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ISDS 2012 Conference Abstracts

Surveillance for Radiation-Related Exposures Reported
to the National Poison Data System
Royal K. Law*1, Colleen Martin1, Alvin Bronstein2, Arthur Chang1 and Joshua Schier1

1Centers for Disease Control and Prevention, Chamblee, GA, USA; 2American Association of Poison Control Centers, Alexandria, VA,
USA

Objective
To describe radiation-related exposures of potential public health

significance reported to the National Poison Data System (NPDS).

Introduction
For radiological incidents, collecting surveillance data can iden-

tify radiation-related public health significant incidents quickly and
enable public health officials to describe the characteristics of the af-
fected population and the magnitude of the health impact which in
turn can inform public health decision-making. A survey adminis-
tered by the Council of State and Territorial Epidemiologists (CSTE)
to state health departments in 2010 assessed the extent of state-level
planning for surveillance of radiation-related exposures and incidents:
70%–84% of states reported minimal or no planning completed. One
data source for surveillance of radiological exposures and illnesses is
regional poison centers (PCs), who receive information requests and
reported exposures from healthcare providers and the public. Since
2010, the Centers for Disease Control and Prevention (CDC) and the
American Association of Poison Control Centers (AAPCC) have con-
ducted ongoing surveillance for exposures to radiation and radioac-
tive materials reported from all 57 United States (US) PCs to NPDS,
a web-based, national PC reporting database and surveillance sys-
tem.

Methods
We collaborated with the American Association of Poison Control

Centers (AAPCC), Poisindex® and Thomson Reuters Healthcare to
develop an improved coding system for tracking radiation-related ex-
posures reported to US PCs during 2011 and trained PC staff on its
usage. We reviewed NPDS data from 1 September 2010 – 30 June
2012 for reported exposures to pharmaceutical or nonpharmaceutical
radionuclides; ionizing radiation; radiological or nuclear weapons;
or X-ray, alpha, beta, gamma, or neutron radiation. CDC medical tox-
icology and epidemiology staff reviewed each reported exposure to
determine whether it was of potential public health concern (e.g. ex-
posures associated with an ongoing public health emergency, several
reported exposures clustered in space and time). When further infor-
mation was needed to classify the potential public health importance
of a call, CDC and AAPCC staff contacted the regional PC where
each call originated. When exposures were spatially and temporally
clustered, we reviewed news stories in the public media for evidence
of an associated radiation incident.

Results
Of 419 exposures reported during the study period, 25 were asso-

ciated with a radiation-related incident. Of these, 4 were related to
an exposure to x-ray radiation from an industrial radiography inci-
dent, 11 were related to a transportation accident involving potential
contamination with radioactive material, and 10 were related to the
Fukushima Daiichi Japan nuclear reactor disaster. Public health, haz-
ardous materials, or hospital radiation safety staff were involved in re-
sponding to each of these events. We also identified 26 reported
exposures associated with a regional radiation anti-terrorism exer-
cise. The reported exposures were followed-up and removed from
analysis once we determined they were part of the exercise. The re-
maining (n=368; 88%) were either requests for information, con-
firmed non-exposures, or exposures deemed unrelated or
non-significant.

Conclusions
The capability to monitor self- or clinician-reported exposures to

radiation and radioactive materials is available in NPDS for state and
local public health use in collaboration with their regional PC and
may improve public health capacity to identify and respond to radi-
ological emergencies. Next steps include testing the system’s capa-
bility to accurately classify and rapidly respond to a cluster of calls
to PCs reporting radiation exposures associated with a “dirty bomb”
exercise during July, 2012.

Keywords
Surveillance; Poison center; radiation

References

Council of State and Territorial Epidemiologists. The Status of State-level
Radiation Emergency Preparedness and Response Capabilities, 2010.
Available at: http://www.cste.org/webpdfs/2010raditionreport.pdf.
Accessed July 19, 2012.

*Royal K. Law
E-mail: hua1@cdc.gov

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e96, 2013