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HEALTH OF SURVIVORS IN UKRAINE IN 20-YEARS DYNAMICS AFTER

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,

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HEALTH OF SURVIVORS IN UKRAINE IN 20-YEARS DYNAMICS AFTER

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  1. International BfS Workshop on the Chernobyl Accident Health ConsequencesMunich 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”

  2. Distribution of Cs-137 in Ukraine before 1985y

  3. Distribution of Cs-137 in Ukraineafter accident in 1998y  (Water)                

  4. 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 -80-95%.(Ministry of Health of Ukraine, 2006)

  5. 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)

  6. Population healthin UkraineData 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 highestrisk 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.

  7. Dynamics of the total number of survivors -1997-2006yy.

  8. Number of people living in different contaminated territories in Ukraine 73 rayons, 12 oblasts (Vinnitsa, Volyn, Zhytomir, Ivano-Frankovsk, Kiev, Rivnae, Sum, Thernopil, Khmelnitsk, Cherkasska, Chernivetska, Chernihivska).

  9. 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.

  10. UKRAINIAN STATE Chernobyl REGISTRY 01.01.20062 252 130 (from 2 594071) persons

  11. 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.

  12. 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.

  13. MORBIDITY of ADULTS SURVIVORSon 10 thousand(Ministry of health of Ukraine)

  14. Dynamics of morbidity in children survivors ( per 10000 persons)

  15. 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)

  16. Mortality of affected people according to the groups of primary count in 1989-2004 per 1000 persons.(Ministry of Health of Ukraine)

  17. Dynamics of collective dose of radiation exposure and mortality of irradiated people and all people in Ukraine..

  18. Chernobyl catastrophe health effects Stochastic effects1. Thyroid

  19. 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)

  20. 370 359 350 331 284 251 249 197 192 183 147 129 118 69 62 37 25 22 19 Number of thyroid cases in children and adolescents (0-18 years old at the time of the Chernobyl accident.).

  21. Thyroid cancer in Children born before accident, after accident (I. Komissarenko, 2005). 1970-1989 y.295 (10) patients 1990-2005y.3124 (560) patients

  22. 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

  23. DINAMICS OF THYROID TUMOURS IN ADULTS

  24. Cancer thyroid in adults Liquidators cancer increasing by 9-fold (for female- by 13-fold); Amongst evacuees – by 6-fold; Among residents of radioactive-contaminated territories – by 4.1-fold. (Source – National Report of Ukraine, 2006)

  25. Dynamics of thyroid cancer incidence rate in Ukraine, Kiev, Zhytomir regions, Kiev city and theterritories 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)

  26. 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.

  27. LEUKEMIA IN UKRAINE! What we know?

  28. 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].

  29. 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.

  30. Lymphoma (ICD-9 200-203) incidence rates in the districts most heavily contaminated with radionuclides.

  31. 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).

  32. OTHERS MALIGNANTTUMOURS MORBIDITY

  33. 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 moderately increasing;

  34. 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)

  35. 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.

  36. 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).

  37. 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.

  38. 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 pre-accident indices. .

  39. Heritable effectsin children with exposure in utero (Stepanova E.I. and all.2006) 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 mSv

  40. 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). (Glazko E.I.,2006).

  41. 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)

  42. 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.

  43. The risk of spontaneous abortion, cumulative year dose and fact of residing on contaminated territories. Spontaneous abortion risk is increasing if cumulative dose reach 5mSv. A.M, Serdyk and all (2004, 2006).

  44. 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!

  45. How many liquidators we have?

  46. Liquidators DOSIMETRY • Doses of radiation to which liquidators and emergency • clean-up workers were subjected are in the average • range and low intensity limits of 50-200 mSv. But due • to the absence of effective dosimetric control and • because of complicated and uninvestigated radiation • conditions many liquidators received doses of over 1Gy • during the 1.5 months following nuclear accident. • This would include many people, especially nuclear • power plant personnel, firemen, military people, miners, • construction workers who built the tunnels and shelter • around destroyed reactor and in the later period on the • roof of the 3rd unit of the Chernobyl NPP. • We can state that among those groups there are people in • whom the ARS was never clinically established. As a • whole, the information about the dosimetric state of • liquidators is incomplete (only 50% of this information • about received doses of radiation is available) and unclear • (since it is unknown how accurate the available records about • these doses may be). This data in its current state cannot • be used to assess radiation risks and to analyze real • radiation medical effects of the explosion and needs revision.

  47. LIQUIDATORS MORBIDITY(by Registry of military liquidators of Ministry Internal Affaires of Ukraine)

  48. The Dynamics of common sickness rate of circulatory diseases.

  49. 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%).

  50. CEREBROVASCULAR DISEASES - ENCEPHALOPATHY SYNDROMThe 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-organicnature of the disorders.

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