Treating radiation injuries in US travelers returning from Japan

March 22, 2011 — In response to the crisis in Japan, the US Centers for Disease Control and Prevention (CDC) hosted a conference call for clinicians to answer questions about treating radiation injuries in US travelers returning from Japan.

During the hour-long Clinician Outreach and Communication Activity call yesterday evening, Jeffrey Nemhauser, MD, who is a captain in the US Public Health Service and a medical officer in the CDC’s Radiation Studies Branch, answered questions from healthcare providers about radiation exposure and treatment.

Dr. Nemhauser stressed that the CDC is not aware of any US travelers returning from Japan who have been “contaminated with material at a level of concern.” If a traveler is contaminated, the CDC will recommend decontamination, collect data, and follow-up with the traveler, he said.

Customs officials routinely screen travelers (and their luggage) entering the United States for radiation contamination, he said. Because of the radiation leaks in Japan, however, the CDC is creating extra screening protocols for airports. Dr. Nemhauser said that these protocols should go into effect this week.

Questions About Potassium Iodide

Many of the callers had questions about the use, availability, and distribution of potassium iodide (KI). Taking a dose of KI floods the thyroid with the stable compound, which prevents radioactive iodine from entering the thyroid.

Dr. Nemhauser said that people at risk for direct exposure to radiation should first evacuate the area, “before there’s even a need to take [KI].” He considered the use of KI a “secondary measure” in responding to a radiation threat.

KI is most effective if it is taken 1 to 2 hours before anticipated exposure to radioactive materials, or up to 3 or 4 hours after exposure, said Dr. Nemhauser. It protects the thyroid from radioactive iodine for about 24 hours.

The risks posed by radioactive iodine are greatest for people younger than 40 years, especially children and pregnant women, Dr. Nemhauser said.

If KI is needed, public health authorities will distribute it. However, Dr. Nemhauser did not know what KI supplies each state has on hand. He also could not share information about how much KI is in the strategic national stockpile.

Questions about KI “come up every single time there’s a radiation scare,” Carl H. Schultz, MD, director of research for the Center for Disaster Medical Sciences at the University of California–Irvine School of Medicine, told Medscape Medical News.

KI is often seen as a “silver bullet” to treat radiation exposure, but it only protects against 1 isotope, said Dr. Schultz. “There are other agents,” he said, such as Prussian blue, used to remove radioactive cesium.

Other Concerns

Some callers asked about the safety of food and water in and around Japan. Dr. Nemhauser said that farmed seafood from Japan such as seaweed and shellfish might be at risk for contamination. Japan is monitoring its food supplies, he said, and the country has embargoed some produce grown near the site of the accident. The US Food and Drug Administration is monitoring food imported from Japan.

The Department of Energy and the Environmental Protection Agency are monitoring the West Coast for radioactive materials brought from Japan by the jet stream.

Resources

Dr. Nemhauser recommended 2 online resources for clinicians who want to know more about radiation issues.

The CDC’s Web site has a page with information about radiation emergencies and links to updates on the situation in Japan.

The US Department of Health and Human Services’ Radiation Emergency Medical Management Web site provides updated information for clinicians on diagnosing and treating radiation injuries. The site includes a download for mobile devices and a listserv.

Kristi L. Koenig, MD, director of the Center for Disaster Medical Sciences at the University of California and Carl H. Schultz, MD, director of research for the Center for Disaster Medical Sciences at the University of California–Irvine School of Medicine are the editors of Koenig and Schultz’s Disaster Medicine, Comprehensive Principles and Practices, published by Cambridge University Press

Laurie Bouck,  freelance writer for Medscape. Article reposted from Medscape Medical News

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