Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident (2004) / Chapter Skim
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6 Existing Distribution Plans for Potassium Iodide
6 Existing Distribution Plans for Potassium Iodide
Pages 86-136
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From page 86... ...
The development of countermeasures to mitigate radioiodine exposures in the event of a release by various countries is then outlined, followed by details on how various countries have made KI available. The US experience is then discussed, starting with recommendations made by public-health institutions regarding K} distribution and the roles and guidance of the involved federal 86
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From page 87... ...
After the attacks and the offering of KT by the Nuclear Regulatory Commission, several states began KT distribution programs. The decisions of states regarding whether to distribute are discussed with the experiences of the states that decided to distribute KI.
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From page 88... ...
The decision to implement the different countermeasures is based on non-uniform criteria, such as the safety status at NPP, results of radiation monitoring on site and in the vicinity, the meteorological situation, the actual release of radioactivity, and, most important, the dose expected or the dose likely to be averted by the protective measures. interestingly, the timing of countermeasures is handled differently in different countries: some countries do not expect to implement them consecutively, but other countries plan to implement them first for the nearby areas and for specific populations (such as pregnant women and schoolchildren)
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From page 89... ...
For most European countries, the IAEA International Basic Safety Standards is the basis for radiation-emergency planning. Recently, the WHO Guidelines for Stable fodine Prophylaxis Following Nuclear Accidents, which were updated in 1999, were implemented by many countries.
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From page 90... ...
Sheltering According to the IAEA International Basic Safety Standarcis, for sheltering the generic optimized intervention level is 10 mGy (1 red) of avertable effective dose2 in a period of no more than 2 days.
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From page 91... ...
. Generally, the recommendations of the IAEA International Basic Safety Standards are followed.
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From page 92... ...
transitions Irelar~d 100 rr'Sv Anticipated averted Thyroid dose from thyroid dose radiolodines Japan Where a high thyroid dose is anticipated, stable iodine prophylaxis taken according to judgement of experts. Luxembourg 30-250 mSv Anticipated organ dose (children)
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From page 93... ...
, , Canada Neonates 1 2.5D c c Infants 25b Children 50b Adults 1 Gob Czech Republic Infants 32 24 h 16 mg 48 h Children 65 24 h 3.5 mg 48 h Adults 130 24 h 65 mg 48 h Pregnant women 130 24 h max. 2x Others 130 Finland Neonates 16 d 24 h Infants 32.5 Children 65 Adults 130 Pregnant women 130 Germany Neonates 12.5 Normally single dosage.
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From page 94... ...
Infants < 3yrs 32.5 In the case of prolonged Children < 12 yrs 65 release, an additional Adults < 40 yrs 130 dosage may be Pregnant women 130 recommended Switzerland Neonates 16.2 Single dosage Only one Infants 32.5 Single dosage time Children 65 Per day Only one Adults 130 Per day time Pregnant women 130 Per day a United Kingdom Neonates 12.5 Single administration Single Infants 25 only, preferred administra Children 50 tion Adults (including 100 provides pregnant and protection lactating women) for 24 hours United States"' Birth through 1 mo 16 Until risk of 1 mo through 3 yrs 32 significant exposure Children 3-12 yrs 65 to Adults 12-18 yrs radiolodin e by either Adults over 18 yrs 130 inhalation PregnantAactating or women ingestion no longer exists 'Neonates: birth-1 month old Infants: 1 month-3 years old Children: 3-12 years old Adults: include adolescents aged 13-16 years old b Federal recommendation follows the 1989 WHO Guidelines.
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From page 95... ...
Source: NEA/OECD, 2003. Information about possible side effects of iodine tablets is presented in leaflets that are distributed by most of the countries to households in EPZs before an emergency.
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From page 96... ...
Any shock and any water and electrolyte disorders are to be treated according to guidelines well known by · P nyslclans. In cases of a previous history of thyroid disorders, even if its course has been so far asymptomatic (especially in case of nodular goiter with functional autonomy)
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From page 97... ...
There are various policies, some provinces decided to predistribute the iodine tablets to residences, other provinces make them available at predesignated locations. Within a radius of about ~ km around Gentilly 2 nuclear power plant, for example, iodine tablets will be predistributed to some 12,500 persons (inhabitants and workers)
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From page 98... ...
Stable iodine tablets are Redistributed to about 1,150 people living around Loviisa NPP (50 permanent inhabitants and about 400 holiday homes with a maximum of 1,100 inhabitants) and 1,370 people surrounding Olkiluoto NPP (70 permanent inhabitants and about 450 holiday homes with a maximum of 1,300 inhabitants)
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From page 99... ...
in Japan, the tablets are stockpiled by local authorities and distributed at public shelters during an emergency. In Luxembourg, stable iodine tablets will be commercially available in pharmacies for children of up to five years only.
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From page 100... ...
In Switzerland, iodine tablets are predistributed about 4 km (zone I) around the nuclear power plants.
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From page 101... ...
For areas outside a radius of 25 km around a NPP In the entire territory of the Federal Republic of Germany, central stocks (at several places, if appropnate) of iodine tablets should be made available for children and adolescents up to ~ ~ years old and for pregnant women.
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From page 102... ...
The French experience revealed that home delivery allowed successful distribution to over 90°/O of the population involved, compared to 60-70% for pickup from pharmacies (Le Guen et al., 2002~. In the UK, experience 2 years after the predistribution of iodine tablets to households, almost 60% of the tablets were still available for the target population.
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From page 103... ...
was banned for consumption by children and pregnant and lactating women, all children below age of 4 were provided with powdered milk, and children and pregnant or lactating women were advised to minimize their ingestion of fresh leafy vegetables until May 16. A total of 10.5 million dosages of KIsolution were given to children and 7 million dosages to adults.
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From page 104... ...
A few states with commercial nuclear facilities distributed KI, and one state experimented with different methods of distribution. After the Chornoby} experience and the increased concern over a possible terrorist attack that would lead to radioiodine exposure, several states and the federal government reassessed their policies and initiated K} distribution programs to cover emergencies at NPPs.
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From page 105... ...
One caveat is that, contrary to FDA (2001a) , the AAP recommends that women exposed to radioiodine cease breastLeeding unless there are no alternatives.
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From page 106... ...
KI is given once only to pregnant women and neonates unless other protective measures (evacuation, sheltering, and control of the food supply) are unavailable.
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From page 107... ...
FDA therefore advises that neonates and pregnant and lactating women be given priority with regard to other countermeasures to reduce radioiodine exposure and thereby obviate repeat dosing with KI. FDA further recommends that those under ~ month old treated with KI be monitored for hypothyroidism and hormone therapy be instituted in the event it develops.
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From page 108... ...
guidance for neonates, children, and pregnant and lactating women and increased the level for adults over 40 years old. The 1982 FDA guidance recommended thyroid blocking for anyone likely to receive a dose of at least 250 m Gy (25 red for radioiodine)
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From page 109... ...
The guidance was issued for use by state and local agencies involved in emergency planning and preparedness for accidents at NPPs (FEMA, 2002~. The policy states the federal position that KI should be stockpiled and distributed to emergency workers and institutionalized persons, and that its use should be considered for the general public within the lO-mile EPZ.
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From page 110... ...
. The second, larger planning zone, the ingestion pathway zone, is larger than the first zone- roughly up to 50 miles from the facility (see Chapter 5 for a more complete description of emergency planning procedures)
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From page 111... ...
, Point Beach (near Two Rivers) aSource: Energy Information Agency, Nuclear Regulatory Commission, Nuclear Power Plants Operating in the United States, 2001 and request for information responses.
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From page 112... ...
grew out of meetings of the task force. One consideration in the decision was the Nuclear Regulatory Commission's offering of KI to the states with populations in the vicinity of commercial NPPs.
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From page 113... ...
A safety talk is given to inform employees about the program, to provide information needed "to make an educated decision about whether to take the tablets in the event of a radiation emergency", and to distribute informed-consent forms ("Potassium Iodide Distribution Employee Acceptance Formal. A signature on the form is required to receive KI in a facility distribution conducted in response to a nuclear emergency.
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From page 114... ...
After the September Il. 2001, attack and the Nuclear Regulatory Commission's provision of KI to requesting states, several states began KI distribution programs.
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From page 115... ...
A resolution recently adopted by the Texas Radiation Advisory Board on the use of KI in NPP emergencies (Texas Department of Health, 2002-2003) articulates issues discussed by other states that have chosen not to distribute K]
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From page 116... ...
Various states reported that during an emergency, the consumption of KI by emergency workers would be voluntary. Some states routinely provide training that include instruction on distribution of K} to special populations and emergency workers and assess the effectiveness of the distribution plan in such training.
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From page 117... ...
KI can be predistributed to individuals and groups via the mail, voluntary pick-up or door-to-door; making KI available on a voluntary basis to those interested in obtaining it; or a combination of both. All states with predistribution programs, on which the committee had detailed information, also had postincident distribution programs, many of them extensive.
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From page 118... ...
Two states with postincident distribution plans, Arizona and Mississippi, have relatively small populations living in the 10-mile EPZ. Mississippi notes that the estimated evacuation time for the entire EPZ is 2.5 h.
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From page 119... ...
Connecticut predistributed tablets by mass mailing, Tennessee distributed initially by door-to-door delivery and then by a voluntary pickup program, and Maryland by pickup. The various other state predistribution programs are described in Appendix C
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From page 120... ...
As a major means of making KI available and accessible in an emergency, the state decided to predistribute by mass mailing in the initial phase. The mailing was also seen as another avenue to inform the public and encourage emergency preparedness.
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From page 121... ...
The information was disseminated in a variety of educational materials: letters to physicians and residents, newspaper ads, press releases and a press conference, a cable television program, and the Millstone Emergency Planning Guidebook. The Nuclear Regulatory
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From page 122... ...
It has heard various criticisms regarding its distribution program, for example, objection to mass mailing medication, the delay in distribution (KI was received in March and mailed in October) , the idea that one tablet will not be enough in some circumstances, and the idea that coverage of only the towns in the EPZ will not be sufficient in some emergencies.
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From page 123... ...
Thirty-eight employees of county health departments, after a 1-day training session, attempted to distribute KI to the 5,591 households within 5 miles of the power plant. The households were identified from addresses on TVA meter-reader sheets.
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From page 124... ...
The Tennessee Department of Health decided not to make K} evade to schools or day-care centers, because the facilities would not have health-care professionals available at the time of an emergency to oversee the administration of KI. The plan is to relocate schoolchildren by bus to schools outside the lO-mile radius around a nuclear facility immediately on declaration of an on-site emergency at the power plant.
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From page 125... ...
The state requested KI Mom the Nuclear Regulatory Commission in January 2002 and began distnbuting it in the following spring. Maryland opted for a multipronged distribution strategy predistribution enabling people to pickup dosages at clinics, providing for stockpiles at reception centers in the event of a disaster, and preplacing KI at schools and other facilities, such as senior centers and scout camps.
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From page 126... ...
The cost of the Calvert County predistribution program was fairly low, totaling $13,126 for county health-department staff and printing and mailing. That corresponds to $0.55 per person reached.
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From page 127... ...
Some states are evaluating populations beyond the lO-mile radius. States with predistribution programs currently distribute or offer K} to the entire population; age has not been a factor in predistribution of KI, despite the fact that children and pregnant women with fetuses in the second and third trimester of pregnancy are at most risk.
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From page 128... ...
. An example of the confusion in the FDA guidance on dosing is provided above in discussion of Connecticut's distribution program.
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From page 129... ...
Inefficient predistribution programs (ones who do not manage to predistribute most of the K] they plan to)
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From page 130... ...
In addition to the door-to-door distributions of Tennessee in the early 198Os, other means appear to have been effective. KI reached 2/3 of the effective population in a program involving mass mailing accompanied by publication and public education effort, and a well-orchestrated distribution through schools and local facilities (Calvert County, Maryland)
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From page 131... ...
.......................................................................................................................................................... Calvert Voluntary pickup; distributed to 70% County general population through schools, workplaces, other facilities New Hampshire Requires submitting application 3.5% 350 000 tabletesa available at town halls, and health , department offices over Internet , , New Jersey KI made available at designated About 10% 722,000 tabletsa locations via "public education and distribution" sessions New York Distribution varied by county; 15% of population 1.2 million provided locations for pickup, in EPZ tablets pickup via mail North Carolina Voluntary pickup 35°/O of public 750 000 tabletsa picked up tablets , Ohio Mass mailing of information letter 40°/O of amount with coupon for KI pick-up; mass- received was media campaign distributed _ Pennsylvania Voluntary pickup About 34% for 640,000 people .
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From page 132... ...
Education and Communication Strategies. Distribution programs with extensive public education and use of mass media appeared to be much more effective than those without.
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From page 133... ...
The Nuclear Regulatory Commission has made no commitment to resupply states. If needed in the days after a major incident, resupply is dependent on the Strategic National Stockpile.
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From page 134... ...
Even with the most efficacious predistribution programs, well-developed programs for local stockpiling and postdistribution are required to ensure protection. The Nuclear Regulatory Commission offered KT coverage for those working and living within the lO-mile EPZ, and all local distribution programs in the United States are designed for this features and weather conditions vary coverage.
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From page 135... ...
In this regard, research would benefit the states in the development of effective education and mass-media strategies and benefit FDA and the states in developing packaging and [Labeling messages. Several states' distribution efforts were hampered by the limited support given for distribution programs by the Nuclear Regulatory Commission.
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From page 136... ...
136 DISTRIBUTIONAND ADMINISTRATION OF Kl not committed to support. For some states, decisions on whether to use KI and how to use it also appear to depend on federal funding.
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