Journal of the National Institute of Public Health
Online ISSN : 2432-0722
Print ISSN : 1347-6459
ISSN-L : 1347-6459
Volume 67 , Issue 1
Lessons learned on public health from the Fukushima Daiichi Nuclear Power Plant accident
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  • Tsutomu Shimura, Naoki Kunugita
    Type: Preface
    2018 Volume 67 Issue 1 Pages 1
    Published: 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS
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  • Naoki Kunugita, Tsutomu Shimura, Hiroshi Terada, Ichiro Yamaguchi
    Type: Review
    2018 Volume 67 Issue 1 Pages 2-10
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    Off the Pacific coast of Tohoku Earthquake and subsequent Fukushima nuclear accident attacked Japan on March 11, 2011. The complex disaster with an earthquake, tsunami and nuclear disaster severely damaged and destroyed human life, properties, natural resources and the environment. Mandatory evacuation was ordered after the accident, and loss of the cooling system for safety of the public from the nuclear reactor in the Fukushima Dai-ichi Nuclear Power Plant. This order disturbed the usual daily life of the Fukushima residents and caused an inconvenient situation for a long-time due to the lack of a link to their local community. We tried to discuss various issues regarding the public health activities in response to the Fukushima disaster in this special issue as follows.

    Countermeasures: 1) emergency response to the natural disaster, to mitigate the radiation exposure due to the nuclear accident, 2) medium- to long-term support for secondary health risks and 3) educational activities of radiation health risks on humans and care of mental health issues due to anxiety of radiation exposure. All were implemented by various efforts with the cooperation among national and local politicians, residents, suppliers, distributors and so on. The World Health Organization (WHO), the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), and the International Atomic Energy Agency (IAEA) consulted on the response to the Fukushima situations. Although the Fukushima accident was the second worst nuclear accident in the history of nuclear power generation, radiation doses are limited among Fukushima residents and emergency responders who were apparently not exposed to radiation doses higher than the threshold for induction of acute radiation syndromes. In order to control food contamination, provisional regulation values (PRV) were set during radiological emergency situations. Food monitoring and restriction were conducted to protect internal radiation exposure from contaminated food. The Fukushima Health Management Survey was carried out to take care of and to support the health of the Fukushima residents. As a part of this survey, some issues regarding thyroid monitoring and a medium- to long-term secondary health risks still remained. Furthermore, we mention disaster management laws and systems, and the role of the emergency management cycle according to each phase.

    With all these matters in mind, we overview the Fukushima accident as a brief introduction to this special issue.

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  • Osamu Kurihara
    Type: Review
    2018 Volume 67 Issue 1 Pages 11-20
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    Much effort has been made by Japanese experts to assess the dose to residents of Fukushima Prefecture in the aftermath of the 2011 nuclear disaster. Residents living near the Fukushima Daiichi Nuclear Power Plant (FDNPP) were ordered to evacuate promptly after the accident to minimize radiation exposure. Many papers performing individual dose measurement and estimation of these residents have already been published. This paper provides a brief overview of these publications by dividing the evaluation into the early-phase (< 1 year) and the late-phase (≥ 1 year) studies, and compiling the lessons learnt from the 2011 nuclear disaster. One common view of the studies by the Japanese experts is that the levels of exposure are generally low. Aside from the internal thyroid dose from short-lived radionuclides (mainly 131I) at the early phase, both the external and internal doses attributable to the nuclear disaster are comparable or less than those from natural radiations. A number of individual dose measurements at the late phase have provided useful information for understanding exposure situations in everyday life for people living in the affected area. One key remaining issue for the dose assessment is to evaluate the related uncertainty, in particular for the internal thyroid dose received at the early phase. Thus, there is a role for further studies to improve the certainty of dose estimations.

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  • Hirosh Terada, Ichiro Yamaguchi, Tsutomu Shimura, R. Svendsen Erik, Na ...
    Type: Review
    2018 Volume 67 Issue 1 Pages 21-33
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    After the Fukushima Dai-ichi Nuclear Power Plant accident, the Ministry of Health, Labour and Welfare set the provisional regulation values for radioactive materials in foods by adopting Indices for Food and Beverage Intake Restriction. The indices were established based on 5 mSv of effective dose and 50 mSv of committed equivalent dose to the thyroid in compliance with the recommendations of the International Commission on Radiological Protection and others. On April 1, 2012, the present standard limits were put in force for the exiting exposure situations. The standard limits were intended not to exceed 1 mSv/year from food intake. One milli-Sievert per year of maximum permitted level conforms with the intervention exemption level (reference level) adopted by the Codex Alimentarius Commission. The provisional regulation values and the present standard limits of Japan are lower than the derived intervention levels of the U.S., the EU and Codex.

    Immediately after the monitoring of foods began, public concern was raised since many samples of leafy vegetables and raw milk were found to be above the provisional regulation values. Thus, several public health protection measures were taken to decrease the concentrations of radioactive materials in foods by the Ministry of Agriculture, Forestry and Fisheries, the local governments and the farmers, such as feeding livestock with safe food and the application of potassium fertilizer. Due to these measures, almost all of the marketed foods in Japan are below the standard limits and concentrations of radioactive cesium are sufficiently low at this moment. Results of dose estimation with the monitoring data and total diet studies also show committed effective doses from food are well below the maximum permissible level; thus, it can be concluded that the measures taken by Japan after the Fukushima accident were reasonably successful.

    However, there are still some foods found with radiocesium concentrations above the standard limit like wild mushrooms, wild animal meat, wild vegetables, freshwater fish, and some saltwater fish whose feeding or cultivation management are difficult to control. Thus, monitoring of those foods should be continued.

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  • Tetsuya Ohira, Hironori Nakano, Kanako Okazaki, Fumikazu Hayashi, Yui ...
    Type: Review
    2018 Volume 67 Issue 1 Pages 34-41
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    The Great East Japan Earthquake that occurred on March 11, 2011, was followed by a nuclear accident at the Fukushima Daiichi Nuclear Power Plant. Many residents of the surrounding areas were forced to evacuate their homes and change their lifestyle. The potential influence of the evacuation on the risk factors for cardiovascular diseases (CVD) was investigated through the Fukushima Health Management Survey (FHMS). In the present study, we have reviewed the results of longitudinal studies of lifestyle-related diseases that are based on the FHMS. After the disaster, evacuated residents presented an increased proportion of overweight/obese people and a higher prevalence of hypertension, diabetes mellitus, dyslipidemia, liver dysfunction, atrial fibrillation, and polycythemia than those before the disaster. Furthermore, the prevalence of diabetes mellitus and dyslipidemia increased between FY2011–2012 and FY2013–2014, after the disaster. Results show that disaster evacuees may be more predisposed to CVDs, such as myocardial infarction and stroke. Preventive programs for obesity, hypertension, diabetes mellitus, and dyslipidemia should be implemented in collaboration with local governments and communities.

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  • Hideto Takahashi
    Type: Review
    2018 Volume 67 Issue 1 Pages 42-49
    Published: February 01, 2018
    Released: April 14, 2018
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    After the accident occurred at the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant, the Fukushima Health Management Survey (FHMS) was initiated. The FHMS consists of a basic survey and four detailed surveys: a thyroid ultrasound examination, a comprehensive health check, a mental health and lifestyle survey, and a pregnancy and birth survey. In this article, we briefly summarized whether an association exists between radiation exposure and the observation of thyroid cancer cases according to the results of the first-round thyroid examination in the FMHS. Regarding this issue, Tsuda and his colleagues showed an association using an internal comparison (odds ratio (OR)=2.6, 95% confidence interval (CI): 0.99-7.0) and an external comparison (incidence rate ratio =50, 95% CI : 25-90). However, for this internal comparison, Ohira and his colleagues used two ways of objective classifications of districts in Fukushima; (1) the group of municipalities of which proportion of the exposed external dose level of more than 5 mSv was higher than or equal to 1% (≧1% of 5 mSv), the group of municipalities of which proportion of the exposed external dose level less than 1 mSv was higher than or equal to 99.9% (≧99.9% of 1m Sv<99%), and others, and (2) the location groups applied by WHO. For the classification (1), they obtained OR=1.49 (95% CI : 0.36-6.23) from the highest group to the lowest, which was similar to the results of the classification (2). For the external comparison, Takahashi and his colleagues developed a cancer-progression model with several sensitivities under non-accident conditions, and showed 116 cases were possible to observe in Fukushima under non-accident conditions. Katanoda and his colleagues found an observed/expected ratio of 30.8 (95%CI: 26.2-35.9) of the prevalence of thyroid cancer among residents aged ≦ 20

    years (160.1 observed of cases and 50.2 expected cases), and a cumulative number of thyroid cancer deaths in Fukushima Prefecture of 0.6 under age 40 with the same method. This large disparity implied the possibility of over-diagnosis in thyroid examinations.

    A researcher reported the results were unlikely to be explained by a screening effect, which implied the association between thyroid cancer cases and external radiation exposure. However, subsequently, a possibility that it might be a result of over-diagnosis of the thyroid examinations was pointed. And, no significant associations were found by applying objective classification of districts and by raising comparability with the incidence data of whole Japan, respectively. In the Basic Survey of FHMS, only individual external doses in the first four months after the accident has been observed. So neither external dose after the four months nor internal dose was applied in these studies. Further studies are necessary to clarify the existence of the association by applying the estimation of individual overall thyroid dose.

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  • Masaharu Maeda, Misari Oe, Yuriko Suzuki
    Type: Review
    2018 Volume 67 Issue 1 Pages 50-58
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    There are substantial differences between natural and nuclear disasters in terms of the psychosocial impact associated with many factors such as human and material losses, psychological acceptance, community cohesiveness, stigmas, and media influence. Although the Great East Japan Earthquake and tsunami that occurred in Fukushima, Japan, was a major disaster, the impact of the subsequent nuclear accident seemed to be even more devastating on residents’ mental health. These effects included not only posttraumatic responses but also chronic psychiatric symptoms such as depression and alcohol abuse, which can also contribute to self-destructive behavior such as suicide. In addition to these psychiatric problems, Fukushima residents had to endure public and self-stigma towards the radiation effects. In particular, negative risk perceptions about the genetic effects of radiation were associated with depressive symptoms among the evacuees. Significant exhaustion and various types of depressive symptoms have been reported among relief workers in Fukushima, who require more intensive care and treatment. To maintain and develop the current care network in Fukushima successfully, cooperation between different resources involving outside experts is key.

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  • Shinya Ito, Aya Goto, Kayoko Ishii, Misao Ota, Seiji Yasumura, Keiya F ...
    Type: Review
    2018 Volume 67 Issue 1 Pages 59-70
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    Objectives: The aims of this study are (1) to review the Pregnancy and Birth Survey section of the Fukushima Health Management Survey (FHMS); (2) to clarify the proportion of anxieties felt by mothers from Fukushima that relate to radiation exposure as a stigma in society, and also to identify associated factors; and (3) to explore the attitudes of future mothers from the region in regard to childbirth by developing a new scale, known as the “Fukushima Future Parents Attitude Measure (FPAM).

    Methods: (1) We reviewed 11 studies that reported using the FHMS Pregnancy and Birth Survey to determine the health of infants and mothers. (2) To analyze levels of anxiety, we used the data from a 2011 baseline survey and its 2015 follow-up, ascertaining the mothers' subjective health, depressive symptoms, maternal confidence, and anxieties regarding radiation exposure. (3) Finally, to achieve our third aim, we distributed a questionnaire to all 310 students at a women's college in Fukushima Prefecture.

    Results: (1) Analyses of FHMS data showed that the Fukushima nuclear accident did not affect pregnancy outcomes, but did affect maternal mental health. (2) An examination of the surveys of mothers' mental health revealed that 974 mothers (41.2%) reported having feelings of anxiety associated with the stigma of radiation exposure. In particular, maternal age, depressive symptoms, receiving antenatal care as scheduled, and post-quake medical history were significantly associated with a higher proportion of anxieties related to this stigma. (3) Exploratory and confirmatory factor analyses were conducted, allowing us to identify two Factors: “caring for a baby” (three items) and “giving birth to a baby” (three items). Both factors correlated with the students' quality of life, self-efficacy, and self-esteem scales, and the factor, “giving birth to a baby,” also correlated with radiation-related risk perception.

    Conclusions: The FHMS highlighted the importance of providing mental health support to the mothers of young children. It should be particularly noted that over 40 percent of mothers in the follow-up study in 2015 had anxieties about being stigmatized for their radioactive exposure. In addition, young women's attitudes toward future pregnancy, as measured by the FPAM, are associated with their radiation risk perception.

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  • Masaharu Tsubokura
    Type: Review
    2018 Volume 67 Issue 1 Pages 71-83
    Published: February 01, 2018
    Released: April 14, 2018
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    Nuclear accidents and their associated radiation hazards can cause radioactive contamination in the surrounding areas and health effects associated with radiation exposure for local residents. However, the effects of radiation disasters on local residents are not limited to those caused by radiation exposure. This paper outlines the secondary health issues, unrelated to radiation exposure, experienced by residents of Soma and Minamisoma Cities after the Great East Japan Earthquake and Fukushima nuclear power plant accident. The most serious problem, during the early stages of the accident, involved the health effects of evacuation, especially among elderly people. While evacuation is the most effective way to reduce radiation dose, it can have the greatest mid- and long-term health impact, in particular, by exacerbating of chronic diseases, lifestyle diseases, and motor functions. In fact, the worsening of diabetes can have much more significant health effects than radiation exposure. There are also problems related to medical treatment, consultation behaviors, and nursing care, resulting from the lack of social support, rather than the judgment or decision-making of individuals. It is therefore necessary to give serious, balanced consideration to a wide range of health risks and to put in place long-term countermeasures after a nuclear accident.

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  • Shojiro Yasui
    Type: Review
    2018 Volume 67 Issue 1 Pages 84-92
    Published: February 01, 2018
    Released: April 14, 2018
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    This article reviewed the papers which address issues of radiation protection for emergency workers and decontamination workers relating to the Fukushima Daiichi Nuclear Power Plant accident in 2011. The papers were published from 2012 to 2017 and they extracted lessons learned from the experiences and provided guidance regarding future preparedness for a similar accident. Numerous reports have been published about the accident. However, the issues regarding the radiation protection of workers have rarely been presented. The reviewed papers provide detailed information on the problems substantiated by reliable primary sources. The article is not arranged chronologically but divided into four broad topics: (a) emergency responses for radiation protection and health care, (b) post emergency responses, (c) establishment of new regulations for decontamination/remediation, and (d) the epidemiological study on health effects of radiation exposure.

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  • Ichiro Yamaguchi, Tsutomu Shimura, Hiroshi Terada, R. Svendsen Erik, N ...
    Type: Review
    2018 Volume 67 Issue 1 Pages 93-102
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    Introduction: The Fukushima nuclear disaster has brought numerous difficulties to the Japanese society, such as mental health issues, and secondary health issues during the recovery phase of the nuclear disaster. To promote a balanced public health policy, sound risk communication strategies are required.

    Methods: Risk communication guidelines and public health activities regarding radiation risk communication after the Fukushima nuclear disaster were reviewed within the scientific literature by using the PubMed electronic database for medical journals to clarify the current perception of the risk communication issues.

    Results: There was a consistent recognition of the applicability and importance of risk communication within the Fukushima accident, as was evident in each guideline and journal article which included both the MeSH Major Topics "radiation" and "communication" with the term ”Fukushima” [All Fields]. Basic concepts of each Japanese risk communication guideline are consistent with guidelines issued by other international organizations.

    Discussion: These risk communication principles indicated in the guidelines were useful for establishing good practices in local communities to empower residents and strengthen community function, potentially reducing the secondary health impacts induced by the Fukushima accident. However, the strengths within social sciences are thought to create new challenges because the ethical, legal, and social implications (ELSI) are newly recognized difficulties within local public health activities regarding radiation risk communication, and there is only a limited number of articles focused on these relationships and radiation risk communication within the social sciences. The collaborative problem-solving strategy should be strengthened to deal with the difficult issues in local communities since ELSI are all within local public health activities regarding radiation risk communication. Therefore, a collaborative problem-solving strategy within social sciences is a challenge issue to study.

    Conclusions: Successful risk communication practices were helpful to the local community and supported by the local community. They were observable in local communities by employing the strategic approaches directed by a team organized with many experts in local issues, including local risk communicators. Established risk communication guidelines are helpful, especially regarding the ELSI of science and technology.

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  • Ryuma Shineha, Mikihito Tanaka
    Type: Reveiw
    2018 Volume 67 Issue 1 Pages 103-114
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    The 3.11 disaster brought not only direct damages, but also huge ramifications to Japanese society. To consider confusion and structural issues of communication regarding the 3.11, we overviewed history of science communication and current studies on media analysis concerning the 3.11.

    In the 3.11 disaster context, we should not overlook that fact that the Nuclear Power Plant accident deprived media attention from topics concerning the earthquake and tsunami, particularly in national and social media. There were also gaps in the media framing between national/social media and local newspapers in the Tohoku area.

    In addition, current studies on science communication taught us that we should not solely examine the scientific contents, but also the social contexts of science and technology. They indicated that the public tends to be aware of and regard risks, responsibility and liability, and other post-disaster schemes as important factors rather. To secure “trust,“ mutual understanding, and proper communication concerning post-disaster schemes, including responsibility and liability, is essential. The opening of stakes will support this process.

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  • Tsutomu Shimura, Ichiro Yamaguchi, Hiroshi Terada, Naoki Kunugita
    Type: Review
    2018 Volume 67 Issue 1 Pages 115-122
    Published: February 01, 2018
    Released: April 14, 2018
    JOURNALS OPEN ACCESS

    Herein we summarize the important issues for radiation health effects on humans based on the reliable scientific literature. Radiation effects are categorized “tissue reactions” and “stochastic effects”. The former are previously called “deterministic effects” which have a threshold below which the effect does not occur. The tissues and organs-threshold doses of local exposure has been estimated at around 100 mSv for fetal abnormalities, temporary infertility of the male and 120~200 mSv for severe mental retardation among the atomic bomb survivors of Hiroshima and Nagasaki who were exposed in utero. Whole body irradiation >1000 mGy causes acute radiation syndrome (ARS), including erythema, nausea, vomit, headache, diarrhea, fever and confusion. On the other hand, stochastic effects consist of cancer and genetic effects. Cancer risks for human exposure to radiation are estimated by epidemiological study among the atomic bomb survivors of Hiroshima and Nagasaki. Radiation risks below around 100 mSv are not capable to be estimated directly from this epidemiological data. Although all the epidemiological data do not support the linear nonthreshold (LNT) model, the model is useful for the purpose of radiation protection but not for risk assessment. In order to understand radiation effects on humans, we explain the essential terms relative biological effectiveness, equivalent dose, effective dose, dose and dose-rate effectiveness factor in this manuscript.

    We hope that this review paper facilitates the knowledge acquisition of the radiation effects on humans and may help administrative officers and public health nurses to implement public health actions against future nuclear disasters or radiological accidents.

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  • R. Svendsen Erik
    Type: Review
    2018 Volume 67 Issue 1 Pages 123-132
    Published: February 01, 2018
    Released: April 14, 2018
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    Introduction: Although disaster epidemiology is essentially recognized as the use of epidemiology in disaster settings, it now has unique methods and tools applicable only within public health disaster settings. Herein I will briefly describe the history and development of disaster epidemiology, its unique characteristics, and illustrate its potential to both respond to and learn from public health disasters within the current literature.

    Methods: This literature review was used to motivate the potential application of disaster epidemiology more extensively in the on-going disaster-related public health recovery and research within Fukushima after the 2011 radiological disaster, and preparedness activities to mitigate any such future event. The PubMed electronic database for medical journals was used exclusively to identify literature suitable for inclusion in the literature review paper using the following search terms anywhere in the article: disaster and epidemiology; “disaster epidemiology”.

    Results: Disaster epidemiology can be used to understand the frequency and severity of disasters, to rapidly learn about the needs of the disaster population and intervene in those needs, and to learn how to minimize the public health impacts of future disasters: tracking, mitigating, and researching, accordingly. To date, the majority of journal articles have been focused on mitigating disasters (10 of the 19 papers).

    Discussion: There was a consistent recognition of the applicability of epidemiology within disasters, as was evident in the large number of journal articles which included both the terms “epidemiology” and “disaster”. However, that did not translate over to an understanding of “disaster epidemiology” as a sub-discipline because only 19 articles were focused on that concept. Within those there was variability in how the term was being used. More work is needed to better educate the scientific and public health community about the unique niche which disaster epidemiology plays within public health disaster management and preparedness.

    Conclusions: Disaster epidemiology is a unique sub-discipline which can help advance the tracking, mitigation, and research of public health disasters. Further training and development of this sub-discipline within epidemiology training programs could help reduce the burden of disasters on public health and advance our understanding of unique environmental exposures within disaster settings.

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