences
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• v.38 no.6
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• pp.503-509
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• 2012

Objectives: This study was performed in order to evaluate the generation characteristics of airborne bacteria and fungi while operating a household humidifier, in consideration of user habits. Methods: Microbial samples were collected in a closed chamber with a total volume of 2.76 $m^3$, in which a humidifier was operated according to experimental strategies. A cultivation method based on the viable counts of mesophilic heterotrophic bacteria and fungi was performed. Experimental strategies were divided into three classes: the type of water in the water reservoir (tap water, cooled boiled water); the frequency of filling the reservoir (refill every day, no refill); and the sterilization method (sterilization function mode, humidifier disinfectants). Results: Significant increases in the concentration of airborne bacteria were observed while the humidifier was in operation. The concentration had increased to 2,407 $CFU/m^3$ by 120 hours when tap water filled the reservoir without any application of sterilization, while for cooled boiled water, it was merely 393 $CFU/m^3$ at a similar time point. Usages of disinfectant in the water tank were more effective in decreasing bioaerosol generation compared to sterilization function mode operation. Generation characteristics of airborne fungi were similar to those of bacteria, but the levels were not significant in all experiments. Calculated exposure factor can be used as an indicator to compare biorisk exposure. Conclusion: This study identified the potential for bioaerosol generation in indoor environments while operating a household humidifier. User practices were critical in the generation of bioaerosol, or more specifically, airborne bacteria. Proper usage of a humidifier ensures that any biorisks resulting from generated bioaerosol can be prevented.

• 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.

• Journal of Environmental Health Sciences
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• v.46 no.4
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• pp.433-443
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• 2020

Objective: This study aimed to introduce the use of humidifier disinfectant (HD) in hospitals based on an on-site investigation. Methods: A preliminary survey and on-site investigation of HD use were conducted in 23 hospitals. Among them, one hospital without previous information on HD use was selected for a pilot investigation; 22 hospitals were selected based on previous documents and exposure statements from parliamentary investigation and exposure assessment regarding HD. Descriptive statistics were used to present distribution and characteristics of HD purchase and HD use in hospitals. Also, details on interviews from the on-site investigation were described. Results: Among the 23 hospitals, a total of ten were confirmed to have purchased and used an HD (nine hospitals) or HD-like product (one hospital). For the purchased HD products, four hospitals reported 'Aekyung Gaseupgi Mate', two hospitals reported 'Oxy Ssakssak New Gaseupgi Dangbun', and one hospital reported 'Homeplus Gaseupgi Chungjungje' (one hospital used three kinds of HD products). One hospital reported an HD-like product and four hospitals were 'Unknown'. For the number of HD products purchased, five hospitals reported '100 or less', two hospitals reported 'More than 100', and three hospitals were 'Unknown'. For each of the ten hospitals, we described detailed characteristics of HD purchase and its exposure status obtained through on-site investigation, including the purchase volume (i.e., number of products), exposure space (i.e., patient's room, staff space), and exposure period. Additionally, a comparison of on-site investigation and parliamentary investigation or exposure assessment regarding HD was reported. Conclusion: This study introduced detailed cases of HD purchase and HD use in hospitals based on an on-site investigation, and our findings revealed a possibility of a considerable volume of HD exposure in various multiuse facilities, including hospitals.