What strategy of secondary prevention after a nuclear beyond design-basis accident? Martin Walter, MD, Michel Fernex, Professor and MD, Claudio Knüsli, MD (members of the board of IPPNW/PSR/Switzerland (International Physicians for the Prevention of Nuclear War/Physicians for Social Responsibility/Swiss affiliate of IPPNW) 31th march 2012 Introduction There is no doubt, that ionizing radiation causes solid cancers and other malignancies such as lymphomas and various forms of leukaemias. Malformations (due to teratogenesis or mutations), other genetic abnormalities or even more severe genetic abnormalities in the following generations as well as disturbed brain development are also scientifically accepted consequences of ionizing radiation. Confronted with these facts we must decide within the society which risks we will and can accept from radiation produced by normal and abnormal operation of nuclear power plants. In the case of a nuclear accident like the beyond design-basis accident (an in german so called «SuperGau») of Chernobyl or the Fukushima - we must protect the population as far as possible and as much as technically achievable from the possible consequences of ionizing radiation. We have learned lessons from the Chernobyl disaster and we can implement this lessons for reducing radiation damage in people affected by the Fukushima Dai-ichi accident. We must take into consideration that ionizing radiation causes not only malignancies, teratogenesis and genetic disorders but also diseases of the endocrine system, the heart and the circulatory system, in addition to psychological problems and psychoses, stillbirths1, increased perinatal mortality and disturbances of the sex odds ratio of lifebirths.2 Proposals for a secondary prevention strategy after a nuclear power plant disaster In the eventual case of a nuclear disaster in Switzerland we would propose to our government: • Distribution of stable iodine already when a release of radioactivity could just be anticipated or when a meltdown is possible.3,4 After the Chernobyl accident a significant increase of thyroid cancer incidence in children and young adults was observed.5 Iodine prophylaxis has been shown to be a safe and effective procedure among 10 millions of children in Poland, preventing 131iodine induced thyroid cancers. 131iodine has a short half live of 8 days. Eighty days after incorporation an individual dosimetry is no longer useful, because almost all incorporated 131iodine has decayed. • If prophylactic intake of iodine tablets was not done, routine sonographic screening for thyroid cancer in children is mandatory. • Food must be systematically measured for radioactive isotopes and limits must be set in a differentiated manner to protect with first priority children and, especially, pregnant women. • Children6 and adults as well, must be controlled by whole body counter measurements with best technical instruments to detect anticipated and unanticipated burdens of 137cesium and 134cesium. • Sampling deciduous teeth of children to measure 90strontium contamination of children.7,8 • Measures must be taken to reduce the burden of Isotopes such as providing immediately clean food. Intake of pectines aiming at depletion of the body burden of isotopes is strongly recommended9,10. Protection against extern radiation resulting from the contamination of the soils with radioisotopes is also important. Maybe the only realistic measure will be evacuation of contaminated regions. • In Switzerland we as an NGO would never accept a dose limit of 20 mSv/year for children as a long-term dose limitation. 1 • As an indicator of detriments one have to build up cancer registries11 long before the accident, as well as malformation registries and other morbidity registries. What happens with the incidence of malignant tumors, general morbidity of children and adults after a nuclear accident? We have to get facts - not epidemiological estimates as until now - about these consequences. • For prevention of cardiac diseases children must undergo cardiac examination to find and define cardiac arrhythmias if they have a detectable 137cesium- and 134cesium burden.12 • Statistical research must be done to observe the sex odds ratio before and after the Fukushima accident.2 The human embryo is very sensitive to radiation, female embryos more than males. • Scientific research must take into consideration the genomic instability produced by radiation, which will be transmitted to the next generations. Perhaps we will have a paradigm change in radiation biology from target theorem to a more complicated model of radiation damages. An 13 already accepted concept? 1 Stillbirths among offspring of male radiation workers at Sellafield nuclear reprocessing plant, Louise Parker, Mark S Pearce, Heather O Dickinson, Murray Aitkin, Alan W Craft, THE LANCET, Vol 354 • October 23, 1999, p 1407-1414 2 The human sex odds at birth after the atmospheric atomic bomb tests, after Chernobyl, and in the vicinity of nuclear facilities, Hagen Scherb & Kristina Voigt, Environ Sci Pollut Res DOI 10.1007/s11356-011-0462-z, Accepted: 31 January 2011 3 Guidelines for Iodine Prophylaxis following Nuclear Accidents, Update 1999 WHO/SDE/PHE/99.6 4 Between stable iodine prophylaxis and evacuation, Keith Baverstock Ph D, WHO European Centre for Environment and Health, Bonn, Germany, Rethinking Nuclear Energy and Democracy after 09/11, April 26/27 2002, A symposium organized by PSR/IPPNW/Switzerland 5 Thyroid cancer in Belarus post-Chernobyl: Improved detection or increased incidence?, Theodor Abelin, Juri I. Averkin, Matthias Egger, Bruno Egloff, Alexander W. Furmanchuk, Felix Gurtner, Jewgeni A. Korotkevic, M, Arthur Marx, Ivan I.Matveyenko, Alexei E. Okeanov, Charles Ruchti , Walter Schaeppi, Soz Präventivmed 1994, 39, 189-197 6 Chronic Cs-137 incorporation in children’s organs, Y. I. Bandazhevsky,SWISS MED WKLY 2003; 133: 488–490 www.smw.c h 7 Investigation of Strontium-90 intake in teeth of children living near Chernobyl, André Herrmann, Matthias Stöckli, Markus, Zehringer, Food Control Authority, State Laboratory of Basel-City, Switzerland, 21.04.2006 8 POSSIBILITIES OF USING HUMAN TEETH FOR, RETROSPECTIVE DOSIMETRY: ANALYSIS OF THE TECHA RIVER DATA, E. I. Tolstykh, M. O. Degteva1, E. A. Shishkina1, V. I. Zalyapin and V. A. Krivoschapov, Urals Research Center for Radiation Medicine, Chelyabinsk, Russia, Southern Urals State University, Chelyabinsk, Russi: Radiation Protection Dosimetry (2007), Vol. 127, No. 1–4, pp. 511–515 doi:10.1093/rpd/ncm358 Advance Access publication 12 July 2007 9 About purified apple-pectin – a summaey from Prof Michel Fernex, 9.6.2006 and a google reseach about Zosterin ultra, 4.3.2012 10 137 Reducing the Cs-load in the organism of “Chernobyl” children with apple-pectin, V. B. Nesterenko, A.V. Nesterenko, V.I. Babenko, T.V. Yerkovich, I.V. Babenko, SWISS MED WKLY 2004; 134: 24–27 11 A national cancer registry to assess trends after the Chernobyl accident, A. E. Okeanov, E. Y. Sosnovskaya, O. P. Priatkina Clinical Institute of Radiation Medicine and Endocrinology Research, Minsk, Belarus, SWISS MED WKLY 2004 ; 134 : 645–649 12 137 Relationship between Caesium ( Cs) load, cardiovascular symptoms, and source of food in “Chernobyl” children – preliminary observations after intake of oral apple pectin, G. S. Bandazhevskaya, V. B. Nesterenko, V. I. Babenko, I. V. Babenko, T. V. Yerkovich, Y. I. Bandazhevsky, Institute of Radiation Safety Belrad, Minsk, Republic of Belarus, SWISS MED WKLY 2004; 134: 725–729 13 Strahlenschutz – Argumente gegen die von der ICRP (Internationale Kommission für Strahlenschutz) vorgesehenen Lockerungen der Regeln, M. Walter, Schweizerische Ärztezeitung / Bulletin des médecins suisses / Bollettino dei medici svizzeri, 2005;86: Nr 26, 1584-1588* - Translated in English by Alex Rosen from IPPNW Germany: Radiation protection – Arguments against the easing of rules recommended by the ICRP (International Commission on Radiological Protection) 2 Reference 1 Articles Stillbirths among offspring of male radiation workers at Sellafield nuclear reprocessing plant Louise Parker, Mark S Pearce, Heather O Dickinson, Murray Aitkin, Alan W Craft Summary Introduction There has been concern about possible transgenerational Background Ionising radiation is a known mutagen, but few effects of exposure to ionising radiation since the earliest studies have examined transgenerational effects of paternal days of radiobiological research. Exposure of male exposure in human beings. The workforce at the Sellafield mammals to preconceptional ionising radiation causes a nuclear reprocessing plant in the county of Cumbria, UK, is range of adverse outcomes in their offspring, including the most highly exposed workforce in western Europe and death, cancer, and congenital anomaly.1–5 In 1988 a UK North America. This study, which is part of a larger government committee6 investigating the excess risk of programme of work investigating the health of the children of leukaemia in children in the vicinity of the Dounreay the Sellafield workforce, set out to find whether there was nuclear-fuel reprocessing plant in the north of Scotland evidence of an association between stillbirth risk and recommended that “epidemiological studies should be set paternal exposure to ionising radiation. up to consider any possible effects on the health of the Methods We collected details from birth registration offspring of parents occupationally exposed to radiation”. documents for all singleton 248 097 livebirths