• 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.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.4.1-4.2
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• 2016

Once released into the air, humidifier disinfectants became tiny nano-size particles, and resulted in chemical bronchoalveolitis. Families had lost their most beloved members, and even some of them became broken. Based on an estimate of two million potential victims who had experienced adverse effects from the use of humidifier disinfectants, we can say that what we have observed was only the tip of the iceberg. Problems of entire airways, as well as other systemic effects, should be examined, as we know these nano-size particles can irritate cell membranes and migrate into systemic circulation. The story of humidifier disinfectant is not finished yet.

• 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.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.44 no.5
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• pp.409-420
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• 2018

Objectives: An outbreak of humidifier disinfectant-related respiratory disease has not only been a massive disaster for end users, but it is also a concern for the workers of the manufacturers. This study presents the results of a questionnaire survey on the health effects among workers involved in the manufacture of humidifier disinfectants. Methods: Seven sites where humidifier disinfectants were manufactured were identified. A questionnaire survey was conducted to assess the physical symptoms experienced by workers related to humidifier disinfectants. Among a total of 177 workers, 42 subjects were available for the survey. Results: Twenty-one of the 42 respondents reported that they experienced respiratory or skin and mucosal irritation symptoms during work. Of the respondents who experienced symptoms, 14 believed that their symptoms were related to the work process and reported that the symptoms were experienced while working. However, no respondents reported ongoing symptoms or sequelae during the investigation period, and this result could not minimize selection bias due to low response rates. We then compared the characteristics of the group who experienced suspicious symptoms with those of the group without any symptoms. There was no statistically significant difference between two groups. Conclusions: We could not find significant health effects related to the humidifier disinfectant manufacturing process, although 21 respondents experienced stimulant symptoms and 14 respondents believed that the symptoms were related to the work process. Due to the long period of time after occupational exposure and the lack of data, there were many limitations to this study. However, this is one of the few follow-up investigations of workers related to this large-scale disaster in South Korea and the limitations of this study highlight the need to follow up with a nationwide database rather than an occasional survey.

• Journal of Environmental Health Sciences
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• v.45 no.4
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• pp.295-309
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• 2019

Eight years have passed since the Korean government's medical agency officially reported that the fatal lung disease found in some hospitals in 2011 was caused by chemical disinfectants used in household humidifiers, marking the introduction of the humidifier disinfectant disaster. Over the past eight years, a medical-scientific approach has been taken by the Korean government in its efforts to solve the problems in terms of relief of and compensation for the potential victims. One of the unintended consequence of this approach has been the fact that the number of "official victims" recognized by the government is quite small compared to the total number of applicants who claim to be suffering from the humidifier disinfectant disaster. This is mainly due to the fact that the medical-scientific approach relies on excessively strict, rigid, and narrow medical-scientific criteria provided by medical experts for judging the degree of applicants' bodily damage from the use of humidifier disinfectants. As a result, this medical-scientific approach is becoming increasingly criticized by patients' organizations mainly composed of rejected applicants. Based on the analysis of the limits of this medical-scientific approach and after clarifying the social implications of the disaster from a sociological perspective, this paper proposes certain social approaches focused on participatory governance as a means of dealing with the current issue. Finally, the paper emphasizes that the act of taking social responses to the humidifier disinfectant disaster should also be considered a process of enlarging and deepening democracy in Korea.

• Journal of Environmental Health Sciences
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• v.46 no.5
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• pp.481-494
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• 2020

Objectives: No study has been conducted to review characteristics of humidifier disinfectants (HD) products, such as real numbers, levels and types of HD substances contained, or the volume marketed. We aimed to review the characteristics of HD through a literature review. Methods: We collected literature reporting the names, numbers, and ingredients of HD and discussed them with a focus on the number of HD products and the chemicals used as a disinfectant. Results: A total of eight publications has reported the names of HD brands or types of disinfectants from 2011 to 2020. To date, a total of 40 HD products have been used, excluding four products. Eight HD products used polyhexamethylene guanidine phosphate (PHMG) and 14 used a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) as disinfectants. Benzalkonium chloride (BKC) and sodium dichloroisocyanurate (NaDCC) were also used as a disinfectant in several HD products. A total of 19 HD products were associated with the development of HD associated lung injury (HDLI). The Oxy Saksak HD product containing PHMG showed the highest number of HD associated health effects. The type of disinfectant from a total of 14 HD products has not been identified. Conclusions: A total of 40 HD products have been marketed in South Korea since 1994. Further studies should be conducted to identify the association of product characteristics, including type of HD ingredients, with health effects.

• Korean Journal of Environmental Biology
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• v.38 no.2
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• pp.271-277
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• 2020

Toxicities to many organs caused by humidifier disinfectants have been reported. Recently, humidifier disinfectants have been reported to cause cardiovascular, embryonic, and hepatic toxicities. This study was designed to investigate the toxic mechanism of humidifier disinfectants and compare toxicity in a cellular model and a zebrafish animal model. Because brain toxicity and skin toxicity have been less studied than other organs, we evaluated toxicity in a human dermal cell line and zebrafish under various concentrations of humidifier disinfectants that included polyhexamethyleneguanidine phosphate (PHMG), oligo-[2-(2-ethoxy)-ethoxyethyl-guanidinium-chloride] (PGH) and methylchloroisothiazolinone/methylisothiazolinone (CMIT/MIT). A human dermal fibroblast cell line was treated with disinfectants (0, 2, 4, 6, 8, and 16 mg L^-1) to compare their cytotoxicity. The fewest PHMG-treated cells survived (up to 33%), while 49% and 40% of the PGH- and CMIT/MIT-treated cells, respectively, survived. The quantification of oxidized species in the media revealed that the PHMG-treated cells had the highest MDA content of around 28 nM, while the PGH- and CMIT/MIT-treated cells had 13 and 21 nM MDA, respectively. As for brain toxicity, treatment of the zebrafish tank water with CMIT/MIT (final 40 mg L^-1) for 30 min resulted in a 17-fold higher production of reactive oxygen species (ROS) than in the control. Treatment with PGH or PHMG (final 40 mg L^-1) resulted in 15- and 11-fold higher production, respectively. The humidifier disinfectants (PHMG, PGH, and CMIT/MIT) showed severe dermal cell toxicity and brain toxicity. These toxicities may be relevant factors in understanding why some children have language disorders, motor delays, and developmental delays from exposure to humidifier disinfectants.

• 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.45 no.4
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• pp.326-339
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• 2019

Objectives: Minamata disease was an environmental health disaster of worldwide notoriety that occurred in Japan. The acknowledged patients total roughly 3,000, and the relieved victims currently include 77,099 cases. Still, many cases await acknowledgment or relief. The humidifier disinfectant issue is an environmental health catastrophe that took place in Korea. Over 9.98 million products spanning 43 brands of humidifier disinfectant have been sold and 835, cases have been recognized to date as relevant victims by the government. So far, 2,144 cases have been relieved by the fund of the producing companies. Four million consumers and 560,000 victims are estimated. Finding hints as to how to develop solutions in terms of fact-finding and prevention are the objectives of this study. Methods: Fields visits, interviews, and workshops as well as reference reviews have been conducted. A comparison was attempted to show the similarities and differences between the two disasters on 38 items. Results: Apparent similarities in the two disasters are the failure of industrial safety measures and governmental safety systems as well as relief systems for the victims. No comprehensive investigation was performed for all of the affected areas in Japan and all of the consumers in Korea. Both governments have tried to hide the faults and responsibilities of the companies and minimize the scale of the victims. Only after the government was changed through a general election did the new governments apologize and attempt to find political and social solutions through special relief laws. Conclusions: Over the process of each event, in the beginning, debates took place regarding the cause and the heath damages involved. For both, medical and toxicological relations are the keys while afterward finding a social solution became the subsequent issue.