International Bf. S Workshop on the Chernobyl Accident Health Consequences Munich 9 -10 November 2006, Germany HEALTH OF SURVIVORS IN UKRAINE IN 20 -YEARS DYNAMICS AFTER THE CHERNOBYL CATASTROPHE Professor Dr Angelina I. Nyagu Ministry of Public Health of Ukraine, Association “ Physicians of Chernobyl”
Distribution of Cs-137 in Ukraine before 1985 y
Distribution of Cs-137 in Ukraine after accident in 1998 y (Water)
Irradiation dose of population in Polesye region in Ukraine is forming in result of: inhalation dose-0, 1%; internal exposure with water- 2%, external exposure-5 -20%; internal exposure with food -8095%. (Ministry of Health of Ukraine, 2006)
Level exceeding concentration of radionuclids in foodstuff ( milk, meat, soft-fruit, mushrooms, herbs) in Ukrainian regions: Volyn, Zhitomyr, Kievska, Rovno, Chernygov oblast. (Source- Ministry of Health of Ukraine)
Population health in Ukraine Data of Ministry of Health Long-term screening separated the survivors into the following categories subject 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 -2006 yy. Categories of the survivors and Number On 1997 -2006 yy. • Category 1997 2 2005 2006 to 1997% 59582 1 - Invalids 2000 86775 105251 106824 • 179 276 072 268815 • 79 • 197 817 191 167 76 (24%) • 90 78 255 77 647 339666 • 307 352939 277 135 86726 80 847 558637 549 69 620 62729 489 017 Including: 2 a- 1986 -1987 yy. liquidators 982 2 b- survivors- evacuees • Category 3 • 533144 • 95 55 391 52346 • 75 486 720 482113 • 480798 • 98 1 169 804 1 150273 1 081 469 2530 • 2862 • 2780 Including: 3 a 1987 -1990 liquidators 3 b survivors Category 4 • Category D: people who worked beyond the territory of the exclusion Zone • Children survivors (including those with thyroid gland irradiation in 1986) • 1 083 107 • 1 264 329 • Total • 3 213 326 • 3 361 870 • (Died 504 117 persons? ? ? ) • 537 • 643 • 2 504 030 646 106 • 1 065 022 • 2606 • 617 660 2 594071 • 91 • 103 • 57 • 81
Number of people living in different contaminated territories in Ukraine Indices Number of settlements Total Exlusion zone) Zone 2 15 -40 Ci/km 2) Zone 3 Zone 4 5 -15 Ci/km 2) (1 -5 Ci/km 2 2293 76 92 835 1290 2291. 93 0. 12 9. 04 637. 23 1645. 54 Including Children under 14 488. 69 0 1. 87 150. 16 336. 66 Territories (km 2) 53454 2122 2003 22619 26710 Including forests 25357 1058 1315 14194 8790 Population (in thousands) 73 rayons, 12 oblasts (Vinnitsa, Volyn, Zhytomir, Ivano-Frankovsk, Kiev, Rivnae, Sum, Thernopil, Khmelnitsk, Cherkasska, Chernivetska, Chernihivska).
Kiev 1986 (spring) n These are the official figures but many believe the reality is much worse because these data do not include the 3 million people living in the capital of Kiev, which is less than 100 kilometres away from Chernobyl. Residents of Kiev were exposed to fallout from the accident including radioactive iodine. According to research conducted at the Nuclear Research Institute and the Geology Institute of the National Academy of Sciences of Ukraine, Kiev should have been classified as part of the third zone.
UKRAINIAN STATE Chernobyl REGISTRY 01. 2006 2 252 130 (from 2 594 071 ) persons
Dynamic of birth-rate and mortality of population of the most contaminated regions and according of the groups of primary count per 1000 persons (Ministry of Health of Ukraine). People on polluted territories in Ukraine suffer protracted medical and demographic crises in the form of increase of birth-rate, decrease of aging mortality, short-cut of life expectancy and qualitative changes of structure of death cause. The most heavily contaminated regions have a lower level of the human development index.
HEALTH (state statistics) 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 SURVIVORS on 10 thousand (Ministry of health of Ukraine) 1987 y 2005 y NEOPLASMS 22, 9 82, 25 MALIGNANT NEOPLASMS 15, 3 36, 86 Endocrine diseases system 63, 2 149, 27 Incl. Thyroid diseases 34, 0 96, 95 Hematological diseases system 8, 5 39, 61 Incl. anemia 0, 0 31, 27 Mental disorders 24, 9 51, 87 Nervous system diseases 286, 2 212, 97 Cardiovascular system diseases 223, 8 585, 20 Respiratory system diseases 315, 4 2091, 4 Digestive system diseases 104, 1 319, 59 Urogenital system diseases Skin and subcutaneous tissue diseases 71, 8 456, 76 119, 5 331, 89 Muscular – skeletal diseases 69, 4 322, 99 Injuries and poisoning 0, 0 508, 13 1372, 9 6017, 8 Classes of diseases All
Dynamics of morbidity in children survivors ( per 10000 Classes of diseases persons) 1987 y 2005 y NEOPLASMS 0, 27 2, 5 Malignant neoplasms 0, 1 0, 2 Endocrine system diseases 23, 3 49, 9 Including Thyroid diseases 15, 7 36, 9 Hematological diseases 14, 2 39, 4 Incl. Anemia (iron – deficient) 0, 0 28, 2 Mental disorders 2, 6 5, 6 Nervous system diseases 15, 2 26, 7 Cardiovascular system diseases 7, 6 18, 4 Respiratory system diseases 314, 2 874, 6 Digestive system diseases 23, 9 76, 3 Urogenital system diseases 3, 3 22, 7 Skin and subcutaneous tissue diseases 17, 7 72, 9 Muscular-skeletal system diseases 11, 4 40, 0 Certain conditions originating in perinatal period 0, 0 9, 25 Congenital diseases 0, 8 4, 9 455, 4 1437, 8 ALL diseases
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) Clas s of dise ases Names of class diseases An average index for examined provinces An average index for other provinces of Ukraine Percent difference between compared indexes 2. 0 Neoplasm 7. 6 5. 5 +38. 2 3. 0 Diseases of blood and hemopoietic organs 2. 7 2. 5 +8. 0 4. 0 Diseases of endocrine system 12. 2 11. 2 +8. 9 5. 0 Mental and behavioral disorders 37. 5 41. 7 -10. 1 6. 0 Diseases of nervous system 44. 4 41. 3 +7. 5 10. 0 Diseases of respiration organs 15. 0 12. 9 +16. 3 11. 0 Diseases of digestion organs 5. 4 3. 1 +74. 2 14. 0 Diseases of urogenital system 5. 0 4. 6 +8. 7 15. 0 Congenital anomalies 35. 9 26. 7 +34. 0
Mortality of affected people according to the groups of primary count in 1989 -2004 per 1000 persons. (Ministry of Health of Ukraine)
Dynamics of collective dose of radiation exposure and mortality of irradiated people and all people in Ukraine. .
Chernobyl catastrophe health effects Stochastic effects 1. 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 m. Gy)
Number of thyroid cases in children and adolescents (0 -18 years old at the time of the Chernobyl accident. ). 370 359 350 331 284 251 183 118 62 69 19 25 22 37 129 147 192 197 249
Thyroid cancer in Children born before accident, after accident (I. Komissarenko, 2005). 1970 -1989 y. 295 (10) patients 1990 -2005 y. 3124 (560) patients
Since 1990, i. e. starting after four years of latency, a quite remarkable increase of thyroid cancer incidence rate was observed, especially in children and juvenile age groups. (FGI, 2004) Thyroid cancer (ICD-9 193) incidence rates in the districts most heavily contaminated with radionuclides. Males + females
DINAMICS OF THYROID TUMOURS IN ADULTS
Cancer thyroid in adults Liquidators cancer increasing by 9 fold (for female- by 13 -fold); Amongst evacuees – by 6 -fold; Among residents of radioactivecontaminated territories – by 4. 1 fold. (Source – National Report of Ukraine, 2006)
Dynamics of thyroid cancer incidence rate in Ukraine, Kiev, Zhytomir regions, Kiev city and the territories most heavily contaminated with radionuclides in 1980 -2004. Age-standardized average annual thyroid cancer incidence rates in Ukraine in separate time periods (males and females)
INDICIES OF NEUROONCOLOGIC MORBIDITY DYNAMICS AMONG YANGER CHILDREN IN UKRAINE The pre-Chernobyl period (1981 -1985) – 49 cases. The post - Chernobyl period 1986 -1990 - 75 cases (1, 9 -fold increase); 1991 -1995 - 116 cases (2, 9 - fold increase); 1996 -2000 - 85 cases (2, 1 – fold increase); 2001 -2004 - 94 cases (2, 3 – fold increase). For children under one year old – 6, 2 –fold growth. To account a decrease in birth rate and natural reduction of absolute quantity of children, the growth of average index 5, 8 fold more is very significant. Malignant tumour constitute 43% of all central nervous system neoplasm in children aged under 3 years.
LEUKEMIA IN UKRAINE! What we know?
n n The preliminary analysis of infant leukaemia incidence in Kyiv city after Chernobyl within 1986 -1997 period showed also an increase in acute myeloid leukaemia and B-cell acute lymphoblast leukaemia [Gluzman et al. , 1999]. At present leukaemia's rank first in the patterns of morbidity and mortality due to malignancies in children of Ukraine aged 0 -14 years [Fedorenko et al. In: Bull National Cancer Register of Ukraine 2004]. 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 most contaminated with radionuclides [Noschenko A. and al. 2001; 2002; Pushkar LO and Klimnyuk GI, 2005]. Moreover, recently several limited studies of the infant leukaemia's after Chernobyl have been performed also in several European countries with particular emphasis on the children believed as having been exposed in utero (judging by the dates of their birth) [Petridou, et al. , 1996; Michaelis et al. , 1997; Noschenko A. and al. 2001; 2002; D. Davidescu and all. 2004, Davis S. and al. 2005].
According to Ukrainian studies of Chernobyl liquidators the incidence of leukemia, especially in the group that received the dose of 150 -300 m. Gy is increasing. Multiple myeloma incidence twofold increase within structure of hemodblastoses is found in 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 is appearing among liquidators against the backdrop of myelodisplastic syndrome. The question of increasing leukemia cases among adults is still open.
Lymphoma (ICD-9 200 -203) incidence rates in the districts most heavily contaminated with radionuclides.
NOTE Considering that leukemia incidence rate is the principal indicator of possible radiation effects, it is critically important to continue wide scale epidemiological studies on the issue taking into account the factors of uncertainty in medical and dosimetry information. Special attention should be drawn to groups which were in early age at the moment of Chernobyl accident (exposed in utero, 0 -9, 10 -19 years old). ( Resolution of Int. conf. 29 May-June 3, Kiev 2006).
OTHERS MALIGNANT TUMOURS MORBIDITY
Incidence rates of main forms of solid cancers in districts most heavily contaminated with radionuclides (2004, FGI) Solid cancer incidence rate in territories of interest during is characterised by a moderatel increasing; Tumour site (code ICD-9) Sex Period (age standardised rate standard error) 1980 -1990 (1) Rate ratio 2/1 (95% CI) 1991 -1999 (2) All solid cancers (140 -203) Males+females 160. 83 2. 12 186. 71 3. 17 1. 12 - 1. 22 Buccal cavity, pharynx (140 -149) Males+females 10. 48 0. 54 12. 08 0. 77 0. 98 - 1. 36 Digestive system (150 -159) Males+females 47. 80 1. 12 51. 14 1. 55 0. 99 - 1. 15 Respiratory system (160165) Males+females 25. 63 0. 83 27. 21 1. 12 0. 96 - 1. 18 Skin (172, 173) Males+females 15. 49 0. 63 14. 71 0. 80 0. 83 - 1. 08 Breast (174) Females 16. 82 0. 97 25. 31 1. 67 1. 25 - 1. 81 Female genital organs (180 -184) Females 20. 83 1. 06 20. 21 1. 59 0. 81 - 1. 16 Prostate (185) Males 7. 59 0. 70 10. 90 0. 99 1. 11 - 1. 86 Bladder (188) Males 8. 68 0. 76 9. 35 0. 95 0. 83 - 1. 40 Brain (191) Males+females 3. 40 0. 36 4. 11 0. 63 0. 83 - 1. 77 Thyroid (193) Males+females 1. 70 0. 24 6. 69 0. 76 2. 56 - 6. 07 Lymphoma (200 -203) Males+females 4. 86 0. 43 6. 52 0. 71 1. 01 - 1. 79
Prostate cancer (ICD-9 185) incidence rates in the districts most heavily contaminated with radionuclides. According to international evaluation, prostate cancer does not belong to radiosensitive form of cancer. Study prostate cancer incidence rate grew up rapidly in 1987 and since then was much higher than in pre-accidental period. (FGI , 2004)
Breast cancer (ICD-9 174) incidence rates in the districts most heavily contaminated with radionuclides. Close attention should be drawn to breast cancer. After six or seven years of a stable level of breast cancer incidence rate (with small fluctuations) a sharp increase has been observed since 1992. This form of cancer belongs to radiosensitive form of malignancies and needs close attention in the future.
Other malignant tumor morbidity: all tumors in liquidators and evacuees people 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 DAMAGE n n n According to government statistics, the frequency of congenital malformation in the affected regions IS 5 -fold INCREASE (2005). At the same time IN ALL THE GROUPS MONITORED DURING POSTACCIDENT PERIOD THE RATE OF CHROMOSOME ABERRATIONS IN PERIFERAL BLOOD LYMPHOCYTES SIGNIFICANTLY EXEEDED PRE-ACCIDENT INDICES CHARACTERISTIC FOR SPONTANEOUS CHROMOSOME MUTAGENESIS.
Selective cytogenetic monitoring of children (Pilinskaya M. A. and all. 2005). 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. Vistupovici In all groups the rate chromosome aberration in peripheral blood lymphocitytes significantly exceeded preaccident indices.
Heritable effects in children with exposure in utero (Stepanova The cytogenetic examination show the higher of aberrant cells and interdependence with equivalent dose of red bone morrow: Frequency of the chromosome aberrations per 100 cells; The doses of red bone morrow 10— 376 m. Sv E. I. and all. 2006)
The frequency of chromosome aberrations in lymphocytes of periphery blood of children, which were exposed in utero (group 1) and living in radionuclide pollution territories (group 2) (M m) 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 to cell death, such as inversions, inserts, reciprocal translocations). It allows to suppose that 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. This process can complicate the forming of gametal cells ( the meiosis).
An increased frequency rate of chromosome aberrations was found in children who had been exposed to combined 131 I and 137 Cs radiation. The influence of thyroid pathology on induction of chromosome non-stability in human somatic sells was demonstrated. A deferred cytogenetic effects has been found in successive cell generations in the progeny of irradiated parents proving for real transmission of chromosome non- stability. (National Report of Ukraine, 2006)
Where’s mutants! Later 20 years after Chernobyl catastrophe the experimental investigations in 30 -km zone and numerous investigations in humans permit to make the follow unfavorable conclusions: the main problem of habitants of ecologic naturally changes is not in received dose of irradiation, but in their newness; the main population consequences there not in the decreasing of mutants, but pauperization of genetic found: from reproduction go out the genes what it is responsible for sensibility of organisms to new radioecological conditions. So, survive the individuals with the least specialized genotypes. The mutants did not born! 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 development, or its not able to implantation. The contribution of Chernobyl accident in changes of humans gene found should be estimated through several years because the generation what was born after accident only now start in reproductive period.
The risk of spontaneous abortion, cumulative year dose and fact of residing on contaminated territories. Cumulative dose All women OR Dose ДІ Women 19 -30 old OR ДІ 1, 36 1, 14 -1, 63 1, 23 1, 00 -1, 53 Up to 5, 0 m. Sv 1, 33 1, 09 -1, 63 1, 22 0, 96 -1, 55 5, 0 m. Sv and more 1, 42 1, 10 -1, 83 1, 26 0, 94 -1, 70 Spontaneous abortion risk is increasing if cumulative dose reach 5 m. Sv. A. M, Serdyk and all (2004, 2006).
DETERMINISTIC EFFECTS LIQUIDATORS! For today we don’t know accuracy how many liquidators were! What why for therefore it is hard to estimate the real those health risks 1997 – 339 666 2006 – 268 815 71851 (24%) persons go out. Where? We have not the accuracy information about they. Liquidators and those families are living in many states in the world: SEE!
How many liquidators we have? Countries 2006 UKRAINE Belarus Russian Federation Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan Latvia Lithuania Moldova Uzbekistan Tajikistan Turkmenistan Estonia Israel USA 268 815 -? 200 000 -? 2200 6000 2000 30000 1810 5020 7124 4500 10000 2150 2000 3000 1056 4000 ?
Liquidators DOSIMETRY n. Doses of radiation to which liquidators and emergency nclean-up workers were subjected are in the average nrange and low intensity limits of 50 -200 m. Sv. But due nto the absence of effective dosimetric control and nbecause of complicated and uninvestigated radiation nconditions many liquidators received doses of over 1 Gy nduring the 1. 5 months following nuclear accident. n. This would include many people, especially nuclear n power plant personnel, firemen, military people, miners, n construction workers who built the tunnels and shelter naround destroyed reactor and in the later period on the n roof of the 3 rd unit of the Chernobyl NPP. n. We can state that among those groups there are people in n whom the ARS was never clinically established. As a n whole, the information about the dosimetric state of nliquidators is incomplete (only 50% of this information nabout received doses of radiation is available) and unclear n(since it is unknown how accurate the available records about n these doses may be). This data in its current state cannot n be used to assess radiation risks and to analyze real nradiation medical effects of the explosion and needs revision.
LIQUIDATORS MORBIDITY(by Registry of military liquidators of Ministry Internal Affaires of Ukraine)
The Dynamics of common sickness rate of circulatory diseases.
Prevalence of psychological disorders in liquidators (2005, FGI project) 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 SYNDROM The postradiation brain organic syndrome is compressed by micro focal neurological signs, personality disorders, negative psychopathological symptoms, depression and cognitive deficit. Atherosclerotic changes, hypertensive vessel tonus, interhemispheric asymmetry of blood supply, angiosclerosis, as well as high frequency of stenos were the causes of cerebral haemodynamics disorders. Brain atrophy, enlargement of ventricula, and lacunar brain abnormalities, supported the cerebral-organic nature of the disorders.
CATARACTA 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 threshold of irradiation doses is set for cataract development compared to earlier assessments. 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 threshold absorbed dose. ( Fedirko P. , 2005) Distribution of irradiation dose ratio (UACOS) in liquidators. The risk of cataract development in liquidators Dose c. Gy 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 nonstochastic effects gradual progress within all period extent passed since the Chernobyl NPP accident. Direct time link to radiation factor, dose-dependence and dose threshold 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).
Pregnancy and thyroid Normal pregnancy - 25. 8 (26 c. Gy) and 12. 5% ( dose 36 c. Gy) and 63, 3% in control group. Children born by irradiated woman recently confined 1, 5 -2 - fold had more deflections in physical development.
Evacuees and Resettled survivors 164 700 thousand- 52 000 families in 2006 INCIDENCE and PREVALENCE The evacuated adult population disability indices since 1988 to 2003 increased from 4, 6% to 103, 4%. National Report, Ukraine 2006
NOTE n It was accepted that growth of somatic illnesses among victims wasn’t linked directly to the radiation factor, but to the contrary it is dependant on the dose of radiation and time under risk as well. These illnesses include endocrine system and metabolic diseases, psychological disturbances, diseases of the nervous system, sensory organs and digestive tract organs, cerebral-vascular diseases, essential arterial hypertension, and cataracts.
State of Health of СHILDREN n About 20% of all children population in Ukraine inhabit the territories where the level of radionuclides is above the background one.
Dynamic of non-tumour diseases prevalence (per 10 000) among children and adolescent affected due to the Chernobyl catastrophe. (National Report of Ukraine, 2006). Presently in the structure of disease incidence of children of 0 -14 years predominant are diseases of the respiratory, nervous, digestive and blood systems, skin and subcutaneous tissue diseases. The most unfavorable changes have been observed in adolescents with high doses of thyroid gland irradiation and in adolescent irradiated in utero.
Value of thyroid gland dose correlate with health status of children and adults. In this cohort of survivors only 2, 8% are healthy. % (Stepanova E. I. , 2006)
Children irradiated in utero. Thyroid Dose exposure – in the range 0, 1 - 28, 5 Gy (I-131, 132, 129, ); Dose of hole-body irradiation - 5, 0 - 376, 0 m. Sv due to external 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%) who had been exposed in utero to thyroid doses >1 Sv; (13. 2%) received in utero fetal doses of >100 m. Sv. ( Nyagu A. I. , Stepanova E. I. , Repin V. S. and all. , 2000, 2004)
Distribution of children by periods of cerebrogenesis at the time of explosion (April 26 th, 1986) 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 distribution (ICRP-88)
Dose on thyroid in utero distribution (ICRP-88) According to the model by ICRP-88 there is a strong influence of gestational age on the thyroid doses in utero: later intrauterine period at the time of exposure — higher the thyroid doses in utero
Intelligence of children (WISC) Full scale IQ 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 8 th and later weeks of gestation with exposure of the embryo and fetus to more 20 m. Sv and doses of thyroid gland in utero more 300 m. Sv.
Diseases of Nervous System (G) and Mental and Behavioral Disorders (F)according to the ICD-10 in children. Prenatally exposed children have more neuropsychiatric disorders than the control children from Kiev for the following categories: 1) paroxysmal states; 2) organic mental disorders; 3) neurotic, stress-related and somatoform disorders; 4) disorders of psychological development; 5) childhood behavioural and emotional disorders.
Mother’s stress events 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 also demonstrate poor health. n The number of healthy children is 2, 5 -9, 2% (control group - 18, 6 -24, 6%). This cohort is characterized by a retardation of biological age, immunity disorders, more often manifest external disembriogenetic stigmata, minor malformations of internal organs and congenital malformations, enhanced mutations processes both in indicator cells and target cells. National 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 radioactively contaminated 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 children Abnormal psychological development has been detected in 60 -70% of children and teenagers exposed to radiation. This is twohold higher than among general population. The mental state children of all cohorts is significantly worse compared to that of controlled groups: self-sensation as a victim, lack of initiative, rental aims. More than 60% of teenagers see their futures away from home because radiation pollution; Children from the highrisk groups are becoming the carriers of a crisis psychology (mentality) and as a result will spread a crisis relationship in society. Inadequate parental or family environments as well as the circumstances of their immediate surroundings – teachers, doctors will contribute to a heightened level of anxiety, fear and lowered self-esteem. What why the concept of “psychological rehabilitation” should be shifted in the direction of the concept of “education and psychological correction”.
NOTE n Methods of risk assessment for exposures to low-dose radiation (more typical for the population exposed to the Chornobyl disaster) are not yet developed. That is why the results of post-Chornobyl epidemiological studies must have first-priority in assessing the scientific and practical significance for the assessment of low-dose radiation influence on people. The results should be obtained from direct monitoring with the same-time usage of all-national cancer studies data and national registry data.
Chernobyl is a reminder for international community should to consolidate efforts to build safe future.
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