Inflammopharmacol (2009) 17:163169

DOI 10.1007/s10787-009-0001-4

Inflammopharmacology

RESEARCH ARTICLE

Clinical aspects of the health disturbances in Chernobyl Nuclear

Power Plant accident clean-up workers (liquidators) from Latvia
M. E. Eglite T. J. Zvagule K. D. Rainsford
urbakova N. N. Kurjane
J. D. Reste E. V. C

Received: 29 January 2009 / Accepted: 4 March 2009 / Published online: 13 June 2009
Birkhauser Verlag, Basel/Switzerland 2009

Abstract The health status of some 6,000 workers from

Latvia who went to clean-up the Chernobyl Nuclear Power
Plant (CNPP) site following the explosion on 26 April 1986
has been analyzed. The data on these workers have been
recorded in the Latvian State Register of Occupational disease patients and people exposed to ionizing radiation due to
Chernobyl NPP accident (Latvian State Register) that was
established in 1994. From these data, estimates have been
made of external ionizing radiation to which these workers
were exposed together with observations on the impact of
exposure to heavy metals (especially lead and zinc) and
radioactive isotopes released during the reactor meltdown.
These factors along with psycho-emotional and socialeconomic stresses account for a marked excess of mortality and
morbidity in the group of CNPP accident clean-up workers
compared with that of the non-exposed normal Latvian
population adjusted for age and sex. The number of diseases
or conditions in the CNPP accident clean-up workers has
progressively risen from an average of 1.3 in 1986 to 10.9 in
2007. This exceeds for the Latvian population when adjusted
for age and sex. The most serious conditions affect the

M. E. Eglite (&)
Institute of Occupational Safety and Environmental Health, Riga
Stradins University, 16 Dzirciema Street, Riga 1069, Latvia
e-mail: maija.eglite@rsu.lv
T. J. Zvagule
J. D. Reste
E. V. Curbakova
N. N. Kurjane
The Center of Occupational and Radiological Medicine, Paula
Stradins Clinical University Hospital, 13 Pilsonu Street,
Riga 1002, Latvia
e-mail: arodacentrs@stradini.lv
K. D. Rainsford
Biomedical Research Centre, Sheffield Hallam University,
Howard Street, Sheffield S1 1WB, UK
e-mail: k.d.rainsford@shu.ac.uk

nervous, digestive, respiratory, cardiovascular, endocrine

(especially thyroid) and immunological systems. While the
morbidity associated with diseases of the respiratory and
digestive systems has decreased in recent years that in the
other systems is increasing. In recent years, there has been an
increased occurrence of cancers affecting the thyroid, prostate and stomach. Clinical and laboratory investigations
suggest that surviving CNPP accident clean-up workers
exhibit signs of immuno-inflammatory reactions causing
premature aging with evidence of autoimmune diseases and
immunological deficiencies or abnormalities. It is suggested
that the CNPP accident clean-up workers may have a specific
syndrome, the Chernobyl post-radiation neurosomatic
polypathy, due to sustained oxidant stress injury, as a result
of exposure to radiation and lead.
Keywords Chernobyl clean-up workers

Health disturbances
Mortality
Morbidity

Introduction
One of the most disastrous nuclear power plant (NPP)
accidents in the world occurred on 26 April 1986 in
Chernobyl in the Ukraine (Mould 2000). The total amount
of radioactive materials vastly exceeded the radioactivity
caused by the bombing of Hiroshima and Nagasaki. Large
areas of the surrounding territories of Europe as well as
agricultural products and water were polluted (Alexakhin
et al. 2007). The local inhabitants were exposed not only to
external radiation but also to internal radiation from the
absorbed or inhaled radionuclides (Moysich et al. 2002;
Alexakhin et al. 2007; Bouville et al. 2007). The group
with greatest exposure was the group of Chernobyl NPP
accident clean-up workers (Mould 2000).

164

More than 6,000 Latvian inhabitants (principally young

men of reproductive age) worked to clean-up the Chernobyl
nuclear power plant (CNPP) site during 19861991. The
duration of their radiation exposure was 16 months and
they were exposed to both external (e.g. c-radiation and other
types) as well as internal (e.g. cesium, iodine) radiation.
Data on the health status of the CNPP accident clean-up
workers from Latvia have been collected since 1987. Since
1994, this information has been recorded in the Latvian
State Register. As of 1 January 2007, there were 6,873
persons recorded in this register, among them being (a)
5,415 Latvian CNPP accident clean-up workers, (b) 1,320
children of Latvian clean-up workers, and (c) 138 people,
who were exposed to occupational ionizing radiation. The
patient data in this register include (a) estimates of external
radiation exposure, (b) so-called passport data (which
includes dates and times where the workers were located),
(c) information from a structured questionnaire comprising
60 answers to specific questions about clinical and social
aspects of the health of the workers, and (d) information
from clinical examinations and laboratory investigations.
This registry has data on (a) the time and period present at
the Chernobyl clean-up works, (b) the place and kind of
work, (c) doses of radiation received, (d) protective measures employed, (e) food ingested, and (f) concomitant
conditions or diseases and health status of these workers
while at Chernobyl. There are also data about habits that
may have affected health (smoking, drinking, etc.), previous contacts with ionizing radiation and/or other harmful
occupational exposures, and on any chronic disease known
before the accident. Thus, this registry comprises an
extensive and comprehensive database comprising the
clinical examination and investigations and information on
health status of persons who have been regularly examined
within the period from 1987 until 2008. With this information, it is possible to analyze the dynamics of health
status of the CNPP accident clean-up workers over long
period of time.
The CNPP accident clean-up workers from Baltic states
are unique as a group because they were exposed to ionizing radiation only for defined periods of time and since
then they have mostly lived in areas that are relatively
uncontaminated with radioactive materials. This contrasts
with those CNPP accident clean-up workers from Ukraine,
Belorussia and Russia who have experienced considerable,
if variable exposure to environmental sources of radiation
since the accident. The Latvian group provides unique
opportunity to investigate mainly the impact of ingested
radioactive materials and heavy metals.
The health problems of the Latvian CNPP clean-up
workers have not only been due to exposure to ionizing
radiation itself but also by other factors connected with the
clean-up work among these factors being psycho-emotional

M. E. Eglite et al.

stress, exposure to toxic chemicals (e.g. heavy metals),

physical overload, different social difficulties (economic
hardship, unbalanced and poor diet), which can also confound the assessment and causality attributed to health
problems.
The aim of the present studies was to estimate received
external radiation doses and analyze changes in the health
of CNPP accident clean-up workers over the observation
period 19872007.

Materials and methods

Data from the Latvian State Register of the CNPP clean-up
workers were used to estimate the external radiation doses
and for the analysis of diseases and health status of these
workers. This comprises data from 5,399 males (mean age
46.20 0.91). The register includes estimated external
radiation doses, passport data, questionnaire with 60 questions and clinical examination results. For the categorization
and analysis of morbidity, international classification of
diseases (ICD) 10 was employed. Data from a control group
comprising 237 males (servicemen, policemen, drivers,
firemen) of mean age 46.07 0.99 were used for comparison. For comparison of the cancer morbidity in CNPP
accident clean-up workers with that in the normal Latvian
population, data from the latter were obtained from the
Latvian Cancer Registry and the Government of Latvia
Central Bureau of Statistics. The oncological morbidity of
CNPP accident clean-up workers was compared with that of
the age- and sex-matched non-exposed population.

Results
Radiation exposure
Detailed analysis of the doses of external radiation exposure was obtained for 3,093 persons (i.e. 57.29% total
CNPP accident clean-up workers). The minimal dose was
0.1 mSv (milliSivert) while the maximal dose was
500 mSv; the mean exposure being 128.6 70.73 mSv.
The estimates of external radiation doses in relation to
radiation type, the period of exposure and age were as
follows:
(a)

Radioactive iodine exposure in 26 April 1986 to June

1986: the number of persons with estimated external
radiation doses was 623, minimal dose was 0.2 mSv,
the maximum was 490 mSv, while the mean was
159.29 64.64 mSv.
(b) Non-iodine exposure period in July 1986 to December 1986: the number of persons with estimated

Health of Latvian Chernobyl NPP workers

165
500

External radiation dose, mSv

External radiation dose, mSv

500

400

300

200

100

400
300
200
100
0
-100
N=

-100
N=

623
period of iodine

1057
non-iodine period

1409
1987-1990

27

1231

1832

15-19

20-29

30 and older

Age in the moment of participation in clean-up works

Time of participation in clean-up works

Fig. 1 The estimates of external radiation doses experienced by

CNPP workers in relation to the period of exposure

(c)

external radiation doses was 1,056, the minimum dose

was 0.5 mSv, the maximum was 400 mSv, with the
mean being 160.81 62.19 mSv.
In 19871990, a total of 1,409 exposed to external
radiation experienced a minimum dose of 0.1 mSv, a
maximum dose of 500 mSv, with the mean being 91.
35 60.36 mSv (Fig. 1).

The estimates of external radiation doses in relation to

age in the time of the participation in the accident clean-up
works were analyzed in two groups comprising 2029 and
3070 year olds. In the 2029-year-old group (n = 1,231),
mean dose of received external radiation was 147.46
63.16 mSv, as well as received minimum dose was
0.2 mSv ranging to maximum dose of 400 mSv. In the
3070-year-old group (n = 1,832), mean dose of received
external radiation was 116.05 72.79 mSv with the
minimum dose 0.1 mSv up to maximum dose of 500 mSv
(Fig. 2). Thus, young men of reproductive age received
greater radiation dose in comparison with older workers.
Morbidity
Data from the monitoring of over 6,000 clean-up workers
in relation to quantitative and qualitative aspects of the
nature of morbidity and health disturbances have been
analyzed. Overall, their morbidity exceeds that of age- and
sex-matched non-exposed population with a trend for
increase in the progression of the number of diseases and
their severity. Thus, the average number of diseases diagnosed per person ranged from 1.28 in 1986, 1.49 in 1990 to
3.24 in 1996. This progressively increased thereafter to
8.72 in 1999 (P \ 0.01), 10.22 in 2002 (P \ 0.001) and
10.88 in 2007 (Fig. 3). The average number of diseases per

Fig. 2 The estimated external radiation doses in relation to age of

workers

person in the control group was 1.5 in 1996, compared with

2.4 in 2002 (P [ 0.05) and 3.1 in 2005 (P [ 0.05) (Fig. 3).
In 6065-year-old Latvian males, the number of diseases
per person in 2002 was 7.5, but mean age of cleanup
workers in 2007 was 51.58 6.84. Even taking into
account the necessity of more frequent examination of
clean-up workers, this could reflect signs of premature
aging in this group.
The occurrence of the different types of diseases per 100
persons during 19962001 in the group comprised:
(a)

The occurrence of diseases of nervous system and

organs of sense in the CNPP accident clean-up
workers was 57.1 2.7 compared with control group
(in the normal Latvian population adjusted for age
and sex) where the occurrence was 5.9 3.3
(P \ 0.001).
(b) Mental disorders in the group of clean-up workers
was 61.2 3.0 compared with controls 5.6 3.4
(P \ 0.001).
(c) Thyroid diseases 19.8 2.4 and 5.1 1.6 in controls (P \ 0.001).
(d) Respiratory diseases 29.3 2.6 and 9.7 2.4 in
controls (P \ 0.001).
(e) Diseases of digestive system 40.9 3.5 in CNPP
accident clean-up workers and 20.6 2.9 in the
controls (P \ 0.001).
This analysis of the morbidity in CNPP accident cleanup workers from 1998 until 2007 clearly shows marked
changes in the nature of the diseases in this group of
patients. In 2007 the most frequent were, in order of
decreasing frequency (a) diseases of nervous system, (b)
organs of sense and mental disorders, (c) diseases of the
cardiovascular and endocrine system; these increased
considerably during 19982003. However, the morbidity

166

M. E. Eglite et al.

Fig. 3 The average number of

diseases for one Chernobyl
accident clean-up worker from
year 1986 until year 2007 in
comparison with control group
of Latvian males

12

10,7 10,8 11,0 10,9

10,1

Number of diseases

10

10,2 10,3

9,6
8,7

8
5,6

6
3,9

4
2,1 2,1

2 1,3

1,4 1,3 1,3

1,5

2,5

2,8

3,2 3,2

3,1
2,4

1,5

19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07

Years

% from total morbidity in corresponding year

Clean-up workers

18
16
14
12
10
8
6
4
2
0
1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year
diseases of endocrine system

mental disorders

diseases of nervous system and organs of sense

cardiovascular diseases

respiratory diseases

diseases of digestive system

Fig. 4 The occurrence of diseases in Chernobyl accident clean-up

workers during 19982007

with respiratory diseases and diseases of digestive system

decreased in the same period (Fig. 4).
Cancers
The oncological morbidity of Chernobyl NPP accident
clean-up workers has progressively increased in 1998
2007 (Fig. 5). During 19982004, there has been an
increase of occurrence of malignant diseases of the thyroid
gland, prostate and stomach. During 20052007, there has
been a marked increase of occurrence of oncological diseases of prostate, stomach and lungs; this is higher than
that in the age- and sex-matched groups of Latvian
population.
The thyroid iodine concentrates and much of the
radioactivity released from the damaged reactor were in the

Control

form of radioiodine; this radioactive iodine could have

accumulated from both internally deposited radioiodine
and exposure to external radiation. This could have
accounted for the development of thyroid cancers.
The number of cases of malignant diseases in the CNPP
accident clean-up workers in relation to age is shown in
Fig. 5. The highest occurrence of these diseases is in cleanup workers in the 4559-year age group but it is notably
lower in the population above 60 years.
The number of thyroid cancer cases found in clean-up
workers in 19902005 was 8.6 times larger compared with
that of other men living in Latvia. Cases of thyroid cancer
occur in an earlier age compared to the general population;
this being at age 4050 for clean-up workers and age 5565
for the general population.
Cases of benign thyroid diseases in Chernobyl clean-up
workers during 19902005 included diffuse euthyroidal
goiter and nodular euthyroidal goiter. The frequency of
non-malignant thyroid nodular goiter was almost three
times higher in clean-up workers than in the control group.
The morbidity with other benign thyroid diseases (chronic
thyroiditis, hypothyroidism, thyroitoxicosis) in Chernobyl
NPP clean-up workers suggests range in control group.
Initial presentation of diseases
The results of clinical examinations show that the first
signs of health problems in the CNPP accident clean-up
workers were observed soon after the accident (1986
1992). These comprised various clinical syndromes and
diseases including acute respiratory syndrome, tracheitis,
headaches of unknown etiology and transient alterations of
blood pressure. These symptoms are connected with disturbances in autonomic nervous system. There was a

Health of Latvian Chernobyl NPP workers

167

Fig. 5 Number of cases of

oncological diseases among
Chernobyl NPP accident cleanup workers in relation to age

12
10

Number of cases

10

7 7

5
4

3
2 2 2

1 1
0

0 0 0 0

35-39

40-44

45-49

2 2

50-54

55-59

60-64

65-69

Age groups
thyroid gland

progressive increase in the clinical symptoms and diseases

presented by patients thereafter and has gradually increased
till date.
The progressive nature of the functional disturbances in
different organs and systems in the CNPP accident cleanup workers combined with significant metabolic disorders
and hormonal and immune dysfunction suggests that these
workers could have a syndrome that can be described as
either post-radiation neurosomatic polypathia or that due
to unspecified radiation effects. This syndrome is
accompanied by widespread pains in bones, generalized
polyneuropathy, encephalopathy, various thyroid gland
disorders, gastroduodenal disorders including development
and persistence of gastroduodenal ulcers and symptoms of
other organ diseases. For Chernobyl NPP accident clean-up
workers, the typical presentation is the simultaneous
occurence of pathology of many organs with complicated
and unclear pathogenesis.
Mortality
A total of 523 clean-up workers died during 19862006.
The main reasons for this mortality were (a) diseases in
66%, (b) accidents in 24% and (c) suicides in 10%. The
principal reasons for death from the disease category were
related to the cardio-circulatory system, malignant diseases
and chronic alcoholism.
Discussion
The exposure to external radiation doses by the Latvian
CNPP accident clean-up workers is relatively low. In
contrast, there is reason to believe that the principal cause
of the marked increase of the occurrence of diseases in this

prostate

stomach

lungs

group is from the accumulation of long half-life radioisotopes which have accumulated in the bone (e.g. cesium,
strontium), thyroid (e.g. radioiodine) as well as in other
organs. For example, radioactive cobalt accumulates in the
liver, and 134cesium and 137cesium disperse into many
organs, mostly in the lymphatic system, soft tissues and
genitalia (Bacbkeyro 1991). Evidence for the accumulation of radiation in the bone of these workers comes from
electron spin resonance (ESR) measurements of the
absorbed doses in tooth enamel (Mironova-Ulmane et al.
2001). Higher levels of b-radioactivity from 90Sr have been
found in clean-up workers compared with that in the Latvian population.
The observed high morbidity of Chernobyl NPP accident clean-up workers and their premature aging may be
related to severe abnormalities of their immune system.
Investigations of the immune system have been undertaken
in the CNPP accident clean-up workers from Latvia. A
considerable number of abnormalities of the immune system were observed (Zvagule et al. 2002; Bruvere et al.
2003; Kurjane et al. 2004) as follows:
(a)

Leucopenia which was initially observed during the

first years of investigation in 1435% of workers,
which has progressed to leucocytosis in recent years.
(b) Serious dysfunction of the interferon (IFN) system
was evident. The ability of peripheral blood lymphocytes (PBL) to produce IFNs has been found to be
significantly decreased in 6590% of accident cleanup workers and there was an increased level of
circulating IFN in 40% patients.
(c) Increased plasma levels of IgA have been found in
2637% of CNPP accident clean-up workers and
decreased levels of IgM in 1827% of the workers
(Zvagule et al. 2002).

168

M. E. Eglite et al.

(d)

2003). The hypothesis that exposure to ionizing radiation

accelerates the natural process of aging has been studied in
the population of atomic bomb survivors in Japan by
clinical, epidemiological, and laboratory methods. Phytohemaglutinin (PHA) response and mixed lymphocyte
culture response showed equivocal radiation effects among
A-bomb survivors (Sasaki et al. 1991). The occurrence of T
lymphocyte T-cell receptor mutation increases accordingly
with age and also with radiation dose. Injury to the immune
system is a critical component of the syndrome that occurs
soon after irradiation and plays a crucial role in the late
effects of exposure to radiation, such as tumor development
and early aging (Sasaki et al. 1991).

Functional deficiency of the immune system of cleanup workers was observed during 19902005. The
CNPP clean-up workers were found to have a
statistically significant depression of proliferative
ability of T and B lymphocytes and had elevated
plasma concentrations of interleukin-6 (IL-6). Induction of TNF-a in the PBMC of clean-up workers was
higher than that in healthy controls and this was
correlated with age. The significant increases have
also been observed in the functions of the complement system as well as in the high levels of IL-6,
TNF-a and SP-selectin. These observations suggest
that the CNPP accident clean-up workers have a
systemic chronic inflammatory process with possible
accompanying decay of the functions of major organs
during more than two decades following the accident.
(e) The Latvian Chernobyl accident clean-up workers
had three times less phagocytic activity of neutrophils
compared to that of a control group (Bruvere et al.
2003).
(f) A study of neutrophil ultrastructure from CNPP
accident clean-up workers showed that these cells
lacked specific granules, with vacuoles having unclear
content and signs of accompanying activation (e.g.
increased pseudopodia). These findings indicate sustained and progressive neutrophil activation in these
cells of CNPP workers accompanied by impaired
capacity of phagocytosis (Kurjane et al. 2004).
Ionizing radiation, even at low levels, can disturb the
cellular metabolism, weaken the immune defense system,
and provoke organic stress that leads to premature aging
(Sasaki et al. 1991). Early studies on the CNPP accident
clean-up workers from Latvia provided evidence that they
have been exposed to sustained oxidant stress injury
(Kumerova et al. 2000). This could form the basis of the
large number of conditions which have been observed in
the Latvian CNPP accident clean-up workers. Among these
conditions, aging is associated with increased inflammatory
activity (reflected by increased levels of pro-inflammatory
cytokines and tissue destructive free oxyradicals and oxidants) as well as decreased T-cell-mediated immune
response due to the thymic involution with age (Aspinall
and Andrewe 2000). The phenomenon, which is referred to
as inflammatory aging, is provoked by a continuous
antigenic load and exposure to a variety of stresses
(Franceschi and Bonafe 2003). The persistence of inflammatory stimuli over time represents the biologic
background favoring the susceptibility to age-related
pathologies such as cancer, increased susceptibility to
infectious diseases and autoimmune disorders, cardiovascular diseases as well as ill-defined and generalized
multimorbidity (Ginaldi et al. 1999; Zhang and Grizzle

Summary and conclusions

1.

2.

3.

4.

Detailed analysis of external radiation exposure doses

for Latvian Chernobyl NPP accident clean-up workers
has been obtained up to 2008. The external radiation
exposure was determined in 3,093 persons comprising
a total of 57.29% of all CNPP accident cleanup workers from Latvia. The minimal received dose
was 0.1 mSv and the maximal 500 mSv, mean
128.6 70.73 mSv.
The monitoring of the health status of over 6,000
clean-up workers has enabled compilation and analysis
of unique data on quantitative and qualitative changes
of the nature and severity of morbidity and decline in
health status of these patients. Their morbidity exceeds
age- and sex-matched non-exposed population morbidity; there is a trend for progression of this tendency.
The number of diseases diagnosed per person was 1.3
in 1986, 3.2 in 1996, compared with 10.2 in 2002
(P \ 0.001), and 10.9 in 2007. In the control group,
the number of diseases per person was 1.5 in 1996,
compared with 2.4 in 2002 (P [ 0.05) and 3.1 in 2005
(P [ 0.05). In 6065-year-old Latvian males, the
number of diseases per person was 7.5 in 2002. Even
taking into account more frequent examination of
clean-up workers, the results are a sign of premature
aging in this group.
The morbidity of Chernobyl NPP accident clean-up
workers during 19862001 has progressively
increased. There is a marked increase in occurrence
of diseases of nervous system and organs of sense,
mental disorders, thyroid diseases, respiratory diseases
and diseases of digestive system. These data are
statistically significant and notably higher than that
among age- and sex-matched control groups.
Analysis of morbidity from 1998 till 2007 shows
changes in the nature and severity of diseases. In 2007,

Health of Latvian Chernobyl NPP workers

5.

6.

the most frequent were (in order of decreasing

occurrence) diseases of the nervous system, organs
of sense and mental disorders, morbidity with diseases
of cardiovascular and endocrine systems is increasing
in comparison with period 19982003 but morbidity
with respiratory diseases and diseases of digestive
system is decreasing.
The oncological morbidity of Chernobyl NPP accident
clean-up workers had progressively increased. During
19982004, there was a notable increase of occurrence
of oncological diseases of thyroid gland, prostate and
stomach. In 20052007, the most important increase in
occurrence of oncological diseases of prostate, stomach and lungs was observed in Chernobyl NPP
accident clean-up workers, and it was higher than that
among age- and sex-matched groups of Latvian
population.
For Chernobyl NPP accident clean-up workers typically there is simultaneous pathology of many organs
with complicated and unclear pathogenesis. Clean-up
workers exposed to low-dose ionizing radiation have
marked signs of premature aging, but this hypothesis
requires further investigation.

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