Toxicovigilance: poison control centres and anses working to combat everyday poisoning

Joint interview with Juliette Bloch, Director of Health Alerts and Vigilance at ANSES, and Jérôme Langrand, head of the Paris poison control centre.

What are your respective roles in the toxicovigilance scheme, and how do they fit together?

JÉRÔME LANGRAND. A poison control centre is a hospital department specialising in medical toxicology. The rather unique feature of poison control centres is that their mission covers both treatment and vigilance. Each centre provides round-the-clock telephone support for poisoning cases. Poison control centres also communicate signals to health agencies, such as ANSES or the ANSM depending on the situation, and exchange information among themselves within the framework of the coordination provided by ANSES. 

JULIETTE BLOCH. Since 2016, ANSES has been coordinating the toxicovigilance scheme, along with the vigilance activities of the eight French poison control centres and the specific scheme for the Indian Ocean. To do this, we rely on the expertise of toxicologists from poison centres and other experts, within the framework of the Agency's thematic working groups on
chemicals, regulated products (pesticides, biocides, veterinary medicines) and natural toxins.

How does this work in practice? 

JÉRÔME LANGRAND. With each call, we take on the case and collect the related information. We add information to our database in real time: it now contains almost 4 million cases! The data can be extracted by different operators. We directly report any serious or new phenomena, or anything that catches our attention... Starting with one unusual case, we check
whether others may have gone unnoticed. Sometimes our investigations end without any health alert being issued. At the Paris poison control centre, we had two very serious poisoning cases following the consumption of morels. When we queried the
database, we found others. Our experience has shown us that signal detection cannot be either 100% human or 100% computerised. 

JULIETTE BLOCH. ANSES is the recipient of the reports and can also access the poison control centres' database. It can initiate studies, for example on certain types of poisoning, and performs automated signal detection. We can also set up daily surveillance on certain topics, check trends and test hypotheses. Our work may result in products being withdrawn from the market. This was the case, for example, in 2021 with adulterated food supplements, i.e. containing substances that should
not have been present (in this case sibutramine and sildenafil). We work with the DGCCRF, customs and the Central Office for Combating Damage to the Environment and Public Health, which have intervention powers. These specific actions are very
gratifying, they crystallise our duty to protect consumers from dangerous products. Three times a year, we publish Vigil'anses, the bulletin for all our vigilance schemes, which looks back at representative alerts issued by the network of poison control centres.
Available in French and English on the ANSES website, it helps raise awareness among the public and professionals. 

What are the prospects for improving consumer safety?

JÉRÔME LANGRAND. ANSES's coordination of the poison control centres' activities enables them to share information within a structured framework and carry out joint work combining their various skills. This is a virtuous collaboration! 

JULIETTE BLOCH. If you don't know what you are looking for, the database remains a black box. Without direct reports to ANSES from the experts in the poison control centres, we would have difficulty in focusing our research. Our collaboration is working
very well and is set to be strengthened, since 2022 will see the setting up of two new toxicovigilance schemes in Martinique and Guadeloupe, which will not provide an emergency telephone hotline service, but will analyse data on poisoning cases based on
hospital admissions and use of emergency care.