DISTRIBUTION AND ADMINISTRATION OF POTASSIUM IODIDE IN THE EVENT OF A NUCLEAR INCIDENT

Committee to Assess the Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident

Board on Radiation Effects Research

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES


THE NATIONAL ACADEMIES PRESS
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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident DISTRIBUTION AND ADMINISTRATION OF POTASSIUM IODIDE IN THE EVENT OF A NUCLEAR INCIDENT Committee to Assess the Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident Board on Radiation Effects Research Division on Earth and Life Studies NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by contract DHHS 200-2000-00629, Task Order Number 16, between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number 0-309-09098-9 (Book) International Standard Book Number 0-309-52811-9 (PDF) Library of Congress Control Number 2003115709 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Copyright 2004 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident COMMITTEE TO ASSESS THE DISTRIBUTION AND ADMINISTRATION OF POTASSIUM IODIDE IN THE EVENT OF A NUCLEAR INCIDENT DAVID J. TOLLERUD (Chairman), University of Louisville, Louisville, KY DAVID V. BECKER, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY LEWIS E. BRAVERMAN, Boston University School of Medicine, Boston, MA L. ROBIN KELLER, University of California, Irvine, CA KAREN S. LANGLEY, University of Utah, Salt Lake City, UT TIMOTHY J. MAHER, Massachusetts College of Pharmacy and Health Sciences, Boston, MA KENNETH MILLER, Pennsylvania State University Hershey Medical Center, Hershey, PA CHRISTOPH H-J REINERS, University of Würzburg, Würzburg, Germany JOHN J. RUSSELL, Washington State University, Richland, WA ROBERT H. VOLLAND, Federal Emergency Management Agency (ret.), California, MD EDWARD L. WILDS, Connecticut Department of Environmental Protection, Hartford, CT Sir E. DILLWYN WILLIAMS, Christ's College, University of Cambridge, Cambridge, UK LAUREN ZEISE, California Environmental Protection Agency, Oakland, CA NATIONAL RESEARCH COUNCIL STAFF ISAF AL-NABULSI, Study Director LAURA E. WATERS, Project Assistant DORIS E. TAYLOR, Staff Assistant NORMAN GROSSBLATT, Senior Editor INSTITUTE OF MEDICINE STAFF DAVID BUTLER, Senior Program Officer SPONSOR’S PROJECT OFFICER JAMES SMITH, Centers for Disease Control and Prevention

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident BOARD ON RADIATION EFFECTS RESEARCH S. JAMES ADELSTEIN (Chairman), Harvard Medical School, Boston, MA JOEL S. BEDFORD, Colorado State University, Fort Collins, CO VALERIE BERAL, (member until 7/31/2003), University of Oxford, Oxford, United Kingdom JAMES E. CLEAVER, University of California San Francisco Cancer Center, San Francisco, CA SARAH S. DONALDSON, Stanford University Medical Center, Stanford, CA SHARON L. DUNWOODY, University of Wisconsin, Madison, WI EDWARD R. EPP, Professor Emeritus, Harvard University, Boston, MA DANIEL KREWSKI, University of Ottawa, Ottawa, Canada WILLIAM F. MORGAN, University of Maryland, Baltimore, MD THEODORE L. PHILLIPS, University of California, San Francisco, CA FRANKLYN G. PRENDERGAST, Mayo Clinic Cancer Center, Rochester, MN ANDREW M. SESSLER, Lawrence Berkeley National Laboratory, Berkeley, CA DANIEL O. STRAM, (member until 7/31/2003), University of Southern California, Los Angeles, CA PAUL L. ZEIMER, Purdue University, West Lafayette, IN NATIONAL RESEARCH COUNCIL STAFF EVAN B. DOUPLE, Director, Board on Radiation Effects Research ISAF AL-NABULSI, Senior Program Officer RICK JOSTES, Senior Program Officer CATHERINE S. BERKLEY, Administrative Associate TAJUANA CLAYTON, Project Assistant (until 9/5/2003) TINA KING, Project Assistant DIANNE STARE, Research Assistant (until 9/19/2003) DORIS E. TAYLOR, Staff Assistant LAURA E. WATERS, Project Assistant

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident Acknowledgments During the course of the committee’s deliberations, several people provided information to the committee. Their contributions invigorated committee deliberations and enhanced the quality of this report. The committee expresses its appreciation to the Centers for Disease Control and Prevention for sponsoring the study and, in particular, to Dr. James Smith. The committee and the staff of the Board on Radiation Research Effects (BRER) are grateful for the information provided by invited speakers who generously contributed their time and participated in the committee’s information-gathering meetings: James Smith, Ed Hildebrand, Craig Conklin, Brian Mattiello, Ron Fraass, Ed Tupin, Brad Leissa, Patricia Milligan, Nicki Pesik, Ruth Hagstrom, Jan Carney, John Harrald, Jan Wolff, Andre Bouvillé, Stephen Floyd, Ralph Andersen, and David Reid. The committee and the BRER staff appreciate the information, feedback, and background materials provided by Alan Morris and Michael Sinclair. We also appreciate the effort of LaTeya C. Foxx, Banneker-Anderson summer intern, for contacting all the states and collecting data on past, current, and future state plans to distribute potassium iodide to the public and nuclear workers. The committee is indebted to the input from each

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident state’s authority for taking the time to summarize plans for distribution of potassium iodide. The committee was extremely fortunate in the staffing of this study. We wish to thank our study director, Dr. Isaf Al-Nabulsi, for her expertise, dedication, and hard work; for keeping the committee focused and assisting in the writing and preparation of our report; and for her enormous effort in producing a clearly written, well-organized report that reflects the thought of the committee. Dr. Al-Nabulsi was well assisted in the administration of the committee’s work by Laura E. Waters and Doris E. Taylor.

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident REVIEWERS This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purposes of this review are to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their participation in the review of this report: Andre Bouvillé, National Cancer Institute, Bethesda, MD John T. Dunn, University of Virginia School of Medicine, Charlottesville, VA P. Andrew Karam, Rochester Institute of Technology, Rochester, NY Robert S. Lawrence, Johns Hopkins University, Baltimore, MD Andrew M. Sessler, E. O. Lawrence Berkeley National Laboratory, Berkeley, CA Roger P. Shaw, Independent Consultant, Red Bank, NJ Roy E. Shore, New York University School of Medicine, New York, NY Theofanis G. Theofanous, University of California, Santa Barbara, CA Susan Wiltshire, Independent Consultant, S. Hamilton, MA

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Richard B. Setlow, Brookhaven National Laboratory (Senior Biophysicist). Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author committee and the National Research Council.

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident CONTENTS     EXECUTIVE SUMMARY   1 1   INTRODUCTION   9 2   THYROID PHYSIOLOGY   14      Overview of Thyroid Function,   14      Physiology Need for Iodine and Sources of Iodine,   16      Radioactiove Iodine,   18      How KI Works,   20      Why KI is Used,   21      Current Recommended Use of KI in the Event of a Nuclear Incident,   22      Adverse Effects of KI,   26 3   POTENTIAL EXPOSURE TO RADIOACTIVE IODINE   30      Sources of Radioactive Iodine,   31      Routes of Exposure,   34

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident      Reactor Design,   36      Naval Nuclear Propulsion Plants,   42 4   HEALTH CONSEQUENCES OF RADIATION EXPOSURE   44      Radiation from Atomic Bombs,   48      Atomic-Bomb Tests,   49      Nuclear Power Plant Accidents,   53      Relevance of Fallout Exposure to Stable Iodine Prophylaxis,   62 5   PROTECTIVE MEASURES   68      Accident Classifications,   70      Strategies for the Central Public,   73      Phases of Emergency Response,   73      KI Pharmaceutical Issues,   83 6   EXISTING DISTRIBUTION PLANS FOR POTASSIUM IODIDE   86      International Experience with Potassium Iodide and Other Countermeasures in Nuclear Emergency,   87      US Experience in the Distribution of Potassium Iodide,   104      Recommendations from the Public-Health Institutions,   104      Federal Agencies,   107      States,   114      Conclusions,   134 7   PROCESS FOR EVALUATION OF OPTIONS FOR DISTRIBUTION OF POTASSIUM IODIDE   137      Responsibilities for Distribution of KI at Different Government Levels,   140      Potassium Iodide Distribution Before Incident,   140      Potassium Iodide Availability at Time of Incident,   141      Local Area Potassium Iodide Distribution Options,   142      Objectives to Consider in Evaluating Plans,   145

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Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident      Implementation Issues,   150 8   CONCLUSIONS AND RECOMMENDATIONS   155     REFERENCES   168 APPENDIX A   PUBLIC LAW 107-188, PUBLIC HEALTH SECURITY AND BIOTERRORISM PREPAREDNESS AND RESPONSE ACT OF 2002, CONFERENCE COMMITTEE (05/21/02)   183 APPENDIX B   FISSION PRODUCT INVENTORIES   187 APPENDIX C   POTASSIUM IODIDE DISTRIBUTION IN THE STATES   188 APPENDIX D   ILLUSTRATION OF PROCESS FOR EVALUATING KI DISTRIBUTION PLANS   207 APPENDIX E   INFORMATION AND COMMUNICATION MESSAGES REGARDING POTASSIUM IODIDE OR RADIOACTIVE IODINE   219     GLOSSARY   223     COMMITTEE BIOGRAPHIES   239

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