Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation.

OBJECTIVES: Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence. METHODS: Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized. RESULTS: Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach. CONCLUSIONS: The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.

Ambient air pollution and the risk of neurological diseases in residential areas near multi-purposed industrial complexes of korea: A population-based cohort study.

Emerging evidence suggest that long-term exposure to air pollution may induce adverse effects on the central nervous system. However, no study explored the associations in large industrial complex (IC) areas which are one of the major contributors to air pollution. Therefore, we aimed to investigate the pollution status and the association between residential proximity and incidence of neurological diseases near two major ICs characterized as multi-purposed ICs in Korea. A retrospective cohort of residents near the ICs was constructed using Korea's health insurance data and monitored from 2008 to 2019. Emission amounts of the ICs and the air pollution status in the nearby (exposed) and remote (control) area were evaluated using data from national regulatory networks, and hazard ratios (HRs) and 95% confidence intervals (CIs) for neurological diseases of the exposed group compared to the control group were calculated using Cox proportional regression models. Overall, the complexes emitted large amounts of VOCs, CO, NOx, and PM10, and annual levels of ambient PM (2.5, 10), gaseous substances (NO2, SO2), VOCs and PAHs were higher in the exposed area compared to the control and/or the national average. The risk of inflammatory disease of the CNS (G00-09) and extrapyramidal and movement disorders (G20-26) were higher in the exposed area with a HR (95% CI) of 1.36 (1.10-1.68) and 1.33 (1.27-1.39) respectively. Among the subclasses, other extrapyramidal and movement disorders (G25) and epilepsy (G40) were associated with higher risks in the exposed area (HR (95%CI): 1.11 (1.04-1.18), 1.08 (1.00-1.16)) after adjusting for potential confounders. These results suggest that people living near ICs are more likely to be exposed to higher air pollution levels and have higher risks of developing several neurological disorders. However, further epidemiological studies in these industrial areas supplemented with other indicators of environmental exposure and control of other diverse factors are warranted.

Evaluation of residual level and distribution characteristics of organochlorine pesticides in agricultural soils in South Korea.

In this study, we evaluated the residual levels and distribution characteristics of 10 organochlorine pesticides (OCPs) in the soil of agricultural lands (paddy field, vegetable field, and orchard, n = 150) nationwide. As a result of the investigation, 3-10 types of OCPs were detected in combination in 144 locations (96%) of the total 150 locations. Among those OCPs, dichlorodiphenyltrichloroethane (DDT) and endosulfan were detected in high amounts. The geometric mean concentrations of DDT and endosulfan were ∑DDT 0.31 ng g-1 (ND-2187.18 ng g-1) and ∑endosulfan 0.33 ng g-1 (ND-312.68 ng g-1), respectively. OCP concentrations were generally higher in orchards than in other agricultural fields due to a large amount of pesticides used. DDT in two orchards was detected at 2187.18 ng g-1 and 1061.78 ng g-1, exceeding the levels stated in the Canadian DDT Soil Quality Guidance (SQG, 700 ng g-1). The result of applying the isomer ratio to evaluate the recent or past use of DDT, endosulfan, and hexachlorocyclohexane (HCH), which had a high detection rate, showed that it could be attributable to historical usage. DDT and HCH showed statistically similar residual distribution patterns; however, endosulfan did not show a clear correlation with DDT and HCH due to the effect of its recent use. Thus, the results of evaluation of OCP residual levels and distribution characteristics can be used for the soil management policy of OCPs in agricultural lands in Korea.

Development of diagnostic systems for wide range and highly sensitive detection of two waterborne hepatitis viruses from groundwater using the conventional reverse transcription nested PCR assay.

Waterborne epidemics of human hepatitis virus A and E (HAV and HEV) have been reported worldwide. Molecular biology techniques, such as reverse transcription polymerase chain reaction (RT-PCR), have been widely used to detect the two hepatitis viruses. However, comparative studies of various types of samples are needed, and different environmental factors, including the low copy pathogens, presence of PCR inhibitors in the sample, unknown non-specific reaction with template, and sequence diversity leading to new variants in viruses, should be considered. In addition, standard positive material is required to determine the accuracy of the PCR and should be able to distinguish between false and real positives. In this study, we developed RT-PCR primer sets and optimised standard templates for HAV and HEV detection to address the above concerns associated with test sensitivity and possible PCR inhibition. Finally, previously reported diagnostic methods of HAV and HEV were compared and an applicability test using groundwater was performed. The nested RT-PCR developed in this study is expected to contribute to assess water safety by monitoring HAV and HEV in non-disinfected water, like groundwater.

Characterization of urinary cotinine concentrations among non-smoking adults in smoking and smoke-free homes in the Korean national environmental health survey (KoNEHS) cycle 3 (2015-2017).

BACKGROUND: Although many indoor public places have implemented smoke-free regulations, private homes have remained sources of tobacco smoke pollutants. This study examined differences in urinary cotinine concentrations in the Korean non-smoking adult population between living in smoking and smoke-free homes, and the relationship of urinary cotinine concentrations with socio-demographic factors in smoke-free homes. METHODS: Samples from 2575 non-smoking adults (≥19 years old) in the Korean National Environmental Health Survey cycle 3 (2015-2017), a representative Korean study, were used. Smoking and smoke-free homes were defined based on whether there were smokers at homes. Weighted linear regression models were used to determine urinary cotinine concentrations and identify factors associated with urinary cotinine. RESULTS: The geometric mean of urinary cotinine concentrations for non-smoking adults living in smoking homes was 2.1 µg/L (95% confidence interval [CI] = 1.8-2.4), which was significantly higher than the mean of 1.3 µg/L (95% CI = 1.2-1.4) for those living in smoke-free homes. Urinary cotinine concentrations were different significantly by home smoking status in most socio-demographic subgroups. Data from smoke-free home showed urinary cotinine concentration in adults was significantly higher in those who lived in homes with ventilation duration < 30 min/day, those who spent more time indoors at home, those who spent less time outdoors, and those who worked in non-manual or manual occupations. CONCLUSIONS: The urinary cotinine concentration in Korean non-smoking adults living in smoking homes was higher than that in adults living in smoke-free homes. Even in smoke-free homes, home-related factors, such as ventilation duration and time spent indoors, were associated with urinary cotinine concentration. Further study is warranted to examine potential sources of tobacco smoke pollution in smoke-free homes.

Spatial variation of pharmaceuticals in the unit processes of full-scale municipal wastewater treatment plants in Korea.

Several reports have elucidated the removal of pharmaceutical residues in municipal wastewater treatment plants (WWTPs). However, there remains a need to determine the spatial distribution of pharmaceuticals in the unit processes of full-scale municipal WWTPs. Herein, spatial variations of fifteen pharmaceuticals in the unit processes of four full-scale municipal WWTPs were assessed by analyzing both solid and liquid samples. Furthermore, different pathways of each pharmaceutical such as biodegradation, adsorption, deconjugation, and electrostatic interaction were investigated. Pharmaceutical mass loading were measured at various points for the different unit process and evaluated using liquid chromatography-tandem mass spectrometry. The average mass loading of acetaminophen and caffeine decreased tremendously in the first biological treatment process regardless of the process configuration. In contrast, a temporary increase was observed in the mass loading of ibuprofen in the anaerobic and/or anoxic processes, which was presumably caused by deconjugation. Additionally, the adverse effect of coagulation on ibuprofen removal was validated. The major removal mechanism for the selected antibiotics, except for sulfamethoxazole, was the adsorption by biosolids due to electrostatic interaction. Subsequently, a drastic decrease was observed in their mass loadings in the solid-liquid separation process of the WWTPs. The membrane bioreactor (MBR) shows excellent capability for mitigation of pharmaceuticals in municipal wastewater because it comprises a high concentration of biosolids that act as adsorbents. The evaluation of the spatial variations of the selected pharmaceuticals in different unit processes provides valuable information on their behavior and removal mechanisms.

Efficacy of in situ well-based denitrification bio-barrier (WDB) remediating high nitrate flux in groundwater near a stock-raising complex.

This study assessed the feasibility of an in situ well-based denitrification bio-barrier (WDB) for managing groundwater contaminated with high-strength nitrate. To evaluate the efficacy of WDB using fumarate as a carbon source and/or electron donor, three sequential single-well push-pull tests (SWPPTs) were conducted at six test sites. The values of the isotope enrichment factor (ɛ) ranging from -6.5‰ to -22.6‰ and the detection and degradation of nitrite and nitrous oxide confirmed complete in situ denitrification of nitrate to nitrogen gas. The ratio of the first-order rate coefficient of fumarate to nitrate (k1,fum/k1,NO3) was obtained to estimate the amount and frequency of fumarate injection for the effective design of WDB. At three sites, the ratios ranged from 0.67 to 0.80, while the other two sites showed higher ratios of 2.97 and 2.20 than the theoretical values and significant amounts of sulfate reduction, theoretically equivalent to 6.5% of total fumarate consumption. Considering the theoretical mole ratio of fumarate to nitrate of 0.98, the amount and frequency of fumarate injection is site specific. During the operating WDB, the average annual nitrate mass degraded (95% CI) was 2.2 ± 1.0 kg N/yr/well. The amount of N reduced by one well of WDB is equivalent to treating 110 m3 of groundwater at 30 mg N/L to the level of 10 mg N/L for one year. WDB would be an effective remediation option for managing high nitrate flux in groundwater.

National Reconnaissance Survey of Microplastics in Municipal Wastewater Treatment Plants in Korea.

Large quantities of microplastics are thought to be emitted to freshwater environments via wastewater treatment plants (WWTPs). To evaluate the occurrence of microplastics in Korean WWTPs, a nationwide study was conducted for the first time in 50 representative WWTPs with large treatment capacities. Grab sampling and laboratory filtration were used for influents, whereas in situ filtration using a custom-made sampling device was used for effluents. The filtrates were pretreated using wet peroxidation and density separation prior to the identification of microplastics with a dissection microscope and Fourier-transform infrared spectroscopy. Pooled analyses of the microplastics revealed that they were predominantly fragment-shaped, and thermoplastics and synthetic fibers were the dominant microplastic materials in WWTPs. The concentration ranged from 10 to 470 L-1 in influents and 0.004 to 0.51 L-1 in effluents. The removal efficiency of microplastics during wastewater treatment was calculated to be 98.7-99.99% in 31 WWTPs. Additionally, WWTPs using advanced phosphorus removal processes exhibited higher removal efficiency than those not implementing such processes. Power-law distribution was successful in describing microplastic particle sizes down to 100 µm, although it was not applicable for smaller particles. This comprehensive monitoring study provides information on the current level and characteristics of microplastics in WWTPs in Korea.

Nocardioides suum sp. nov. isolated from the air environment in an indoor pig farm.

A bacterial strain PBT33-2T was isolated from the air environment in an indoor pig farm. Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain PBT33-2T belonged to the genus Nocardioides in the phylum Actinobacteria, and was most closely related to Nocardioides daphnia D287T in a maximum-likelihood and neighbor-joining phylogenetic trees. Strain PBT33-2T shared 95.3% sequence identity with N. daphnia D287T. However, the highest sequence similarity was shown with N. sediminis MSL-01T (96.0%). It had less than 96.0% sequence identities with other type species of the genus Nocardioides. Strain PBT-33-2T grew at 15-45°C (optimum 20-35°C), pH 5.0-11.0 (optimum pH 7.0) and 0-4.0% (w/v) NaCl (optimum 0%). The major fatty acid and quinone were iso-C16:0 and MK-8, and the DNA G+C content of strain PBT33-2T was 69.3 mol%. On the basis of poly-phasic results, strain PBT33-2T represents a novel species of the genus Nocardioides, for which the name Nocardioides suum sp. nov. is proposed. Its type strain is PBT33-2T (=KCTC 39558T =DSM 102833T).

Tracking Mallards (Anas platyrhynchos) with GPS Satellite Transmitters Along Their Migration Route Through Northeast Asia.

In this study, Global Positioning System satellite transmitters were attached to three mallards (Anas platyrhynchos) wintering in South Korea to track their migration routes, stopover sites, breeding sites, and migration patterns. We successfully tracked only one mallard (no. 108917) from November 15, 2011, to November 29, 2013, and determined separate migration routes in two cases of spring migration and one case of fall migration. The mallard repeatedly migrated to the same final destination, even though the travel path varied. We identified six stopover sites: Hunhe River, Liaohe River, Yinma River, Yalu River, Songjeon Bay, and Dahuofang Reservoir in China and South Korea. The wintering sites of two migration cases were discovered to be identical (Gokgyo River in Asan, South Korea). The terminal sites, which were presumed to be breeding grounds, were the same in both cases (Hinggan League in Inner Mongolia Autonomous Region, China). On the basis of the migration routes identified in this study, we suggest that future efforts to control highly pathogenic avian influenza (HPAI) should not only include avian influenza surveillance but also implement flyway-based strategies, with regard to all countries affected by potential HPAI outbreaks.

Prevalence of avian influenza virus in wild birds before and after the HPAI H5N8 outbreak in 2014 in South Korea.

Since 2003, highly pathogenic avian influenza (HPAI) virus outbreaks have occurred five times in Korea, with four HPAI H5N1 outbreaks and one HPAI H5N8 outbreak. Migratory birds have been suggested to be the first source of HPAI in Korea. Here, we surveyed migratory wild birds for the presence of AI and compared regional AI prevalence in wild birds from September 2012 to April 2014 for birds having migratory pathways in South Korea. Finally, we investigated the prevalence of AI in migratory birds before and after HPAI H5N8 outbreaks. Overall, we captured 1617 migratory wild birds, while 18,817 feces samples and 74 dead birds were collected from major wild bird habitats. A total of 21 HPAI viruses were isolated from dead birds, and 86 low pathogenic AI (LPAI) viruses were isolated from captured birds and from feces samples. Spatiotemporal distribution analysis revealed that AI viruses were spread southward until December, but tended to shift north after January, consistent with the movement of migratory birds in South Korea. Furthermore, we found that LPAI virus prevalences within wild birds were notably higher in 2013-2014 than the previous prevalence during the northward migration season. The data from our study demonstrate the importance of the surveillance of AI in wild birds. Future studies including in-depth genetic analysis in combination with evaluation of the movement and ecology of migratory birds might help us to bridge the gaps in our knowledge and better explain, predict, and ultimately prevent future HPAI outbreaks.

Pathogens in water deer (Hydropotes inermis) in South Korea, 2010-12.

Water deer (Hydropotes inermis) are among the most common wildlife to approach farmhouses and livestock barns in Korea. We collected 305 water deer from Gangwon (n=168), South Chungcheong (n=89), and Gyeongsang (n=48) provinces in 2010-12 and used PCR and serologic tests to screen the deer for pathogens. In 2010, tests for bovine viral diarrhea virus (BVDV), rotavirus, and Brucella abortus were positive in 8% (5/60), 2% (1/60), and 59% (33/56) of the animals, respectively. In 2010, the water deer were negative for foot-and-mouth disease virus, coronaviruses, and Mycobacterium bovis. All samples collected in 2011 and 2012 were negative for all pathogens analyzed. These results suggest that at least two of the investigated pathogens, BVDV and B. abortus, circulate among water deer in South Korea.

An outbreak of type C botulism in waterbirds: Incheon, Korea.

Five outbreaks of botulism in waterbirds were encountered over a 5-yr period from 2004 to 2008 in Korea. In October 2008, an outbreak of avian type C botulism affected approximately 2,000 wild waterbirds in the Namdong flood control basin, Incheon, South Korea. Ecologic conditions, clinical signs exhibited by moribund birds, and lack of gross pathology and microbial evidence of infectious disease, suggested botulinum intoxication. Type C botulinum toxin was demonstrated in duck sera, liquid culture of intestinal tissue, and an extract of maggots taken from the carcasses. Additionally, 34 of 40 (85.0%) sediment samples from the same area were positive for botulinum toxin by mouse bioassay using multivalent (types A-F) antiserum, indicating that toxigenic Clostridium botulinum was present in the environment. This is the most severe case of avian botulism documented in Korea.

GDSL-lipase1 (CaGL1) contributes to wound stress resistance by modulation of CaPR-4 expression in hot pepper.

A full length cDNA clone encoding Capsicum annuum GDSL-lipase 1 (CaGL1) was isolated by microarray analysis. The expression of CaGL1 was triggered by methyl jasmonic acid (MeJA), an important signal in abiotic/biotic stress response. However, the expression of this gene was not increased by the application of salicylic acid (SA) or ethylene treatment. And, local/systemic wounding stimuli resulted in rapid accumulation of CaGL1 mRNA. However, CaGL1 was not specifically induced during the hypersensitive response upon Tobacco mosaic virus (TMV) inoculation. By using a virus-induced gene silencing (VIGS)-based reverse genetic approach, it was observed that the suppression of CaGL1 attenuates the expression of Capsicum annuumpathogenesis-related protein 4 (CaPR-4) during wound stress. However, the CaPR-4 transcript level induced by TMV was not regulated by CaGL1 expression. These results indicate that CaGL1 may be involved in signaling pathway of MeJA and/or the wound responses through CaPR-4 expression modulation.

Outbreaks of gastroenteritis that occurred during school excursions in Korea were associated with several waterborne strains of norovirus.

In May 2004, 97 of 309 (31%) and 97 of 207 (47%) school students from geographically distant areas were affected by acute gastroenteritis during excursions to neighboring hotels. The two hotels were 300 m apart, on Jeju Island, South Korea. Several strains of norovirus, including both genogroup I and genogroup II viruses, were identified in stool samples from the students and food handlers and in groundwater from the hotels. Of these several strains of norovirus, the nucleotide sequences for one strain were identical for samples from the students, food handlers, and groundwater.