• 한국환경보건학회지
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• 제45권4호
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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.

• 한국환경보건학회지
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• 제46권4호
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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.

• 한국환경보건학회지
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• 제47권2호
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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.

• Environmental Analysis Health and Toxicology
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• 제31권
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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.

• 한국환경보건학회지
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• 제49권3호
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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.

• Tuberculosis and Respiratory Diseases
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• 제80권4호
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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.

• 한국환경보건학회지
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• 제47권4호
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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.

• 한국환경보건학회지
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• 제46권6호
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• pp.764-764
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• 2020

• Environmental Analysis Health and Toxicology
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• 제31권
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• pp.19.1-19.7
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• 2016

A large portion of the Korean population has been exposed to toxic humidifier disinfectants (HDs), and considering that the majority of the victims are infants, the magnitude of the damage is expected to be considerably larger than what has currently been revealed. The current victims are voicing problems caused by various diseases, including but not limited to lung, upper respiratory tract, cardiovascular, kidney, musculoskeletal, eye, and skin diseases, etc. However, there has been difficulty in gaining validation for these health problems and identifying causal relationships due to lack of evidence proving that toxic HD is the specific causes of extrapulmonary diseases such as allergic rhinitis. Furthermore, the victims and bereaved families of the HD case have not received any support for psychological distress such as post-traumatic stress disorder, depression, feelings of injustice, and anger caused by the trauma. In addition, because the underlying mechanisms of the toxic materials within the HDs such as polyhexamethylene guanidine phosphate, poly(oxyalkylene guanidine) hydrochloride, chloromethylisothiazolinone /methylisothiazolinone have yet to be determined, the demand for information regarding the HD issue is growing. The victims of the HD cases require support that goes beyond financial aid for medical costs and living expenses. There is a desperate need for government-led integrated support centers that provide individualized support through health screenings; in other words, we need an integrated facility that provides the appropriate social support to allow the victims to recover their physical and mental health, so as to well prepare them to return to a normal life. The implementation of such a plan requires not only the close cooperation between those departments already directly involved such as the Ministry of Environment and the Ministry of Health and Welfare, but also active support on a national scale from pan-governmental consultative bodies.

• 한국환경보건학회지
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• 제46권3호
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• pp.285-296
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• 2020

Objective: The objective of this study was to describe the characteristics of exposure to humidifier disinfectants (HDs) and their association with the presence of a person who experienced the adverse health effects in general households in Korea. Methods: During the month of December 2016, a nationwide online survey was conducted on adults over 20 years of age who had experience of using HDs. It provided information on exposure characteristics and the experience of health effects. The final survey respondents consisted of 1,555 people who provided information on themselves and their household members during the use of HD. Exposure characteristics at the household level included average days of HD use per week, average hours of HD use per day, the duration within which one bottle of HD was emptied, average input frequency of HD, amount of HD (cc) per one time used, and active ingredients of HD products (PHMG, CMIT/MIT, PGH, or others). The risk of the presence of a person who experienced adverse health effects in the household was evaluated by estimating odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for monthly income and region using a multiple logistic regression model. Subgroup analyses were conducted for households with a child (≤7 years) and households with a newborn infant during HD use. Results: The level of exposure to HD tended to be higher for households with a child or newborn infant for several variables including average days of HD use per week (P<0.0001) and average hours of HD use per day (P<0.0001). The proportion of households in which there was at least one person who experienced adverse health effects such as rhinitis, asthma, pneumonia, atopy/skin disease, etc. was 20.6% for all households, 25.3% for households with children, and 29.9% for households with newborn infants. The presence of a person who experienced adverse health effects in the household was significantly associated with average hours of HD use per day (P_trend<0.001), duration within which one bottle of HD was emptied (P_trend<0.001), average input frequency of HD (P_trend<0.001), amount of HD per one use (P_trend=0.01), and use of HDs containing PHMG (OR=2.23, 95% CI=1.45-3.43). Similar results were observed in subgroup analyses. Conclusion: Our results suggest that level of exposure to HD tended to be higher for households with a child or newborn infant and that exposure to HD is significantly associated with the presence of a person who experienced adverse health effects in the household.