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,

Association “ Physicians of Chernobyl”
Distribution of Cs-137 in
Ukraine before
1985y
Distribution of Cs-137
in Ukraine after
accident in
1998y (Water)
 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)

внутрішнє опромінення, зумовлене інгаляційним надходженням

радіонуклідів з повітрям до 0,1%
внутрішнє опромінення від радіонуклідів, що надходять з питною
водою до 2%
зовнішнє гамма - опромінення 5-20%

внутрішнє опромінення від радіонуклідів, що надходять з продуктами

харчування 80-95%
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)

%
Волинська
20
Житомирська
Київська
15
17,1 Рівненська
Черниговская
10 15,1
5 8,3
2,0 3,2
0
 Population health
in Ukraine
Data 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
highest risk 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.
 Dynamics of the total number of survivors -1997-2006yy.

Categories of the survivors and 1997 2000 2005 2006 2006 to

Number 1997%
On 1997-2006yy.
• Category 1 - Invalids 59582 86775 105251 106824 • 179
• Category 2 339666 • 307 982 276 072 268815 • 79
Including:
2a- 1986-1987 yy. liquidators 352939 277 135 • 197 817 191 167 76
(24%)
2b- survivors- evacuees •90
86726 80 847 78 255 77 647

• Category 3 558637 549 649 • 537 504 • 533144 • 95

Including: 3a 1987-1990 liquidators 69 620 62729 55 391 52346 • 75
3b survivors
489 017 486 720 482113 • 480798 • 98
Category 4 1 169 804 1 150273 1 081 469 • 1 065 022 • 91
Category D:
• 2530 • 2862 • 2780 • 2606 • 103
people who worked beyond the territory
of the exclusion Zone
•Children survivors (including those with • 1 083 107 • 1 264 329 • 643 030 • 617 660 • 57
thyroid gland irradiation in 1986)
•Total • 3 213 326 • 3 361 870 • 2 646 106 2 594071 • 81
•(Died 504 117 persons???)
 Number of people living in different contaminated territories
in Ukraine

Indices Total Exlusion Zone 2 Zone 3 Zone 4

zone) 15-40 Ci/km2) 5-15 (1-5 Ci/km2
Ci/km2)

Number of settlements 2293 76 92 835 1290

Population 2291.93 0.12 9.04 637.23 1645.54

(in thousands)

Including Children 488.69 0 1.87 150.16 336.66

under 14
Territories (km2) 53454 2122 2003 22619 26710

Including forests 25357 1058 1315 14194 8790

73 rayons, 12 oblasts (Vinnitsa, Volyn, Zhytomir, Ivano-Frankovsk, Kiev, Rivnae, Sum,

Thernopil, Khmelnitsk, Cherkasska, Chernivetska, Chernihivska).
 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.
UKRAINIAN STATE Chernobyl REGISTRY 01.01.2006
2 252 130 (from 2 594 071 ) persons

1 493 195

79 277 373 994

305 664
ліквідатори
евакуйовані
проживаючі
особи, що народилися від батьків 1-3 груп
 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).
18

17

16

15

14
рождаемос ть
с мертнос ть
13

12

11

10

8
1970 1974 1978 1982 1986 1990 1994 1998 2002 2006

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.
 HEALTH (state statistics)
100 %
90
80
70
60
50
40
30
20
10
0
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
Роки
Ліквідатори
Евакуйонані
Жителі забруднених територій
Діти, які народились від опромінених батьків
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.
 MORBIDITY of ADULTS SURVIVORS on 10
thousand (Ministry of health of Ukraine)
Classes of diseases 1987 y 2005 y
NEOPLASMS 22,9 82,25
MALIGNANT NEOPLASMS 15,3 36,86
Endocrine diseases system 63,2 149,27
Incl. Thyroid diseases 34,0 96,95
Hematological diseases system 8,5 39,61
Incl. anemia 0,0 31,27
Mental disorders 24,9 51,87
Nervous system diseases 286,2 212,97
Cardiovascular system diseases 223,8 585,20
Respiratory system diseases 315,4 2091,4
Digestive system diseases 104,1 319,59
Urogenital system diseases 71,8 456,76
Skin and subcutaneous tissue diseases 119,5 331,89
Muscular – skeletal diseases 69,4 322,99
Injuries and poisoning 0,0 508,13
All 1372,9 6017,8
Dynamics of morbidity in children survivors ( per 10000 persons)

Classes of diseases 1987 y 2005 y

NEOPLASMS 0,27 2,5
Malignant neoplasms 0,1 0,2
Endocrine system diseases 23,3 49,9
Including Thyroid diseases 15,7 36,9
Hematological diseases 14,2 39,4
Incl. Anemia (iron – deficient) 0,0 28,2
Mental disorders 2,6 5,6
Nervous system diseases 15,2 26,7
Cardiovascular system diseases 7,6 18,4
Respiratory system diseases 314,2 874,6
Digestive system diseases 23,9 76,3
Urogenital system diseases 3,3 22,7
Skin and subcutaneous tissue diseases 17,7 72,9
Muscular-skeletal system diseases 11,4 40,0
Certain conditions originating in perinatal period 0,0 9,25

Congenital diseases 0,8 4,9

ALL diseases 455,4 1437,8

 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)

Clas An average index An average index for Percent difference

s of Names of class diseases for examined other between
dise provinces provinces of Ukraine compared indexes
ases
2.0 Neoplasm 7.6 5.5 +38.2
3.0 Diseases of blood and 2.7 2.5 +8.0
hemopoietic organs
4.0 Diseases of endocrine system 12.2 11.2 +8.9
5.0 Mental and behavioral 37.5 41.7 -10.1
disorders
6.0 Diseases of nervous system 44.4 41.3 +7.5
10.0 Diseases of respiration 15.0 12.9 +16.3
organs
11.0 Diseases of digestion organs 5.4 3.1 +74.2
14.0 Diseases of urogenital 5.0 4.6 +8.7
system
15.0 Congenital anomalies 35.9 26.7 +34.0
Mortality of affected people according to the groups of
primary count in 1989-2004 per 1000 persons.
(Ministry of Health of Ukraine)

22 на 1000
20
18
16
14
12
10
8
6
4
2
0
89
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
Роки
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
1 група обліку 2 група обліку 3 група обліку 4 група обліку
 Dynamics of collective dose of radiation exposure and
mortality of irradiated people and all people in Ukraine.
.

Смертність, х1000 КД
22 100
20
18 80
16
14 60
12
10 40
8
6
4 20
2
0 0
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Роки
Колективна доза опромінення (КД)
Смертність постраждалого населення
Смертність населення
Chernobyl catastrophe health
effects
Stochastic effects
1. Thyroid
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)
Number of thyroid cases in children and adolescents (0-18 years old at
the time of the Chernobyl accident.).

400 370
359
350
350 15-18 331
0-14 284
85 92
300 105
88
251 249
250 67

192 197 81 69
200 183

147 54 61
150 129 66
118 274 278
43 243 245
46 217
100 35
62 69 170 180
138 136
50 37 20 23 104 117
25 22 83 83
19 13
14 11 42 46
11 24
0 8 11 11

86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
 Thyroid cancer in Children born before accident, after
accident (I. Komissarenko, 2005).
120 113
105
100 95
1970-1989 y. 91 1990-2005y.
94
295 (10) patients 80
81
3124 (560) patients
73

60 58
54

48
41
40
33
21 21
20 15
12 1313
7 8
4 4
11 3 32 11 12 2 2
0

Дети и подростки на момент аварии

Дети и подростки рожденные после аварии
Дети и подростки оперированные до аварии
 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
DINAMICS OF THYROID TUMOURS IN
ADULTS

600 588
549

500 483 498

420 452
422 400
400 368
323 377
355
300 306
249
237 238
200 212 191 228

111
100 79
28 45
21

Доброкачественные Злокачественные
 Cancer thyroid in adults
45
А Середня поглинута Liquidators cancer increasing by 9-
Стандартизовані показники на

40 еквівалентна доза
35
30
зовнішнього
опромінення всього
fold (for female- by 13-fold);
тіла 50-200 мЗв
25
Amongst evacuees – by 6-fold;
100000 осіб

20
15
10 Among residents of radioactive-
5
0
contaminated territories – by 4.1-
1990 1992 1994 1996 1998 2000 2002 2004
fold.
Населення України УЛНА
(Source – National Report of Ukraine, 2006)

50 14
В Середня поглинута еквівалентна доза С
Стандартизовані показники на
Стандартизовані показники на

45 опромінення щитовидної залози 12 Середня ефективна

40 184.4 - 857.5 мЗв
35 10 еквівалентна доза
100000 населення
30 опромінення щитовидної
100000 осіб

25 8 залози 187 - 221 мЗв

20
15 6
10
4
5
0 2
1990 1992 1994 1996 1998 2000 2002 2004
0
Населення України Евакуйовані
1980 1983 1986 1989 1992 1995 1998 2001 2004
Населення України
Забр. території
 Age-standardised incidence rate per 100 000
14

12

10

0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

Ukraine Kiev region Zhytomir region

6 Kiev city Contaminated territories

5
Dynamics of thyroid cancer incidence rate
in Ukraine, Kiev, Zhytomir regions, Kiev
4 city and the territories most heavily
contaminated with radionuclides
3
in 1980-2004.
2

0
Age-standardized average annual thyroid
1962-
1969- Females
cancer incidence rates in Ukraine in separate
1964
1972 1977-
1979 1989-
1993-
Males time periods (males and females)
1992 1997-
1996 2001-
2000 2004
 INDICIES OF NEUROONCOLOGIC MORBIDITY
DYNAMICS AMONG YANGER CHILDREN IN
UKRAINE
The pre-Chernobyl period (1981-1985) –
49 cases.
100

The post - Chernobyl period -

количество наблюдений
1986-1990 - 75 cases (1,9 -fold increase);
10

1991-1995- 116 cases (2,9- fold increase);

1996-2000- 85 cases (2,1 – fold increase);
2001-2004- 94 cases (2,3 – fold increase). 1

For children under one year old – 6,2 –fold

80

82

84

86

88

90

92

94

96

98

00

02

04
19

19

19

19

19

19

19

19

19

19

20

20

20
growth. количество больных
To account a decrease in birth rate
and natural reduction of absolute quantity
of children, the growth of average index 5,8 80
70

fold more is very significant. 60

50
40
30
20

Malignant tumour constitute 43% of all 10

0

central nervous system neoplasm in

5

4
98

99

99

00

00
-1

-1

-1

-2

-2
81

86

91

96

01
19

19

19

19

20
children aged under 3 years. злокачественные доброкачественные
LEUKEMIA IN UKRAINE!
What we know?
 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].
 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.
35

30

25
Relative frequency, %

20
Clean-up workers
15
General population
10

0
Chronic Multiple Large Non- Chronic
lymphocytic myeloma granular Hodgkin's myelogenous
leukemia lymphocytic lymphoma in leukemia
leukemia leukemization
phase
Lymphoma (ICD-9 200-203) incidence rates in the districts
most heavily contaminated with radionuclides.
 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).
OTHERS MALIGNANT
TUMOURS MORBIDITY
 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 moderatel
increasing;

Tumour site Sex Period (age standardised rate  Rate ratio 2/1
(code ICD-9) standard error) (95% CI)
1980-1990 (1) 1991-1999 (2)

All solid cancers (140-203) Males+females 160.83  2.12 186.71  3.17 1.12 - 1.22
Buccal cavity, pharynx Males+females 10.48  0.54 12.08  0.77 0.98 - 1.36
(140-149)
Digestive system (150-159) Males+females 47.80  1.12 51.14  1.55 0.99 - 1.15
Respiratory system (160- Males+females 25.63  0.83 27.21  1.12 0.96 - 1.18
165)
Skin (172, 173) Males+females 15.49  0.63 14.71  0.80 0.83 - 1.08
Breast (174) Females 16.82  0.97 25.31  1.67 1.25 - 1.81
Female genital organs Females 20.83  1.06 20.21  1.59 0.81 - 1.16
(180-184)
Prostate (185) Males 7.59  0.70 10.90  0.99 1.11 - 1.86
Bladder (188) Males 8.68  0.76 9.35  0.95 0.83 - 1.40
Brain (191) Males+females 3.40  0.36 4.11  0.63 0.83 - 1.77
Thyroid (193) Males+females 1.70  0.24 6.69  0.76 2.56 - 6.07
Lymphoma (200-203) Males+females 4.86  0.43 6.52  0.71 1.01 - 1.79
 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)
 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.
50,00

45,00

Regression coefficient b ± SE(b):

40,00 The Ukraine: 0.65 ± 0.03

Contaminated areas:
35,00 1980-1989: 0.06 ± 0.38
1990-1999: 1.06 ± 0.19
1980-1999: 0.78 ± 0.18
30,00

25,00

20,00

15,00

10,00

5,00

-
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
 Other malignant tumor morbidity: all tumors in
liquidators and evacuees people

250
Because of different latency period of
Стандартизовані показники на

A Доза не встановлена
200
radiogenic forms of cancer there have to be
100000 населення

150
drawn close attention to cancer of breast,
100

50
lung, esophagus, stomach, bowl, ovary,
0 lymphomas (multiple myeloma) etc.
1990 1992 1994 1996 1998 2000 2002 2004

Населення України УЛНА

Special attention should be drawn to groups of
population irradiated at the beginning of life
400
(in utero, young age 0-9, 10-19).
Стандартизовані показники на

350 В
300
100000 населення

250
200
150
100 Середня поглинута еквівалентна доза
50 зовнішнього опромінення 10-30 мЗв 50-200 Зв
0
1990 1992 1994 1996 1998 2000 2002 2004

Населення України Евакуйовані

 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.
 Selective cytogenetic monitoring of children
(Pilinskaya M.A. and all. 2005).

4
Частота, %
3

1 Середня частота
Хромосомний тип
0 Нестабільні маркери
1 2 Стабільні маркери
3 4 5 6 7 8 9 10 11 12

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.
 Heritable effects in children with exposure in utero
(Stepanova E.I. and all.2006)

18
The cytogenetic examination
show the higher of aberrant Частота

Частота хромосомных аберраций

16
cells and interdependence with аберраций
хромосом
equivalent dose of red bone 14
morrow:
Frequency of the chromosome 12 Частота
aberrations per 100 cells; аберрантны
10 х клеток

8 Частота
стабильных
6 аберраций

4
0 100 200 300 400
The doses of red Эквивалентная доза на красный костный мозг, мЗв
bone morrow
10—376 mSv
 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)
Types of chromosome Group 1 Group 2
aberrations n=8, (1600 metaphases) n=8, (1600 metaphases)
Frequency (%) Frequency (%)
Translocations 0,37  0,10 0,18 0,10
Deletions 1,25 0,30 0,68 0,20
Inversions 0,31 0,10 0,12 0,07
Dicentric 0,06 0,05 0,06 0,05
Circles 0,12 0,07 0
Insertions 0,31 0,12 0
Pare fragments 0,06 0,05 0,18 0,10
Single fragments 0,12 0,07 0,06 0,05

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).
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)
 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.
The risk of spontaneous abortion, cumulative year dose
and fact of residing on contaminated territories.

Cumulative All women Women 19-30 old

dose

OR ДІ OR ДІ
Dose 1,36 1,14-1,63 1,23 1,00-1,53
Up to 5,0mSv 1,33 1,09-1,63 1,22 0,96-1,55
5,0mSv and more 1,42 1,10-1,83 1,26 0,94-1,70

Spontaneous abortion risk is increasing if cumulative dose reach 5mSv.

A.M, Serdyk and all (2004, 2006).
 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!
 How many liquidators we have?

Countries
2006
UKRAINE 268 815-?
Belarus 200 000 -?
Russian Federation 200 000 -?
Armenia 2200
Azerbaijan 6000
Georgia 2000
Kazakhstan 30000
Kyrgyzstan 1810
Latvia 5020
Lithuania 7124
Moldova 4500
Uzbekistan 10000
Tajikistan 2150
Turkmenistan 2000
Estonia 3000
Israel 1056
USA 4000 ?
 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

Индивидуальные дозы "ликвидаторов", измеренные
to the absence of effective dosimetric control and
методом ЭПР эмали зубов, в сравнении с "официальной"
дозой (n=7)
because of complicated and uninvestigated radiation Доза
conditions many liquidators received doses of over 1Gyоблучения 0,8
during the 1.5 months following nuclear accident. (Gy/Sv) 0,8
0,7
This would include many people, especially nuclear

 power plant personnel, firemen, military people, miners, 0,6

0,6
 construction workers who built the tunnels and shelter 0,5
around destroyed reactor and in the later period on the
0,4
 roof of the 3rd unit of the Chernobyl NPP.
0,3 0,25
We can state that among those groups there are people in 0,2 0,19
0,3
 whom the ARS was never clinically established. As a 0,2 0,1
 whole, the information about the dosimetric state of 0,1
0,009 0,035
0,1 0,019 0,013 0,03
liquidators is incomplete (only 50% of this information 0,036
about received doses of radiation is available) and unclear 0
(since it is unknown how accurate the available records 3213 4824 4994 5706 6221 6662 6826
about Номер образца
 these doses may be). This data in its current state cannot

 be used to assess radiation risks and to analyze real

"Официальная" доза, Sv ЭПР доза, Gy 1 Sv=1 Gy
radiation medical effects of the explosion and needs
revision.
LIQUIDATORS MORBIDITY(by Registry of military
liquidators of Ministry Internal Affaires of Ukraine)
Динамика распространенности заболеваний у ЛПА на ЧАЭС СБ и МВД
0
Украины в послеаварийном периоде (в /00)

0
/00
* - достоверность различия в сравнении с контрольной группой 4246
4500
3736
4000
* *
3500
2617
3000
* 3085±260
2500
2039,9±180 3060±142
2000 1347
1500 1999±111
1548,4±162,9
1000
1415.8±103
500
0
КГБ, МВД 1985 г. 1987 - 1995 1996 - 2004 Уровень 2004 г.
I период II период

СБУ МВД Контрольная группа

 The Dynamics of common sickness rate of circulatory
diseases.
1000
y = 52,249x + 120,16 892,2
911,2
%0 2
R = 0,8869
877,7
900

796,6
800

700
ВС-УЛА на ЧАЕС 762,3

638,7
600

529,5 575,0 566,2

550,5
500

430,7
400 411,6
333,3 338,6 310,3 383,9 y = 27,851x + 125,24
321,8 324,6 410,4
386,7 R2 = 0,8916
300 240,0
314,4
253,3 270,0
302,0
283,1 Контрольна група
200 263,9

206,4 212,8
195,3
100

0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
роки
 Prevalence of psychological disorders in liquidators
(2005, FGI project)
40 % 90
35 80
30 80,5
25 70
Liquidators
20 60
15 Ukrainian
10 population 50
5 40
0
All mental Depression 30
disorders
20
22,4
21,4 20,4
10

0
<0,25 Зв >0,25 Зв SIP - вхідний Україна
контроль (ВООЗ)

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%).
CEREBROVASCULAR DISEASES - ENCEPHALOPATHY SYNDROM
The 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-organic nature of the
disorders.
 CATARACTA
In fact, it is observed that the appearance of radiation-induced cataracts among
all groups of survivors, and especially the liquidators, is increasing. Much lower
threshold of irradiation doses is set for cataract development compared to earlier
assessments.
It has been found that radiation cataract can develop due not only to high radiation doses much
lower than 1 Gy and should be considered as a stochastic effect of radiation exposure. No
800
threshold absorbed dose. ( Fedirko P.,2005)
10
700 9

600
8
7
500
6
Frequency

RR
400
5
300 4

200
3
2
100
1
0
0 50 100 150 200 250 300 350 400 450 500 550 600 650 700
0
Total dose, mSv
<8,9 8,9~11 11~18,7 18,7~24 >24
Доза
Distribution of irradiation dose ratio
The risk of cataract development in liquidators
(UACOS) in liquidators. Dose cGy and age (< 40, 40-55, >55 old)

Threshold absorbed dose 0,12 Sv was establish for neuropsychiatric and

psychophysiology pathology also. Organic syndromes have been observed
on absorbed dose 0,3-0,5 Sv.
.
 Alterations in thyroid system are marked characteristic for thyroid irradiation non-
stochastic effects gradual progress within all period extent passed since the Chernobyl
NPP accident. Direct time link to radiation factor, dose-dependence and dose threshold
presence are characteristic signs of non-stochastic radiation effects.

350

Non-tumor thyroid pathologies 300

(autoimmune thyroiditis and its

250
complications, hypothyroidism)
are currently discovered among
200
30-40% of survivors. The quality
of life with thyroid pathologies is 150
worsening due to the necessity of
lifelong treatment, as well as due 100

to the addition of other somatic

50
diseases linked to insufficient
hormonal regulation (myocardiopathy, 0
obesity, high blood pressure, as well 1992 1993 1994 1995 1996 1997 1998 1999 2000
as pre-term aging and dysfunction Мешканці контрольованих територій

of somato-sexual development). Евакуйовані з 30-км зони відчуження

Ліквідатори аварії на ЧАЕС
Pregnancy and thyroid
Normal pregnancy - 25.8 (26cGy)
and 12.5% ( dose 36cGy) and
63,3% in control group. Children
born by irradiated woman
recently confined 1,5-2 - fold had
more deflections in physical
development.
80
60
40
20
0
26 cГр 36 cГр Контроль

% фізіологічної вігітності
 Evacuees and Resettled
survivors
164 700 thousand- 52 000
families in 2006 INCIDENCE
and PREVALENCE
The evacuated adult population disability
indices since 1988 to 2003 increased from
4,6% to 103,4%.
National Report, Ukraine 2006
‰ 4000
3000

2000

1000

0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Роки
Захворюваність Поширеність

Дорослі евакуйовані Дорослі евакуйовані

Доросле населення України Доросле населення України
 NOTE
 It was accepted that growth of somatic
illnesses among victims wasn’t linked directly
to the radiation factor, but to the contrary it is
dependant on the dose of radiation and time
under risk as well. These illnesses include
endocrine system and metabolic diseases,
psychological disturbances, diseases of the
nervous system, sensory organs and digestive
tract organs, cerebral-vascular diseases,
essential arterial hypertension, and cataracts.
 State of Health of СHILDREN

 About 20% of all children

population in Ukraine
inhabit the territories where
the level of radionuclides is
above the background one.
 Dynamic of non-tumour diseases prevalence (per 10 000)
among children and adolescent affected due to the
Chernobyl catastrophe. (National Report of Ukraine,2006).
Presently in the structure of 60000
disease incidence of 48958
46452 47536 47854 48138
children of 0-14 years 50000
predominant are diseases
of the respiratory, nervous, 40000
30651
digestive and blood 24373
systems, skin and 30000 32350

subcutaneous tissue 19152 17729

18845 17833
diseases. The most 20000
unfavorable changes have 18599 17403 17527 17893
been observed in 10000
adolescents with high
doses of thyroid gland 0
irradiation and in 1989 1992 1994 1995 1997 1999 2001 2003-
adolescent irradiated in 2004

utero. Постраждалі Контроль

Value of thyroid gland dose correlate with health status
of children and adults. In this cohort of survivors only
2,8% are healthy.
%
30

25

20

15

10

0
<0,2 0,3-0,75 0,75-2,0 >2,0
(Stepanova E.I., 2006)
 Children irradiated in utero.
Thyroid Dose exposure – in the range 0,1 - 28,5 Gy (I-131,132,129, );
Dose of hole-body irradiation - 5,0 - 376,0 mSv due to external
gamma –radiation and internal radiation ( Cs -137 and Sr-90).
Especially high are the doses to the fetal thyroid. There were children from Pripyat (33.8%)
who had been exposed in utero to thyroid doses >1 Sv; (13.2%) received in utero fetal doses
of >100 mSv.( Nyagu A.I., Stepanova E.I., Repin V.S. and all.,2000, 2004)

4,80%
0,10% Внешнее гамма
облучение

2,30% Облучение
щитовидной железы

Внутреннее облучение
от Cs-137

Внутреннее облучение
от Sr-90

92,80%
 Distribution of children by periods of
cerebrogenesis at the time of explosion
(April 26th, 1986)
% Exposed group
40 in Pripyat
(n=154) P>0.05

35 Comparison
group from Kiev P>0.05
(n=143)
30
P<0.01
25 In exposed group there
P>0.05 are less children who
20 were at the earliest
stages of prenatal
15 development (0–7
weeks after
10 conception) that could
be explained with
5 abortions and
0–7 8–15 16–25 26+ miscarriages due to
Weeks after fertilisation the Chernobyl accident
Dose on embryo and foetus distribution
(ICRP-88)

100 Exposed group in Pripyat

90 (n=151)
80 Comparison group from
70 Kiev (n=142)
60
%
50
40
30
20
10
0
0–2.7

20–40

40–60

60–80
10.4–20

80–100

100–120

140–160

160–180

180–200

200–220

220–240

240–260

260–269.2
Dose range, mSv

Exposed group: M±SD — 65.4±33.9 mSv, Median — 61.6 mSv

Comparison group — 1.2±0.3 mSv, Median — 1.2 mSv
 Dose on thyroid in utero distribution
(ICRP-88)

Exposed group in Pripyat

mSv 1225,5
100 (n=152)
90
80
Comparison group from Kiev
(n=143)
1200
70
60
% 50 1000
40
30
20
10 800
0 623,7
0

0–200
201–400

401–600
601–800

801–1000
1001–1200

1201–1400
1401–1600

1601–1800
1801–2000

2001–2200
2201–2400

2401–2600
2601–2800

2801–3000
3001–3200

3201–3210.5

600
Dose range, mSv

Exposed group (M±SD) — 760.4±631.8 mSv, Median — 746.3 mSv

Comparison group — 44.5±43.3 mSv, Median — 27.4 mSv
400

200
0,4 40,9
According to the model by ICRP-88 0
there is a strong influence of gestational 0–7 8–15 16–25 26+
age on the thyroid doses in utero: later Weeks of gestation
intrauterine period at the time of exposure —
higher the thyroid doses in utero
 Intelligence of children (WISC)
Full scale IQ
120 There are significant (P<0.001) differences
on intelligence of exposed children:
118
a lower total IQ due to a lower verbal IQ
116 and a higher rate of disharmonic intellect
than unexposed children.
114 A radioneuroembriological effects has been
identified for cases intrauterine exposes on
112 the 8th and later weeks of gestation with
110 exposure of the embryo and fetus to more
20mSv and doses of thyroid gland in utero
108 more 300mSv.
Exposed group Comparison
in Pripyat group from Kiev
(n=140) (n=136)
 Diseases of Nervous System (G) and Mental and Behavioral
Disorders (F)according to the ICD-10 in children.
Prenatally exposed children have more neuropsychiatric disorders than the
control children from Kiev for the following categories: 1) paroxysmal states;
2) organic mental disorders; 3) neurotic, stress-related and somatoform
disorders; 4) disorders of psychological development; 5) childhood behavioural
and emotional disorders.
% Exposed group
% 60 in Pripyat
90 P<0.001 P<0.001 (n=154)
Exposed group
80 Comparison
in Pripyat 50 P<0.01 group from Kiev
(n=154)
70 (n=143)
Comparison
group from Kiev 40
60
(n=143)
50 30 P>0.05
40 P<0.001
P<0.05
20
30
20 10 P<0.01
P<0.01 P>0.05
10 P<0.05 P>0.05 P>0.05 P<0.05 P>0.05

0 0
Healthy F06 & F07 F40–F48 F51 F70 F80–F89 F90–F98
Healthy G40 G43 G44 G47 G80 G90
(assumed)
 Mother’s stress events
16 Mothers of children evacuated from Pripyat
14 experienced much more (P<0.001)
12 real stress events
(evacuation, lack of
10 information about relatives, migration,
8 difficulties of medical care, etc.)
6 There is a significant (P<0.001) mental health
4 problems in mothers of children evacuated from
Pripyat: PTSD (0,001)
2
Depression (0,001)
0
Exposed group Comparison Somatoform disorders (0,001)
in Pripyat group from Kiev anxiety, insomnia (0,001)
(n=136) (n=62)
Social dysfunction (0,04)
Severe depression(0,01)
 Children born by exposed parents
also demonstrate poor health.
 The number of healthy children is 2,5-9,2%
(control group - 18,6-24,6%). This cohort is
characterized by a retardation of biological
age, immunity disorders, more often
manifest external disembriogenetic
stigmata, minor malformations of internal
organs and congenital malformations,
enhanced mutations processes both in
indicator cells and target cells. National Report, 2006
There is a continuous increase in the following changes in the
state of health of children in various cohorts under observation:
- among children who were born to Chernobyl liquidators there
has been an increase in the incidence of illnesses of the central nervous system,
congenital birth defects and rare forms of genetic anomalies;

- among children who were exposed during the period of intra-uterine gestation, there is
a high risk of developing chronic somatic pathologies, disorders of the thyroid gland,
pathologies of bone and cartilage, psychological disorders and the development of tumors;

- among those who were children or adolescents at the time of Chernobyl accident and
subjected to combined exposure to cesium and iodine there have been registered the
highest risk of tumors and other illnesses of the thyroid gland.

-Experts predict a further increase in pathologies of the thyroid, which will make a
robust contribution to the deterioration of the general health of affected populations,
and the disruption of reproductive health of young women;

- in the first generation of irradiated persons who continue to live on radioactively

contaminated territories, there is also an increasing risk of children born with
congenital malformations and hereditary diseases.
Conclusion on International Conference. Kiev, June 2006
 Psychological consequences and children
Abnormal psychological development has been detected in 60-70% of
children and teenagers exposed to radiation. This is twohold higher
than among general population.

The mental state children of all cohorts is significantly worse compared

to that of controlled groups: self-sensation as a victim, lack of
initiative, rental aims. More than 60% of teenagers see their futures
away from home because radiation pollution; Children from the high-
risk groups are becoming the carriers of a crisis psychology (mentality)
and as a result will spread a crisis relationship in society. Inadequate
parental or family environments as well as the circumstances of their
immediate surroundings – teachers, doctors will contribute to a
heightened level of anxiety, fear and lowered self-esteem.
What why the concept of “psychological rehabilitation” should be
shifted in the direction of the concept of “education and psychological
correction”.
 NOTE
 Methods of risk assessment for exposures to low-dose
radiation (more typical for the population exposed to
the Chornobyl disaster) are not yet developed. That is
why the results of post-Chornobyl epidemiological
studies must have first-priority in assessing the
scientific and practical significance for the
assessment of low-dose radiation influence on people.
The results should be obtained from direct monitoring
with the same-time usage of all-national cancer
studies data and national registry data.
 Chernobyl is a reminder for international community
should to consolidate efforts to build safe future.