Evaluation report on the causal association between humidifier disinfectants and lung injury.

Mina Ha,Soon Young Lee,Bo Youl Choi,Seung-Sik Hwang,Seungsoo Sheen,Hae Kwan Cheong,Hyesook Park

doi:10.4178/epih.e2016037

Abstract

OBJECTIVESAs of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.METHODSA careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.RESULTSWe found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.CONCLUSIONSAlthough only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

Highlights

The incident by humidifier disinfectants (HDs) in 2011 was a large-scale and unprecedented environmental catastrophic case
Epidemiological reports of the association between humidifier disinfectants and lung injury
There were four case-control studies: an epidemiologic study initially performed immediately after a report of lung injury from a university hospital to the Korea Centers for Disease Control and Prevention (KCDC) in 2011 [12]; a casecontrol study matching sex, age, and date of diagnosis in three controls in children [13]; a case-control study matching sex, age, residential area, and experience of childbirth in a community control group [14]; and a study comparing patients exposed to humidifiers more closely and longer to other family members, as well as to a control group within a family [15]

Summary

Introduction

The incident by humidifier disinfectants (HDs) in 2011 was a large-scale and unprecedented environmental catastrophic case. University hospital in Seoul in April 2011 resulted in the epidemiological investigation by Korea Centers for Disease Control and Prevention (KCDC), studies on HD-induced lung injury have been performed. Based on the initial hospital-based case-control study and the preliminary result of inhalation toxicity test in mice, the government withdrew HDs from the market and banned its sale in order to prevent additional damages in November 2011. With the establishment of a special investigation committee on HDs by the National Assembly, various systemic and political measures were being considered with respect to compensation for victims including recognition of the impact of the disease on other organs, as well as other respiratory diseases. A legal resolution on the prosecution’s indictment, including the possibility of a causal role for HDs in health issues, was yet to be reached in court

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