Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Thorax. 2014 Aug;69(8):703-8. doi: 10.1136/thoraxjnl-2013-204132. Epub 2014 Jan 31.
In April 2011 a tertiary hospital in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults.
To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. Clinicopathological conferences led to the suspicion that the cases related to an inhalation injury. An age- and sex-matched case-control study was therefore performed to examine the inhalation exposure of the patients to various agents.
Of the 28 confirmed cases, 18 agreed to participate. A total of 121 age- and sex-matched controls with pulmonary, allergic or obstetric disease were selected. All patients and controls completed questionnaires with questions about exposure to various inhalants. The crude ORs for patient exposure to indoor mould, humidifier use, humidifier detergent use and insecticide use were 4.4 (95% CI 1.5 to 13.1), 13.7 (95% CI 1.8 to 106.3), 47.3 (95% CI 6.1 to 369.7) and 3.9 (95% CI 1.3 to 11.7), respectively. However, when considered concurrently, indoor mould and insecticide use lost statistical significance. Moreover, humidifier use was ruled out as the cause because of a lack of biological plausibility and the weak strength of the association. This suggested that humidifier disinfectant was the cause of the outbreak. This information led the Korean government to order the removal of humidifier detergents from the market. In the years following the ban, no additional cases were detected.
Epidemiological evidence strongly suggests that the lung injury outbreak was caused by humidifier detergent use at home.
2011 年 4 月，韩国首尔的一家三级医院报告了几例原因不明的年轻成人严重呼吸窘迫病例。
为了找到疫情的传播途径、病原体和患者的危险因素，开展了疫情调查。临床病理会议怀疑这些病例与吸入性损伤有关。因此，进行了一项年龄和性别匹配的病例对照研究，以检查患者对各种吸入物的吸入暴露情况。
在 28 例确诊病例中，有 18 例同意参与。共选择了 121 名年龄和性别匹配的患有肺部、过敏或产科疾病的对照者。所有患者和对照者都完成了一份问卷，问卷中包含了有关暴露于各种吸入物的问题。患者接触室内霉菌、使用加湿器、使用加湿器清洁剂和使用杀虫剂的粗比值比（OR）分别为 4.4（95%置信区间 1.5 至 13.1）、13.7（95%置信区间 1.8 至 106.3）、47.3（95%置信区间 6.1 至 369.7）和 3.9（95%置信区间 1.3 至 11.7）。然而，当同时考虑时，室内霉菌和杀虫剂的使用失去了统计学意义。此外，加湿器的使用被排除为病因，因为缺乏生物学合理性和关联的强度较弱。这表明加湿器消毒剂是疫情爆发的原因。这一信息促使韩国政府下令从市场上移除加湿器清洁剂。在禁令实施后的几年里，没有发现其他病例。
流行病学证据强烈表明，肺部损伤疫情是由家庭使用加湿器清洁剂引起的。
