John Libbey Eurotext

Environnement, Risques & Santé


Identification and assessment of weak toxicovigilance signals Volume 12, issue 4, Juillet-Août 2013


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InVS Département santé-environnement Unité toxicovigilance et surveillance des intoxications 12, rue du Val-d’Osne 94415 Saint-Maurice cedex France, Centre Antipoison de Paris Hôpital Fernand Widal 200, rue du Faubourg Saint-Denis 75475 Paris cedex 10 France, Centre antipoison et de toxicovigilance de Nancy Hôpital Central 29, avenue du Maréchal de Lattre de Tassigny 54035 Nancy cedex France

Toxicovigilance is the monitoring of acute or chronic toxic effects to humans of chemical substances and mixtures, whether natural, manmade, commercially available or present in the environment. Current regulations (section L. 1413-4 of the Public Health Code) require the French Institute for Public Health Surveillance (InVS) to organize toxicovigilance in France through a network including the participants referred to in section L.1341-1 ( i.e., poison control and toxicovigilance centres). These poison centres answer toxicological inquiries from the public and health professionals 24 hours a day 7 days a week. The questions and cases of human exposure are entered into a national information system. The network relies on exchanges of information and signals between all the stakeholders: the poison centres, InVS, Ministry of Health, regional health agencies (ARS), national health and safety agencies, consumer affairs offices (DGCCRF), and international health surveillance networks. Weak toxicovigilance signals may correspond to: i) health events associated with exposure to a natural or synthetic substance, initially of low intensity; or ii) emerging exposure to a biological or chemical agent that could lead to a public health threat despite the lack of any reported adverse effect. Several sets of these emerging signals have been identified and are illustrated by examples in this paper: 1) one or several cases associated with an exposure; 2) sporadic cases or clusters, with the same clinical and toxicological expression; and 3) emerging risks detected through a specific toxicological expert study. The detection and assessment of weak signals require specific organization between all partners and institutions. We propose criteria to validate toxicological signals and assess potential health threats to determine whether alerts should be issued. Multidisciplinary expert assessments and queries of different data sources are essential to assess weak signals in toxicovigilance.