Perinatal mortality after atmospheric nuclear weapon tests, after Chernobyl and Fukushima

1. Perinatal mortality
after atmospheric nuclear weapon tests,
after Chernobyl and Fukushima
Alfred Körblein
Nürnberg
alfred.koerblein@gmx.de

2. Chernobyl consequences
2

3. Definitions
term meaning
Infant mortality mortality within 1st year
Neonatal mortality mortality within 28 days
Early neonatal mortality mortality within 1st week
Stillbirth rate after 22 weeks of pregnancy
Perinatal mortality stillbirth plus 1st week
3

4. 4
First article about my Chernobyl study
in the German newspaper die tageszeitung (taz) on 25 April 1992

5. Perinatal mortality in Germany and
regression line
Lower panel: deviation of observed
from expected rates
(standardized residuals)
Significant 4.9% increase in 1987
(P=0.017)
excess rate = 0.36 per 1000
315 excess cases in 1987
5
Perinatal mortality in Germany

6. Perinatal mortality in Poland and
regression line
Lower panel:
Standardized residuals
Significant 3.8% increase in 1987
(P=0.015)
excess rate = 0.57 per 1000
348 excess cases in 1987
6
Perinatal mortality in Poland

7. Perinatal mortality in Russia
and regression line
Lower panel:
Standardized residuals
Significant 4.1% increase in 1987
(P=0.002)
excess rate = 0.72 per 1000
1853 (817-3010) excess cases in 1987
data obtained from A. Yablokov, Moscow
7
Perinatal mortality in Russia

8. ICRP 90 (2003)
Biological effects after prenatal irradiation (embryo and fetus)
Summary:
• The data confirm embryonic sensitivity to the lethal effects of radiation in the pre-
implantation period but provide no good reason to believe that in general there
are significant risks to health after birth.
• Experimental data on age-dependent patterns of sensitivity to malformation
induction reinforce the view of maximum sensitivity during major organogenesis.
but with a true dose threshold. For practical purposes, risks of induction of
malformation at low doses may therefore be discounted.
• (44) Induction of malformations […] most pronounced during organogenesis
(weeks 3-11 p.c.)
• (60) Most experimental data basically fit sigmoid or shoulder-type dose-response
curves [… ]
8

9. ICRP 90. Fig.1.1: Occurence of lethality and abnormalities in mice
after prenatal radiation exposure of about 2 Gy
9

10. ICRP 90. Fig.3.1: Induction periods in mice for short- and long-term
effects of ionizing radiation
10

11. Shape of the dose-response relationship for stochastic and teratogenic effects
From: http://gd1.med.uni-giessen.de/ugm_2/deu/ugi_nuk/PDF/Rad_V2_Strahlentherapie.pdf
11

12. Calculated shape of dose-response relationship based on the assumption
of randomly distributed doses and radiosensitivities (black dots)
Solid line: regression with a cumulative lognormal distribution
0,0028
0,0081
0,0181
0,0337
0,0556
0,00
0,01
0,02
0,03
0,04
0,05
0,06
0,07
0,08
0 0,2 0,4 0,6 0,8 1 1,2 1,4 1,6 1,8 2
effect[arbitraryunits]
dose [arbitrary units]
12

13. 13

14. Measured cesium-137 concentration in cow milk (crosses) and
cesium burden in pregnant women, calculated with an assumed
biological half-life of 70 days (solid line)
0
5
10
15
20
25
30
35
40
45
0
50
100
150
200
250
300
350
400
450
1986 1987 1988 1989
caesiuminhumans[Bqperkg]
caesiumincowmilk[Bq/l]
calendar years
14

15. Perinatal mortality rates, 1980-93, and regression line
The vertical line indicates the time of the Chernobyl accident
15
Perinatal mortality in West Germany

16. Secular trend with seasonal variations
Lower panel: Deviations from expected
trend (standardized residuals) and
3-month moving average
After Chernobyl (vertical broken line),
significant mortality peaks are found
in February and November 1987.
The association with cesium burden is
signficant (P=0.003, F test).
16
Perinatal mortality in West Germany

17. Perinatal mortality in West Germany (former FRG)
Standardized residuals and 3-month moving average (red line)
Lower graph: cesium burden during pregnany, delayed by 7 months
-8
-6
-4
-2
0
2
4
6
8
1985 1986 1987 1988 1989 1990
standardisedresiduals
calendar years
17

18. Sums of squares, obtained from regressions of West German monthly
perinatal mortality data as a function of time-lag between cesium burden
and perinatal mortality.
The horizontal broken line indicates the width of the 95% CI.
182
184
186
188
190
192
194
196
198
200
202
0 1 2 3 4 5 6 7 8 9
sumofsquares
time-lag [months]
18

19. Excess perinatal mortality risk in West Germany as a function of cesium
burden and regression line (linear-quadratic model).
The cesium dependency is significant (P=0.003, F-test). The dose-response is
curvilinear: linear term <0, quadratic term >0 (P=0.014).
19

20. 20

21. Poland
Infant mortality rates and
trend line with seasonal
variations
Lower panel:
standardized residuals
and 3-month moving average
In 1987, peaks are found in
January , April, and
October/November
21

22. Excess infant mortality risk in Poland as a function of cesium burden and regression line.
The cesium dependency is significant (p=0.014, F-test).
The dose-response is curvilinear: linear term <0, quadratic term >0 (P=0.016)
22

23. Zhytomyr (Ukraine)
Perinatal mortality and trend line
(analysis without data from 1987)
Lower panel:
Standardized residuals and 3-month
moving average
Highly significant increase in April 1987
23

24. Croatia
perinatal mortality and trend line
(analysis without data from April 1986 to
June 1987)
Lower panel:
Standardized residuals and 3-month
moving average
Peak of 3-month moving average in
December 1986 / January 1987
24

25. Studies in most contaminated regions
of Belarus and Ukraine
25

26. 26

27. 27

28. 28
From UMSCEAR 2000 Annex J

29. Perinatal mortality in the oblasts of Belarus and in Germany
In 1994, the definiton of stillbirth was changed (birthweight 1000 g --> 500 g).
0
2
4
6
8
10
12
14
16
18
20
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
mortalityper1000
calendar years
Gomel Mogiliov Vitebsk Grodno
Minsk-City Brest Minsk Germany
29

30. Perinatal mortality in oblasts Gomel (Belarus) and Zhytomyr (Ukraine) and in
control region (Belarus minus Gomel and Minsk-City)
30
6
8
10
12
14
16
18
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
mortalityper1000
calendar years
Zhitomir
Gomel
Belarus minus Gomel and Minsk

31. Odds ratio of perinatal mortality in Gomel and Zhytomyr to Belarus minus
Gomel and Minsk-City
31
0,8
1,0
1,2
1,4
1,6
1,8
1985 1986 1987 1988 1989 1990 1991 1992 1993
oddsratio
calendar year
Zhitomir oblast
Gomel oblast

32. Strontium burden in pregnant women
• Main strontium uptake during period of maximum bone growth
(at age ~14)
• Maximum strontium uptake in 1986
• Strontium burden proportional to percentage of mothers aged
calendar year minus 1972 (--> from maternal age distribution)
• Strontium excretion has to be taken into account
32

33. 33
Main strontium uptake during period
of maximum bone growth (age 14)
Average values of Sr-90 whole-body content
for different age cohorts of Muslyumovo
residents in 1980
(a women, b men)
Women age 43 in 1980 were 14 years old
in 1951
During 1950-52, highest radioactive releases
from Mayak reprocessing facility to Techa
river
From:
Tolstykh et al. in Rad Environ Biophys (1997) 36: 25-29

34. Strontium excretion is determined by a double exponential decrease with
half-lives of 2.42 and 13.65 years. Age at intake: 15 years.
From: ICRP. 1992. Age-dependent Doses to Members of the Public from Intake of Radionuclides
Part 2 Ingestion Dose Coefficients. ICRP Publication 67. Ann. ICRP 22 (3-4).
34
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
strontiumconcentration

35. Maternal age distribution in Belarus (mean values in 1992-1996)
and interpolation line (two superimposed lognormal distributions)
0%
10%
20%
30%
40%
50%
60%
15 20 25 30 35 40 45
proportion
maternal age [years]
35

36. Odds ratio of perinatal mortality in Gomel and Zhytomyr to Belarus minus Gomel and
Minsk-City
36
0,8
1,0
1,2
1,4
1,6
1,8
1985 1986 1987 1988 1989 1990 1991 1992 1993
oddsratio
calendar year
Zhitomir oblast
Gomel oblast

37. Odds ratio of perinatal mortality in Gomel and Zhytomyr to Belarus minus Gomel and
Minsk-City, and results of regressions with average strontium burden during pregnancy
376 excess perinatal deaths in Gomel and 681 in Zhytomyr in 1987-97
37
0,8
1,0
1,2
1,4
1,6
1,8
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
oddsratio
calendar year
Zhitomir oblast
Gomel oblast

38. Odds ratio of perinatal mortality in Gomel plus Zhytomyr to Belarus minus Gomel and Minsk-
City (control region) and result of a regressions with average strontium burden
38
0,8
1,0
1,2
1,4
1,6
1,8
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
oddsratio
calendar year

39. 39

40. Perinatal mortality in Ukraine
Study region:
oblasts Rivne, Zhytomyr,
Kiev, Kiev City
Control region:
Rest of Ukraine
~900 excess perinatal deaths
40

41. Summary: Chernobyl consequences
• Cesium effect:
Significant peaks of perinatal mortality in 1987
associated with the cesium burden of pregnant women
Curvilinear dose-response
• Strontium effect:
Increased perinatal mortality in the most contaminated regions Zhytomyr and
Gomel in the 1990s relative to the trend in the control region (Belarus minus
Gomel and Minsk-City). This increase is associated with the calculated average
strontium burden during pregnancy.
More than 1000 excess perinatal deaths during 1987-97 in Zhytomyr plus Gomel
41

42. UNSCEAR 2000 on pregnancy outcome after Chernobyl
• 382. According to a recent paper [K4], perinatal mortality in Germany
showed a statistically significant increase in1987, and it was concluded
that this was an effect of the Chernobyl accident fallout. The findings were
later questioned, since whole-body doses from incorporated caesium
were found to be 0.05 mSv [R19].
K4 Körblein, A. and H. Küchenhoff. Perinatal mortality in Germany following the Chernobyl
accident. Radiat. Environ. Biophys. 36(1): 3-7 (1997)
• 383. Several studies on adverse pregnancy outcomes related to the
Chernobyl accident have been performed in the areas closest to the
accident and in more distant regions. So far, no increase in birth defects,
congenital malformations, stillbirths, or premature births could be linked
to radiation exposures caused by the accident.
42

43. 43

44. Atmospheric nuclear weapon tests
• Atmospheric nuclear weapon tests in the 1950s and 1960s caused the
greatest radioactive pollution globally in the history of nuclear
technology.
• The cumulative explosive power of the tests corresponded to 550
megatons 2.4.6-trinitrotoluene (TNT) which is equivalent to
40 000 Hiroshima bombs.
• The collective dose to the world population is estimated by UNSCEAR
at 30 million PersonSievert (PersSv) which compares with 600 000
PersSv from the Chernobyl accident in 1986.
44

45. Cesium concentration in grass samples from Rothamsted (GB)
45
From: Warneke et al. in Earth and Planetary Science Letters 203 (2002) 1047-1057

46. Radiation exposure from atmospheric testing (BfS)
46

47. Ernest J. Sternglass
Already in the late 1960s, the
American physicist Ernest
Sternglass predicted possible
detrimental health effects from
atmospheric nuclear weapon tests
with a focus on infant mortality in
the USA.
Here:
Infant mortality in Wyoming, USA
Ernest J. Sternglass. The implications of
Chernobyl for human health. Int.
J. Biosoc. Res. 8 (1986). p. 7-36
47

48. Trend of first day neonatal mortality in the United States and England and Wales
from: Whyte RK. First day neonatal mortality since 1935: re-examination of the Cross hypothesis. BMJ.
1992 Feb 8;304(6823):343-6.
48
Whyte RK
In 1992, Whyte investigated first day
neonatal mortality data from USA
and England and Wales.
Using trend analysis, 195 000 excess
first day neonatal deaths in the USA
and 37 000 in England and Wales
were estimated.

49. Trend of perinatal mortality in West Germany (former FRG), 1955-93.
The grey columns represent the strontium concentration in rain water from
Munich.
49
Perinatal mortality in West Germany
0
5
10
15
20
25
30
35
40
45
50
55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93
mortalityrateper1000

50. 50
Regression with a long-term exponential trend plus a constant
and two lognormally shaped excess terms
Model:
rate~c0+c1*exp(c2*t+c3/t/exp((log(t)-log(c4))^2/c5)+c6/t/exp((log(t)-log(c7))^2/c8))
with t = calendar year minus 1950
Results:
Estimate Std.error t value P value
c0 0.0022 0.0006 3.526 0.0014
c1 0.0568 0.0007 77.847 0.0000
c2 -0.0675 0.0044 -15.213 0.0000
c3 2.3486 0.3016 7.788 0.0000
c4 13.4081 0.6928 19.353 0.0000
c5 0.1451 0.0351 4.136 0.0003
c6 11.9882 1.5133 7.922 0.0000
c7 23.5216 0.3424 68.694 0.0000
c8 0.0906 0.0129 7.038 0.0000

51. Perinatal mortality in West Germany, 1955-93, and result of a regression
with two superimposed lognormal distributions (solid line).
The broken line shows the hypothetical undisturbed trend. The grey
columns represent the strontium concentration in rain water from
Munich (arbitrary units).
51

52. Excess perinatal mortality in West Germany with peak in 1970-71
The mortality peak does not coincide with the fallout peak in 1963, the
year of the Partial Test Ban Treaty between the Soviet Union, the USA,
and Great Britain.
52
0
2
4
6
8
10
12
55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93
excessmortalityper1000

53. Infant mortality rates in USA
and regression line
Broken line:
expected undisturbed trend
Lower panel:
Deviations of observed from expected
rates (excess mortality)
Peak in 1965
406 000 excess infant deaths
53
Infant mortality in the USA

54. Germany plus Great Britain
Excess Infant mortality rates
and regression line
Peak in 1973
287 500 excess infant deaths
France + Spain + Italy
Excess Infant mortality rates
and regression line
Peak in 1968
239 000 excess infant deaths
54
Infant mortality in Europe

55. Hypothesis:
Late effect of incorporated strontium?
55

56. Calculation of strontium burden in pregnant women
• Main strontium uptake during period of maximum bone growth
(at about age 14)
• Strontium uptake in fallout years
(data of strontium concentration in rain water provided by BfS)
• Strontium burden determined from maternal age distributions
• Strontium excretion (effective half life) is taken into account
Suggested mechanism:
Strontium accumulates in bones, irradiates red bone marrow and compromises
immune system which in turn leads to increased infant mortality
56

57. Maternal age distributions in West Germany for selected years, 1955 to 1985
57
0
0,01
0,02
0,03
0,04
0,05
0,06
0,07
0,08
0,09
0,1
15 20 25 30 35 40 45 50
proportion
maternal age (years)
1955
1960
1965
1970
1975
1980
1985

58. Regression model: exponential + constant + strontium term
58
P(t) ~ c0 + c1*exp(c2*t) + c3*Sr(t)
Sr(t,k) ~ ∑k<t q(t,k)^c5
q(t,k) =(A(k)*age(t-k+14)*(0.135+exp(-0.2864*(t-k))+0.099*exp(-0.0508*(t-k))))
with
p: perinatal mortality rate
c0 .. c5 Parameters; c4 is strontium concentration in 1954
t: time (calendar year)
Sr: average strontium burden
A(k): strontium concentration in fallout in calendar year k
age(t-k+14): maternal age distribution for age (t-k+14)
0.135+exp(-0.2864*(t-k)) + 0.099*exp(-0.0508*(t-k)): strontium excretion
BfS data of strontium concentration in rain water only available for 1958-81
1954: test „Alpha Bravo“ on Bikini Atoll (15 Mto TNT)
1961: test „Tsar“ Novaja Semlja (50 Mto TNT)
Therefore: additional parameter c4 is used to estimate Sr-concentration in 1954.

59. Regression model:
59
Formula:
p ~ c0 + c1*exp(c2*t) + c3*((c4*q54)^c5 + q58^c5 + q59^c5 +
q60^c5 + q61^c5 + q62^c5 + q63^c5 + q64^c5 + q65^c5 + q66^c5 +
q67^c5 + q68^c5 + q69^c5 + q70^c5 + q71^c5 + q72^c5 + q73^c5 +
q74^c5 + q75^c5 + q76^c5 + q77^c5 + q78^c5 + q79^c5 + q80^c5 +
q81^c5)
Regression results
Estimate SE t value P value
c0 0.0021 0.0010 2.162 0.0380
c1 0.0577 0.0010 55.201 0.0000
c2 -0.0672 0.0066 -10.163 0.0000
c3 9.0687 8.6363 1.050 0.3010
c4 2.7891 0.2830 9.854 0.0000
c5 1.7999 0.2107 8.543 0.0000

60. Perinatal mortality rates in West Germany,1955-93, and regression line
The grey columns represent the strontium concentration in rain water from
Munich (arbitrary units).
60

61. Excess perinatal mortality rates in West Germany and regression line
61

62. Trend of stillbirth rates (black circles) and early neonatal mortality (+)
in West Germany, 1955-93
From: Körblein A. Perinatal mortality in West Germany following atmospheric nuclear weapons tests.
Arch Environ Health. 2004 Nov;59(11):604-9.
62

63. Excess stillbirth rates and early neonatal mortality in West Germany
Result: 106 000 excess perinatal deaths in 1955-93
63

64. 64

65. 65

66. Effective dose (mSv) in Japanese prefectures near Fukushima Daiichi NPP
First year, adults. Source: UNSCEAR 2013, Figure VII
Study region:
Prefectures Fukushima, Iwate, Miyagi,
Gunma, Tochigi, Ibarki, and Chiba
Control region:
Rest of Japan
66

67. Perinatal mortality in the study- and control region, 2002-2015
Results of a combined regression of the data from the study region (2002-2011)
and from the control region (2002-2015) with individual intercepts and trend parameters,
but with a common lower limit of mortality.
183 (95% CI: 68-276) excess perinatal deaths in 2012-15 (P<0.01)
67

68. Perinatal mortality in the study- and control region: monthly data
The lines are the results of a combined regression of the data from the study region
(2002-Feb 2011) and the control region (2002-2015).
Peaks of perinatal mortality in spring, 2012-15
68

69. Thank you for your attention