Transcript Document

International BfS 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
1985y
Distribution of Cs-137
in Ukraine after
accident in
1998y (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)
внутрішнє опромінення, зумовлене інгаляційним надходженням
радіонуклідів з повітрям до 0,1%
внутрішнє опромінення від радіонуклідів, що надходять з питною
водою до 2%
зовнішнє гамма - опромінення 5-20%
внутрішнє опромінення від радіонуклідів, що надходять з продуктами
харчування 80-95%
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)
%
Волинська
20
15
Житомирська
Київська
Рівненська
17,1
10
5
0
Черниговская
15,1
8,3
2,0
3,2
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 -1997-2006yy.
Categories of the survivors and
Number
On 1997-2006yy.
•
Category 1 - Invalids
1997
2000
2005
2006
59582
86775
105251
106824
Category 2
339666
•
307 982
276 072
268815
Including:
2a- 1986-1987 yy. liquidators
352939
277 135
•
197 817
191 167
86726
80 847
78 255
77 647
Category 3
558637
549 649
Including: 3a 1987-1990 liquidators
3b survivors
69 620
62729
55 391
489 017
486 720
482113
1 169 804
1 150273
1 081 469
•
2b- survivors- evacuees
•
Category 4
Category D:
people who worked beyond the territory
of the exclusion Zone
2530
•
•
2862
•
Children survivors (including those with
thyroid gland irradiation in 1986)
•
1 083 107
•
1 264 329
Total
•(Died 504 117 persons???)
•
3 213 326
•
3 361 870
•
•
537 504
•
•
•
2 646 106
179
•
79
76
(24%)
•90
•
95
52346
•
75
480798
•
98
1 065 022
•
91
•
2780
643 030
•
533144
•
•
2006 to
1997%
•
2606
•
103
617 660
•
57
2 594071
•
81
•
Number of people living in different contaminated territories
in Ukraine
Indices
Number of settlements
Total
Exlusion
zone)
Zone 2
15-40 Ci/km2)
Zone 3
5-15
Ci/km2)
Zone 4
(1-5 Ci/km2
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 (km2)
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)

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 01.01.2006
2 252 130 (from 2 594 071 ) persons
1 493 195
373 994
79 277
305 664
ліквідатори
евакуйовані
проживаючі
особи, що народилися від батьків 1-3 груп
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).
18
17
16
15
14
13
рождаемос ть
с мертнос ть
12
11
10
9
8
1970 1974 1978 1982 1986 1990 1994 1998 2002 2006
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
%
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
100
90
80
70
60
50
40
30
20
10
0
(state statistics)
Роки
Ліквідатори
Евакуйонані
Жителі забруднених територій
Діти, які народились від опромінених батьків
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)
на 1000
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
22
20
18
16
14
12
10
8
6
4
2
0
Роки
1 група обліку
2 група обліку
3 група обліку
4 група обліку
Dynamics of collective dose of radiation exposure and
mortality of irradiated people and all people in Ukraine.
.
Колективна доза опромінення (КД)
Смертність постраждалого населення
Смертність населення
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
22
20
18
16
14
12
10
8
6
4
2
0
КД
100
80
60
40
20
0
Смертність, х1000
Роки
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 mGy)
Number of thyroid cases in children and adolescents (0-18 years old at
the time of the Chernobyl accident.).
400
15-18
0-14
350
250
92
85
284
251
249
88
105
67
183
200
147
150
118
100
0
350
331
300
50
370
359
62 69
19
11
8
25
14
11
22
11
11
37 20
13
24
42
35
129
192 197 81
54
61
66
83
243 245
217
46
23
104 117
278
274
43
170
83
69
180
138 136
46
86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
Thyroid cancer in Children born before accident, after
accident (I. Komissarenko, 2005).
120
113
105
1970-1989 y.
295 (10) patients
100
95
91
94
81
80
73
60
54
48
41
40
58
33
21
15
21
20
4
11 3 32
0
7
12
11
4
12 2 2
1313
8
Дети и подростки на момент аварии
Дети и подростки рожденные после аварии
Дети и подростки оперированные до аварии
1990-2005y.
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
600
588
549
483
500
498
420
422
400
452
400
368
377
323
355
306
300
249
238
237
200
212
191
228
111
79
100
28
21
45
0
Доброкачественные
Злокачественные
Cancer thyroid in adults
Середня поглинута
еквівалентна доза
зовнішнього
опромінення всього
тіла 50-200 мЗв
А
40
35
30
25
20
15
10
5
0
1990 1992 1994 1996 1998 2000 2002 2004
Стандартизовані показники на
100000 осіб
Населення України
50
45
40
35
30
25
20
15
10
5
0
В
УЛНА
Середня поглинута еквівалентна доза
опромінення щитовидної залози
184.4 - 857.5 мЗв
1990 1992 1994 1996 1998 2000 2002 2004
Населення України
Евакуйовані
Liquidators cancer increasing by 9fold (for female- by 13-fold);
Amongst evacuees – by 6-fold;
Among residents of radioactivecontaminated territories – by 4.1fold.
(Source – National Report of Ukraine, 2006)
14
Стандартизовані показники на
100000 населення
Стандартизовані показники на
100000 осіб
45
12
10
8
С
Середня ефективна
еквівалентна доза
опромінення щитовидної
залози 187 - 221 мЗв
6
4
2
0
1980 1983 1986 1989 1992 1995 1998 2001 2004
Населення України
Забр. території
Age-standardised incidence rate per 100 00
14
12
10
8
6
4
2
0
1980
6
1982
1984
1986
1988
1990
1992
1994
Ukraine
Kiev region
Kiev city
Contaminated territories
1996
1998
2000
2002
2004
Zhytomir region
Dynamics of thyroid cancer incidence rate
in Ukraine, Kiev, Zhytomir regions, Kiev
city and the territories most heavily
contaminated with radionuclides
in 1980-2004.
5
4
3
2
1
0
19621964
19691972
19771979
Females
19891992
Males
19931996
19972000
20012004
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.
10
1
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
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.
количество наблюдений
100
количество больных
80
70
60
50
40
30
20
10
злокачественные
20
01
-2
00
4
19
96
-2
00
0
19
91
-1
99
5
19
86
-1
99
0
0
19
81
-1
98
5
Malignant tumour constitute 43% of all
central nervous system neoplasm in
children aged under 3 years.
доброкачественные
LEUKEMIA IN UKRAINE!
What we know?

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 mGy 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.
35
Relative frequency, %
30
25
20
Clean-up workers
15
General population
10
5
0
Chronic
lymphocytic
leukemia
Multiple
myeloma
Large
NonChronic
granular
Hodgkin's
myelogenous
lymphocytic lymphoma in
leukemia
leukemia
leukemization
phase
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)
1991-1999 (2)
Rate ratio 2/1
(95% CI)
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.
50,00
45,00
40,00
35,00
Regression coefficient b ± SE(b):
The Ukraine: 0.65 ± 0.03
Contaminated areas:
1980-1989: 0.06 ± 0.38
1990-1999: 1.06 ± 0.19
1980-1999: 0.78 ± 0.18
30,00
25,00
20,00
15,00
10,00
5,00
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
Стандартизовані показники на
100000 населення
Other malignant tumor morbidity: all tumors in
liquidators and evacuees people
250
Доза не встановлена
A
200
150
100
lung, esophagus, stomach, bowl, ovary,
lymphomas (multiple myeloma) etc.
50
0
1990
1992
1994
1996
1998
2000
Стандартизовані показники на
100000 населення
Населення України
400
350
2002
2004
УЛНА
250
200
150
50
Середня поглинута еквівалентна доза
зовнішнього опромінення 10-30 мЗв 50-200 Зв
0
1990
Special attention should be drawn to groups of
population irradiated at the beginning of life
(in utero, young age 0-9, 10-19).
В
300
100
Because of different latency period of
radiogenic forms of cancer there have to be
drawn close attention to cancer of breast,
1992
1994
1996
Населення України
1998
2000
2002
2004
Евакуйовані
GENETIC DAMAGE



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).
6
5
Частота, %
4
3
2
Середня частота
Хромосомний тип
Нестабільні маркери
Стабільні маркери
1
0
1
2
3
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.
4
5
6
7
8
9
10 11 12
Heritable effects in children with exposure in utero
(Stepanova
E.I. and all.2006)
18
Частота хромосомных аберраций
The cytogenetic examination
show the higher of aberrant
16
cells and interdependence with
equivalent dose of red bone
14
morrow:
Frequency of the chromosome 12
aberrations per 100 cells;
10
8
6
4
The doses of red
bone morrow
10—376 mSv
0
100
200
300
400
Эквивалентная доза на красный костный мозг, мЗв
Частота
аберраций
хромосом
Частота
аберрантны
х клеток
Частота
стабильных
аберраций
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)
Types of chromosome
aberrations
Group 1
n=8, (1600 metaphases)
Frequency (%)
Group 2
n=8, (1600 metaphases)
Frequency (%)
Translocations
0,37  0,10
0,18 0,10
Deletions
1,25 0,30
0,68 0,20
Inversions
0,31 0,10
0,12 0,07
Dicentric
Circles
0,06 0,05
0,12 0,07
0,06 0,05
0
Insertions
0,31 0,12
0
Pare fragments
Single fragments
0,06 0,05
0,12 0,07
0,18 0,10
0,06 0,05
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 5,0mSv
1,33 1,09-1,63 1,22 0,96-1,55
5,0mSv and more 1,42 1,10-1,83 1,26 0,94-1,70
Spontaneous abortion risk is increasing if cumulative dose reach 5mSv.
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 -?
200 000 -?
2200
6000
2000
30000
1810
5020
7124
4500
10000
2150
2000
3000
1056
4000 ?
Liquidators DOSIMETRY
Doses of radiation to which liquidators and emergency
clean-up workers were subjected are in the average
Индивидуальные дозы "ликвидаторов", измеренные
range and low intensity limits of 50-200 mSv. But due
методом ЭПР эмали зубов, в сравнении с "официальной"
to the absence of effective dosimetric control and
дозой (n=7)
because of complicated and uninvestigated radiation
Доза
conditions many liquidators received doses of over 1Gyоблучения
0,8
(Gy/Sv)
0,8
during the 1.5 months following nuclear accident.
0,7
This would include many people, especially nuclear
0,6
 power plant personnel, firemen, military people, miners,
0,6
 construction workers who built the tunnels and shelter
0,5
around destroyed reactor and in the later period on the
0,4
 roof of the 3rd unit of the Chernobyl NPP.
0,25
0,3
We can state that among those groups there are people in
0,2
0,19
0,3
 whom the ARS was never clinically established. As a
0,2
0,1
0,1
 whole, the information about the dosimetric state of
0,009
0,035
0,03
0,013
0,1
0,019
liquidators is incomplete (only 50% of this information
0,036
0
about received doses of radiation is available) and unclear
3213 4824 4994 5706 6221 6662 6826
(since it is unknown how accurate the available records
Номер образца
about
 these doses may be). This data in its current state cannot
"Официальная" доза, Sv
ЭПР доза, Gy 1 Sv=1 Gy
 be used to assess radiation risks and to analyze real
radiation medical effects of the explosion and needs
revision.

LIQUIDATORS MORBIDITY(by Registry of military
liquidators of Ministry Internal Affaires of Ukraine)
Динамика распространенности заболеваний у ЛПА на ЧАЭС СБ и МВД
0
Украины в послеаварийном периоде (в /00)
0
/00
4500
* - достоверность различия в сравнении с контрольной группой
4246
3736
4000
*
*
3500
2617
3000
*
2500
2000
3060±142
2039,9±180
1347
1999±111
1500
1548,4±162,9
1000
1415.8±103
500
0
3085±260
КГБ, МВД 1985 г.
1987 - 1995
I период
СБУ
МВД
1996 - 2004
II период
Контрольная группа
Уровень 2004 г.
The Dynamics of common sickness rate of circulatory
diseases.
1000
900
y = 52,249x + 120,16
%0
892,2
2
R = 0,8869
877,7
911,2
796,6
800
ВС-УЛА на ЧАЕС
700
762,3
638,7
600
529,5
550,5
500
300
430,7
411,6
400
333,3
338,6
321,8
324,6
310,3
575,0 566,2
383,9
386,7
y = 27,851x + 125,24
410,4
R2 = 0,8916
240,0
253,3
263,9
200
195,3
206,4
270,0
302,0
314,4
283,1
Контрольна група
212,8
100
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
роки
Prevalence of psychological disorders in liquidators
(2005, FGI project)
40
% 90
35
80
30
80,5
70
25
Liquidators
20
60
15
Ukrainian
population
10
5
0
50
40
All mental
disorders
Depression
30
20
22,4
21,4
20,4
10
0
<0,25 Зв
>0,25 Зв
SIP - вхідний
контроль
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 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)
800
10
700
9
600
8
7
6
RR
Frequency
500
400
5
4
300
3
200
2
100
1
0
0
50
100
150
200
250
300
350
400
450
500
550
600
Total dose, mSv
Distribution of irradiation dose ratio
(UACOS) in liquidators.
650
700
0
<8,9
8,9~11
11~18,7
18,7~24
>24
Доза
The 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 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.
350
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).
300
250
200
150
100
50
0
1992
1993
1994
1995
1996
1997
1998
Мешканці контрольованих територій
Евакуйовані з 30-км зони відчуження
Ліквідатори аварії на ЧАЕС
1999
2000
Pregnancy and thyroid
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.
80
60
40
20
0
26 cГр
36 cГр Контроль
% фізіологічної вігітності
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
‰ 4000
3000
2000
1000
0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Захворюваність
Поширеність
Роки
Дорослі евакуйовані
Дорослі евакуйовані
Доросле населення України
Доросле населення України
NOTE

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

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.
60000
46452
50000
47536 47854
48138
48958
40000
30651
24373
30000
20000
18845
32350
17729
19152
18599
17403
17833
17893
17527
10000
0
1989
1992
1994
Постраждалі
1995
1997
1999
2001
Контроль
20032004
Value of thyroid gland dose correlate with health status
of children and adults. In this cohort of survivors only
2,8% are healthy.
%
30
25
20
15
10
5
0
<0,2
0,3-0,75
0,75-2,0
(Stepanova E.I., 2006)
>2,0
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 mSv 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 mSv.( Nyagu A.I., Stepanova E.I., Repin V.S. and all.,2000, 2004)
4,80%
0,10%
Внешнее гамма
облучение
2,30%
Облучение
щитовидной железы
Внутреннее облучение
от Cs-137
Внутреннее облучение
от Sr-90
92,80%
Distribution of children by periods of
cerebrogenesis at the time of explosion
(April 26th, 1986)
%
40
35
30
Exposed group
in Pripyat
(n=154)
Comparison
group from Kiev
(n=143)
P>0.05
P>0.05
P<0.01
25
P>0.05
20
15
10
5
0–7
8–15
16–25
Weeks after fertilisation
26+
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 range, mSv
Exposed group: M±SD — 65.4±33.9 mSv, Median — 61.6 mSv
Comparison group — 1.2±0.3 mSv, Median — 1.2 mSv
260–269.2
240–260
220–240
200–220
180–200
160–180
140–160
100–120
80–100
60–80
40–60
20–40
10.4–20
Exposed group in Pripyat
(n=151)
Comparison group from
Kiev (n=142)
0–2.7
100
90
80
70
60
%
50
40
30
20
10
0
Dose on thyroid in utero distribution
(ICRP-88)
mSv
Exposed group in Pripyat
(n=152)
Comparison group from Kiev
(n=143)
1225,5
1200
1000
3001–3200
3201–3210.5
2801–3000
2601–2800
2401–2600
2201–2400
2001–2200
1801–2000
1601–1800
1401–1600
1201–1400
1001–1200
601–800
801–1000
401–600
201–400
0
800
0–200
100
90
80
70
60
% 50
40
30
20
10
0
623,7
600
Dose range, mSv
Exposed group (M±SD) — 760.4±631.8 mSv, Median — 746.3 mSv
Comparison group — 44.5±43.3 mSv, Median — 27.4 mSv
400
200
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
0,4
0
0–7
40,9
8–15
16–25
Weeks of gestation
26+
Intelligence of children (WISC)
Full scale IQ
120
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.
118
116
114
112
110
108
Exposed group Comparison
in Pripyat
group from Kiev
(n=140)
(n=136)
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.
%
90
Exposed group
in Pripyat
(n=154)
60
%
P<0.001
80
70
60
P<0.001
Exposed group
in Pripyat
(n=154)
50
Comparison
group from Kiev
(n=143)
40
50
Comparison
group from Kiev
(n=143)
P<0.01
30
40
P<0.05
30
20
20
P>0.05
P<0.05
P>0.05 P<0.05
0
Healthy
G40
(assumed)
P<0.001
10
P<0.01
10
P>0.05
G43
G44
G47
G80
G90
P<0.01
P>0.05
P>0.05
0
Healthy F06 & F07 F40–F48
F51
F70
F80–F89
F90–F98
Mother’s stress events
Mothers of children evacuated from Pripyat
experienced much more (P<0.001)
real stress events
16
14
12
(evacuation, lack of
information about relatives, migration,
difficulties of medical care, etc.)
10
8
6
4
2
0
Exposed group Comparison
in Pripyat
group from Kiev
(n=136)
(n=62)
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.

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

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.
should
Chernobyl is a reminder for international community
to consolidate efforts to build safe future.