International International BfS Workshop on the Chernobyl Accident Health ConsequencesBfS Workshop on the Chernobyl Accident Health ConsequencesMunich 9-10 November 2006, GermanyMunich 9-10 November 2006, Germany

HEALTH HEALTH OF SURVIVORS IN UKRAINE OF SURVIVORS IN UKRAINE

IN 20-YEARSIN 20-YEARS DYNAMICS DYNAMICS AFTERAFTER

THE CHERNOBYL THE CHERNOBYL CATASTROPHE CATASTROPHE

Professor Dr Angelina I. Nyagu

Ministry of Public Health of Ukraine, Ministry of Public Health of Ukraine, Association “ Physicians of Chernobyl”Association “ Physicians of Chernobyl”

Distribution of Cs-137 in Ukraine before 1985y                                                         

Distribution of Cs-137 in Ukraine after accident in 1998y  (Water)                                                   

Irradiation dose of population in Polesye region in Ukraine is Irradiation dose of population in Polesye region in Ukraine is forming in result of: inhalation dose-0,1%;forming in result of: inhalation dose-0,1%; internal exposure with internal exposure with

water- 2%, external exposure-5-20%;water- 2%, external exposure-5-20%; internal exposure with food -80-internal exposure with food -80-95%.95%. (Ministry of Health of Ukraine, 2006)(Ministry of Health of Ukraine, 2006)

внутрішнє опромінення, зумовлене інгаляційним надходженнямрадіонуклідів з повітрям до 0,1%внутрішнє опромінення від радіонуклідів, що надходять з питноюводою до 2%зовнішнє гамма - опромінення 5-20%

внутрішнє опромінення від радіонуклідів, що надходять з продуктамихарчування 80-95%

Level exceeding Level exceeding concentration of radionuclids in foodstuff ( milk, concentration of radionuclids in foodstuff ( milk, meat,meat,

soft-fruit, mushrooms, herbs)soft-fruit, mushrooms, herbs) in Ukrainian regions: Volyn, Zhitomyr, in Ukrainian regions: Volyn, Zhitomyr, Kievska, Rovno, Chernygov oblast.Kievska, Rovno, Chernygov oblast. (Source- Ministry of Health of Ukraine)(Source- Ministry of Health of Ukraine)

17,1

8,3

2,0

15,1

3,20

5

10

15

20

%Волинська

Житомирська

Київська

Рівненська

Черниговская

Population healthPopulation healthin Ukrainein Ukraine

Data of Ministry of HealthData of Ministry of HealthLong-term screening separated the survivors into the following categoriessubject for prolonged monitoring:1-liquidators of the accident, especially people who took part in the liquidation of the consequences of the accident in 1986-87 and those who were removed from the highest risk zones of first-priority;2-persons evacuated in 1986 and relocated during the next 20 years from the evacuation zones and the first-priority relocation zones;3-people living on the radioactively polluted territories with significant density of cesium-137, strontium-90, plutonium in the soil;4-people born from irradiated parents (liquidators of the accident evacuated and relocated people).5-Risk groups also include persons irradiated in utero and those with thyroid irradiated by radioisotopes of iodine at the age of 0-18 years at the time of the accident.

Dynamics of the total number of survivors -1997-2006yy.

Categories of the survivors and Categories of the survivors and Number Number

On 1997-2006yy.On 1997-2006yy.

19971997 20002000 20052005 20062006 2006 to 2006 to 1997%1997%

•Category 1 - InvalidsCategory 1 - Invalids 5958259582 8677586775 105251105251 106824106824 •179179

•Category 2Category 2 339666339666 •307 982307 982 276 072276 072 268815268815 •7979

Including: Including: 2a- 1986-1987 yy. liquidators2a- 1986-1987 yy. liquidators

2b- survivors- evacuees2b- survivors- evacuees

352939352939

8672686726

277 135277 135

80 84780 847

•197 817197 817

78 25578 255

191 167191 167

77 64777 647

7676(24%)(24%)

•9090

•Category 3Category 3 558637558637 549 649549 649 •537 504537 504 •533144533144 •9595

Including: 3a 1987-1990 liquidatorsIncluding: 3a 1987-1990 liquidators 3b survivors3b survivors

69 62069 620

489 017489 017

6272962729

486 720486 720

55 39155 391

482113482113

5234652346

•480798480798

•7575

•9898

Category 4Category 4 1 169 8041 169 804 1 1502731 150273 1 081 4691 081 469 •1 065 0221 065 022 •9191

•Category D:Category D:people who worked beyond the territory people who worked beyond the territory of the exclusion Zoneof the exclusion Zone

25302530 •28622862 •27802780 •26062606 •103103

•Children survivors (including those with Children survivors (including those with thyroid gland irradiation in 1986)thyroid gland irradiation in 1986)

•1 083 1071 083 107 •1 264 3291 264 329 •643 030643 030 •617 660617 660 •5757

•Total Total •((Died Died 504 117 persons???) 504 117 persons???)

•3 213 3263 213 326 •3 361 8703 361 870 •2 646 1062 646 106 2 5940712 594071 •8181

IndicesIndices TotalTotal Exlusion Exlusion zone)zone)

ZoneZone 2 215-40 Ci/km15-40 Ci/km22))

ZoneZone 3 35-15 5-15 Ci/kmCi/km22))

ZoneZone 4 4((1-5 Ci/km1-5 Ci/km22

Number of settlementsNumber of settlements 22932293 7676 9292 835835 12901290

Population Population (in thousands)(in thousands)

2291.932291.93 0.120.12 9.049.04 637.23637.23 1645.541645.54

Including Children Including Children under 14under 14

488.69488.69 00 1.871.87 150.16150.16 336.66336.66

Territories (kmTerritories (km2)2) 5345453454 21222122 20032003 2261922619 2671026710

Including forestsIncluding forests 2535725357 10581058 13151315 1419414194 87908790

73 73 rayons,rayons, 12 12 oblastsoblasts ( (Vinnitsa, Volyn, Zhytomir, Ivano-Frankovsk, Kiev, Rivnae, Sum, Vinnitsa, Volyn, Zhytomir, Ivano-Frankovsk, Kiev, Rivnae, Sum, Thernopil, Khmelnitsk, Cherkasska, Chernivetska, Chernihivska).Thernopil, Khmelnitsk, Cherkasska, Chernivetska, Chernihivska).

Number of people living in different contaminated territoriesNumber of people living in different contaminated territories in Ukrainein Ukraine

Kiev 1986 (spring)Kiev 1986 (spring) These are the official figures These are the official figures

but many believe the reality is but many believe the reality is much worse because these data much worse because these data do not include the 3 million do not include the 3 million people living in the capital of people living in the capital of Kiev, which is less than 100 Kiev, which is less than 100 kilometres away from kilometres away from Chernobyl. Residents of Kiev Chernobyl. Residents of Kiev were exposed to fallout from the were exposed to fallout from the accident including radioactive accident including radioactive iodine. According to research iodine. According to research conducted at the Nuclear conducted at the Nuclear Research Institute and the Research Institute and the Geology Institute of the Geology Institute of the National Academy of Sciences National Academy of Sciences of Ukraine, Kiev should have of Ukraine, Kiev should have been classified as part of the been classified as part of the third zone. third zone.

UKRAINIAN STATE Chernobyl REGISTRY UKRAINIAN STATE Chernobyl REGISTRY 01.01.2006 01.01.20062 252 130 (from 2 252 130 (from 2 2 594594 071071 ) ) personspersons

373 994305 664

79 277

1 493 195

ліквідаториевакуйованіпроживаючіособи, що народилися від батьків 1-3 груп

Dynamic of birth-rate and mortality of population of the most Dynamic of birth-rate and mortality of population of the most contaminated regions and according of the groups of primary count contaminated regions and according of the groups of primary count

per 1000 persons (Ministry of Health of Ukraine).per 1000 persons (Ministry of Health of Ukraine).

8

9

10

11

12

13

14

15

16

17

18

1970 1974 1978 1982 1986 1990 1994 1998 2002 2006

рождаемость

смертность

People on polluted territories in Ukraine suffer protracted People on polluted territories in Ukraine suffer protracted medical and demographic crises in the form of increase medical and demographic crises in the form of increase of birth-rate, decrease of aging mortality, short-cut of life expectancy andof birth-rate, decrease of aging mortality, short-cut of life expectancy and qualitative changes of structure of death cause.qualitative changes of structure of death cause. The most heavily The most heavily contaminated regions have a lower level of the human development index. contaminated regions have a lower level of the human development index.

HEALTHHEALTH ((state statistics)state statistics)

0102030405060708090

100 %

ЛіквідаториЕвакуйонаніЖителі забруднених територійДіти, які народились від опромінених батьків

Роки

Part of adult population which has been identified as ill by medical examination, is constantly growing and at present it amounts to 94,2% for accident liquidators, 89,8% for evacuees and 84,7% for residents of radioactive contaminated territories. 79,8% of children who have been directly or indirectly affected by the accident were considered also as ill.

MORBIDITY of ADULTS SURVIVORSMORBIDITY of ADULTS SURVIVORS onon 10 10 thousandthousand (Ministry of health of Ukraine)(Ministry of health of Ukraine)Classes of diseasesClasses of diseases 1987 1987 yy 2005 2005 yy

NEOPLASMSNEOPLASMS 22,922,9 82,2582,25

MALIGNANT NEOPLASMSMALIGNANT NEOPLASMS 15,315,3 36,8636,86

Endocrine diseasesEndocrine diseases system system 63,263,2 149,27149,27

Incl. Thyroid diseasesIncl. Thyroid diseases 34,034,0 96,9596,95

Hematological diseases systemHematological diseases system 8,58,5 39,6139,61

Incl. anemia Incl. anemia 0,00,0 31,2731,27

Mental disordersMental disorders 24,924,9 51,8751,87

Nervous system diseasesNervous system diseases 286,2286,2 212,97212,97

Cardiovascular system diseasesCardiovascular system diseases 223,8223,8 585,20585,20

Respiratory system diseasesRespiratory system diseases 315,4315,4 2091,2091,44

Digestive system diseasesDigestive system diseases 104,1104,1 319,59319,59

Urogenital system diseasesUrogenital system diseases 71,871,8 456,76456,76Skin and subcutaneous tissue diseasesSkin and subcutaneous tissue diseases 119,5119,5 331,89331,89

Muscular – skeletal diseasesMuscular – skeletal diseases 69,469,4 322,99322,99

Injuries and poisoningInjuries and poisoning 0,00,0 508,13508,13

AllAll 1372,91372,9 6017,86017,8

Classes of diseasesClasses of diseases 1987 1987 yy 2005 2005 yy

NEOPLASMSNEOPLASMS 0,270,27 2,52,5

Malignant neoplasms Malignant neoplasms 0,10,1 0,20,2

Endocrine system diseasesEndocrine system diseases 23,323,3 49,949,9

Including Thyroid diseasesIncluding Thyroid diseases 15,715,7 36,936,9

Hematological diseasesHematological diseases 14,214,2 39,439,4

Incl. Anemia (iron – deficient)Incl. Anemia (iron – deficient) 0,00,0 28,228,2

Mental disordersMental disorders 2,62,6 5,65,6

Nervous system diseasesNervous system diseases 15,215,2 26,726,7

Cardiovascular system diseasesCardiovascular system diseases 7,67,6 18,418,4

Respiratory system diseasesRespiratory system diseases 314,2314,2 874,6874,6

Digestive system diseasesDigestive system diseases 23,923,9 76,376,3

Urogenital system diseasesUrogenital system diseases 3,33,3 22,722,7

Skin and subcutaneous tissue diseasesSkin and subcutaneous tissue diseases 17,717,7 72,972,9

Muscular-skeletal system diseasesMuscular-skeletal system diseases 11,411,4 40,040,0

Certain conditions originating in perinatal period Certain conditions originating in perinatal period 0,00,0 9,259,25

Congenital diseasesCongenital diseases 0,80,8 4,94,9

ALL diseasesALL diseases 455,4455,4 1437,81437,8

Dynamics Dynamics of morbidity in children survivors ( per 10000of morbidity in children survivors ( per 10000 persons persons))

AVERAGE INDEXES OF TOTAL CHILDREN DISABILITY IN AGE OF 14–15 IN UKRAINIAN PROVINCES WITH POPULATION SURVIVED AFTER THE CHERNOBYL ACCIDENT

FOR 2001 (PER 10,000 CHILDREN POPULATION OF 14–15 YEARS OLD)

ClasClass of s of disediseasesases

Names of class diseasesNames of class diseasesAn average indexAn average index

for examined for examined provincesprovinces

An average index for An average index for other other

provinces of Ukraineprovinces of Ukraine

Percent difference Percent difference betweenbetween

compared indexescompared indexes

2.02.0 NeoplasmNeoplasm 7.67.6 5.55.5 +38.2+38.2

3.03.0 Diseases of blood and Diseases of blood and hemopoietic organshemopoietic organs

2.72.7 2.52.5 +8.0+8.0

4.04.0 Diseases of endocrine systemDiseases of endocrine system 12.212.2 11.211.2 +8.9+8.9

5.05.0 Mental and behavioral Mental and behavioral disordersdisorders

37.537.5 41.741.7 -10.1-10.1

6.06.0 Diseases of nervous systemDiseases of nervous system 44.444.4 41.341.3 +7.5+7.5

10.010.0 Diseases of respiration Diseases of respiration organsorgans

15.015.0 12.912.9 +16.3+16.3

11.011.0 Diseases of digestion organsDiseases of digestion organs 5.45.4 3.13.1 +74.2+74.2

14.014.0 Diseases of urogenital Diseases of urogenital systemsystem

5.05.0 4.64.6 +8.7+8.7

15.015.0 Congenital anomaliesCongenital anomalies 35.935.9 26.726.7 +34.0+34.0

Mortality of affected people according to the groups of Mortality of affected people according to the groups of primary count in 1989-2004 per 1000 persons.primary count in 1989-2004 per 1000 persons.

(Ministry of Health of Ukraine)(Ministry of Health of Ukraine)

02468

10121416182022

Роки

на 1000

1 група обліку 2 група обліку 3 група обліку 4 група обліку

Dynamics of collective dose of radiation exposure and Dynamics of collective dose of radiation exposure and mortality of irradiated people and all people in Ukraine.mortality of irradiated people and all people in Ukraine.

..

02468

10121416182022

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

020

4060

80100КД

Колективна доза опромінення (КД) Смертність постраждалого населенняСмертність населення

Смертність, х1000

Роки

Chernobyl catastrophe health Chernobyl catastrophe health effects effects

Stochastic effectsStochastic effects1. Thyroid1. Thyroid

Children from 17.3 thousand communities (60% from all communities of Ukraine) had an excess of irradiation dose rate limits to thyroid ( dose on thyroid more 50 mGy)

Number of thyroid cases in children and adolescents Number of thyroid cases in children and adolescents (0-18(0-18 years old at years old at the time of the Chernobyl accident.).the time of the Chernobyl accident.).

Number of thyroid cases in children and adolescents Number of thyroid cases in children and adolescents (0-18(0-18 years old at years old at the time of the Chernobyl accident.).the time of the Chernobyl accident.).

811 11

141111 24

1342

20

46

2383

35

83

46

104

43

117

66

138

54

136

61

170

81

217

67

180

69

274

85

243

88

245

105

278

92

0

50

100

150

200

250

300

350

400

86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

15-180-14

1919 2525 22223737

6262 6969

118118129129

147147

183183 192192 197197

251251

228844

249249

359359

331331335050

337070

Thyroid cancer in Children born before accident, after Thyroid cancer in Children born before accident, after

accidentaccident ( (I. Komissarenko, 2005).I. Komissarenko, 2005).

23

113

9491

95

105

81

73

5854

48

33

41

12

21

74

1313

2115

84222111311

0

20

40

60

80

100

120

Дети и подростки на момент аварии

Дети и подростки рожденные после аварии

Дети и подростки оперированные до аварии

1970-1989 y.295 (10) patients

1990-2005y.3124 (560) patients

Since 1990, i.e. starting after four years of latency, a quite remarkable increase of Since 1990, i.e. starting after four years of latency, a quite remarkable increase of thyroid cancerthyroid cancer incidence rate was observed, especially in children and juvenile age incidence rate was observed, especially in children and juvenile age

groups. (groups. (FGI, 2004)FGI, 2004)

0

2

4

6

8

10

12

14

16

18

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Regression coefficient b ± SE(b):The Ukraine: 0.15 ± 0.01

Contaminated areas: 1980-1986: (-0.14) ± 0.081987-1999: 0.79 ± 0.22

Thyroid cancer (ICD-9 193) incidence rates Thyroid cancer (ICD-9 193) incidence rates

in the districts most heavily contaminated in the districts most heavily contaminated

with radionuclides. Males + femaleswith radionuclides. Males + females

DINAMICS OF THYROID TUMOURS IN ADULTSDINAMICS OF THYROID TUMOURS IN ADULTS

422

498

238

306

452

588

237212

368

355377323

483

549

420400

191

28 2145

79

249

111

228

0

100

200

300

400

500

600

Доброкачественные Злокачественные

Cancer thyroid in adultsCancer thyroid in adults

0

5

10

15

20

25

30

35

40

45

1990 1992 1994 1996 1998 2000 2002 2004

Населення України УЛНА

Ста

нд

арти

зов

ані

по

казн

ики

на

1000

00 о

сіб

А Середня поглинута еквівалентна доза зовнішнього опромінення всього тіла 50-200 мЗв

05

101520253035404550

1990 1992 1994 1996 1998 2000 2002 2004

Населення України Евакуйовані

Ста

нд

арти

зов

ані

по

казн

ики

на

1000

00 о

сіб

В Середня поглинута еквівалентна доза опромінення щитовидної залози184.4 - 857.5 мЗв

0

2

4

6

8

10

12

14

1980 1983 1986 1989 1992 1995 1998 2001 2004

Населення УкраїниЗабр. території

Ста

нд

арти

зов

ані

по

казн

ики

на

1000

00 н

асел

енн

я

ССередня ефективна еквівалентна доза опромінення щитовидної залози 187 - 221 мЗв

Liquidators cancer increasing by 9-Liquidators cancer increasing by 9-fold (for female- by 13-fold);fold (for female- by 13-fold);

Amongst evacuees – by 6-fold;Amongst evacuees – by 6-fold;

Among residents of radioactive-Among residents of radioactive-contaminated territories – by 4.1-fold.contaminated territories – by 4.1-fold.(Source – National Report of Ukraine, 2006)(Source – National Report of Ukraine, 2006)

0

2

4

6

8

10

12

14

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

Ag

e-s

tan

dard

ised

in

cid

en

ce r

ate

per

10

0 0

00

Ukraine Kiev region Zhytomir region

Kiev city Contaminated territories

1962-1964 1969-

1972 1977-1979 1989-

19921993-1996

1997-2000

2001-2004

Males

Females

0

1

2

3

4

5

6

Dynamics of tDynamics of thyroid cancer incidence rate hyroid cancer incidence rate in Ukraine, Kiev, Zhytomir regions, Kiev in Ukraine, Kiev, Zhytomir regions, Kiev city and thecity and the territories most heavily territories most heavily contaminated contaminated with radionuclides with radionuclides in 1980-2004. in 1980-2004.

Age-standardized average annual thyroid cancer incidence rates in Ukraine in separate time periods (males and females)

INDICIES OF NEUROONCOLOGIC MORBIDITY INDICIES OF NEUROONCOLOGIC MORBIDITY DYNAMICS AMONG YANGER CHILDREN IN DYNAMICS AMONG YANGER CHILDREN IN

UKRAINEUKRAINEThe pre-Chernobyl period (1981-1985) – The pre-Chernobyl period (1981-1985) – 49 cases.49 cases.

The post - Chernobyl period - The post - Chernobyl period - 1986-1990 - 75 cases (1,9 -fold increase);1986-1990 - 75 cases (1,9 -fold increase);1991-1995- 116 cases (2,9- fold increase);1991-1995- 116 cases (2,9- fold increase);1996-2000- 85 cases (2,1 – fold increase);1996-2000- 85 cases (2,1 – fold increase);2001-2004- 94 cases (2,3 – fold increase).2001-2004- 94 cases (2,3 – fold increase).For children under one year old – 6,2 –fold For children under one year old – 6,2 –fold growth.growth.To account a decrease in birth rate To account a decrease in birth rate and natural reduction of absolute quantityand natural reduction of absolute quantityof children, the growth of average index 5,8of children, the growth of average index 5,8fold more is very significant.fold more is very significant.

Malignant tumour constitute 43% of allMalignant tumour constitute 43% of allcentral nervous system neoplasm incentral nervous system neoplasm inchildren aged under 3 years.children aged under 3 years.

1

10

100

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

кол

ич

еств

о н

абл

юд

ени

й

количество больных

0

10

20

30

40

50

60

70

80

злокачественные доброкачественные

LEUKEMIA IN UKRAINE!LEUKEMIA IN UKRAINE! What we know? What we know?

The preliminary analysis of infant leukaemia incidence in Kyiv city after The preliminary analysis of infant leukaemia incidence in Kyiv city after Chernobyl within 1986-1997 period showed also an increase in acute myeloid Chernobyl within 1986-1997 period showed also an increase in acute myeloid leukaemia and B-cell acute lymphoblast leukaemia leukaemia and B-cell acute lymphoblast leukaemia [Gluzman et al., 1999].[Gluzman et al., 1999].

At present leukaemia's rank first in the patterns of morbidity and mortality At present leukaemia's rank first in the patterns of morbidity and mortality due to malignancies in children of Ukraine aged 0-14 years due to malignancies in children of Ukraine aged 0-14 years [Fedorenko et al. [Fedorenko et al. In: In: Bull National Cancer Register of Ukraine 2004Bull National Cancer Register of Ukraine 2004]. ].

The stable tendency towards increased rates of acute lymphoid leukaemia's has The stable tendency towards increased rates of acute lymphoid leukaemia's has been noticed both in Ukraine as a whole and in particular regions being the been noticed both in Ukraine as a whole and in particular regions being the most contaminated with radionuclides most contaminated with radionuclides [[Noschenko A. and al. 2001; 2002; Noschenko A. and al. 2001; 2002; Pushkar LO and Klimnyuk GI, 2005Pushkar LO and Klimnyuk GI, 2005]. ].

Moreover, recently several limited studies of the infant leukaemia's after Moreover, recently several limited studies of the infant leukaemia's after Chernobyl have been performed also in several European countries with Chernobyl have been performed also in several European countries with particular emphasis on the children believed as having been exposed in utero particular emphasis on the children believed as having been exposed in utero (judging by the dates of their birth) (judging by the dates of their birth) [Petridou, et al., 1996; Michaelis et al., [Petridou, et al., 1996; Michaelis et al., 1997; 1997; Noschenko A. and al. 2001; 2002; Noschenko A. and al. 2001; 2002; D. Davidescu and all. 2004D. Davidescu and all. 2004, Davis S. and , Davis S. and al.2005al.2005]. ].

According to Ukrainian According to Ukrainian studies of Chstudies of Cheernobyl liquidators the incidence of leukemia, rnobyl liquidators the incidence of leukemia, especially in the group that received the dose of 150-300 mGy is increasing. Multiple especially in the group that received the dose of 150-300 mGy is increasing. Multiple myeloma incidence twofold increase within structure of hemodblastoses is found in myeloma incidence twofold increase within structure of hemodblastoses is found in

liquidators. Trent towards increase in chronic myeloid leukemia, non-Hodgkin’s malignant liquidators. Trent towards increase in chronic myeloid leukemia, non-Hodgkin’s malignant lymphomas in leukemization stage incidence is observed. In 20% of cases the acute leukemia lymphomas in leukemization stage incidence is observed. In 20% of cases the acute leukemia

is appearing among liquidators against the backdrop of myelodisplastic syndrome. The is appearing among liquidators against the backdrop of myelodisplastic syndrome. The question of increasing leukemia cases among adults is still open. question of increasing leukemia cases among adults is still open.

0

5

10

15

20

25

30

35

Chroniclymphocytic

leukemia

Multiplemyeloma

Largegranular

lymphocyticleukemia

Non-Hodgkin's

lymphoma inleukemization

phase

Chronicmyelogenous

leukemia

Rel

ativ

e fr

equ

ency

, %

Clean-up workers

General population

Lymphoma (ICD-9 200-203) incidence rates in the districts Lymphoma (ICD-9 200-203) incidence rates in the districts most heavily contaminated with radionuclides. most heavily contaminated with radionuclides.

0

1

2

3

4

5

6

7

8

9

10

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Regression coefficient b ± SE(b):Contaminated areas: 0.15 ± 0.08The Ukraine: 0.02 ± 0.02

Considering that leukemia incidence rate is the Considering that leukemia incidence rate is the principal indicator of possible radiation effects, it is principal indicator of possible radiation effects, it is critically important to continue wide scale critically important to continue wide scale epidemiological studies on the issue taking into epidemiological studies on the issue taking into account the factors of uncertainty in medical and account the factors of uncertainty in medical and dosimetry information. dosimetry information.

Special attention should be drawn to groups which Special attention should be drawn to groups which were in early age at the moment of Chernobyl were in early age at the moment of Chernobyl accident (exposed in utero, 0-9, 10-19 years old).accident (exposed in utero, 0-9, 10-19 years old).

( ( Resolution of Int. conf. 29 May-June 3, Kiev 2006). Resolution of Int. conf. 29 May-June 3, Kiev 2006).

NOTENOTE

OTHERS MALIGNANTOTHERS MALIGNANTTUMOURS MORBIDITYTUMOURS MORBIDITY

Incidence rates of main forms of solid cancers in districts most Incidence rates of main forms of solid cancers in districts most heavily contaminated with radionuclides (heavily contaminated with radionuclides (2004, FGI)2004, FGI)

Solid cancer incidence rate in territories of interest during is characterised by a Solid cancer incidence rate in territories of interest during is characterised by a moderately increasing;moderately increasing;

Tumour siteTumour site(code ICD-9)(code ICD-9)

SexSex Period (age standardised rate Period (age standardised rate standard error)standard error)

Rate ratio Rate ratio 2/12/1

(95% CI)(95% CI)

1980-1990 (1)1980-1990 (1) 1991-1999 (2)1991-1999 (2)

All solid cancers (140-203)All solid cancers (140-203) Males+femalesMales+females 160.83 160.83 2.12 2.12 186.71 186.71 3.17 3.17 1.12 - 1.221.12 - 1.22

Buccal cavity, pharynx Buccal cavity, pharynx (140-149)(140-149)

Males+females Males+females 10.48 10.48 0.54 0.54 12.08 12.08 0.77 0.77 0.98 - 1.360.98 - 1.36

Digestive system (150-159)Digestive system (150-159) Males+femalesMales+females 47.80 47.80 1.121.12 51.14 51.14 1.55 1.55 0.99 - 1.150.99 - 1.15

Respiratory system (160-Respiratory system (160-165)165)

Males+femalesMales+females 25.63 25.63 0.830.83 27.21 27.21 1.12 1.12 0.96 - 1.180.96 - 1.18

Skin (172, 173)Skin (172, 173) Males+femalesMales+females 15.49 15.49 0.63 0.63 14.71 14.71 0.80 0.80 0.83 - 1.080.83 - 1.08

Breast (174)Breast (174) FemalesFemales 16.82 16.82 0.970.97 25.31 25.31 1.67 1.67 1.25 - 1.811.25 - 1.81

Female genital organs Female genital organs (180-184)(180-184)

FemalesFemales 20.83 20.83 1.06 1.06 20.21 20.21 1.59 1.59 0.81 - 1.160.81 - 1.16

Prostate (185)Prostate (185) MalesMales 7.59 7.59 0.700.70 10.90 10.90 0.99 0.99 1.11 - 1.861.11 - 1.86

Bladder (188)Bladder (188) MalesMales 8.68 8.68 0.76 0.76 9.35 9.35 0.95 0.95 0.83 - 1.400.83 - 1.40

Brain (191)Brain (191) Males+femalesMales+females 3.40 3.40 0.36 0.36 4.11 4.11 0.63 0.63 0.83 - 1.770.83 - 1.77

Thyroid (193)Thyroid (193) Males+femalesMales+females 1.70 1.70 0.240.24 6.69 6.69 0.76 0.76 2.56 - 6.072.56 - 6.07

Lymphoma (200-203)Lymphoma (200-203) Males+femalesMales+females 4.86 4.86 0.430.43 6.52 6.52 0.71 0.71 1.01 - 1.791.01 - 1.79

Prostate cancer (ICD-9 185) incidence rates in the districts Prostate cancer (ICD-9 185) incidence rates in the districts most heavily contaminated with radionuclides.most heavily contaminated with radionuclides.

According to international evaluation, prostate cancer does not belong to According to international evaluation, prostate cancer does not belong to radiosensitive form of cancer. Study prostate cancer incidence rate grew radiosensitive form of cancer. Study prostate cancer incidence rate grew

up rapidly in 1987 and since then was much higher than in pre-accidental up rapidly in 1987 and since then was much higher than in pre-accidental period. period. (FGI ,2004)(FGI ,2004)

-

2,00

4,00

6,00

8,00

10,00

12,00

14,00

16,00

18,00

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Regression coefficient b ± SE(b):Contaminated areas: 0.33 ± 0.10The Ukraine: 0.41 ± 0.03

Breast cancer (ICD-9 174) incidence rates in the districts Breast cancer (ICD-9 174) incidence rates in the districts most heavily contaminated with radionuclides.most heavily contaminated with radionuclides.

Close attention should be drawn to breast cancer. After six or Close attention should be drawn to breast cancer. After six or seven years of a stable level of breast cancer incidence rate seven years of a stable level of breast cancer incidence rate

(with small fluctuations) a sharp increase has been observed (with small fluctuations) a sharp increase has been observed since 1992. This form of cancer belongs to radiosensitive form since 1992. This form of cancer belongs to radiosensitive form

of malignancies and needs close attention in the future.of malignancies and needs close attention in the future.

-

5,00

10,00

15,00

20,00

25,00

30,00

35,00

40,00

45,00

50,00

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002

Regression coefficient b ± SE(b):The Ukraine: 0.65 ± 0.03

Contaminated areas: 1980-1989: 0.06 ± 0.381990-1999: 1.06 ± 0.191980-1999: 0.78 ± 0.18

Other malignant tumor morbidity: all tumors in Other malignant tumor morbidity: all tumors in liquidators and evacuees peopleliquidators and evacuees people

0

50

100

150

200

250

1990 1992 1994 1996 1998 2000 2002 2004

Населення України УЛНА

Ста

нд

арти

зов

ані п

ока

зни

ки н

а 10

0000

нас

елен

ня

A Доза не встановлена

0

50

100

150

200

250

300

350

400

1990 1992 1994 1996 1998 2000 2002 2004

Населення України Евакуйовані

Ста

нд

арти

зов

ані п

ока

зни

ки н

а 10

0000

нас

елен

ня

В

Середня поглинута еквівалентна доза зовнішнього опромінення 10-30 мЗв 50-200 Зв

Because of different latency period of radiogenic forms of cancer there have to be drawn close attention to cancer of breast, lung, esophagus, stomach, bowl, ovary, lymphomas (multiple myeloma) etc.

Special attention should be drawn to groups of population irradiated at the beginning of life (in utero, young age 0-9, 10-19).

GENETIC DAMAGEGENETIC DAMAGE

According to government statistics, the frequency of According to government statistics, the frequency of congenital malformation in the affected regions IScongenital malformation in the affected regions IS

5-fold INCREASE5-fold INCREASE (2005) (2005). At the same time. At the same time IN ALL THE GROUPS MONITORED DURING IN ALL THE GROUPS MONITORED DURING

POSTACCIDENT PERIOD THE RATE OF POSTACCIDENT PERIOD THE RATE OF CHROMOSOME ABERRATIONS IN PERIFERAL CHROMOSOME ABERRATIONS IN PERIFERAL BLOOD LYMPHOCYTES SIGNIFICANTLY BLOOD LYMPHOCYTES SIGNIFICANTLY EXEEDED PRE-ACCIDENT INDICES EXEEDED PRE-ACCIDENT INDICES CHARACTERISTIC FOR SPONTANEOUS CHARACTERISTIC FOR SPONTANEOUS CHROMOSOME MUTAGENESIS. CHROMOSOME MUTAGENESIS.

Selective cytogenetic monitoring of childrenSelective cytogenetic monitoring of children((Pilinskaya M.A. and all. 2005).Pilinskaya M.A. and all. 2005).

1 2 3 4 5 6 7 8 9 10 11 12

Стабільні маркери Нестабільні маркери

Хромосомний типСередня частота

0

1

2

3

4

5

6

Ча

сто

та, %

1.Yagotin ,2.Kozelets, 3.Trostyanets, 4. Kiev, 5. Priryat, 6.Vilcha, 7. Мala -chernihivka, 8. Velika Chernihivka, 9. Preshotravneva, 10. Polisske, 11. Narodichi, 12. VistupoviciIn all groups the rate chromosome aberration in peripheral blood lymphocitytes significantly exceeded pre-accident indices. .

Heritable effectsHeritable effects in children with exposure in utero in children with exposure in utero ((Stepanova E.I. and all.2006Stepanova E.I. and all.2006))

4

6

8

10

12

14

16

18

0 100 200 300 400Эквивалентная доза на красный костный мозг, мЗв

Час

тота

хро

мос

омн

ых

абер

рац

ий Частота

аберрацийхромосом

Частотааберрантных клеток

Частотастабильныхаберраций

The cytogenetic examination The cytogenetic examination show the higher of aberrantshow the higher of aberrant cells and interdependence withcells and interdependence with equivalent dose of red boneequivalent dose of red bone morrow:morrow:Frequency of the chromosomeFrequency of the chromosomeaberrations per 100 cells;aberrations per 100 cells;

The doses of red The doses of red bone morrowbone morrow10—376 mSv10—376 mSv

It was testified that after irradiation in utero children, investigated in 14-16 years age, It was testified that after irradiation in utero children, investigated in 14-16 years age, accumulated the cell clones with specific types of cytogenetic anomalies (which did not lead accumulated the cell clones with specific types of cytogenetic anomalies (which did not lead to cell death, such as inversions, inserts, reciprocal translocations).to cell death, such as inversions, inserts, reciprocal translocations). It allows to suppose that It allows to suppose that in future we can meet with the reproductive problems in children, which were born after in future we can meet with the reproductive problems in children, which were born after 1986 y and obtained low doses of ionizing radiation in utero.1986 y and obtained low doses of ionizing radiation in utero. This process can complicate This process can complicate the forming of gametal cells ( the meiosis). the forming of gametal cells ( the meiosis). (Glazko E.I.,2006).(Glazko E.I.,2006).

The frequency of chromosome aberrations in lymphocytes of periphery blood The frequency of chromosome aberrations in lymphocytes of periphery blood of children, which were exposed of children, which were exposed in utero (in utero (group 1group 1) ) and living in radionuclide and living in radionuclide

pollution territories pollution territories ((groupgroup 2) (M 2) (M m) m)Group 1

n=8, (1600 metaphases)Group 2

n=8, (1600 metaphases)Types of chromosome

aberrationsFrequency (%) Frequency (%)

Translocations 0,37 0,10 0,18 0,10Deletions 1,25 0,30 0,68 0,20

Inversions 0,31 0,10 0,12 0,07Dicentric 0,06 0,05 0,06 0,05Circles 0,12 0,07 0

Insertions 0,31 0,12 0Pare fragments 0,06 0,05 0,18 0,10

Single fragments 0,12 0,07 0,06 0,05

An increased frequency rate of chromosome An increased frequency rate of chromosome aberrations was found in children who had been aberrations was found in children who had been exposed to combined 131 I and 137 Cs radiation. exposed to combined 131 I and 137 Cs radiation. The influence of thyroid pathology on induction of The influence of thyroid pathology on induction of chromosome non-stability in human somatic sells chromosome non-stability in human somatic sells was demonstrated.was demonstrated.

A deferred cytogenetic effects has been found in A deferred cytogenetic effects has been found in successive cell generations in the progeny of successive cell generations in the progeny of irradiated parents proving for real transmission irradiated parents proving for real transmission of chromosome non- stability. of chromosome non- stability.

(National Report of Ukraine, 2006)(National Report of Ukraine, 2006)

Where’s mutants!Where’s mutants! Later 20 years after Chernobyl catastrophe the experimental Later 20 years after Chernobyl catastrophe the experimental

investigations in 30-km zone and numerous investigations in humans permit investigations in 30-km zone and numerous investigations in humans permit to make the follow unfavorable conclusions:to make the follow unfavorable conclusions:

the main problem of habitants of ecologic naturally changes is not in the main problem of habitants of ecologic naturally changes is not in received dose of irradiation, but in their newness;received dose of irradiation, but in their newness;

the main population consequences there not in the decreasing of mutants, the main population consequences there not in the decreasing of mutants, but pauperization of genetic found: from reproduction go out the genes but pauperization of genetic found: from reproduction go out the genes what it is responsible for sensibility of organisms to new radioecological what it is responsible for sensibility of organisms to new radioecological conditions. So, survive the individuals with the least specialized conditions. So, survive the individuals with the least specialized genotypes.genotypes.

The mutants did not born! The mutants did not born! Because first of all maybe the gametes don’t develop into from defective Because first of all maybe the gametes don’t develop into from defective

pre meiosis cells, or the embryos are eliminating on early stage of pre meiosis cells, or the embryos are eliminating on early stage of development, or its not able to implantation.development, or its not able to implantation.

The contribution of Chernobyl accident in changes of humans gene found The contribution of Chernobyl accident in changes of humans gene found should be estimated through several years because the generation what should be estimated through several years because the generation what was born after accident only now start in reproductive period.was born after accident only now start in reproductive period.

The risk of spontaneous abortion, cumulative year dose The risk of spontaneous abortion, cumulative year dose and fact of residing on contaminated territories.and fact of residing on contaminated territories.

Cumulative Cumulative dosedose

All womenAll women Women 19-30 oldWomen 19-30 old

OROR ДІДІ OROR ДІДІ

DoseDose 1,361,36 1,14-1,631,14-1,63 1,231,23 1,00-1,531,00-1,53Up toUp to 5,0 5,0mSvmSv 1,331,33 1,09-1,631,09-1,63 1,221,22 0,96-1,550,96-1,555,05,0mSv and moremSv and more 1,421,42 1,10-1,831,10-1,83 1,261,26 0,94-1,700,94-1,70

Spontaneous abortion risk is increasing if cumulative dose reach 5mSv.Spontaneous abortion risk is increasing if cumulative dose reach 5mSv.A.M, Serdyk and all (2004, 2006).A.M, Serdyk and all (2004, 2006).

DETERMINISTIC EFFECTS DETERMINISTIC EFFECTS

LIQUIDATORS!LIQUIDATORS!For today we don’t know accuracy how many liquidators were! What For today we don’t know accuracy how many liquidators were! What

why for therefore it is hard to estimate the real those health riskswhy for therefore it is hard to estimate the real those health risks 1997 – 339 6661997 – 339 6662006 – 268 8152006 – 268 815 71851 (24%) persons go out. Where?71851 (24%) persons go out. Where? We have not the accuracy information about they. We have not the accuracy information about they.

Liquidators and those families are living in many Liquidators and those families are living in many states in the world:states in the world:

SEE!SEE!

CountriesCountries 20062006UKRAINEUKRAINE

BelarusBelarus

Russian FederationRussian Federation

ArmeniaArmenia

Azerbaijan Azerbaijan

GeorgiaGeorgia

Kazakhstan Kazakhstan

KyrgyzstanKyrgyzstan

LatviaLatvia

LithuaniaLithuania

MoldovaMoldova

UzbekistanUzbekistan

TajikistanTajikistan

Turkmenistan Turkmenistan

EstoniaEstonia

IsraelIsrael

USAUSA

268 815-?268 815-?

200 000 -?200 000 -?

200 000 -? 200 000 -?

22002200

60006000

20002000

3000030000

18101810

50205020

71247124

45004500

1000010000

21502150

20002000

30003000

10561056

4000 ?4000 ?

How many liquidators we have?How many liquidators we have?

Liquidators Liquidators DOSIMETRY DOSIMETRY

0,1

0,25

0,019

0,8

0,013

0,6

0,009

0,3

0,036

0,1

0,035

0,2

0,03

0,19

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

3213 4824 4994 5706 6221 6662 6826Номер образца

Индивидуальные дозы "ликвидаторов", измеренные методом ЭПР эмали зубов, в сравнении с "официальной"

дозой (n=7)

"Официальная" доза, Sv ЭПР доза, Gy

Дозаоблучения

(Gy/Sv)

1 Sv=1 Gy

Doses of radiation to which liquidators and emergency Doses of radiation to which liquidators and emergency clean-up workers were subjected are in the average clean-up workers were subjected are in the average range and low intensity limits of 50-200 mSv. But due range and low intensity limits of 50-200 mSv. But due to the absence of effective dosimetric control and to the absence of effective dosimetric control and because of complicated and uninvestigated radiation because of complicated and uninvestigated radiation conditions many liquidators received doses of over 1Gy conditions many liquidators received doses of over 1Gy during the 1.5 months following nuclear accident. during the 1.5 months following nuclear accident. This would include many people, especially nuclearThis would include many people, especially nuclear power plant personnel, firemen, military people, miners,power plant personnel, firemen, military people, miners, construction workers who built the tunnels and shelter construction workers who built the tunnels and shelter around destroyed reactor and in the later period on thearound destroyed reactor and in the later period on the roof of the 3rd unit of the Chernobyl NPP. roof of the 3rd unit of the Chernobyl NPP. We can state that among those groups there are people inWe can state that among those groups there are people in whom the ARS was never clinically established. As awhom the ARS was never clinically established. As a whole, the information about the dosimetric state of whole, the information about the dosimetric state of liquidators is incomplete (only 50% of this informationliquidators is incomplete (only 50% of this informationabout received doses of radiation is available) and unclear about received doses of radiation is available) and unclear (since it is unknown how accurate the available records (since it is unknown how accurate the available records aboutabout these doses may be). This data in its current state cannotthese doses may be). This data in its current state cannot be used to assess radiation risks and to analyze real be used to assess radiation risks and to analyze real radiation medical effects of the explosion and needs radiation medical effects of the explosion and needs revisionrevision..

LIQUIDATORS MORBIDITY(by Registry of military LIQUIDATORS MORBIDITY(by Registry of military liquidators of Ministry Internal Affaires of Ukraine)liquidators of Ministry Internal Affaires of Ukraine)

1347

2039,9±180

1548,4±162,9

1415.8±103

3085±260

3060±142

1999±111

4246

3736

2617

0

500

1000

1500

2000

2500

3000

3500

4000

4500

0/00

КГБ, МВД 1985 г. 1987 - 1995 1996 - 2004 Уровень 2004 г.

Динамика распространенности заболеваний у ЛПА на ЧАЭС СБ и МВД

Украины в послеаварийном периоде (в 0/00)

СБУ МВД Контрольная группа

I период II период

*

* *

* - достоверность различия в сравнении с контрольной группой

The Dynamics of common sickness rate of circulatory The Dynamics of common sickness rate of circulatory diseases.diseases.

430,7

383,9

529,5

411,6

638,7

566,2575,0550,5

410,4386,7

283,1314,4302,0

270,0253,3

212,8

263,9

206,4195,3

240,0

333,3 338,6321,8 324,6 310,3

762,3

796,6

892,2 877,7911,2y = 52,249x + 120,16

R2 = 0,8869

y = 27,851x + 125,24

R2 = 0,8916

0

100

200

300

400

500

600

700

800

900

1000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

ВС-УЛА на ЧАЕС

Контрольна група

%0

роки

Prevalence of psychological disorders in liquidators Prevalence of psychological disorders in liquidators (2005(2005, FGI project, FGI project))

0

5

10

15

20

25

30

35

40

All mentaldisorders

Depression

Liquidators

Ukrainianpopulation

21,4

80,5

22,420,4

0

10

20

30

40

50

60

70

80

90

<0,25 Зв >0,25 Зв SIP - вхіднийконтроль

Україна(ВООЗ)

%

There is practically two-fold increase of the prevalence of any mental disorders (36%) in liquidators in comparison with Ukrainian general population (20.5%); dramatically increase of the prevalence of depression (24.5%) in liquidators in comparison with Ukrainian general population (9.1%). Anxiety (panic disorder) is also increased in liquidators (12.6% vs 7.1%). At that time, there is no clear cut distinction increasing of alcohol dependence in liquidators (8.6% vs 6.4%).

CEREBROVASCULAR DISEASES - ENCEPHALOPATHY SYNDROMCEREBROVASCULAR DISEASES - ENCEPHALOPATHY SYNDROMThe postradiation brain organic syndrome is compressed by micro focal The postradiation brain organic syndrome is compressed by micro focal neurological signs, personality disorders, negative psychopathological neurological signs, personality disorders, negative psychopathological symptoms, depression and cognitive deficit. Atherosclerotic changes, symptoms, depression and cognitive deficit. Atherosclerotic changes, hypertensive vessel tonus, interhemispheric asymmetry of blood supply, hypertensive vessel tonus, interhemispheric asymmetry of blood supply, angiosclerosis, as well as high frequency of stenos were the causes of angiosclerosis, as well as high frequency of stenos were the causes of cerebral haemodynamics disorders. Brain atrophy, enlargement of ventricula, cerebral haemodynamics disorders. Brain atrophy, enlargement of ventricula, and lacunar brain abnormalities, supported the cerebral-organicand lacunar brain abnormalities, supported the cerebral-organic nature of the nature of the disorders.disorders.

Distribution of irradiation doseDistribution of irradiation dose ratio ratio (UACOS) in liquidators.(UACOS) in liquidators.

CATARACTACATARACTAIn fact, it is observed that the appearance of radiation-induced cataracts among In fact, it is observed that the appearance of radiation-induced cataracts among all groups of survivors, and especially the liquidators, is increasing. Much lower all groups of survivors, and especially the liquidators, is increasing. Much lower

threshold of irradiation doses is set for cataract development compared to earlier threshold of irradiation doses is set for cataract development compared to earlier assessments.assessments.

It has been found that radiation cataract can develop due not only to high radiation doses much It has been found that radiation cataract can develop due not only to high radiation doses much lower than 1 Gy and should be considered as a stochastic effect of radiation exposure. No lower than 1 Gy and should be considered as a stochastic effect of radiation exposure. No

threshold absorbed dose. ( Fedirko P.,2005) threshold absorbed dose. ( Fedirko P.,2005)

0

100

200

300

400

500

600

700

800

0 50 100 150 200 250 300 350 400 450 500 550 600 650 700

Total dose, mSv

Fre

qu

ency

0

1

2

3

4

5

6

7

8

9

10

<8,9 8,9~11 11~18,7 18,7~24 >24

ДозаR

RThe risk of cataract development in liquidators Dose cGy and age (< 40, 40-55, >55 old)

Threshold absorbed dose 0,12 Sv was establish for neuropsychiatric and psychophysiology pathology also. Organic syndromes have been observed on absorbed dose 0,3-0,5 Sv..

Alterations in thyroid system are marked characteristic for thyroid irradiation non-Alterations in thyroid system are marked characteristic for thyroid irradiation non-stochastic effects gradual progress within all period extent passed since the Chernobyl stochastic effects gradual progress within all period extent passed since the Chernobyl NPP accident. Direct time link to radiation factor, dose-dependence and dose threshold NPP accident. Direct time link to radiation factor, dose-dependence and dose threshold

presence are characteristic signs of non-stochastic radiation effects.presence are characteristic signs of non-stochastic radiation effects.

Non-tumor thyroid pathologies (autoimmune thyroiditis and its complications, hypothyroidism) are currently discovered among 30-40% of survivors. The quality of life with thyroid pathologies is worsening due to the necessity of lifelong treatment, as well as due to the addition of other somatic diseases linked to insufficient hormonal regulation (myocardiopathy, obesity, high blood pressure, as well as pre-term aging and dysfunction of somato-sexual development).

0

50

100

150

200

250

300

350

1992 1993 1994 1995 1996 1997 1998 1999 2000

Мешканці контрольованих територій

Евакуйовані з 30-км зони відчуження

Ліквідатори аварії на ЧАЕС

Pregnancy and thyroid Pregnancy and thyroid

0

20

40

60

80

26 cГр 36 cГр Контроль

% фізіологічної вігітності

Normal pregnancy - 25.8 (26cGy)and 12.5% ( dose 36cGy) and 63,3% in control group. Children born by irradiated woman recently confined 1,5-2 - fold had more deflections in physical development.

0

1000

2000

3000

4000

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Роки

‰

Дорослі евакуйовані Дорослі евакуйовані

Доросле населення України Доросле населення України

Захворюваність Поширеність

Evacuees and Resettled Evacuees and Resettled survivorssurvivors164 700 thousand- 52 000 164 700 thousand- 52 000 families in 2006 INCIDENCE families in 2006 INCIDENCE and PREVALENCEand PREVALENCE

The evacuated adult population disability The evacuated adult population disability indices since 1988 to 2003 increased from indices since 1988 to 2003 increased from 4,6% to 103,4%.4,6% to 103,4%.National Report, Ukraine 2006National Report, Ukraine 2006

NOTENOTE

It was accepted that growth of somatic It was accepted that growth of somatic illnesses among victims wasn’t linked directly illnesses among victims wasn’t linked directly to the radiation factor, but to the contrary it is to the radiation factor, but to the contrary it is dependant on the dose of radiation and time dependant on the dose of radiation and time under risk as well. These illnesses include under risk as well. These illnesses include endocrine system and metabolic diseases, endocrine system and metabolic diseases, psychological disturbances, diseases of the psychological disturbances, diseases of the nervous system, sensory organs and digestive nervous system, sensory organs and digestive tract organs, cerebral-vascular diseases, tract organs, cerebral-vascular diseases, essential arterial hypertension, and cataracts.essential arterial hypertension, and cataracts.

State of Health of State of Health of ССHILDRENHILDREN

About 20% of all children About 20% of all children population in Ukraine population in Ukraine inhabit the territories where inhabit the territories where the level of radionuclides is the level of radionuclides is above the background one. above the background one.

Dynamic of non-tumour diseases prevalence (per 10 000) Dynamic of non-tumour diseases prevalence (per 10 000) among children and adolescent affected due to the among children and adolescent affected due to the

Chernobyl catastrophe. Chernobyl catastrophe. (National Report of Ukraine,2006).(National Report of Ukraine,2006).

Presently in the structure Presently in the structure of disease incidence of of disease incidence of children of 0-14 years children of 0-14 years predominant are diseases predominant are diseases of the respiratory, nervous, of the respiratory, nervous, digestive and blood digestive and blood systems, skin and systems, skin and subcutaneous tissue subcutaneous tissue diseases. The most diseases. The most unfavorable changes have unfavorable changes have been observed in been observed in adolescents with high adolescents with high doses of thyroid gland doses of thyroid gland irradiation and in irradiation and in adolescent irradiated in adolescent irradiated in utero. utero.

24373

30651

32350

46452 47536 47854 4813848958

18845

18599

19152

17403

17729

17527

17833

17893

0

10000

20000

30000

40000

50000

60000

1989 1992 1994 1995 1997 1999 2001 2003-2004

Постраждалі Контроль

Value of thyroid gland dose correlate with health Value of thyroid gland dose correlate with health status of children and adults. In this cohort of survivors status of children and adults. In this cohort of survivors

only 2,8% are healthy.only 2,8% are healthy.

(Stepanova E.I., 2006)

0

5

10

15

20

25

30

<0,2 0,3-0,75 0,75-2,0 >2,0

%

Children irradiated in utero.Children irradiated in utero.Thyroid DoseThyroid Dose exposure – in the range exposure – in the range 0,1 0,1 -- 28,5 28,5 GyGy (I-131,132,129, ); (I-131,132,129, );

Dose of Dose of hole-body irradiation - hole-body irradiation - 5,0 5,0 -- 376,0 376,0 mSvmSv due to external due to external gamma –radiation and internal radiation ( Cs -137 and Sr-90). gamma –radiation and internal radiation ( Cs -137 and Sr-90).

Especially high are the doses to the fetal thyroid. There were children from Pripyat (33.8%) Especially high are the doses to the fetal thyroid. There were children from Pripyat (33.8%) who had been exposed in utero to thyroid doses >1 Sv; (13.2%) received in utero fetal doses who had been exposed in utero to thyroid doses >1 Sv; (13.2%) received in utero fetal doses

of >100 mSv.( Nyagu A.I., Stepanova E.I., Repin V.S. and all.,2000, 2004)of >100 mSv.( Nyagu A.I., Stepanova E.I., Repin V.S. and all.,2000, 2004)

92,80%

0,10%

2,30%

4,80%

Внешнее гаммаоблучение

Облучениещитовидной железы

Внутреннее облучениеот Cs-137

Внутреннее облучениеот Sr-90

Distribution of children by periods of Distribution of children by periods of

cerebrogenesis at the time of explosion cerebrogenesis at the time of explosion (April 26th, 1986)(April 26th, 1986)

5

10

15

20

25

30

35

40

0–7 8–15 16–25 26+

Weeks after fertilisation

Exposed groupin Pripyat(n=154)

Comparisongroup from Kiev(n=143)

P<0.01

P>0.05

P>0.05

P>0.05

%

In exposed group there are less children who were at the earliest stages of prenatal development (0–7 weeks after conception) that could be explained with abortions and miscarriages due to the Chernobyl accident

Dose on embryo and foetus distributionDose on embryo and foetus distribution

(ICRP-88)(ICRP-88)

0102030405060708090

1000–

2.7

10.4

–20

20–4

0

40–6

0

60–8

0

80–1

00

100–

120

140–

160

160–

180

180–

200

200–

220

220–

240

240–

260

260–

269.

2

Dose range, mSv

Exposed group in Pripyat(n=151)Comparison group fromKiev (n=142)

%

Exposed group: M±SD — 65.4±33.9 mSv, Median — 61.6 mSv Comparison group — 1.2±0.3 mSv, Median — 1.2 mSv

Dose on thyroid Dose on thyroid in uteroin utero distribution distribution (ICRP-88)(ICRP-88)

0102030405060708090

100

0

0–20

0

201–

400

401–

600

601–

800

801–

1000

1001

–120

0

1201

–140

0

1401

–160

0

1601

–180

0

1801

–200

0

2001

–220

0

2201

–240

0

2401

–260

0

2601

–280

0

2801

–300

0

3001

–320

0

3201

–321

0.5

Dose range, mSv

Exposed group in Pripyat(n=152)

Comparison group from Kiev(n=143)

%

Exposed group (M±SD) — 760.4±631.8 mSv, Median — 746.3 mSv Comparison group — 44.5±43.3 mSv, Median — 27.4 mSv

0,4 40,9

623,7

1225,5

0

200

400

600

800

1000

1200

0–7 8–15 16–25 26+

Weeks of gestation

mSv

According to the model by ICRP-88there is a strong influence of gestational age on the thyroid doses in utero: laterintrauterine period at the time of exposure — higher the thyroid doses in utero

Intelligence of children (WISC) Intelligence of children (WISC) Full scale IQFull scale IQ

108

110

112

114

116

118

120

Exposed groupin Pripyat(n=140)

Comparisongroup from Kiev

(n=136)

There are significant (P<0.001) differences on intelligence of exposed children: a lower total IQ due to a lower verbal IQ and a higher rate of disharmonic intellect than unexposed children. A radioneuroembriological effects has been identified for cases intrauterine exposes on the 8th and later weeks of gestation with exposure of the embryo and fetus to more 20mSv and doses of thyroid gland in utero more 300mSv.

Diseases of Nervous System (G) and Diseases of Nervous System (G) and Mental and Behavioral Mental and Behavioral Disorders (F)Disorders (F)according to the ICD-10 in children.according to the ICD-10 in children.

Prenatally exposed children have more neuropsychiatric disorders than the Prenatally exposed children have more neuropsychiatric disorders than the control children from Kiev for the following categories: 1) paroxysmal states; control children from Kiev for the following categories: 1) paroxysmal states;

2) organic mental disorders; 3) neurotic, stress-related and somatoform 2) organic mental disorders; 3) neurotic, stress-related and somatoform disorders; 4) disorders of psychological development; 5) childhood disorders; 4) disorders of psychological development; 5) childhood

behavioural and emotional disorders.behavioural and emotional disorders.

0

10

20

30

40

50

60

70

80

90

Healthy G40(assumed)

G43 G44 G47 G80 G90

Exposed groupin Pripyat(n=154)

Comparisongroup from Kiev(n=143)

P<0.01

%

P<0.05

P<0.05

P>0.05 P>0.05 P<0.05

P<0.001

0

10

20

30

40

50

60

Healthy F06 & F07 F40–F48 F51 F70 F80–F89 F90–F98

Exposed groupin Pripyat(n=154)

Comparisongroup from Kiev(n=143)

P<0.001

%

P<0.01

P<0.01P>0.05P>0.05

P>0.05

P<0.001

Mother’s stress eventsMother’s stress events

0

2

4

6

8

10

12

14

16

Exposed groupin Pripyat(n=136)

Comparisongroup from Kiev

(n=62)

Mothers of children evacuated from Pripyat experienced much more (P<0.001) real stress events (evacuation, lack of information about relatives, migration, difficulties of medical care, etc.)There is a significant (P<0.001) mental health problems in mothers of children evacuated from Pripyat: PTSD (0,001) Depression (0,001) Somatoform disorders (0,001) anxiety, insomnia (0,001) Social dysfunction (0,04)Severe depression(0,01)

Children born by exposed parents Children born by exposed parents also demonstrate poor health.also demonstrate poor health.

The number of healthy children is 2,5-9,2% The number of healthy children is 2,5-9,2% (control group - 18,6-24,6%). This cohort is (control group - 18,6-24,6%). This cohort is characterized by a retardation of characterized by a retardation of biological age, immunity disorders, more biological age, immunity disorders, more often manifest external disembriogenetic often manifest external disembriogenetic stigmata, minor malformations of internal stigmata, minor malformations of internal organs and congenital malformations, organs and congenital malformations, enhanced mutations processes both in enhanced mutations processes both in indicator cells and target cells. indicator cells and target cells. National Report, 2006National Report, 2006

There is a continuous increase in the following changes in the state of health of children in various cohorts under observation: - among children who were born to Chernobyl liquidators there has been an increase in the incidence of illnesses of the central nervous system, congenital birth defects and rare forms of genetic anomalies; - among children who were exposed during the period of intra-uterine gestation, there is a high risk of developing chronic somatic pathologies, disorders of the thyroid gland, pathologies of bone and cartilage, psychological disorders and the development of tumors;

- among those who were children or adolescents at the time of Chernobyl accident and subjected to combined exposure to cesium and iodine there have been registered the highest risk of tumors and other illnesses of the thyroid gland. -Experts predict a further increase in pathologies of the thyroid, which will make a robust contribution to the deterioration of the general health of affected populations, and the disruption of reproductive health of young women;

- in the first generation of irradiated persons who continue to live on radioactivelycontaminated territories, there is also an increasing risk of children born with congenital malformations and hereditary diseases.Conclusion on International Conference. Kiev, June 2006

Psychological consequences and childrenPsychological consequences and children Abnormal psychological development has been detected Abnormal psychological development has been detected in 60-70% of in 60-70% of

children and teenagers exposed to radiation. This is twochildren and teenagers exposed to radiation. This is twoholdhold higher higher than among general population.than among general population.

The mental state children of all cohorts is significantly worse The mental state children of all cohorts is significantly worse compared to that of controlled groups: self-sensation as a victim, lack compared to that of controlled groups: self-sensation as a victim, lack of initiative, rental aims. of initiative, rental aims. More than 60% of teenagers see their futures More than 60% of teenagers see their futures away from home because radiation pollution; away from home because radiation pollution; Children from the high-Children from the high-risk groups risk groups are becoming the carriers of a crisis psychologyare becoming the carriers of a crisis psychology (mentality) (mentality) and as a result will spread a crisis relationship in society. Inadequate and as a result will spread a crisis relationship in society. Inadequate parental or family environments as well as the circumstances of their parental or family environments as well as the circumstances of their immediate surroundings – teachers, doctors will contribute to a immediate surroundings – teachers, doctors will contribute to a heightened level of anxiety, fear and lowered self-esteem. heightened level of anxiety, fear and lowered self-esteem.

What why the concept of “psychological rehabilitation” should be What why the concept of “psychological rehabilitation” should be shifted in the direction of the concept of “education and psychological shifted in the direction of the concept of “education and psychological correction”. correction”.

NOTENOTE Methods of risk assessment for exposures to low-dose Methods of risk assessment for exposures to low-dose

radiation (more typical for the population exposed to radiation (more typical for the population exposed to the Chornobyl disaster) are not yet developed. That is the Chornobyl disaster) are not yet developed. That is why the results of post-Chornobyl epidemiological why the results of post-Chornobyl epidemiological studies must have first-priority in assessing the studies must have first-priority in assessing the scientific and practical significance for the scientific and practical significance for the assessment of low-dose radiation influence on people. assessment of low-dose radiation influence on people. The results should be obtained from direct monitoring The results should be obtained from direct monitoring with the same-time usage of all-national cancer with the same-time usage of all-national cancer studies data and national registry data. studies data and national registry data.

Chernobyl is a reminder for international community Chernobyl is a reminder for international community should to consolidate efforts to build safe future.should to consolidate efforts to build safe future.