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Pediatric Considerations Before, During, and After Radiological Or Nuclear Emergencies

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Pediatric Considerations Before, During, and After Radiological Or Nuclear Emergencies TECHNICAL REPORT Pediatric Considerations Before, During,Martha S. Linet, MD, MPH, and a, b Ziad Kazzi, After MD, c, d Jerome A. RadiologicalPaulson, MD, FAAP, e COUNCIL ON ENVIRONMENTAL HEALTH or Nuclear Emergencies Infants, children, and adolescents can be exposed unexpectedly to ionizing abstract radiation from nuclear power plant events, improvised nuclear or radiologic dispersal device explosions, or inappropriate disposal of radiotherapy equipment. Children are likely to experience higher external and internal radiation exposure levels than adults because of their smaller body and aRadiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland; bAgency for organ size and other physiologic characteristics as well as their tendency to Toxic Substances and Disease Registry, Centers for Disease Control pick up contaminated items and consume contaminated milk or foodstuffs. and Prevention, Atlanta, Georgia; cNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia; This technical report accompanies the revision of the 2003 American dDepartment of Emergency Medicine, Emory University, Atlanta, Georgia; and eDepartment of Pediatrics, School of Medicine and Health Academy of Pediatrics policy statement on pediatric radiation emergencies Sciences, and Department of Environmental and Occupational Health, by summarizing newer scientific data from studies of the Chernobyl and the Milken Institute School of Public Health, George Washington University, Washington, District of Columbia Fukushima Daiichi nuclear power plant events, use of improvised radiologic Drs Linet and Kazzi contributed much of the technical information in dispersal devices, exposures from inappropriate disposal of radiotherapy this report, and Dr Paulson was responsible for drafting the document; equipment, and potential health effects from residential proximity to and all authors approved the final manuscript as submitted. nuclear plants. Also included are recommendations from epidemiological This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have studies and biokinetic models to address mitigation efforts. The report filed conflict of interest statements with the American Academy includes major emphases on acute radiation syndrome, acute and long-term of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of psychological effects, cancer risks, and other late tissue reactions after Pediatrics has neither solicited nor accepted any commercial low-to-high levels of radiation exposure. Results, along with public health involvement in the development of the content of this publication. and clinical implications, are described from studies of the Japanese atomic Technical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and bomb survivors, nuclear plant accidents (eg, Three Mile Island, Chernobyl, external reviewers. However, technical reports from the American and Fukushima), improper disposal of radiotherapy equipment in Goiania, Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. Brazil, and residence in proximity to nuclear plants. Measures to reduce The guidance in this report does not indicate an exclusive course of radiation exposure in the immediate aftermath of a radiologic or nuclear treatment or serve as a standard of medical care. Variations, taking disaster are described, including the diagnosis and management of external into account individual circumstances, may be appropriate. and internal contamination, use of potassium iodide, and actions in relation All technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, to breastfeeding. revised, or retired at or before that time. DOI: https:// doi. org/ 10. 1542/ peds. 2018- 3001 To cite: Linet MS, Kazzi Z, Paulson JA. Pediatric Considerations Before, During, and After Radiological or Nuclear Emergencies. Pediatrics. 2018;142(6):e20183001 Downloaded from www.aappublications.org/news by guest on September 26, 2021 PEDIATRICS Volume 142, number 6, December 2018:e20183001 FROM THE AMERICAN ACADEMY OF PEDIATRICS BACKGROUND AND RATIONALE FOR UPDATE recommendations for treating, led to long-term follow-up studies of mitigating, and preventing serious mortality (established in 1950) and Children can be exposed to health effects in children. An update cancer incidence (begun in 1958) environmental radiation as a result to the policy statement is needed that continue to the present day and of nuclear power, fuels reprocessing, that incorporates (1) new scientific have 10yielded critically important “ and weapons production plant knowledge from late-effects studies data. ” of the Chernobyl event, (2) lessons (hereafter designated nuclear Four major nuclear plant accidents from the 2011 Fukushima Daiichi plant ) events; from an improvised have occurred: Windscale in Japanese nuclear power plant event, nuclear device or radiologic dispersal Seascale, Cumbria, in the United (3) information pertinent to the use device; or from abandoned medical Kingdom (1957); Three Mile Island of improvised radiologic dispersal radiation equipment that could in Pennsylvania (1979); Chernobyl devices and the specter of nuclear potentially result in substantial levels in Ukraine (1986); and Fukushima detonation in heavily populated of radiation exposure and associated Daiichi nuclear power plant in regions, (4) radiation exposures health effects. Because the radiation Fukushima Prefecture, Japan (2011). levels from these sources could lead from the inappropriate disposal of to a radiation emergency, this term radiotherapy equipment, (5) reports Beginning in 1945, atmospheric is used to refer to these types of of potential health effects associated nuclear testing was undertaken exposures hereafter in this report. with radiation exposures of children by the United States (New Mexico, Children and their families are living in proximity to nuclear plants, Nevada, and the Marshall Islands), likely to be extremely anxious about and (6) recommendations based on the Soviet Union (Kazakhstan), such events and about residential new knowledge from epidemiological the United Kingdom (Australian proximity to nuclear plants (the studies and from biokinetic models to territories and some Pacific Islands), latter being associated with very low address mitigation efforts. France (French Polynesia), and China (Gobi Desert in Xinjiang Province) or no radiation exposure) and may A number of AAP publications and resulted in 504 devices exploding turn to their medical professional are related to the material in “ at 13 sites. A 1963 treaty led to a for advice. Health care professionals this technical report, including limited test ban by the Soviet Union, are concerned about these exposures (1) Medical Countermeasures the United States, and the United because, in general, children are for Children in Public Health ” “ Kingdom, but atmospheric testing more sensitive to radiation and are Emergencies, Disasters, or 6 ” continued until 1974 by France more likely to develop the short-term Terrorism ; (2) Ensuring the 4 “ 7 and until 1980 by China. Health and some of the long-term effects Health of Children in Disasters ; studies have been focused on cancer of radiation exposure. Children are and (3) Providing Psychosocial risks in military participants and/ likely to experience higher external Support to Children and Families ” or observers and on thyroid cancer and internal radiation exposure in the Aftermath of Disasters and 8 and leukemia occurring among levels than adults because children Crises. This technical report the general population living in are shorter and have smaller 1 presents detailed information that 19, 24 body diameters and organ sizes. proximity to the testing sites. supports the recommendations of9 the Children have a longer time to accompanying policy statement. Events involving abandoned medical live and, thus, more time in which TYPES OF RADIATION EMERGENCIES radiation equipment have resulted to develop adverse outcomes. AND RELATED EXPOSURES in acute radiation sickness and In addition, children may ingest deaths as well as contamination 22of radioactive material from picking thousands of people and homes. up contaminated items and putting 2 The description and findings from Since 1983, concerns about excess hands in their mouths3 when crawling, ingesting soil, or consuming milk epidemiological studies of the leukemia among children living most important types of radiation in proximity to nuclear power, from cows feeding4 on contaminated pastures or feed. emergencies and related exposures fuels reprocessing, and weapons- are summarized in Table 1. Concern production facilities have led to In a policy5 statement published about health effects associated with epidemiological studies of more in 2003, the American Academy radiation emergencies began with the than 200 nuclear23 facilities in 10 atomic bombings in Hiroshima and countries. Most of the studies of Pediatrics (AAP) Council on Environmental Health summarized Nagasaki in 1945 that killed more reveal no association. Confounding the history, features, and health than 100000 people and injured cannot be ruled out in the few studies
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