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French Agency for Food, Environmental and Occupational Health & Safety

Occupational disease

The "emerging diseases" strategy of the National Network for Monitoring and Prevention of Occupational Diseases (RNV3P)

Detect, evaluate and provide early recognition of occupational diseases

Updated on 04/10/2016

Keywords : RNV3P (National Network for Monitoring and Prevention of Occupational Diseases), Occupational disease, Occupational pathology, Occupational health

Since 2001, the National Network for Monitoring and Prevention of Occupational Diseases (RNV3P), coordinated by ANSES, has progressively brought together the 32 Centres for occupational disease consultations (CCPPs) in metropolitan France and a sample of nine Occupational health services (SSTs). This network aims to gather the data from each consultation in a national database on occupational diseases (patient demographics data, diseases, exposures, job sectors and professions). The data collected are used to produce knowledge and for surveillance (detection of new, unusual or serious events) and prevention of occupational diseases. The RNV3P's 2013 scientific report is devoted to the detection of emerging occupational diseases. It presents its innovative "emerging diseases" strategy, identifies a number of signals detected using it and how they were handled, as well as the European partnerships on new occupational diseases topic which extends beyond French borders.  

The main goals of the network are to detect and describe health risk situations in France and to find new etiologies and emerging risks. The RNV3P is this first network of clinicians to take a stance internationally on the issue of early identification of new occupational diseases.

To do so, the RNV3P, coordinated by ANSES, receives support from its national partners, for whom the detection of new occupational diseases also represents a major challenge (hospitals, universities, Occupational health services, French National Health Insurance Fund for Employees [CNAMTS], French Institute for Public Health Surveillance [InVS]). In order to develop early identification of occupational diseases, an Emerging diseases working group was created within the network. The RNV3P has therefore set up an "emerging diseases" strategy which aims to detect, evaluate and provide early recognition of new occupational diseases.

Indeed, ones of the major priorities for the network is providing the RNV3P with tools allowing it to spontaneously detect elements related to the onset of new occupational diseases which might currently only involve a few cases but which could be a health warning which needs to be taken into consideration.


The "emerging diseases" strategy 

The "emerging diseases" strategy that has been set up aims to detect, evaluate and provide early recognition of potential new occupational diseases. The latter are defined as:
new {disease x exposure} pairs (for example, cases of non-Hodgkin's lymphoma in welders, whose specific attribution to dichloromethane exposure is currently under discussion
or {disease x exposition} pairs that are already known but have been detected in a new job or occupational sector (for example, asthma cases clearly linked to a particular type of mould that coffee distributor maintenance people are exposed to).

It is a three-stage process:

  • Stage 1: Detection, in which information ("warnings") needs to be located and recognised as early as possible in order to detect occupational diseases that are still unknown or which have not yet been described in a given job sector or occupation. This detection phase is based both on a proactive approach to direct voluntary reporting by the CCPPs ("clinical emergence") and on the use of so-called data mining methods which search for these new pairs in the RNV3P data base ("statistical emergence"). During reporting outside of the RNV3P network (international collaboration, scientific literature, etc.), queries are made in its database in order to find similar cases.
  • Stage 2: Expert assessment of these reports by members of the Emerging diseases working group.
  • Stage 3: Actions to be implemented are standardised based on an algorithm using the number of cases, the severity of each case and the likelihood of a causal link to the agent or occupational situation in question. These actions can span from recommending preventive measures to alerting the competent authorities to initiate regulatory management measures.


Strategic outlook

Emergence as defined in this scientific report is only one of the aspects of the occupational health surveillance approach developed within the network. In terms of public health, it is also important to not only attempt to describe temporal trends in the pathologies observed, but also to describe the numerous occupational risk situations for which the RNV3P is a precious source of information. Indeed, in the framework of surveillance strategy, the RNV3P can make it possible to more effectively identify risks that have not yet been identified or which are insufficiently recognised.

It is important that physicians be informed of the possibility of referring their patients to the CCPPs for a specialist opinion when an occupational link is suspected, regardless of the disease in question. In addition to diagnostic aid and the recognition of known occupational diseases, the CCPPs are primary contacts for detecting emerging diseases in the area of occupational health.

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