• Journal of Environmental Health Sciences
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• v.46 no.4
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• pp.457-469
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• 2020

Objective: This study was designed to estimate the precise nationwide number of those who used humidifier disinfectants (HDs) and experienced specific health effects, including death, due to exposure to HDs in Korea between 1994 and 2011. Methods: A total of 5,000 households (15,472 people) were surveyed by stratifying the sample with a design that is equivalent to nationally approved household systematic sampling and face-to-face interviews from October 16, 2019 to December 30, 2019. Results: The proportion of use of humidifier disinfectants at home was 18.4% (2,844/15,472 people) and the proportion of those who experienced health effects among those who were exposed to HDs was 10.7% (303/2,844 people). Based on these factors, it was estimated that 8.94 million people (95% CI=8.25-9.63 million) were exposed to HDs and 0.95 million people (95% CI=0.87-1.02 million) experienced health effects, which means almost one in five and one in fifty Koreans respectively. The estimated number of deaths from HDs were 20,366 people (95% CI=18,801-21,931). Conclusion: The survey was large and analyzed a representative sample across the country, so this estimation of the nationwide population exposed and at risk to HDs is more accurate and reliable than previous studies. However, it is necessary to confirm whether results similar to those of this study can be reproduced through a survey using a cross-sectional survey at the national level. In particular, a survey focused on death cases is needed.

• Journal of Environmental Health Sciences
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• v.46 no.3
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• pp.312-323
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• 2020

Objective: This study aimed to summarize the physiochemical properties, toxicity, and legal regulation of chloromethylisothiazolinone (CMIT) and/or methylisothiazolinone (MIT), review the health effects caused by exposure to CMIT/MIT, and evaluate the individual association of lung injury with the use of humidifier disinfectants (HD) containing a mixture of CMIT and MIT. Method: A literature review was conducted by searching keywords such as CMIT, MIT, health effect, dermatitis, asthma, and lung injury, either singly or combined. Results: Both CMIT and/or MIT were found to be associated with the development of several types of adverse health effects. In particular, respiratory diseases including asthma, nasal symptoms, cough, and rhinitis were caused by the use of products including CMIT or/and MIT. The mixture of CMIT/MIT has been banned in cosmetics. As of the end of 2017, nine patients who were confirmed to have HD associated lung injury (HDLI) were found to have used only an HD brand containing CMIT and MIT. Their responses regarding the name of the HD used could be trustworthy based on the short duration of HD use (less than six months) before the onset of HDLI and frequent use of HD per day. Conclusion: According to the toxicity and HDLI cases, the use of HD containing CMIT and /or MIT can cause fatal lung injury. Further study with manufacturers' assistance is necessary in order to obtain more clear evidence on the causal relationship since HDLI cases are being reported continuously.

• Journal of Environmental Health Sciences
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• v.44 no.4
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• pp.301-314
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• 2018

Objectives: The aim of this study was to introduce the overall progress of exposure assessment to humidifier disinfectant (HD); to present participants' demographic characteristics, exposure characteristics to humidifier disinfectant, and exposure classification; and furthermore to compare those characteristics between survivors and non-survivors. Methods: An assessment of environmental exposure to HD was conducted using modified HD-specific questionnaires that had been previously validated. We analyzed the data from 4,482 participants who had been potentially exposed to HD and had registered with the KEITI (Korea Environmental Industry & Technology Institute) from September 2016 to May 2018 (the fourth survey). Environmental exposure assessments were performed as follows: 1) contact with participants, 2) environmental exposure assessment though face-to-face interviews, 3) assessment review and coding, and 4) exposure rating. Results: Overall, survivors made up 77.1% (3,457 subjects) and non-survivors made up 22.9% (1,025 subjects). When compared with the survivors, non-survivors had a higher proportion of subjects aged >60 years and subjects who answered as suffering lung damage and having purchased HD because it is "Beneficial to health" (p<0.05). For the exposure characteristics compared to survivors, non-survivors had a higher proportion of cases of distance from humidifier to face being less that one meter and the spray direction being toward the face (p<0.05). Overall, respondents who used the "Oxy Ssak Ssak New Gaseupgi Dangbun", "Aekyung Gaseupgi Mate", "Homeplus Gaseupgi Chungjungje", and "E-Mart Gaseupgi Salgyunje" products made up 66.1, 12.3, 4.0, and 3.6%, respectively, and 72.5% of respondents used products with PHMG as the active chemical. When compared with survivors, non-survivors had a higher proportion of use of "Oxy Ssak Ssak New Gaseupgi Dangbun" but a lower proportion of use of products with CMIT/MIT, PGH, or PHMG as the active chemical. Conclusions: This study provided demographic characteristics and exposure assessment for applicants who have been injured by HD. In spite of the limitations of performing past exposure assessment through a questionnaire survey, such as recall bias, useful results may be obtained by comparing survivors with non-survivors. Further studies such as the exposure rating method and so on are necessary to assess past exposure to HD.

• Journal of Environmental Health Sciences
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• v.47 no.2
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• pp.111-122
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• 2021

Objectives: There was a judgment of acquittal for the manufacturer SK Chemical and the vendor Aekyung regarding humidifier disinfectant (HD) containing 5-chloro-2-methylisothiazol-3(2H)-one/2-methylisothiazol-3(2H)-one (CMIT/MIT). The rationale used in this judgement is discussed here 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 risk of HD and external and internal exposure to CMIT/MIT are discussed based on scientific evidence. Results: Rendering a determination in a criminal trial of insufficient evidence of causation, the court dismissed the prosecution's motion that humidifier disinfectant-associated lung injuries (HDLI) and asthma were associated with the utilization of these products. However, CMIT/MIT, a strong sensitizing and corrosive substance, has been reported to be associated with brain toxicity, allergic contact dermatitis, and asthma. Furthermore, the judgment did not consider total consumption amounts or the cumulative dose of CMIT/MIT in the humidifier. Lastly, there are several cases supporting the fact that exposure to water-soluble substances including CMIT/MIT can cause lower respiratory tract diseases. In addition to cases of asthma among the workers exposed to CMIT/MIT, we identified lung injury victims who were exposed to HDs exclusively containing CMIT/MIT. 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 judgement.

• Journal of Environmental Health Sciences
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• v.46 no.6
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• pp.764-764
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• 2020

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.15.1-15.6
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• 2016

A number of absurdities surrounding the humidifier disinfectant (HD) incident may have occurred because 1) a judicial system operates on the underlying false assumption that the involved parties are equals in knowledge, information and resource mobilization capabilities, regardless of respective real status as company or individual; 2) there is a lack of a system that mandates a company to prevent and actively manage possible catastrophes; 3) the regulatory scheme makes companies believe that as long as they are complying with the existing regulations, they have satisfied all of their responsibilities. I believe that this issue is an opportunity to bring about changes in the judicial redress system, the system of internal management of manufacturers, and the regulatory system of the government. The following regulation amendments are needed to move towards the changes stated above. First, legislation relating to victim relief that is applicable to the HD incident must be established. Second, a risk management system must be formed within the manufacturing company and to this end an institutional environment for the system must be established within regulatory framework. Furthermore, legislation must be passed that could punish companies themselves that have caused severe damage to individuals because they had failed to take necessary actions to avoid foreseeable harm. Finally, the framework of regulation must be changed so that the company, who has the necessary information regarding the product and the component chemicals used in the product, must self-directed experiment and assessment of the safety of their own products.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.12.1-12.2
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• 2016

• Journal of Environmental Health Sciences
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• v.46 no.2
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• pp.128-135
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• 2020

Objective: The objectives of this study are to report the number of humidifier disinfectant (HD) associated health problems, including HD associated lung injury (HDLI), by year. This data was analyzed by the type of HD and HD brand. Methods: A total of 530 patients registered with the national program on HD through its third round were distributed based on the year when they developed their first health problem including HDLI (N=221). The distribution of health problems at diagnosis was clinically evaluated in order to examine the association between their lung injury and the use of HD. Results: The number of HD associated victims and HDLI patients was found to rise sharply from 2008 to 2011, with a peak in 2011. This trend was found not only for HD brands containing polyhexamethylene guanidine phosphate (PHMG), but also chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT). The number of patients who responded as developing health problems in the specific year was 35 for 2008, 51 for 2009, 108 for 2010 and 182 for 2011. Other types of HD brands and HD chemicals did not follow the trend of abrupt increase in HD associated patients since 2008. Conclusion: This study found the number of HD associated victims and HDLI patients who used HD brands containing PHMG sharply increased starting in 2008. A significant change in the process of manufacturing PHMG can be suspected with the abrupt rise in HD associated patients in specific years.

• KIPS Transactions on Software and Data Engineering
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• v.6 no.4
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• pp.177-184
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• 2017

The abstract should concisely state what was done, how it was done, principal results, and their significance. It should be less than 300 words for all forms of publication. Recently social disasters have been occurring frequently in the increasing complicated social structure, and the scale of damage has also become larger. Accordingly, there is a need for a way to prevent further damage by rapidly responding to social disasters. Twitter is attracting attention as a countermeasure against disasters because of immediacy and expandability. Especially, collecting public opinion on Twitter can be used as a useful tool to prevent disasters by quickly responding. This study proposes a collecting method of Twitter public opinion through keyword analysis, issue topic tweet detection, and time trend analysis. Furthermore we also show the feasibility by selecting the case of humidifier disinfectant which is a social issue recently.

• Journal of Environmental Health Sciences
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• v.45 no.4
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• pp.358-369
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• 2019

Objective: This study aimed to introduce cases of exposure to humidifier disinfectant (HD) in hospitals and to present their exposure characteristics. Methods: We used data from 4,393 subjects who participated in the fourth assessment survey of environmental exposure to HD conducted by the Korea Environmental Industry & Technology Institute. In this study, we selected 301 subjects who reported their place of use of HD as a hospital. Then, we classified cases as 'Hospital-provided'. 'Probably hospital-provided', 'Individual purchased', and 'Unknown' according to the supply sources of HD. Also, we introduced detailed exposure characteristics for the selected cases. Results: Of the 4,393 subjects, 301 (6.9%) reported the use of HD in 392 hospitals (including duplicate answers for the use in ${\geq}2$ hospitals). The 301 hospital-user subjects included 139 survivors and 162 non-survivors. When we classified the 392 cases by supply sources, 'Hospital-provided' was 12.2% (48 cases), 'Probably hospital-provided' was 25.5% (100 cases), 'Individual purchased' was 59.7% (234 cases), and 'Unknown' was 2.6% (10 cases). Among the 'Hospital-provided' cases, we selected six cases and provided a detailed description of the HD use in this study. Additionally, we reported details for six cases that had purchased HD upon a doctor or nurse's recommendation and for three cases that had purchased it at hospital stores. Conclusion: This study presents various cases of HD exposure in hospitals. Because there may be a considerable burden of HD exposure in public spaces, including hospitals, further studies are necessary to assess HD exposure in hospitals and public places.