• 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.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.

• 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.

• 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.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.

• 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.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.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.

• Journal of Environmental Health Sciences
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• v.46 no.2
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• pp.224-231
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• 2020

Objective: The objectives of this study are to update the information on the characteristics of humidifier disinfectant (HD) usage with HD associated health problems and to discuss the role of HD exposure assessment in the national program to monitor health problems in patients with HD associated diseases. Method: A total of 201 HD associated patients who registered to undergo clinical examination at Kangbuk Samsung Hospital was interviewed to acquire their responses regarding several HD use characteristics, including type of HD brands used, HD use duration, average daily HD use hours, and the volume of the room in which HD was used. The responses of the HD associated patients to HD use-related questions were compared between responses in the lung injury investigation and this study. Results: The responses of HD associated patients in this study were found to be different from those in the lunginjury investigation. In particular, some of the patients who had not answered in the lung-injury investigation were able to answer thanks to assistance from the investigator in this study. For their responses regarding the name of the most commonly used HD brand, the number of patients who did not answer (N=11) was reduced to eight in this study. Significant changes in the responses of study subjects to questions related to HD use were achieved through the interview in this study. Conclusion: This study found significant changes in the responses regarding HD use characteristics. HD exposure assessment should be included in the program in order to allow surveillance of HD associated health problems.