Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

artificial because followup in almost all studies has been brief. After surgery and RIA,
thyroid hormone is prescribed to suppress thyrotropin (thyroid stimulating hormone
[TSH]) without inducing hyperthyroidism. Routine surveillance for recurrence has
generally included 131 iodine whole body scans and serum thyroglobulin (Tg) levels
performed after thyroid hormone withdrawal. After total thyroidectomy and RIA,
undetectable serum Tg when the patient is off thyroid hormone is predictive of complete
remission, whereas Tg levels >10 ng/mL off thyroid hormone suppression or TSHstimulated
Tg levels >2 ng/mL indicate residual disease. Despite favorable survival,
recurrence is three times as likely in children as in adults.
Due to the increased incidence of leukemia in children exposed to high doses of
radiation, close followup with regular physical examinations and complete blood counts
is warranted. The incidence of breast cancer is also increased in young women who had
been either pubertal or lactating at the time of exposure to the Hiroshima device. Cancers
began to appear as early as ages 25 to 30 years, which was earlier than in sibling controls.
For that reason, regular breast examinations should be emphasized, and abnormalities
should be evaluated with a high level of suspicion. Enrollment in a high-risk breast clinic
may be indicated. The latency period (i.e., the time interval between irradiation and
appearance of a malignancy) is shortest for leukemia (5–7 years) but can extend to 45
years or more for solid tumors.
Environmental Issues Affecting Children After a
Terrorist Incident Involving Radioactive Materials
The environmental damage from a terrorist incident involving radiation has many
potential consequences for children. These effects can be minimized by a better
understanding of the types of incidents that involve radioactive material and the
environmental exposure pathways involved. Response planning involves actions that may
be taken to minimize exposure both immediately after and during recovery from a
terrorist incident.
Type of Incident
The environmental damage and effects on children differ significantly depending on the
type of terrorist incident. More specifically, whether the incident involves a/an:
• Radiological dispersal device (RDD, or “dirty bomb”).
• Improvised nuclear device (IND).
• Attack on a nuclear power plant.
Radiation dispersal device. An RDD is any device that causes the spread of radioactive
material across an area, typically to contaminate people and buildings in an urban
environment. RDDs can also be used to contaminate water, livestock, fish, and food
crops. The radioactive material acts as a toxic chemical that is harmful or fatal. RDDs use
an explosive device to scatter the radioactive material over a general but fairly confined
area. Simple RDDs spread radioactive material without the use of explosives, typically by
the covert placement of radioactive material in a high traffic area. The radioactive
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