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The Fukushima Dai-ichi NPP accident contaminated the soil of densely-populated regions in Fukushima Prefecture with radioactive cesium, which poses significant risks of internal and external exposure to the residents. If we apply the knowledge of post-Chernobyl accident studies, internal exposures in excess of a few mSv/y would be expected to be frequent in Fukushima. Extensive whole-body-counter surveys (n = 32,811) carried out at the Hirata Central Hospital between October, 2011 and November, 2012, however show that the internal exposure levels of residents are much lower than estimated. In particular, the first sampling-bias-free assessment of the internal exposure of children in the town of Miharu, Fukushima, shows that the 137Cs body burdens of all children (n = 1,383, ages 6–15, covering 95% of children enrolled in town-operated schools) were below the detection limit of 300 Bq/body in the fall of 2012. These results are not conclusive for the prefecture as a whole, but are consistent with results obtained from other municipalities in the prefecture, and with prefectural data. (Communicated by Toshimitsu YAMAZAKI, M.J.A.)

Foot and ankle joint disorders are serious issues for patients with rheumatoid arthritis (RA). We compared the differences between patients with RA whose first symptom involved a foot or ankle joint (FOOT group) versus other joints (non-FOOT group) within the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort in our institute. In the IORRA survey conducted in April 2016, patients were invited to complete six questionnaires about their first symptom at RA onset, current foot or ankle symptoms, daily living activities, and mental health. Disease activity, clinical laboratory variables, functional disability, quality of life, use and ratio of anti-inflammatory and antirheumatic drugs, daily living activities and mental health were compared between the two groups. Among 5,637 Japanese patients with RA who participated in the IORRA survey on April 2016, 5,479 (97.2%) responded to the questionnaire regarding their debut joint. Of these patients, 2,402 (43.8%) reported that their first symptom of RA involved a foot or ankle joint. The FOOT group (n = 2,164) had higher disease activity, higher disabilities, lower quality of life, lower activities of daily living, and poorer mental health and used anti-inflammatory drugs at a higher rate and at higher doses compared with the non-FOOT group (n = 2,164). On the other hand, the use of medications to suppress the disease activity of RA was similar between the groups. Clinicians should pay more attention to foot and ankle joints in daily practice so as not to underestimate the disease activity of RA.

BABYSCAN, a whole-body counter (WBC) for small children was developed in 2013, and units have been installed at three hospitals in Fukushima Prefecture. Between December, 2013 and March, 2015, 2707 children between the ages of 0 and 11 have been scanned, and none had detectable levels of radioactive cesium. The minimum detectable activities (MDAs) for 137Cs were ≤3.5 Bq kg−1 for ages 0–1, decreasing to ≤2 Bq kg−1 for ages 10–11. Including the 134Cs contribution, these translate to a maximum committed effective dose of ∼16 µSv y−1 even for newborn babies, and therefore the internal exposure risks can be considered negligibly small. Analysis of the questionnaire filled out by the parents of the scanned children regarding their families’ food and water consumption revealed that the majority of children residing in the town of Miharu regularly consume local or home-grown rice and vegetables, while in Minamisoma, a majority avoid tap water and produce from Fukushima. The data show, however, no correlation between consumption of locally produced food and water and the children’s body burdens.

Comprehensive whole-body counter surveys of Miharu-town school children have been conducted for four consecutive years, in 2011–2014. This represents the only long-term sampling-bias-free study of its type conducted after the Fukushima Dai-ichi accident. For the first time in 2014, a new device called the Babyscan, which has a low 134/137Cs MDA of <50 Bq/body, was used to screen the children shorter than 130 cm. No child in this group was found to have detectable level of radiocesium. Using the MDAs, upper limits of daily intake of radiocesium were estimated for each child. For those screened with the Babyscan, the upper intake limits were found to be ≲1 Bq/day for 137Cs. Analysis of a questionnaire filled out by the children’s parents regarding their food and water consumption shows that the majority of Miharu children regularly consume local and/or home-grown rice and vegetables. This however does not increase the body burden.

Maintaining low levels of chronic internal contamination among residents in radiation-contaminated areas after a nuclear disaster is a great public health concern. However, the efficacy of reduction measures for individual internal contamination remains unknown. To reduce high levels of internal radiation exposure in a group of individuals exposed through environmental sources, we performed careful dietary intervention with identification of suspected contaminated foods, as part of mass voluntary radiation contamination screenings and counseling program in Minamisoma Municipal General Hospital and Hirata Central Hospital. From a total of 30,622 study participants, only 9 residents displayed internal cesium-137 (Cs-137) levels of more than 50 Bq/kg. The median level of internal Cs-137 contamination in these residents at the initial screening was 4,830 Bq/body (range: 2,130-15,918 Bq/body) and 69.6 Bq/kg (range: 50.7-216.3 Bq/kg). All these residents with high levels of internal contamination consumed homegrown produce without radiation inspection, and often collected mushrooms in the wild or cultivated them on bed-logs in their homes. They were advised to consume distributed food mainly and to refrain from consuming potentially contaminated foods without radiation inspection and local produces under shipment restrictions such as mushrooms, mountain vegetables, and meat of wild life. A few months after the intervention, re-examination of Cs levels revealed remarkable reduction of internal contamination in all residents. Although the levels of internal radiation exposure appear to be minimal amongst most residents in Fukushima, a subset of the population, who unknowingly consumed highly contaminated foodstuffs, experienced high levels of internal contamination. There seem to be similarities in dietary preferences amongst residents with high internal contamination levels, and intervention based on pre- and post-test counseling and dietary advice from medical care providers about risky food intake appears to be a feasible option for changing residents' dietary practices, subsequently resulting in a reduction in Cs internal contamination levels.

Resettlement to their radiation-contaminated hometown could be an option for people displaced at the time of a nuclear disaster; however, little information is available on the safety implications of these resettlement programs. Kawauchi village, located 12-30 km southwest of the Fukushima Daiichi nuclear power plant, was one of the 11 municipalities where mandatory evacuation was ordered by the central government. This village was also the first municipality to organize the return of the villagers. To assess the validity of the Kawauchi villagers' resettlement program, the levels of internal Cesium (Cs) exposures were comparatively measured in returnees, commuters, and non-returnees among the Kawauchi villagers using a whole body counter. Of 149 individuals, 5 villagers had traceable levels of Cs exposure; the median detected level was 333 Bq/body (range, 309-1050 Bq/kg), and 5.3 Bq/kg (range, 5.1-18.2 Bq/kg). Median annual effective doses of villagers with traceable Cs were 1.1 x 10(-2) mSv/y (range, 1.0 x 10(-2)-4.1 x 10(-2) mSv/y). Although returnees had higher chances of consuming locally produced vegetables, Cochran-Mantel-Haenszel test showed that their level of internal radiation exposure was not significantly higher than that in the other 2 groups (p=0.643). The present findings in Kawauchi village imply that it is possible to maintain internal radiation exposure at very low levels even in a highly radiation-contaminated region at the time of a nuclear disaster. Moreover, the risks for internal radiation exposure could be limited with a strict food control intervention after resettlement to the radiation-contaminated village. It is crucial to establish an adequate number of radio-contaminated testing sites within the village, to provide immediate test result feedback to the villagers, and to provide education regarding the importance of re-testing in reducing the risk of high internal radiation exposure.

Comprehensive whole-body counter surveys covering over 93% of the school children between the ages of 6 and 15 in Miharu town, Fukushima Prefecture, have been conducted for three consecutive years, in 2011, 2012 and 2013. Although the results of a questionnaire indicate that approximately 60% of the children have been regularly eating local or home-grown rice, in 2012 and 2013 no child was found to exceed the 137Cs detection limit of 300 Bq/body.

A possible increase in thyroid cancer in the young represents the most critical health problem to be considered after the nuclear accident in Fukushima, Japan (March 2011), which is an important lesson from the Chernobyl disaster (April 1986). Although it was reported that childhood thyroid cancer had started to increase 3-5 yr after the Chernobyl accident, we speculate that the actual period of latency might have been shorter than reported, considering the delay in initiating thyroid surveillance in the then Soviet Union and also the lower quality of ultrasonographic testing in the 1980s. Our primary objectives in the present study were to identify any possible thyroid abnormality in young Fukushima citizens at a relatively early timepoint (20-30 months) after the accident, and also to strive to find a possible relationship among thyroid ultrasonographic findings, thyroid-relevant biochemical markers, and iodine-131 ground deposition in the locations of residence where they stayed during very early days after the accident. This is a cross-sectional study. We targeted the Fukushima residents who were 18 yr old or younger (including fetuses) at the time of the accident. Our examinations comprised a questionnaire, thyroid ultrasonography, thyroid-related blood tests, and urinary iodine measurement. We analyzed a possible relationship among thyroid ultrasonographic findings (1,137 subjects), serum hormonal data (731 subjects), urinary iodine concentrations (770 subjects), and iodine-131 ground deposition (1,137 subjects). We did not find any significant relationship among these indicators, and no participant was diagnosed to contract thyroid cancer. At the timepoint of 20-30 months after the accident, we did not confirm any discernible deleterious effects of the emitted radioactivity on the thyroid of young Fukushima residents. This is the first report in English detailing the thyroid status of young Fukushima residents after the nuclear disaster.

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FNPP1: Fukushima Daiichi Nuclear Power Plant. https://doi.org/10.1371/journal.pone.0133345.g001 1. (2014) The Thyroid Status of Children and Adolescents in Fukushima Prefecture Examined during 20–30 Months after the Fukushima Nuclear Power Plant Disaster: A Cross-Sectional, Observational Study.