J Korean Med Sci.  2025 Apr;40(15):e144. 10.3346/jkms.2025.40.e144.

Roots of the Large-Scale Household Humidifier Disinfectant Poisoning Tragedy: Regulatory and Surveillance Shortcomings in Korea

• Park DU
• Zoh KE
• Cho DH
• Park S
• Hwang J
• Choi CH
• Koh DH
• Choi Y
• Park J

• KMID: 2567196
• DOI: http://doi.org/10.3346/jkms.2025.40.e144

Abstract

The multi-decade household humidifier disinfectant poisoning tragedy (HHDT) in South Korea highlights the importance of investigating government failures. This study aims to identify and discuss key failures and shortcomings in the South Korean authorities’ approach to regulating humidifier disinfectants (HDs) and monitoring cases of chemical poisoning. We reviewed both the HD risk prevention measures that the South Korean Ministry of Environment (KME) should have implemented under the Toxic Chemicals Control Act (TCCA) (1991–2013). Polyhexamethylene guanidine phosphate (PHMG), a new chemical, was approved for use as a disinfectant under the TCCA. KME declared PHMG non-hazardous based solely on preproduction documentation provided by the industry. In addition, the Korea Disease Control and Prevention Agency (KDCPA) failed to detect the HHDT that had accumulated each year for more than a decade. KME’s neglect of its responsibilities, coupled with KDCPA’s lack of chemical poisoning surveillance systems, led to the accumulation of widespread HHDT.

Keyword

Humidifier Disinfectant; Polyhexamethylene Guanidine Phosphate (PHMG); Chemical Poisoning

Reference

1. Park DU, Lee S, Lim HK, Kim SY, Kim J, Park J, et al. Comprehensive review on humidifier disinfectant (HD) products, focusing on the number of products and their disinfectant type. J Environ Health Sci. 2020; 46(5):481–494.

2. KEITI. A portal dedicated to supporting victims of the humidifier disinfectant tragedy in South Korea. Statistical status. Updated 2024. Accessed March 31, 2025. https://healthrelief.or.kr/home/content/stats01/view.do .

3. Kim HJ, Lee MS, Hong SB, Huh JW, Do KH, Jang SJ, et al. A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation. Thorax. 2014; 69(8):703–708. PMID: 24488371.

4. KME. Notice of the preparation methods for chemical substance declaration forms and required data, Korea Ministry of Environment. Enforced in Dec. 30. 4, 1996; Notice No. 1996-175. Updated 1993. Accessed July 15, 2024. https://theme.archives.go.kr/viewer/common/archWebViewer.do?singleData=N&archiveEventId=0028284321#5 .

5. Korea Ministry of Environment. Toxic Chemical Control Act. Enforced in Feb. 4, 1995; Act No. 4784; Partially amended in Aug. 3, 1994. Sejong: Korea Ministry of Environment;1995.

6. Korea Ministry of Environment. Toxic Chemical Control Act Enforcement Decree in April 6, 1996; Act No. 14971; Partially amended in Article 7 of the Enforcement Decree. Dec. 23, 1994. Sejong: Korea Ministry of Environment;1996.

7. EPA. Polymer Exemption Guidance Manual (EPA 744-B-97-001). Updated May 22, 1997. Accessed July 15, 2024. https://www.epa.gov/sites/default/files/2015-03/documents/polyguid.pdf .

8. Sanderson H, Hansen A, Brill J, Rawlings J, Lam M, Connors K, et al. Overview of aquatic risk assessment of polymers – evidence from cationic polymers. Updated 2019. Accessed July 15, 2024. https://cefic-lri.org/wp-content/uploads/2018/07/Sanderson_112_Overview-of-aquatic-risk-assessment-of-polymers.pdf .

9. Brill JL, Rawlings JM, Connors KA, Belanger SE, Lam M, Hansen AMB, et al. Progress in understanding the ecotoxicology of cationic polymers: evidence with Polyquat 10’s. Updated 2019. Accessed July 15, 2024. https://cefic-lri.org/wp-content/uploads/2018/07/Brill_ecotox-of-cat-polymers-SETAC-2019.pdf .

10. Polymer PROC. Cationic polymer: understanding its properties and applications. Updated 2024. Accessed July 15, 2024. https://polymer-process.com/cationic-polymer/ .

11. GAO. Chemical regulation. Comparison of U.S. and recently enacted European union approaches to protect against the risks of toxic chemicals (GAO - 07 - 825). Updated 2024. Accessed July 15, 2024. https://www.gao.gov/products/gao-07-825 .

12. Chemicals EU. Commission seeks views on revision of REACH, the EU’s chemicals legislation. Updated 2022. Accessed July 15, 2024. https://environment.ec.europa.eu/news/chemicals-commission-seeks-views-revision-reach-eus-chemicals-legislation-2022-01-20_en .

13. Park DU, Kim J, Nam M, Mun E, Lee Y, Ha K, et al. Recommendation for the establishment of a poison control center at the Korea Disease Control and Prevention Agency. Environ Anal Health Toxicol. 2020; 35(3):e2020017. PMID: 32979902.