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Domestic Health Studies and Activities

Purpose

The Atomic Energy Act of 1957 — Section 8(a) requires research and development activities relating to the protection of health during research and production activities. The requirement is fulfilled by conducting and supporting health studies and other research activities to determine if DOE workers and people living in communities near DOE sites are adversely affected by exposures to hazardous materials from DOE operations; by enabling appropriate responses to disease outbreaks and radiation accidents; and to address critical research needs for important occupational exposures. The ultimate use of the information is to protect and promote the health of DOE workers, their families and residents of neighboring communities and to share the information and data with the public.

Activities

  • Conduct priority epidemiologic investigations to assess the human health implications of exposures to hazardous materials for workers within the DOE complex and in communities that host facilities.
  • Coordinate with and support epidemiologic studies and other public health activities by various agencies within the Department of Health and Human Services to assess the health implications of exposures to hazardous materials found in the DOE workplace.
  • Determine the need for epidemiologic studies or public health activities based on reviews of analytic and descriptive epidemiologic studies, other public health activities, and information from site profiles.
  • Analyze historical trends in worker illness and injury surveillance data for workers at participating sites across the DOE complex.
  • Develop, maintain, and support unique registries of DOE workers to understand the development and progression of health outcomes associated with exposures to specific hazardous materials of particular interest to DOE.  These are the Beryllium Associated Worker Registry and the U.S. Uranium and Transuranium Registries.  Oversee the research use of archived blood and tissues from participants in the Department's medical screening initiatives for Beryllium sensitization and disease. 
  • Communicate health effects information and the results of studies to all interested stakeholders within and outside DOE.
  • Provide expert guidance to the DOE Biological Events Monitoring Team concerning communicable disease outbreaks and spread through the DOE complex, including influenza, and represent DOE on Federal work groups for National preparedness and response to Weapons of Mass Destruction.
  • Enhance the DOE capacity to protect the health of workers involved in radiation accidents by supporting the Radiation Emergency Assistance Center/Training Site that provides training in radiation medicine and medical consultation to site physicians and participation in the National response to radiation accidents.
  • Make research data available to the public through the Comprehensive Epidemiology Data Resource; a repository for data used in epidemiologic studies of DOE and other workers.

BERYLLIUM-ASSOCIATED WORKER REGISTRY (BAWR)

Beryllium is a silver-gray metallic element found in approximately 30 minerals. It has applications in the electronics and aerospace industries as well as uses in nuclear weapons, experimental reactors, and accelerators. Exposure to beryllium is not without potential health consequences. Inhalation of beryllium fumes or dust or contact with broken skin can lead to a range of respiratory responses from sensitization to chronic, progressive lung impairment via granuloma formation, as in chronic beryllium disease (CBD). CBD can be treated but is not curable. Sensitization to beryllium can be assessed with a blood test called the Beryllium Lymphocyte Proliferation Test (BeLPT). A positive test suggests that an individual has become sensitized to beryllium, although most people exposed to beryllium won’t become sensitized. When an initial BeLPT is positive, a second test is recommended to reduce the possibility that a diagnosis will be made based on erroneous results  from the first test.

Given the potential health consequences associated with beryllium exposure, the U.S. Code of Federal Regulations (CFR) Title 10, Part 850 Chronic Beryllium Disease Prevention Program requires DOE sites to inventory and assess beryllium exposure hazards to determine whether employees are at risk for CBD. In response, the DOE Office of Domestic and International Health Studies supports the operation of a surveillance registry of current workers who are exposed to beryllium in their current jobs or may have been exposed to beryllium in the past from work conducted at a DOE site. The DOE Beryllium-Associated Worker Registry (BAWR) is a collection of health and exposure information on individuals potentially at risk for CBD due to their work at DOE-owned or leased facilities. The goal of the registry is to determine the incidence and prevalence of beryllium sensitization and CBD. An additional goal is to monitor and evaluate the effectiveness of DOE's Chronic Beryllium Disease Prevention Program. The BAWR continues to monitor workers either exposed or at risk for exposure to beryllium and to assess the occurrence of sensitization and CBD diagnoses to determine the effectiveness of exposure prevention programs. 

The annual report summarizes data cumulative through the most recent calendar year with complete reporting from sites that have determined that employees are at risk due to ongoing or past work. These sites have implemented CBD prevention programs that include the reporting of health and exposure data to the DOE BAWR. The data at hand provide a basic evaluation of worker protection in beryllium work, both historical and current. Analyses in this report may indicate areas of substantial success and provide information that could be of use in identifying areas in which further work may be of benefit in the prevention of CBD.

The most recent report is for Calendar Year 2014: Beryllium-Associated Worker Registry Summary: Through 2014.

For further information on the Beryllium-Associated Worker Registry, please contact: Dr. Cliff Strader.

United States Transuranium and Uranium Registries (USTUR)

The USTUR is a unique national resource. The mission of the USTUR is to study the uptake, movement and retention, and tissue dosimetry for actinide materials taken into the body. Actinides are the15 metallic radioactive chemical elements with atomic numbers from 89 to 103. The actinides enter the body mainly through the respiratory and digestive tracts and in some instances through wounds. USTUR is a national and international resource for testing and improving the application of excreta monitoring and other contemporary bioassay data to predict tissue dose rates measured at autopsy. The ultimate goal is to provide information to national and international organizations engaged in determining and validating radiation protection standards and practices. 

USTUR General Goals

  • Increase credibility (level of certainty) in determining actual tissue doses received by weapons-site workers from intakes of all important types of plutonium and other actinide materials.
  • Complete determination of causes of death among registrants, in relation to actinide tissue contents and modeled tissue doses.
  • Put actinide exposures and any observed disease associations into perspective with the exposure of USTUR registrants to common industrial workplace materials.
  • Evaluate U.S. human experience of actual internal exposures to plutonium and other actinides in comparison with “likelihood of cancer causation” developed by the National Cancer Institute and other models of risk.
  • Make pathology, bioassay and radiochemical tissue analysis data available to national and international scientific peers and public.
  • Inform energy-policy decision-makers about actual human experience of negligible risk to human health from well-regulated occupational and environmental exposures to plutonium and other actinide materials.

For more information go to the USTUR: http://ustur.wsu.edu/index.html

Radiation Emergency Assistance Center/Training Site (REAC/TS)

Working with radioactive materials carries significant risk of exposure both externally and internally as a result of workplace accidents. The DOE approach to managing the response to accidents is to have a robust rapid response team and trained responders in place across the DOE complex. REAC/TS provides the rapid response, training of first responders, and medical advice to site physicians for more than 40 years. In addition to preparing and responding to accidents across the DOE complex, REAC/TS is a critical part of the national response team for accidental or intentional radiological events. REAC/TS provides what are called “medical countermeasures” or drugs for treating internal radiation exposures, and acts as the historian of such events where countermeasures were used by maintaining a “registry.”  The registry supports a wide range of research on the effective application of countermeasures and the results.

REAC/TS stores and distributes the drugs to site medical directors. The drugs include a number of chemicals that bind to heavy metals such as plutonium and americium and more commonly lead. These drugs belong to a class of drugs commonly known as “chelating” agents from the Greek word for crab’s claw. The chelating agents bind to the heavy metal and allow it to be eliminated from the body in the urine. The technical names of these chelating chemicals are: pentetate calcium trisodium, pentetate zinc trisodium, and ferric ferrocyanide. Several of these chemicals are very expensive and may have only one source approved by the U.S. Food and Drug Administration. They also have a short “shelf-life” and need to be continually replaced.  AU-10 has primary responsibility for funding medical countermeasures used by REAC/TS. 

REAC/TS activities supported by NNSA Office of Emergency Response (OER) include: Clinical evaluation and treatment of radiation accident victims; direct medical care in support of a radiological emergency anywhere in the world; on-site training at REAC/TS; emergency planning assistance; cytogenetic analysis for dosimetric purposes; and participation as a member of the Federal Radiological Monitoring and Assessment Center (FRMAC).

For more on REAC/TS:

For more on NNSA/OER:

For more on FRMAC:

For more information on the AU-10 role contact:  Dr. Joey Zhou

Illness and Injury Surveillance Data Repository

The Department of Energy's Illness and Injury Surveillance Program (IISP) Data Repository is a legacy resource to identify groups of workers who may be at increased risk for occupationally related injury and illness. The surveillance program was one response to the Department of Energy's legislative mandate (Atomic Energy Act, Energy Reorganization Act of 1974, and Department of Energy Organization Act, 1977) to monitor the impact of its operations on the health of its work force.

The repository contains health and demographic data already collected from existing health and safety data sources. All data are accompanied only by encrypted identifiers, and only the site of ownership can identify records for an individual at their site using these identifiers. Each site assigned its own encrypted identifiers to records using an encryption algorithm known only to those individuals directly involved with the program at the site; the algorithms were not shared with the IISP data center or DOE Headquarters.

Illness and Injury Surveillance began as a pilot project in the 1980s at the Hanford Site and Idaho National Laboratory to determine whether routine health surveillance could be conducted at low cost to assess the health of current contractor workers and to identify groups of workers at increased risk of illness or injury. The program became DOE Headquarters-based with the formation of the Office of Health in 1989. Illness and Injury Surveillance monitored the health of approximately 79,000 current contractor workers at 16 DOE sites at the height of its operation. Site participation was voluntary, with the number of sites participating set by the availability of program funding.

The health surveillance program is an example of corporate health oversight by a federal agency and ultimately recognized as an important part of a corporate occupational medical programs. In 1998, 8 years after the establishment of the DOE health surveillance program and 13 years after the first pilot health surveillance program at a DOE site, the International Labour Office “Technical and ethical guidelines for workers' health surveillance” noted that “Monitoring sickness absence can help to identify whether there is any relation between the reasons for ill health or absence and any health hazards which may be present in the workplace.” 

Notable accomplishments of the surveillance program through 2013 included: integration with overall Office of Health goals; developing the DOE Technical Standard on collection and reporting of worker health information; disseminating health data to workers, citizens' groups, state government representatives, and other stakeholders through internet-based information; presentations to workers at various sites and to community members; providing technical support to site and headquarters management; presenting findings at the NIOSH/CDC Worklife 2007 Symposium; and presentations at national professional meetings with interest in worker health.

The repository data continues to be analyzed in new ways to characterize the patterns of illness and injury among workers across DOE sites and over time. The program’s most recent reports are provided for download as PDF files. A full list of reports is also included for information purposes. Requests for a specific report can be made to the program manager.

For further information contact: Dr. Cliff Strader.

Comprehensive Epidemiologic Data Resource (CEDR)

Operating as a public-use data repository, CEDR is a prime example of the Department's commitment to worker and community health programs. The internet presence and capabilities of CEDR facilitate the sharing of information and de-identified data collected during DOE-supported epidemiologic, environmental, and related health studies.

CEDR's large collection primarily pertains to occupational epidemiologic studies conducted at many nuclear weapons plants, such as Hanford, Los Alamos, Oak Ridge, Rocky Flats, and Savannah River. They include working and analytic data from cohort and case-control design studies, many of which have individual-level radiation exposure measurements. These valuable data have many possibilities for future research exploration. Additionally, CEDR presents data from studies of past DOE releases of hazardous materials that entered the environment of nearby communities, as well as data from classic studies of radiation health effects, such as the radium dial painters. The sharing of these data, at no cost to the user, encourages independent scientific inquiry and diversity of analyses.

Becoming an authorized user is a simple process. Data files in CEDR are available to those who wish to conduct statistical modeling or explore the data for research purposes. Separate on-line application forms are available for those who do or do not need access to mortality data. The application forms, submitted electronically, require contact information and a brief statement of the research purpose or statistical application for which the data will be used.  If mortality data are not needed, the process requires only a form submitted to the Department of Energy. However, three States have determined that they wish to review separate application forms if the applicant wants access to mortality data involving residents of their states. Mortality data sharing is contingent on approval by three of the States that provide information on cause of death and it is not possible to separate out their information from the files should the States not accept the user application; in this case CEDR cannot grant authorization. The CEDR application and the CEDR catalog are accessible at https://www.orau.gov/cedr. The CEDR catalog site also has links to a tour of CEDR on YouTube.

CEDR "authorized" user account information and data are protected by the Federal Information Security Management Act (FISMA) and the National Institute of Standards and Technology (NIST) 800-53, state-of-the-art governmental cyber-security laws that ensure CEDR data is secure, trustworthy, and resilient.

For more information about the CEDR program contact: Dr. Cliff Strader.

Beryllium BioBank (formerly Beryllium Bio-Repository)

Chronic Beryllium Disease (CBD), which may result from occupational exposure to beryllium, has been one of the serious health problems affecting the former and current DOE workforce. As yet, there is no animal model to study the disease; current research to improve the understanding, diagnosis, and treatment of beryllium-related disease depends entirely on studies of human cells and tissues. Funded by the DOE Office of Health and Safety, the Beryllium BioBank initiative has evolved from an initial phase (the Beryllium Bio-Repository) focused on development of a standard protocol for data collection and management developed by a committee of expert clinicians and scientists from National Jewish Medical and Research Center, University of Pennsylvania Hospital, University of California Los Angeles, University of California San Francisco, University of Colorado, National Institute for Occupational Safety and Health, and Mayo Clinic. The initiative has matured into the Beryllium BioBank (Phase 2) managed by National Jewish Medical and Research Center. 

The goal of the Beryllium BioBank is to archive important clinical specimens and related data to ensure their future availability for research to improve our understanding of beryllium-related disease. The participants in this program are all volunteers and have given their written consent for the use of their donated bio-samples. Based on the current number of workers who were diagnosed with CBD or beryllium sensitization (BeS) and matching controls, the total number of donors for the Repository is estimated at 1,200 to 1,500 individuals. 

Phase 2 (tissue donations and storage) involved the participation of the five clinical centers which have conducted clinical evaluations for the majority of current and former DOE workers suspected of having CBD: National Jewish Medical and Research Center, University of Pennsylvania Hospital, East Tennessee Pulmonary Associates, University of California Los Angeles, and University of California San Francisco. Donations of blood and tissue samples have been obtained from individuals diagnosed either with CBD or BeS, as well as matching control individuals (those exposed to beryllium but without sensitivity or disease). In addition, other medical information related to CBD and BeS, occupational work histories, and exposure information have been collected. All biological specimens and clinical data were de-identified at the clinical centers before being banked and stored.

For further information on the Beryllium BioBank, please contact Dr. Cliff Strader.

To apply for use of the BioBank data, please visit http://www.ucdenver.edu/academics/colleges/PublicHealth/research/ResearchProjects/bbb/Pages/default.aspx  (Accessed in May 2014).

Worker and Public Health Activities

The aim of the Worker and Public Health Activities Program is to improve our understanding of the consequences of exposures to ionizing radiation and other hazardous materials to workers and to the public. One of the program's strategic objectives is to support studies related to current and past operations of DOE facilities that ascribe to the highest scientific standards and policies and to communicate the health effects into impact-driven practices for improving worker and public health. This objective strives to ensure that the studies and public health activities address the most relevant research pertaining to DOE operations and provide a framework for intervention. Periodic evaluation of the research via independent external peer review enhances this objective. DOE encourages publication in scientific peer-reviewed journals and presentations at scientific meetings.

The program promotes the health of the Department's workers and communities surrounding DOE sites by supporting:  (1) Occupational health studies of DOE's historical workforce, (2) Historical dose reconstruction studies, which evaluate the risk to the public of past releases of radiation and chemicals around DOE's nuclear weapons facilities, and (3) Studies of communities located near DOE Superfund sites to determine if current contaminants in the environment could result in adverse human health effects.

In the Worker and Public Health Activities Program, information sharing is accomplished through an extensive communication network over the life of a study and beyond. Communication guidelines are set out in the Access Handbook (see link below). Completed and proposed studies are communicated through inter-agency agreements with the Centers for Disease Control and Prevention (CDC), specifically, the Agency for Toxic Substances and Disease Registries (atsdr), the National Institute for Occupational Safety and Health (NIOSH), and the National Center for Environmental Health (NCEH). Sharing extends to making the analysis database available in perpetuity to other researchers and the public through DOE's Comprehensive Epidemiologic Data Resource.

Links:

For More Information contact: Bonnie Richter