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Congenital Malformations - Chornobyl Impacted Area - Rivne Province – Ukraine W Congenital Malformations - Chornobyl Impacted Area - Rivne Province – Ukraine W. Wertelecki, M.D. [email protected] Congenital Malformations - Chornobyl Impacted Area - Rivne Province – Ukraine W. Wertelecki, M.D. [email protected] POPULATION RATES (2000-2009) 145,437 Pregnancies ELEVATED POPULATION RATES OF NEURAL CONGENITAL MALFORMATIONS (NTD – MICROCEPHALY … BLASTOPATHIES) (RATES HIGHEST IN RIVNE-POLISSIA) (RATES AMONG THE HIGHEST IN EUROPE) NATIVE POLISSIA POPULATION – WELL DEFINED ECOLOGY and ETHNOLOGY (CHARACTERISTICS OF A POPULATION ISOLATE) IMPERATIVE - PROSPECTIVE INVESTIGATIONS OF RISK FACTORS (CALL FOR INTERNATIONAL PARTNERSHIPS) Congenital Malformations - Chornobyl Impacted Area - Rivne Province – Ukraine W. Wertelecki, M.D. [email protected] POPULATION RATES (2000-2009) 145,437 Pregnancies ELEVATED POPULATION RATES OF NEURAL CONGENITAL MALFORMATIONS (NTD – MICROCEPHALY … BLASTOPATHIES) (RATES HIGHEST IN RIVNE-POLISSIA) (RATES AMONG THE HIGHEST IN EUROPE) NATIVE POLISSIA POPULATION – WELL DEFINED ECOLOGY and ETHNOLOGY (CHARACTERISTICS OF A POPULATION ISOLATE) IMPERATIVE - PROSPECTIVE INVESTIGATIONS OF RISK FACTORS (CALL FOR INTERNATIONAL PARTNERSHIPS) ACKNOLWEDGMENTS Ukrainian Ministry of Health; Academy of Sciences; Academy of Medical Sciences. Ukrainian Universities and Research Institutes: Mohyla Academy; Lviv Medical University U.S. Universities: South Alabama; California at Berkeley, at San Diego, at Davis; New York at Burlington (SUNY); Emory; Indiana and, South Carolina. Provincial Public Health Authorities; Rivne; Volyn; Khmelnytsky; Kherson; Crimea. U.S. Agencies and Foundations: Centers for Disease Control; USAID; March of Dimes; National Institutes of Health. International Organizations European Consortium of Malformation Monitoring Systems International Congenital Malformations Clearing House OMNI-Net Ukraine Child Development Programs Programs and Data Collection Points * Chornobyl OMNI-Net Resource Centers Support Academic Centers 1986 2011-08-26c– fig.1a Polissia *** Chornobyl Khmelnythsky Prypiat River and Tributaries POLISSIA NPP1 Chornobyl NPP Ostroh NPP2 Khmelnytsky 2011-09-21a a BELARUS 1 Regions Polissia soils 2 Designated Chornobyl impacted zones nonPolissia 4 3 Nuclear power plants 30 km radius b zones VOLYN PROVINCE Rivne city (provincial capital) Distant Polissia Counties ZHYTOMYR PROVINCE 1 – Zarichne 2 – Dubrovytsia 3 – Rokytne Other sites 5 4 – Volodymyrets County 5 – Rivne County 6 – Ostroh County 6 a, b, c – Rivers Prypiat, Styr and Horyn c TERNOPIL PROVINCE KHMELNYTSKY PROVINCE Figure 1. Schematic representation of Rivne province counties indicating those with soils characteristic of a region called Polissia and those counties designated as impacted by Chornobyl ionizing radiation. Also shown is the area of “distant” Polissia, the location of nuclear power plants and the trajectory of major rivers of the region BELARUS Regions 1 Polissia soils Designated as Chornobyl impacted zone 2 nonPolissia Nuclear power plants (NPP) 4 3 30 km radius zones Rivne city (capital) Distant Polissia VOLYN 1 – Zarichne County OBLAST 2 – Dubrovytsia County 3 – Rokytne County Other sites 5 4 – Kuznetsovsk NPP 5 – Rivne County 6 – Ostroh County 7 – Khmelnytsky NPP 6 7 KHMELNYTSKY OBLAST 2011-08-26a – fig.1b TERNOPIL OBLAST POLISSIA River Prypiat – Prypiat Marshes – Polishchuks Cs Transfer from Soil-to-Food Chain Index Highest in Ukraine OMNI-Net Ukraine 2009 Fig. 1. Twenty five regions of Ukrainian territory and their corresponding daily 137Cs intakes. Dietary iodine and bromine intakes ● K. Shiraishi et al. - Health Physics January 2009, Volume 96, Number 1 2011-09-13a Ukrainian Ministry of Health – OMNI Birth Status Report Neonatal Population Registry Congenital Malformations Population Registry W. Wertelecki, M.D. [email protected] 2012-01-10a Table 1a. Rates* ALL INDIVIDUALS with Congenital Malformations in Rivne Province of Ukraine (a) Polissia Non-Polissia Polissia Non-Polissia Polissia vs. Non-Polissia 2000-2004 2005-2009 2000-2004 2005-2009 2000-2009 2000-2009 P OR CL Live Births 33703 38676 33205 39853 72379 73058 Neural Tube Defects 29.08 23.53 18.37 14.80 26.11 16.43 <0.0001 1.59 1.26,2.02 Craniocervicothoracic 12.76 11.64 7.83 5.77 12.16 6.71 0.0008 1.81 1.26,2.63 Anencephaly(b) 6.23 INDIVIDUALS4.14 5.12 3.01 5.11 3.97 0.3264 1.29 0.77,2.17 Isolated 5.64 3.88 4.82 3.01 4.70 3.83 0.448 1.23 0.72, 2.10 Other Malformations n/c n/c n/c n/c n/c 0.3727 3.03 0.24, 159 Craniorachischisis(c) 3.26 5.95 2.71 1.76 4.70 2.19 0.0106 2.15 1.15, 4.16 Isolated 2.08 4.14 1.81 1.51 3.18 1.64 0.0641 1.93 0.92, 4.27 Other Malformations n/c 1.81 n/c n/c 1.52 n/c 0.0755 2.78 0.82, 12.0 Spina Bifida High(d) 3.26 1.55 n/c 2.35 n/c 0.0042 4.29 1.40, 17.53 Isolated 2.37 1.55 n/c 1.93 n/c 0.0187 3.53 1.11, 14.7 Other Malformations n/c n/c Lumbo-Sacral Spina Bifida(e) 10.09 10.34 7.23 7.03 10.22 7.12 0.0496 1.44 0.99, 2.09 Isolated 8.90 9.05 6.02 6.52 8.98 6.30 0.071 1.43 0.96, 2.13 Syndromes n/c n/c Other Malformations n/c 1.29 n/c n/c 1.11 0.82 0.6056 1.35 0.41, 4.71 Spina Bifida Isolated Undefined(f) 3.26 n/c 1.52 n/c 0.0755 2.78 0.82, 12 Encephalocele 2.97 1.55 2.11 2.01 2.21 2.05 0.8594 1.08 0.50, 2.34 Isolated 2.08 1.29 1.51 1.51 1.66 1.51 0.8381 1.1 0.44, 2.75 Syndromes n/c n/c n/c n/c 0.6233 2.02 0.11, 119 Other Malformations n/c n/c n/c n/c n/c n/c 1 0.67 0.06, 5.87 Microcephaly 5.04 6.72 3.31 3.26 5.94 3.29 0.02 1.81 1.07, 3.12 Isolated 2.67 1.29 n/c 1.25 1.93 W. Wertelecki1.10 0.208, M.D. 1.77 0.69, 4.86 Syndromes n/c 2.84 2.11 1.76 2.07 [email protected] 0.8549 1.08 0.49, 2.42 Other Malformations n/c 2.59 n/c n/c 1.93 n/c 0.0022 7.07 1.62, 64.07 Microphthalmos(g) 1.78 3.10 n/c n/c 2.49 0.82 0.0142 3.03 1.15, 9.32 Isolated n/c 1.55 n/c 1.11 n/c 0.2646 2.02 0.54, 9.16 Syndromes n/c n/c n/c n/c 0.3727 3.03 0.24, 159 Other Malformations n/c n/c n/c 0.97 n/c 0.0382 7.07 0.91, 318 Conjoined Twins(h) n/c n/c n/c n/c 0.68 0.4531 0.4 0.04, 2.47 Teratomas(i) 1.48 n/c n/c n/c 0.83 n/c 0.5469 1.51 0.36, 7.30 Omphalocele(j) 1.78 1.81 2.41 4.27 1.80 3.42 0.073 0.52 0.25, 1.07 Isolated n/c n/c 1.81 2.76 0.69 2.33 0.0169 0.3 0.09, 0.84 Syndromes n/c n/c n/c n/c n/c 0.6233 2.02 0.11, 119 Other Malformations n/c n/c n/c 1.51 0.83 0.96 1 0.87 0.24, 3.01 Urinary Bladder Exstrophy(k) n/c n/c n/c n/c 1.11 0.68 0.4218 1.62 0.47, 6.27 Isolated n/c n/c n/c n/c 1.11 0.68 0.4218 1.62 0.47, 6.27 Gastroschisis n/c 3.36 3.31 3.01 2.35 3.15 0.4297 0.75 0.37, 1.46 Isolated n/c 3.36 3.01 3.01 2.35 3.01 0.5225 0.78 0.39, 1.54 Other Malformations n/c n/c n/c All 42.13 39.82 29.81 28.35 40.90 29.02 0.0001 1.41 1.18, 1.69 Isolated 32.93 27.92 22.89 23.59 30.26 23.27 0.011 1.3 1.06, 1.60 Syndromes 2.37 3.88 3.01 1.76 3.18 2.33 0.3468 1.37 0.70, 2.72 Other Malformations 6.82 8.02 3.92 3.01 7.46 3.42 0.001 2.18 1.33, 3.66 Neural Congenital Malformations Population Rates Period 2000-2004 vs 2005-2005 Pregnancies Difference Polissia 33703 38678 N.S. non-Polissia 33205 39853 N.S. Polissia non-Polissia P OR L/U CL Pregnancies 72379 73058 NTD 189 120 ** 1.59 1.26-2.02 Cephalad (a) 88 49 ** 1.81 1.27-2.63 Microcephaly 43 24 ** 1.81 1.07-3.12 Microphthalmos 18 6 ** 3.03 1.15-9.32 After Excluding Individuals with Recognizable Malformation Syndromes, exposures to Alcohol, Genomic anomalies and Holoprosencephaly NTD 186 119 ** 1.58 1.25-2.01 Anencephaly + Cranio-rachi-schisis 71 45 ** 1.59 1.08-2.37 Microcephaly 15 5 * 2.83 1.33-6.52 Microphthalmos 18 6 * 3.03 1.05-10.65 Sentinel Anomalies Cleft Lip a/o Palate 68 69 N.S. Down Syndrome 101 97 N.S. NTD = Neural Tube Defects * P< 0.05 ** P<0.01 (a) Anencephaly + Cranio-rachischisis + Cervico-thoracic Spina Bifida Table Ic.
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