• Journal of Environmental Health Sciences
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• v.42 no.3
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• pp.141-146
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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 objectives of this study are to estimate both airborne HD concentration in the room where HD was used and the amount of humidifier disinfectant absorbed into the respiratory system. Information and data on the HDs were collected using a structured questionnaire and home environmental investigations include the volume of HD (ml) and hours used per day, concentration of disinfectants contained in the HD brand (${\mu}g/ml$), volume of the room ($m^3$), assumed ventilation rate ($m^3/hr$) and breathing rate assumed ($m^3/hr$). We used children aged under five years old as a sample and estimated both airborne HD concentrations and amount of HD absorbed into the respiratory system. The estimated airborne concentration of HD in the room ranged from 68 to $369{\mu}g/m^3$ for PHMG (polyhexamethylene guanidine phosphate) and from 16 to $239{\mu}g/m^3$ for PGH (oligo (2-(2-ethoxy) ethoxyethyl guanidine). The amount of HD absorbed in the respiratory system per day was estimated to range from 227 to $1,225{\mu}g$ for PHMG and from 53 to $794{\mu}g$ for PGH. In conclusion, a great amount of HD was likely absorbed into respiratory system, likely beyond the level of the capacity of the immune system to remove the HD absorbed.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.13.1-13.4
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• 2016

An analysis of patients and fatalities due to exposure to polyhexamethylene guanidine (PHMG) shows that PHMG causes mainly lung diseases such as pulmonary fibrosis. However, no research on the other organs has been conducted on this matter yet. So, an in-depth discussion on toxicological techniques is needed to determine whether or not PHMG is toxic to organs other than just the lungs. For the test of target organ toxicity by PHMG exposure, a toxicokinetic study must first be conducted. However, measurement method for PHMG injected into the body has not yet been established because it is not easy to analyze polymer PHMG, so related base studies on analytical technique for PHMG including radio-labeling chemistry must come first. Moreover, research on exposure-biomarker and effect-biomarker must also be conducted, primarily related to clinical application. Several limitations seem to be expected to apply the biomarker study to the patient because much time has passed after exposure to the humidifier disinfectant. It is why a more comprehensive toxicological researches must be introduced to the causality for the victims.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.24.1-24.7
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• 2016

The humidifier disinfectant disaster (HDD) was not a simple poisoning accident by biocides, but a singular disaster in history created by chemicals in household products. This disaster was a result of the failure of a system for the management of chemical and product safety. Since the management authority for chemical usage safety is different from those for chemical safety in products, many blind areas for chemical safety management in products still remain. The 'Act on the Registration and Evaluation, etc. of Chemical Substances (ARECS)' or the new 'Biocidal Product Act' must not only address the blind areas in the management system for chemical and product safety, but also prevent a second HDD. To prevent another HDD, an integrated registration, evaluation, and management system for chemicals and consumer products must be incorporated into the 'ARECS' as an essential part for chemical safety in consumer products.

• Health Policy and Management
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• v.30 no.1
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• pp.4-14
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• 2020

Since the government is fully aware of the specificity and importance of the healthcare field, it operates bureaucracy and affiliated organizations composed of many government ministries and experts and is also handling the related bureaus. However, recent incidents of humidifier disinfectant not only make these government activities unreliable but also cause disappointment to many people. Why did not the government take active measures to ensure product safety? But why was the Korea Centers for Disease Control and Prevention (KCDC) able to speed up the identification of the cause and the recovery of the product? The purpose of this study is to clarify the behavioral mechanisms of government intervention by comparing the behaviors of the Ministry of Trade, Industry and Energy and the KCDC. Then, we will discuss the desirable government structure.

• Journal of Environmental Health Sciences
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• v.45 no.4
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• pp.340-357
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• 2019

The purpose of this paper is to help develop a comprehensive understanding of the humidifier disinfectant disaster from diverse perspectives based on a critical review of the relevant academic research papers published so far in the fields of both natural and social science. The authors reviewed pertinent articles in the six academic areas of law, social science, humanities, medicine, toxicology, and environmental health. A proper understanding of the issue of humidifier disinfectant is a challenging task because diverse aspects of it have become related over the more than two decades since such products were first released to the market in 1994. Technical and esoteric issues such as the complex system for relief and compensation for health damages and the approval of chemical toxicity are known to be major impediments to viewing the bigger picture regarding this tragedy. The authors believe that experts need to consider a comprehensive perspective going beyond their individual research arena to gain a better understanding of this issue, especially since it was an alarm signal on ethics and the role of experts and scholars in Korean society. Besides the two professors arrested by the prosecutor's office, it should be remembered that medical doctors recommended patients use humidifiers and disinfectants, and the media was inactive in reporting on this issue. Furthermore, the current paucity of examination of the social and political implications of this tragedy calls for more active engagement by researchers in the humanities and social sciences. In this regard, this paper is a work of self-examination and self-criticism by the authors that could resonate with the overall academic community.

• Journal of Environmental Health Sciences
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• v.38 no.2
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• pp.166-174
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• 2012

Introduction: After 17 years since the first production of humidifier disinfectants in Korea, Korea Centers for Disease Control and Prevention (KCDC) announced that the odds ratio of lung injury related with humidifier disinfectant usage was 47.3 (95% confidence interval 6.0-369.7) according to a case-control study with 18 adult cases, including 8 pregnant women at a university hospital in Seoul. Results: From September 2011 to April 2012, one-hundred and seventy four victim cases have been reported to an environmental non-governmental group (NGO). We summarized timetable of humidifier disinfectants accidents, analyzed health outcomes (death, lung or lung and heart transplantation, pulmonary disease) of reported victims, and classified some information for humidifier disinfectants with health outcomes, and government action for this accident. Among the victims, number of death cases are 52 (30.0%), including 26 babies less than 3 years old. Sixty-nine victims come from twenty-seven family with 2 to 4 members per family. About twenty types of humidifier disinfectant products and about 600,000 product items a year have been sold. Fifty-two death cases used 7 different types of disinfectant products, including imported goods and some private brands of well-known supermarkets. KCDC confirmed inhalation toxicity of 6 products through an animal experimental test, and based on this observation recalled disinfectants containing PHMG (polyhexamethylene guanidine) and PGH (Oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride). Discussions: The use of these biocides involved highly fatal consequences among biologically vulnerable victims, such as pregnant women, several family member victims after semi-acute exposure. This is the first biocide disaster in Korea with non-specific targets, and unknown scale of victims, warranting concerns on use of biocides in the living environment. Conclusions: Special administrative agency for chemical safety and compensation act for environmental health victims are needed to prevent similar problems.

• Journal of Environmental Health Sciences
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• v.45 no.4
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• pp.381-393
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• 2019

Objectives: The purpose of this study was to assess the association between the use of humidifier disinfectant (HD) and bronchiolitis and allergic rhinitis diagnoses in Korean children. Methods: This study used data from the $8^{th}$ panel study on Korean children in 2015. Of these 2150 cases, 1598 cases were used for the final study. Diagnoses of bronchiolitis and allergic rhinitis by medical doctors were self-reported as outcome variables. Whether children had used HDs or not, the periods of using HDs were used as independent variables. Results: A total of 77.0% had used a humidifier, and the rate of HD usage among humidifier users was found to be 35.4%. When comparing 'children who had used HDs for less than 12 months' and 'children who had used HDs for more than 12 months' with 'children who had not used HDs', the adjusted odds ratio (OR)s for 'bronchiolitis' were 1.38 (95% confidence interval (CI), 1.36-1.40) and 1.80 (95% CI, 1.71-1.89), respectively. When comparing 'children who had used HDs for less than 12 months' and 'children who had used HDs for more than 12 months' with 'children who had not used HDs', the adjusted ORs for 'allergic rhinitis' were 1.44 (95% CI, 1.42-1.46) and 1.43 (95% CI, 1.37-1.49), respectively. Conclusions: The period of using HDs was statistically significantly associated with increased odds of bronchiolitis and allergic rhinitis. The results of this study will provide a very useful scientific basis for establishing the environmental health policy and using the educational data related to the use of humidifier disinfectant in the future.

• Clinical and Experimental Pediatrics
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• v.63 no.7
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• pp.251-258
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• 2020

Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8%-58.0%. Although 18.1%-31.1% of the general population used HDs, only a small proportion of HD users were diagnosed with HD-ILDs. This finding suggests that investigation of the pathophysiologies underlying HD-ILDs is needed in addition to the identification of susceptibility to HD-ILDs. Further, there have been several concerns regarding the diverse health effects of exposure to toxic chemicals in HDs, including those that have not been identified, and long-term prognoses in terms of pulmonary function and residual pulmonary lesions observed on follow-up chest images. In this review, we summarize the clinical features, pathologic findings, and changes in radiologic findings over time in patients with HD-ILDs and the results of previous experimental research on the mechanisms underlying the effects of toxic chemicals in HDs. Studies are currently underway to identify the pathophysiologies of HD-ILDs and possible health effects of exposure to HDs along with the development of targeted therapeutic strategies. The experience of identification of HD-ILDs has encouraged stricter control of safe chemicals in everyday life.

• Journal of Environmental Health Sciences
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• v.48 no.1
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• pp.9-18
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• 2022

In today's civilization, it can be impossible to prevent disasters that cause large-scale human and material harm, and the environmental industry is not excepted from this. Over the last 50 years, several large and small environmental health catastrophes have occurred in Korea. Notable instances include the phenol pollution accident in the Nakdong River, the Hebei Spirit oil spill in Taean, Chungcheongnam-do, and the humidifier disinfectant disaster. Looking at these instances, it is clear that the government failed to prevent similar incidents and accidents after the tragedies. The government created and executed different policies to prevent such incidents and accidents, but the majority of them were highly fragmented. It is understandable that depending on the political and social level of the society in which the environmental health hazard incident/accident happened, the investigation of the cause, countermeasures, and policy reaction may differ. To put it another way, the more authoritarian and non-democratic a political social system is, the more likely it is to cover up occurrences and accidents without a deep examination. This is in line with the members of society's level of political awareness and acknowledgment of the importance of life and safety. In 1985, when the Onsan pollution disease was discovered, and in 2011, when we recognized the realities of the humidifier disinfectant disaster, South Korea's political and social systems were entirely different.

• Environmental Analysis Health and Toxicology
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• v.30
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• pp.16.1-16.1
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• 2015