1. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

2. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

5. Accident at Chernobyl Saturday, April 26, 1986 at 01:23:48 Chornobyl Nuclear Power Plant, Ukraine, USSR Total Radioactivity Released by the accident 50-100 x 10 6 Ci Total Radioactivity Released into Belarus 70%: 35-70 x 10 6 CI Radioactive Materials Released by the Accident I, Cs, Sr, Co, Xe, Kr, Pu, etc. Williams D. Science and society: Cancer after nuclear fallout: lessons from the Chernobyl accident. Nature Reviews Cancer 2002;2:543-549 (01 Jul).

10. Populations at High Risk for Thyroid Neoplasia from Exposure to Radiation Fetus after 12 weeks of gestation in April 1986. Number of cases dramatically decreased after 2000. Children ages < 6 years in April, 1986. Children ages 0 to 1 year have the highest risk. Children living in areas with iodine deficiency. Greater radioiodine uptake increases the dose of radiation exposure to the thyroid gland. Children exposed to > 1 cGy of radiation. Rapid thyroid growth in young children occurs with chromosomal rearrangements (PTC1 and PTC3).

11. The Carcinogenic Effects of Radiation The isotopes of iodine-131, -132, -133 Chronic exposure to Cesium-137 Higher tissue exposure to radiation occurs in those tissues that concentrate iodine: –Thyroid → ↑ incidence of adenoma, carcinoma –Breast → ↑ incidence of carcinoma –Salivary gland –Gastric mucosa

12. Iodine Prophylaxis in Poland Radiation detected 36 hours after initial release. KI distribution began in the PM on day 3. –10.5 million doses of KI given to children – 7 milion doses of KI given to adults Exposure to radioiodines in infants age < 1 year –> 50 mSv (5 Rem) if unprotected from radioiodine –< 50 mSv when protected by KI + substituted milk KI caused ~ 40% reduction in Rem dose to thyroid. With early prophylaxis, ~ 60-70% reduction in Rem dose primarily because inhaled 131 I is blocked. Incidence of 0.2% for medically significant, but not serious side effects.

13. Radiologic Terrorism Radiation Exposure Dirty Bombs Atomic Bombs Five decades after the first atomic bomb Terrorist atomic bomb Nuclear Power Plants Three Mile Island accident 1978 in PA Chernobyl accident, April 26, 1986, in the Ukrainian SSR Management of pregnant women and children

14. Management of Pregnant Women and Children Exposed to Radiation Evacuation –Priority evacuation protocols for pregnant women, infants and pre-pubertal children –Evacuation to an identified location at least 50 miles from the source of radiation Potassium Iodide –KI tablets or liquid administered on notification by authorities of the possibility of radiation exposure. –Dose schedules and negligible toxicity

15. Evacuation of Pregnant Women and Children Exposed to Radiation Priority Evacuation –Priority identification signs should be provided to pregnant women and families of infants and pre-pubertal children to display on the windshield for priority rapid “HOV-lane” emergency evacuation. –Evacuation routes should be defined in advance. Distance from Radiation Source –The radiation plume travels in the direction and at the speed of the prevailing winds. –Biologically significant radiation exposure may occur 100-200 miles from the source depending upon the atmospheric conditions.

16. Management of Pregnant Women and Children Exposed to Radiation Evacuation –Priority evacuation protocols for pregnant women, infants and pre-pubertal children –Evacuation to an identified location at least 50 miles from the source of radiation Potassium Iodide –KI tablets or liquid administered on notification by authorities of the possibility of radiation exposure. –Dose schedules and negligible toxicity

17. KI Therapy for Pregnant Women and Children Exposed to Radiation Potassium Iodide for Radioiodine Exposure –Pre-packaged, pre-distributed KI tablets or liquid should be readily available in homes, schools, day care centers and nurseries near reactors. –On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency. KI toxicity –Negligible, minor side effects, and rare in children.

18. Potassium Iodide Doses AAP Committee on Environmental Health. Pediatrics 2003;111:1459

19. KI Therapy for Pregnant Women and Children Exposed to Radiation Potassium Iodide for Radioiodine Exposure –Pre-packaged, pre-distributed KI tablets or liquid should be readily available in homes, schools, day care centers and nurseries near reactors. –On notification by authorities of the possibility of radiation exposure, parents should give or have given authorization to dispense KI if authorities declare a radiation-exposure emergency. KI toxicity –Negligible except in very rare cases of iodinism.

20. Potassium Iodide Safety KI toxicity –Acute poisoning is uncommon –Hypersensitivity reactions are rare, but dangerous: Angioedema and laryngeal edema Serum-sickness-like reactions [fever, lymphadenitis, arthralgia, arthritis] Chronic exposure –Iodism (parotid pain and swelling); skin rashes –Goiter and primary hypothyroidism on occasion at any age Contraindicated during pregnancy and infancy High dose KI as treatment of Sporotrichosis –Children:50 mg/dose tid; ↑ by 50 mg/dose daily –Children:150-500 mg/dose up to 500-750 mg tid –Older Child:250 mg tid; Maximum: 1-2 grams/dose tid

21. Management of Children Exposed to Ionizing Radiation Preparation: Supplies of KI, infant formula, powered milk Evacuation routes and locations Emergency battery operated communications –Radios –Cellular telephones Priority Evacuation Defined routes [HOV Routes] Priority evacuation Identification on vehicles Potassium iodide Priority 1: pregnant women and infants Priority 2:young children Monitor TSH in infants and pregnant women

22. Radiologic Terrorism: Bibliography Williams, Dillwyn. Science and society: Cancer after nuclear fallout: lessons from the Chernobyl accident. Nature Reviews Cancer 2002;2:543-549 (01 Jul). [Review] CDC: www.bt.cdc.gov/radiationwww.bt.cdc.gov/radiation AAP Policy Statement. Radiation disasters and children. Pediat 2003;111(6):1455-1466. Mettler FA, Voelz GL. Major radiation exposure – what to expect and how to respond. NEJM 2002;346:1554-1561. www.atomicarchives.com/Example/ExampleStart.shtml Nauman J, Wolff J. Iodide prophylaxis in Poland after the Chernobyl reactor accident: Benefits and risks. Am J Med 1993;94(5):524-532. [Review] Nagataki S, Yamashita S, Eds. Nagasaki Symposium Radiation & Human Health, Elsevier, 1996, p xii.