1. Radiation Contamination in Fukushima Mitsuyoshi Urashima MD, PhD, MPH Chief of Molecular Epidemiology, Pediatric Oncologist, Associate Professor, Jikei University School of Medicine Tokyo, JAPAN urashima@jikei.ac.jp

2. Earthquake 2:46PM Hydrogen Explosion At 1 st reactor Hydrogen Explosion At 3 rd reactor Explosion At 2 nd reactor

3. 330microSv/hr 270microSv/hr 255microSv/hr 50 km NuclearPowerPlants 20 km 30 km March 15 th

4. Earthquake 2:46PM Radio-Contamination In food supply And water Hydrogen Explosion At 1 st reactor Hydrogen Explosion At 3 rd reactor Hydrogen Explosion At 2 nd reactor

5. Risk Communication by Government This level of irradiation has no hazardous effects on health for now. People think: That’s means some problems later, cancer, congenital anomalies, infertility? This level of irradiation in water and food has no hazardous effects on health if you do not take long term. However, if you can avoid taking, please do so. But if you can’t, it’s OK. Doesn’t matter. People think: This must be quite danger.

6. Earthquake 2:46PM Contamination In food supply And water Broadcast “Close Up Today” NHK Hydrogen Explosion At 1 st reactor Hydrogen Explosion At 3 rd reactor Hydrogen Explosion At 2 nd reactor Phone call From NHK Water radio-contamination In Tokyo

8. Audience rate = 14% 2011/3/24 (Thur) 8 – 9 PM

9. Risk communication Demonstrate Chernobyl as scientific evidence Increase of thyroid cancer in children No significant increase of cancer in adults No significant increase in congenital anomalies What we need to do is protecting children. 1. People outside the area of disaster do not have to worry about yourself. 2. We should have sympathy to the causalities with serious anxiety as if they are our family or friends. 3. If the society be confused and depressed, the situation will be much more worsened. So, we should seek more positive side of things. Try to keep unequivocal attitude to wipe out anxiety and suspicion of the people in their hard time

10. 1.Power of Media Many e-mails and phone calls I felt the atmosphere of Japanese society had been changed totally after that. 2. Dynamic changes of behavior in such a short period. Go home earlier. People seek behavior: Do the right things, Justice. 3. Things have both negative and positive side. Crisis made us notice what is the most important in life and gave us a chance to change dramatically.

11. At Home of Prof. Craig Van Dyke Early April

12. Aftermath of Tsunami, Iwaki city

13. In a Refuge, Fukushima city

15. 2011 Nov 5th  Sv/hr  Sv/hr → mSv/year 9.5 50 3.8 20 1.9 10 1.0 5 0.5 2.5 0.2 1 0.1 0.5 Kouri city Fukushima city

16. Seminar at Fukushima city Health Center For Staffs, Early June

19. < 3,700Bq/L< 300Bq/L ChernobylFukushima 3,700Bq/L << 100Bq/L Milk Powdered milk 1 ～ 2 weeks Start 1 day or 5 days Thoroughness ? Better ? Threshold of iodide131

20. <15 at the accident Incidence of thyroid cancer: 5127 Death: 9 <19 at the accident Incidence of thyroid cancer: 6848 Death: 15 20 years after Chernobyl accident Fatality ： 0.2 ％ Survival rate ： 99.8 ％ Fatality ： 0.2 ％ Survival rate ： 99.8 ％ Report by UN

21. Oct, Nov and Dec 2011 Thyroid tumor screening test for 0 ~ 18 years old ECHO Till 2014 March, first 3 years Every 2 years Ever 5 years 20 years old Screening of Thyroid Cancer in children

22. No nodules or cysts: 2,622 (69.6%) Nodules < 5mm or Cysts < 20mm: 1,117 (29.7%) Nodules 5mm < or Cysts 20mm <: 26 (0.7%) Need to proceed next step: 0 (0%) ECHO Blood and Urine Exams To make sure

23. During summer vacation, children in Fukushima spent their time in west side of Japan. NGO associating Chernobyl measured thyroid function of these children. Ten of 130 were out of normal range. Mother whose child was out of normal commented to media’s interview “When I was told the results by a doctor, my brain was totally white”. We do not have preventive way for radiation inducible-cancers.

24. Never before have people been asked to live with such ambiguity. The TMI accident – an accident we cannot see or taste or smell … is an accident that is invisible. I think the fact that it is invisible creates a sense of uncertainty and fright on the part of people that may well go beyond the reality of the accident itself.

25. Why risk perception is much higher than real risk? Radiation is invisible: Smoking is avoidable because it can be seen. Radiation is not controllable: Food poisoning by pathogenic E Coli was avoidable by heating meat. Children’s issue: Dividing cells may be more sensitive to radiation induced toxicity, theoretically. Long lasting: Not 1 year’s problem, but will continue decades. Uncertainty: We have only a few evidence of low dose radio-contamination in history.

26. Why risk perception is much higher than real risk? Reliability: The national government is doing little and unreliable. Cancer: People may have devastative image to cancer. Human made disaster: People feel sorrow lost families and friends by the earthquake and tsunami, but never complain. However, people complain invisible radiation before health hazard. Why? I believe people look that this accident is human made but not nature made.

27. Be an Advisor of Kouri town

28. 1.One whole body counter 2.Two machine to measure radiation levels in food and water Kouri town bought I advised we should visualize radiation.

29. Radiation of drain May/13: 21  Sv/h May/30: 1.38  Sv/h Wash with High pressured water ground High radiation level 30cm lower than the other side Rainwater pool I advised we should control radiation.

30. Dig Pile Up Sheet Radiation levels reduced to 10%. Till June, schools and parks has been changed into safe places for children. Lateral view of ground Dig 3m in depth, and pile up the dug soil. Put nylon sheet. Put them into dug hole. Peel superficial soil.

32. 0 50 100 150 200 Frequency 01234567 Predicted External exposure mSv/Year 0.5 1 Frequency 0.511.522.533.544.555.566.57 Max 3.6mSv/y Sep + Oct (adjusted into 1 year by 6 times) Nov + Dec + Jan (adjusted into 1 year by 4 times)

33. Dreams by Akira Kurosawa in 1990

34. Mount Fuji in Red The film's second nightmare sequence. A large nuclear power plant near Mount Fuji has begun to melt down, painting the sky a horrendous red and sending the millions of Japanese citizens desperately fleeing into the ocean. Three adults and two children are left behind on land, but they soon realize that the radiation will kill them anyway.

35. Village of the Watermills This is the last of eight dreams. A young man finds himself entering a peaceful, stream-laden village. The traveler meets an old, wise man who is fixing a broken watermill wheel. The elder explains that the people of his village decided long ago to forsake the polluting influence of modern technology and return to a happier, cleaner era of society. They have chosen spiritual health over convenience, and the traveler is surprised but intrigued by this notion.

36. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Accident of Nuclear Power Plant Three mile island Chernobyl Fukushima Health Mental Psycho motor disease Anxiety Depression Society Collapse of community, unemployment Disease Thyroid cancer in children Family with children