Table 1 Description of the Health Surveillance and Treatment programs of Seveso, Three Mile Island, Bhopal, Chernobyl, WTC and Fukushima
Seveso, Italy [69] | Fukushima, Japan [74] | |||||
|---|---|---|---|---|---|---|
Incident date (m/d/y) | 7/10/76 | 3/13/78 | 12/2/82 | 4/26/86 | 9/11/01 | 3/11/11 |
Types of exposure (average exposure intensity if known) | 2,3,7,8-tetrachlorodibenzo-p-dioxin | Ionizing radiation | Methyl isocyanate gas (MIC) and other unknown chemicals | Ionizing radiation | Cement dust (pH 10.0-11.0) Glass fibers Lead and Heavy Metals Polychlorinated biphenyls (PCBs) Chrysotile Asbestos Toxic Products of Combustion: • Benzene and VOCs • Polycyclic Aromatic Hydrocarbons • Dioxins • Diesel fumes • Sulfur dioxide | Ionizing radiation (<2 mSv – residents) (<680 mSv – workers) Organic and inorganic dust, originating from sludge, rubble and debris, occasionally including asbestos |
Estimated exposed workers/responders | 37,000 workers and residents | 600,000 workers and residents | 500,000 workers and residents | 600,000 | 90,000 | 20,000 |
Estimated exposed Residents/survivors | 5 million | 400,000 | 200,000 | |||
Immediate deaths | No immediate deaths | No immediate deaths | Estimated from 3787 to 10,000 (¾ of deaths occurred during the first 72 h of the leak) | 29 | 2753 (2996 including all sites of 9/11 attack) | No immediate deaths |
Follow-up cohort | 220,000 surveyed | 160,000 population within 10 miles of Three Mile Island | 80,000, from severely, moderately, and mildly exposed areas and unexposed area controls. | 600,000 | 37,281 workers responders [46] • 48% protective/military service • 23% construction • 7% electrical/telecom repair • 4% transportation • 2% unemployed/retired • 16% other 15,000 Firefighters 5000 resident (‘survivors’) | 20,000 |
Frequency of health surveillance | annual | Permanent TMI Employees as of March 1st, 1979 were surveyed by telephone interview | No formal health surveillance program (Indian Council of Medical Research halted after 1994) | annual | annual | annual |
Content of health surveillance | 17,000 residents from zones A, B, and R received systematic medical testing through 1984. All school children received skin examinations. | (Elevated cancer rates were reported.) | not applicable | medical examination | Physical Health, Mental Health and Exposure questionnaires, physical examination, pulmonary function test, clinical chemistry. Chest X-Ray every 2 years. Cancer screening for cervical, breast, colon, lung cancer | Eye examination for cataracts (effective dose > 50 mSv) Cancer screening and thyroid tests (effective dose > 100 mSv |
Mental health effects | None reported | None reported | Based on reported symptoms: Depression, anxiety, adjustment disorder | Clinical depression, anxiety, PTSD | Major depression, PTSD, panic disorders | Psychological distress, e.g., depression, PTSD |
Physical effects | Chloracne [1], peripheral neuropathy and elevated hepatic enzymes | A modest association was found between proximity to TMI and cancer (OR = 1.4; 95% CI = 1.3, 1.6) [71]. | Reported pulmonary fibrosis, bronchial asthma, chronic obstructive pulmonary disease (COPD), emphysema, recurrent chest infections, keratopathy and corneal opacities | Cardiovascular diseases | Asthma, sinusitis, abnormal spirometry, gastro-esophageal reflux | to be determined (see text and [75]) |
Carcino-genic effects | Excess risk of Lymphatic and hematopoietic tissue neoplasms [16] and breast cancer after 20 years follow-up. | High rates of all cancers, lung cancer, and leukemia [71]. | Lung, orophrarynx, and oral cavity cancers were reported. | Excess risk of Leukemia, Solid cancers, Thyroid cancers | All cancer sites combined, soft tissue, combined hematopoietic cancers, thyroid, prostate after 10 years follow up. | Too soon for comprehensive cancer risk assessment. At least six workers have exceeded lifetime legal limits for radiation and more than 300 have received significant radiation dose |
MeSH term | “Seveso Accidental Release” | “Radioactive Hazard Release”[Mesh] AND (“Pennsylvania/epidemiology”[Mesh] OR “Pennsylvania/statistics and numerical data”[Mesh]) | “Bhopal Accidental Release” | “Chernobyl Nuclear Accident” | “September 11 Terrorist Attacks” | “Fukushima Nuclear Accident” |
Number of health-related publications through December 2015 | 21 | 12 | 22 | 1228 | 957 | 767 |