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      Managing Terrorism or Accidental Nuclear Errors, Preparing for Iodine-131 Emergencies: A Comprehensive Review

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          Abstract

          Chernobyl demonstrated that iodine-131 ( 131I) released in a nuclear accident can cause malignant thyroid nodules to develop in children within a 300 mile radius of the incident. Timely potassium iodide (KI) administration can prevent the development of thyroid cancer and the American Thyroid Association (ATA) and a number of United States governmental agencies recommend KI prophylaxis. Current pre-distribution of KI by the United States government and other governments with nuclear reactors is probably ineffective. Thus we undertook a thorough scientific review, regarding emergency response to 131I exposures. We propose: (1) pre-distribution of KI to at risk populations; (2) prompt administration, within 2 hours of the incident; (3) utilization of a lowest effective KI dose; (4) distribution extension to at least 300 miles from the epicenter of a potential nuclear incident; (5) education of the public about dietary iodide sources; (6) continued post-hoc analysis of the long-term impact of nuclear accidents; and (7) support for global iodine sufficiency programs. Approximately two billion people are at risk for iodine deficiency disorder (IDD), the world’s leading cause of preventable brain damage. Iodide deficient individuals are at greater risk of developing thyroid cancer after 131I exposure. There are virtually no studies of KI prophylaxis in infants, children and adolescents, our target population. Because of their sensitivity to these side effects, we have suggested that we should extrapolate from the lowest effective adult dose, 15–30 mg or 1–2 mg per 10 pounds for children. We encourage global health agencies (private and governmental) to consider these critical recommendations.

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          Most cited references135

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          Iodine deficiency.

          Iodine deficiency has multiple adverse effects in humans, termed iodine deficiency disorders, due to inadequate thyroid hormone production. Globally, it is estimated that 2 billion individuals have an insufficient iodine intake, and South Asia and sub-Saharan Africa are particularly affected. However, about 50% of Europe remains mildly iodine deficient, and iodine intakes in other industrialized countries, including the United States and Australia, have fallen in recent years. Iodine deficiency during pregnancy and infancy may impair growth and neurodevelopment of the offspring and increase infant mortality. Deficiency during childhood reduces somatic growth and cognitive and motor function. Assessment methods include urinary iodine concentration, goiter, newborn TSH, and blood thyroglobulin. But assessment of iodine status in pregnancy is difficult, and it remains unclear whether iodine intakes are sufficient in this group, leading to calls for iodine supplementation during pregnancy in several industrialized countries. In most countries, the best strategy to control iodine deficiency in populations is carefully monitored universal salt iodization, one of the most cost-effective ways to contribute to economic and social development. Achieving optimal iodine intakes from iodized salt (in the range of 150-250 microg/d for adults) may minimize the amount of thyroid dysfunction in populations. Ensuring adequate iodine status during parenteral nutrition has become important, particularly in preterm infants, as the use of povidone-iodine disinfectants has declined. Introduction of iodized salt to regions of chronic iodine deficiency may transiently increase the incidence of thyroid disorders, but overall, the relatively small risks of iodine excess are far outweighed by the substantial risks of iodine deficiency.
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            Iodine deficiency in 2007: global progress since 2003.

            Iodine deficiency is a global public health problem, and estimates of the extent of the problem were last produced in 2003. To provide updated global estimates of the magnitude of iodine deficiency in 2007, to assess progress since 2003, and to provide information on gaps in the data available. Recently published, nationally representative data on urinary iodine (UI) in school-age children collected between 1997 and 2006 were used to update country estimates of iodine nutrition. These estimates, alongside the 2003 estimates for the remaining countries without new data, were used to generate updated global and regional estimates of iodine nutrition. The median UI was used to classify countries according to the public health significance of their iodine nutrition status. Progress was measured by comparing current prevalence figures with those from 2003. The data available for pregnant women by year of survey were also assessed. New UI data in school-age children were available for 41 countries, representing 45.4% of the world's school-age children. These data, along with previous country estimates for 89 countries, are the basis for the estimates and represent 91.1% of this population group. An estimated 31.5% of school-age children (266 million) have insufficient iodine intake. In the general population, 2 billion people have insufficient iodine intake. The number of countries where iodine deficiency is a public health problem is 47. Progress has been made: 12 countries have progressed to optimal iodine status, and the percentage ofschool-age children at risk of iodine deficiency has decreased by 5%. However, iodine intake is more than adequate, or even excessive, in 34 countries: an increase from 27 in 2003. There are insufficient data to estimate the global prevalence of iodine deficiency in pregnant women. Global progress in controlling iodine deficiency has been made since 2003, but efforts need to be accelerated in order to eliminate this debilitating health issue that affects almost one in three individuals globally. Surveillance systems need to be strengthened to monitor both low and excessive intakes of iodine.
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              Variability of iodine content in common commercially available edible seaweeds.

              Dietary seaweeds, common in Asia and in Asian restaurants, have become established as part of popular international cuisine. To understand the possibility for iodine-induced thyroid dysfunction better, we collected samples of the most common dietary seaweeds available from commercial sources in the United States, as well as harvester-provided samples from Canada, Tasmania, and Namibia. Altogether, 12 different species of seaweeds were analyzed for iodine content, and found to range from 16 microg/g (+/-2) in nori (Porphyra tenera) to over 8165 +/- 373 microg/g in one sample of processed kelp granules (a salt substitute) made from Laminaria digitata. We explored variation in preharvest conditions in a small study of two Namibian kelps (Laminaria pallida and Ecklonia maxima), and found that iodine content was lowest in sun-bleached blades (514 +/- 42 microg/g), and highest amount in freshly cut juvenile blades (6571 +/- 715 microg/g). Iodine is water-soluble in cooking and may vaporize in humid storage conditions, making average iodine content of prepared foods difficult to estimate. It is possible some Asian seaweed dishes may exceed the tolerable upper iodine intake level of 1100 microg/d.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                15 April 2014
                April 2014
                : 11
                : 4
                : 4158-4200
                Affiliations
                [1 ]Department of Psychiatry, College of Medicine, University of Florida and McKnight Brain Institute, Gainesville, FL 32610, USA; E-Mail: ericb1957@ 123456gmail.com
                [2 ]Department of Clinical Neurology, PATH Foundation NY, New York, NY 10010, USA; E-Mails: helpingotherstoday@ 123456comcast.net (B.L.); fkreuk.path@ 123456gmail.com (F.K.)
                [3 ]Department of Neurosurgery, Weill-Cornell Medical College, New York, NY 10065, USA
                [4 ]Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA; E-Mail: Robert.Baker@ 123456ttu.edu
                [5 ]Natural Science Research Laboratory, Museum of Texas Tech University, Lubbock, TX 79409, USA
                [6 ]Department of Endocrinology, National University Hospital of Singapore, Singapore 119228; E-Mail: Peiling_Yang@ 123456nuhs.edu.sg
                [7 ]Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA; E-Mail: jrh2004@ 123456med.cornell.edu
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: Drd2gene@ 123456gmail.com ; Tel.: +1-646-367-7411 (ext. 123); Fax: +1-212-213-6188.
                Article
                ijerph-11-04158
                10.3390/ijerph110404158
                4025043
                24739768
                d28066f9-d176-4fd0-9343-2b377296e751
                © 2014 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 05 February 2014
                : 26 March 2014
                : 28 March 2014
                Categories
                Review

                Public health
                iodine-131 (131i),potassium iodide (ki),nuclear terrorism,accidental errors,uranium fission,children,plume radius

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