Evaluación de riesgo sobre la salud en
respuesta al accidente de Fukushima-Daiichi
Dra Maria del Rosario Pérez
Departamento de Salud Pública y Medio Ambiente
WHO Response to Fukushima accident
Headquarters
Geneva
1
2
WHO emergency response
plan was immediately activated
with continuous situation
monitoring from
1, 2, 3
Western Pacific
Regional Office
(WPRO, Manila)
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3
Kobe Centre
WHO short-term response actions
Relevant WHO technical programs (Radiation Team, Water and
Sanitation, Food Safety, Children Health, Mental Health, etc.) and
expert networks (REMPAN, INFOSAN) to assess health risks and
provide advice on public health measures
Technical support to national authorities (food, water, travel,
transport, trade, mental health, public information…)
Continuous information to governments, media, public (dedicated
website, media statements, press conferences, Fact Sheets and
Q&As, social networks - Facebook, Twitter, etc.)
Congreso IRPA Latinoamericano – Rio de Janeiro, Abril 2013
Crisis communication- lessons learned ….
Importance of providing
timely and accurate
information
– To inform decision-making
(e.g. travel, trade)
– To prevent risky reactions
(e.g. potassium iodide)
– To allay unnecessary fears
(e.g. travel, breastfeeding)
– To promote healthy
behaviours
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WHO assessment of health risk
resulting from
Fukushima Daiichi NPP
Health Risk Assessment
To fulfil WHO's role and
responsibilities under the Joint
Plan
To provide information for
Member States and the public
To identify needs and priorities
for public health action
including health surveillance
and long-term epidemiological
studies
http://www.who.int/ionizing_radiation/pub_meet/fukushi
/
ma_dose_assessment/en
http://www.who.int/ionizing_radiation/pub_meet/fukushi
ma_risk_assessment_2013/en/index.html
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HRA report: the steps
Exposure
Assessment
What exposures are
likely to occur, and what
is the resulting dose to
humans?
Risk
Characterization
What is the extra risk of
health problems in the
exposed population?
Hazard
Identification
Dose-response
Relationship
What is the agent and
what health problems
are potentially caused
by the agent?
What are the health
problems at different
exposures?
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WHO Preliminary Dose Assessment
International Panel established by WHO to
conduct an initial assessment of radiation
exposure of populations inside and outside
Japan – June 2011
Independent scientific experts from UK
(HPA), Russia (IRH), Germany (BfS), Japan
(NIRS, NIPH), USA
Representatives from WHO, IAEA and FAO
Observers
– UNSCEAR and the Government of Japan
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Observers:
Independent experts
Lynn Anspaugh
Mikhail Balonov
Carl Blackburn
Florian Gering
Stephanie Haywood
Jean-René Jourdan
Gerhard Proehl
Shin Saigusa
Jane Simmonds
Ichiro Yamaguchi
and other contributors listed in the report
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International Dose
Assessment Expert Panel
Planning Meeting / Vienna, 30 June
Planning meeting (30 June 2011)
Working meeting- assumptions, scenarios,
approaches
(5-6 Sept 2011)
Compilation of measurement data in Japan and
human monitoring data performed outside Japan
(end Sept 2011)
Radiation dose assessment
and expert meeting
to review and discuss study results (Oct 2011)
Draft reports v01, v02, v03 (Nov-Dec 2011)
Final review and editing (Jan-Feb 2012)
Publication (May 2012)
Working Meeting / Geneva, 5-6 Sept
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Review Meeting / Geneva, 13-14 Oct.
Assessed exposure pathways
IAEA report on Environmental consequences of the Chernobyl accident and their remediation: twenty years of experience (2006)
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WHO Health Risk Assessment
Observers:
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Independent experts
Makoto Akashi
Billy Amzal
Lynn Anspaugh
Anssi Auvinen
Nick Gent
Peter Jacob
Dominique Laurier
Charles Miller
Ohtsura Niwa
Roy Shore
Richard Wakeford
Linda Walsh
Wei Zhang
and other contributors listed in the report
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Health Risk Assessment Working Group
December 2011: WHO established a HRA
WG and convened 1st meeting to agree on
working methods, dose response models,
age groups, end points, work plan and
timeline
March 2012: 2nd HRA WG meeting
discussed results, identified gaps and areas
requiring refinement, reviewed the HRA
report outline, agreed on next steps
Report completed in December 2012;
editing, formatting, proof reading in Jan-Feb
2013, published end of Feb 2013.
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Geneva, 14-16 December 2011
Geneva, 23-24 March 2012
Scope
Radiation doses and risks to the public and workers
(since workers doses were not assessed by the panel, dose estimations provided by TEPCO were used )
Different age groups
–Public: 1y infants, 10y children and 20y adults (females and males)
–Workers: 20, 40, 60 year olds (males)
Global geographical coverage
–Fukushima Prefecture
–Other prefectures in Japan
–Countries neighbouring Japan
–Other regions of the world
(excluding the evacuation zone within 20 km of the NPP): no dosimetric data
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End-points of the HRA
Lifetime Attributable Risk (LAR) estimates of radiation-related
cancer risk based on organ doses:
–
–
–
–
all solid cancers incidence
leukaemia incidence
thyroid cancer incidence
female breast cancer incidence
Non-cancer risks were considered but not modeled (thyroid
nodules, thyroid dysfunction, visual impairment, circulatory
diseases, reproductive dysfunctions, risk of radiation-induced
tissue damage and developmental changes in embryo and fetus)
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Lifetime dose model - ratio of lifetime dose to 1-year dose
On the basis of the Chernobyl
experience, and taking into
consideration the
differences between the Chernobyl
and Fukushima Daiichi NPP
accidents, the HRA Expert
Group considered it reasonable to
assume that the ratio of long-term
dose to 1-year
dose would be equal to 2 and that
the result should be treated as a
lifetime dose commitment
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Japanese survival curve, 2010
Probabilty of cancer free survival
1.2
1.0
0.8
Male and Female
Male survival curve
Female survival curve
0.6
0.4
0.2
0.0
0
10
20
30
40
50
60
70
80
90
100
110
Age at lower boundary of the Age group (years)
Lifetime baseline risk (LBR) based on cancer incidence rates from a general population
is the cumulated baseline probability of having a specific cancer over the lifetime
LBR
All solid
cancer
Thyroid
Leukaemia
Males
0.41
0.002
0.006
Females
0.29
0.008
0.004
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Breast
0.056
Lifetime Fractional Risk (LFR)
LAR can be scaled to the lifetime “spontaneous”
cancer incidence in the reference population (LBR)
LFR = LAR/LBR.
LFR is more suggestive of the actual level of a
radiation risk than the LAR.
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LAR (x 10-2)
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LAR (x 10-2)
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LAR (x 10-2)
LFR~70%
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LAR (x 10-2)
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The occupational health assessment
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Occupational doses
23.172 workers
– 5,639: TEPCO (24%)
– 17,533: contracted (76%)
Maximum total effective dose: 678.8 mSv
Maximum internal dose: 590 mSv
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Occupational doses
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Workers’ thyroid doses
Dose (mSv)
Workers
> 10,000
2
> 2,000 – 10,000 or <
10
> 1,000 – 2,000 or <
32
> 500 – 1,000 or <
50
> 200 - 500 or <
69
> 100 - 200 or <
15
100 or <
344
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Considerations
The dose estimates and assumptions used in this
assessment were deliberately chosen to minimize the
possibility of underestimating eventual health risks so
some overestimation of doses may have occurred.
The results should be regarded as inferences of the
magnitude of health risks (not effects). Because
scientific understanding of radiation effects, particularly
at low doses, may increase in the future, it is possible
that further investigation may change our understanding
of the risks of this nuclear accident.
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Conclusions
No discernible increase in health risks from the Fukushima
event is expected outside Japan. With respect to Japan,
this HRA estimates that the lifetime risk for some cancers
may be somewhat elevated above baseline rates in certain
age and sex groups that were in the areas most affected.
These estimates provide information for setting priorities in
the coming years for population health monitoring, as has
already begun with the Fukushima Health Management. If
more precise dose estimations become available (e.g.
UNSCEAR study), such data can be used to further refine
these risk estimates.
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