title: National surveillance for radiological exposures and intentional potassium iodide and iodine product ingestions in the United States associated with the 2011 Japan radiological incident.
abstract: BACKGROUND
  In March of 2011, an earthquake struck Japan causing a tsunami that resulted in a radiological release from the damaged Fukushima Daiichi nuclear power plant. Surveillance for potential radiological and any iodine/iodide product exposures was initiated on the National Poison Data System (NPDS) to target public health messaging needs within the United States (US). Our objectives are to describe self-reported exposures to radiation, potassium iodide (KI) and other iodine/iodide products which occurred during the US federal response and discuss its public health impact.
  
  
  METHODS
  All calls to poison centers associated with the Japan incident were identified from March 11, 2011 to April 18, 2011 in NPDS. Exposure, demographic and health outcome information were collected. Calls about reported radiation exposures and KI or other iodine/iodide product ingestions were then categorized with regard to exposure likelihood based on follow-up information obtained from the PC where each call originated. Reported exposures were subsequently classified as probable exposures (high likelihood of exposure), probable non-exposures (low likelihood of exposure), and suspect exposure (unknown likelihood of exposure).
  
  
  RESULTS
  We identified 400 calls to PCs associated with the incident, with 340 information requests (no exposure reported) and 60 reported exposures. The majority (n = 194; 57%) of the information requests mentioned one or more substances. Radiation was inquired about most frequently (n = 88; 45%), followed by KI (n = 86; 44%) and other iodine/iodide products (n = 47; 24%). Of the 60 reported exposures, KI was reported most frequently (n = 25; 42%), followed by radiation (n = 22; 37%) and other iodine/iodide products (n = 13; 22%). Among reported KI exposures, most were classified as probable exposures (n = 24; 96%); one was a probable non-exposure. Among reported other iodine/iodide product exposures, most were probable exposures (n = 10, 77%) and the rest were suspect exposures (n = 3; 23%). The reported radiation exposures were classified as suspect exposures (n = 16, 73%) or probable non-exposures (n = 6; 27%). No radiation exposures were classified as probable exposures. A small number of the probable exposures to KI and other iodide/iodine products reported adverse signs or symptoms (n = 9; 26%). The majority of probable exposures had no adverse outcomes (n = 28; 82%). These data identified a potential public health information gap regarding KI and other iodine/iodide products which was then addressed through public health messaging activities.
  
  
  CONCLUSIONS
  During the Japan incident response, surveillance activities using NPDS identified KI and other iodine/iodide products as potential public health concerns within the US, which guided CDC's public health messaging and communication activities. Regional PCs can provide timely and additional information during a public health emergency to enhance data collected from surveillance activities, which in turn can be used to inform public health decision-making.
authors.affiliation: National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, CDC, Atlanta, GA 30341, USA. Rlaw@cdc.gov
authors.forename: Royal K
authors.initials: RK
authors.lastname: Law
authors.forename: Josh G
authors.initials: JG
authors.lastname: Schier
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Martin
authors.forename: Dagny E
authors.initials: DE
authors.lastname: Olivares
authors.forename: Richard G
authors.initials: RG
authors.lastname: Thomas
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Bronstein
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Chang
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D004781:Environmental Exposure; D005260:Female; D005500:Follow-Up Studies; D062406:Fukushima Nuclear Accident; D006293:Health Promotion; D006801:Humans; D007454:Iodides / Q000633:toxicity*; D007455:Iodine / Q000633:toxicity*; D008297:Male; D010342:Patient Acceptance of Health Care; D011039:Poison Control Centers; D011159:Population Surveillance; D011193:Potassium Iodide / Q000633:toxicity*; D011829:Radiation Dosage; D011830:Radiation Effects; D057566:Self Report; D014481:United States
chemical_list: D007454:Iodides; D011193:Potassium Iodide; D007455:Iodine