BOOK
Chemical Health Threats
Raquel Duarte-Davidson | Tom Gaulton | Stacey Wyke | Samuel Collins
(2018)
Additional Information
Book Details
Abstract
Chemical health threats can have impacts across national borders and so may be more effectively tackled by international cooperation than by individual governments acting alone. As such, in November 2013, the European Union published the EU Decision for Serious Cross Border Threats to Health establishing a number of mechanisms for a coordinated, Europe-wide response with regards to preparedness, risk assessment, risk management, risk communication and international cooperation.
Comprising a series of chapters from leading international researchers, this book covers recent developments in the field which support the implementation of these European legal instruments. It begins by contextualising the need for data that surveillance of toxic threats can deliver, before going on to examine some of the tools that have been developed to facilitate toxicosurveillance in Europe as well as current toxicosurveillance networks outside the EU. In addition, this book covers the European Union regulation concerning the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH), and the work of the Alerting System for Chemical Health Threats (ASHT) project to improve the risk assessment and management of chemical health threats in Europe.
The volume provides a vital resource for researchers, educators, policy-makers and practitioners with an interest in key questions facing global hazardous substance control.
Professor Raquel Duarte-Davidson is head of the International Research and Development (IRD) Group within the Centre for Radiation, Chemical and Environmental Hazards at Public Health England. Many of their current projects are international collaborations with different public health bodies, universities and poisons centres across Europe. Projects relate to risk assessment, exposure assessment, developing alerting systems using poisons centres across Europe and developing guidance, protocols and training material on the management of chemical incidents. Professor Duarte-Davidson also holds a Visiting Professorship at Cranfield University.
Dr Rob Orford is a Principal Scientist within the IRD group. He is the technical lead for two EU co-funded R&D projects on cross border chemical health threats. The projects cover the European Union level response to serious cross border threats to health from chemicals which includes the development of toxicosurveillance approaches for chemical health threats.
Dr Stacey Wyke is also a Principal Scientist within the IRD group and is the technical lead for recovery and remediation of chemical incidents. She has led EU co-funded R&D projects on cross border chemical health threats and toxicosurveillance, has worked as a Poisons Specialist and is a registered Toxicologist.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Cover | Cover | ||
| Chemical Health Threats | i | ||
| Preface | vii | ||
| Acknowledgments | ix | ||
| Contents | xi | ||
| Chapter 1 - Overview of Alerting, Assessing and Responding to Chemical Public Health Threats | 1 | ||
| 1.1 Introduction | 1 | ||
| 1.2 Mechanisms for Reporting Public Health Risks From Chemicals | 2 | ||
| 1.2.1 International Health Regulations (IHR) – Public Health Emergencies and Events of International Concern | 2 | ||
| 1.2.2 EU Decision 1082/2013/EU for Cross-border Threats to Health | 8 | ||
| 1.2.3 Early Warning and Response System (EWRS) | 8 | ||
| 1.2.4 Rapid Alert System for Chemicals (RASCHEM) | 9 | ||
| 1.2.5 Industrial Accident Notification System (IAN) – Cross-border Industrial Accidents | 9 | ||
| 1.2.6 Illicit Drugs and Emerging Psychoactive Drugs (Réseau Européen d'Information sur les Drogues et les Toxicomanies; REITOX) | 12 | ||
| 1.2.7 The Rapid Alert System for Non-food Dangerous Products (RAPEX) | 12 | ||
| 1.2.8 The Rapid Alert System for Food and Feedstuff (RASFF) | 14 | ||
| 1.3 European Supporting Mechanisms for Assessing the Public Health Risk of Exposure to Chemicals | 15 | ||
| 1.3.1 The Role of the Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) | 15 | ||
| 1.4 The Role of Poison Centres and Public Health Authorities | 16 | ||
| 1.5 Conclusion | 18 | ||
| References | 19 | ||
| Chapter 2 - Chemical Regulation at the European Level: Safeguarding Consumer Health and Protecting the Environment | 24 | ||
| 2.1 Introduction | 24 | ||
| 2.2 Requirements for Chemical Manufacturers in Europe: the REACH Regulation | 25 | ||
| 2.2.1 Core Components of REACH | 25 | ||
| 2.2.1.1 Registration | 26 | ||
| 2.2.1.2 Evaluation | 26 | ||
| 2.2.1.3 Authorisation | 26 | ||
| 2.2.1.4 Restriction | 27 | ||
| 2.3 Communicating the Risks Associated with Hazardous Chemicals | 27 | ||
| 2.3.1 Chemical Classification and the Globally Harmonised System (GHS) for Labelling | 27 | ||
| 2.3.2 The Classification, Labelling and Packaging Regulation (CLP) | 29 | ||
| 2.3.3 CLP and the Role of Poison Centres | 31 | ||
| 2.3.4 Submission of Data to Poison Centres: the Unique Formula Identifier (UFI) | 31 | ||
| 2.4 Chemical Regulations for Specific Types of Chemicals | 32 | ||
| 2.4.1 The Biocidal Products Regulation (BPR) | 32 | ||
| 2.4.2 The Plant Protection Products (PPPs) Regulation | 32 | ||
| 2.4.3 Prior Informed Consent Regulation | 32 | ||
| 2.5 Restriction of the use of Chemicals in Specific Sectors | 33 | ||
| 2.6 Summary | 33 | ||
| References | 34 | ||
| Chapter 3 - Medical Management of Mass Intoxications | 36 | ||
| 3.1 Introduction | 36 | ||
| 3.2 Evidence of Mass Poisoning | 37 | ||
| 3.2.1 Examples of When Mass Poisonings May Occur | 37 | ||
| 3.3 Alcoholic Beverages | 39 | ||
| 3.3.1 General Aspects | 39 | ||
| 3.3.2 Mixed Intoxication | 39 | ||
| 3.4 Methanol Poisoning | 40 | ||
| 3.5 Other Drugs | 41 | ||
| 3.5.1 General Aspects | 41 | ||
| 3.5.2 Recreational Drugs | 41 | ||
| 3.5.3 New Psychoactive Substances | 42 | ||
| 3.6 Food | 42 | ||
| 3.6.1 General Aspects | 42 | ||
| 3.6.2 Special Food Poisoning | 43 | ||
| 3.6.2.1 Bacterial Toxins | 43 | ||
| 3.6.2.2 Botulism | 43 | ||
| 3.6.2.3 Poisonous Fungi | 45 | ||
| 3.6.2.4 Poisoning by Fish and Other Marine Animals | 46 | ||
| 3.6.2.5 Food Additives | 47 | ||
| 3.7 Drinking Water | 48 | ||
| 3.8 Medicinal Products | 48 | ||
| 3.8.1 General Aspects | 48 | ||
| 3.8.2 Diethylene Glycol | 48 | ||
| 3.9 Consumer Goods | 49 | ||
| 3.10 Conclusion | 50 | ||
| References | 50 | ||
| Chapter 4 - Hazardous Exposures to Liquid Laundry Detergents Capsules in Young Children | 52 | ||
| 4.1 Introduction | 52 | ||
| 4.2 Evaluation of Evidence on the Emerging Trend of LLDCs-related Injuries in Young Children | 53 | ||
| 4.3 Preventive Measures Adopted in Italy and the Observed Impact | 56 | ||
| 4.4 The AISE Product Stewardship Programme for LLDCs | 58 | ||
| 4.5 European Legislation | 59 | ||
| 4.6 Conclusion | 59 | ||
| References | 61 | ||
| Chapter 5 - Novel Applications of Spatial Mapping to Chemical or Biological Outbreaks | 64 | ||
| 5.1 Introduction | 64 | ||
| 5.2 TWC Alpha (α) | 67 | ||
| 5.2.1 The Concept | 67 | ||
| 5.2.2 The Algorithm | 67 | ||
| 5.3 TWC Beta (β) | 70 | ||
| 5.3.1 The Concept | 70 | ||
| 5.3.2 The Algorithm | 70 | ||
| 5.4 TWC Gamma (γ) | 73 | ||
| 5.4.1 The Concept | 73 | ||
| 5.4.2 The Algorithm | 73 | ||
| 5.5 TWC Theta (θ) | 75 | ||
| 5.5.1 The Concept | 75 | ||
| 5.5.2 The Algorithm | 75 | ||
| 5.6 TWC Iota (ï) | 77 | ||
| 5.6.1 The Concept | 77 | ||
| 5.6.2 The Algorithm | 79 | ||
| 5.7 The German Haemolytic Uremic Syndrome (HUS): May 2011. Application of TWC for Outbreak Investigation | 83 | ||
| 5.7.1 The Application of TWC(α, β, γ, θ) Algorithms | 84 | ||
| 5.7.2 The Theta Distances and the Discrete Markov Chains | 86 | ||
| 5.7.3 The TWC(ï) and the Meta Distances | 90 | ||
| 5.8 Application of TWC for Chemical Incidents | 90 | ||
| 5.9 Conclusion | 91 | ||
| References | 94 | ||
| Chapter 6 - Surveillance of Chemical Health Threats | 96 | ||
| 6.1 Introduction | 96 | ||
| 6.2 The Need for Surveillance | 98 | ||
| 6.3 Requirements for Surveillance | 99 | ||
| 6.4 Who Undertakes Surveillance | 100 | ||
| 6.5 Types of Surveillance Systems | 101 | ||
| 6.5.1 Indicator-based Surveillance | 101 | ||
| 6.5.2 Event-based Surveillance | 102 | ||
| 6.5.2.1 Examples of Events Detected by EBS | 105 | ||
| 6.5.3 Pharmacosurveillance and Pharmacovigilance | 105 | ||
| 6.5.4 Toxicosurveillance and Toxicovigilance | 108 | ||
| 6.6 EU Reporting Requirements for Surveillance Systems | 110 | ||
| 6.7 Conclusions | 110 | ||
| References | 111 | ||
| Chapter 7 - Responding to New Psychoactive Substances in the European Union: Early Warning, Risk Assessment and Control Measures | 114 | ||
| 7.1 Introduction | 114 | ||
| 7.2 The Origins of New Psychoactive Substances | 116 | ||
| 7.3 The Situation in Europe | 117 | ||
| 7.3.1 Production, Marketing, Supply | 120 | ||
| 7.3.2 Spice and the Synthetic Cannabinoids | 122 | ||
| 7.3.3 Recent Developments | 125 | ||
| 7.4 Responding to New Psychoactive Substances in the European Union | 126 | ||
| 7.4.1 Legal Framework | 126 | ||
| 7.4.2 The EMCDDA | 126 | ||
| 7.4.3 Early Warning | 127 | ||
| 7.4.3.1 EU Early Warning System | 127 | ||
| 7.4.3.2 Joint Report | 129 | ||
| 7.4.4 Risk Assessment | 129 | ||
| 7.4.5 Control Measures | 131 | ||
| 7.5 Conclusion | 131 | ||
| Acknowledgements | 132 | ||
| References | 132 | ||
| Chapter 8 - Rapid Public Health Risk Assessments for Emerging Chemical Health Threats | 138 | ||
| 8.1 Introduction | 138 | ||
| 8.2 What is a Rapid Risk Assessment | 140 | ||
| 8.3 Rapid Risk Assessment Methodology | 141 | ||
| 8.3.1 Hazard Assessment | 143 | ||
| 8.3.2 Exposure Assessment | 143 | ||
| 8.3.3 Risk Characterization | 145 | ||
| 8.3.4 Context Assessment | 147 | ||
| 8.4 The Rapid Risk Assessment Team | 148 | ||
| 8.5 Outcomes from the Rapid Risk Assessment | 149 | ||
| 8.6 Conclusion | 149 | ||
| References | 150 | ||
| Chapter 9 - Review of Risk Management Measures to Mitigate Against Exposures to Household Chemical Consumer Products | 152 | ||
| 9.1 Introduction | 152 | ||
| 9.2 How Are Risk Management Measures Developed? | 154 | ||
| 9.3 Administrative Risk Management Measures | 156 | ||
| 9.3.1 Are Administrative Risk Management Measures Effective | 158 | ||
| 9.4 Product-integrated Risk Management Measures | 160 | ||
| 9.4.1 Physical RMMs | 160 | ||
| 9.4.2 Are Physical Risk Management Measures Effective | 160 | ||
| 9.4.3 Chemical Risk Management Measures | 162 | ||
| 9.4.4 Are Chemical Risk Management Measures Effective | 162 | ||
| 9.5 Consumer-related Risk Management Measures | 163 | ||
| 9.5.1 Labelling | 163 | ||
| 9.5.2 Are Consumer Risk Management Measures Effective | 164 | ||
| 9.6 Conclusions | 165 | ||
| References | 167 | ||
| Chapter 10 - Understanding and Managing Behavioural and Psychological Responses to Chemical Incidents | 171 | ||
| 10.1 Introduction | 171 | ||
| 10.2 Likely Public Behaviour During Chemical Incidents | 172 | ||
| 10.3 Management of Members of the Public during Chemical Incidents | 172 | ||
| 10.4 Communicating with Members of the Public during Chemical Incidents | 173 | ||
| 10.5 Communicating Public Health Messages Following a Chemical Incident | 174 | ||
| 10.6 Conclusion | 178 | ||
| References | 179 | ||
| Chapter 11 - Strategic, Technical and Scientific Advice in an Environmental Emergency | 182 | ||
| 11.1 Introduction | 182 | ||
| 11.1.1 Types of Environmental Emergencies | 182 | ||
| 11.1.2 Principles of Emergency Preparedness and Planning | 184 | ||
| 11.2 Risk Assessment for Emergency Planning | 185 | ||
| 11.2.1 Planning for Emergencies | 185 | ||
| 11.2.2 Warning and Informing | 187 | ||
| 11.2.3 Roles and Responsibilities | 187 | ||
| 11.2.4 Cross-border Health Threats | 188 | ||
| 11.3 Principles of Emergency Response | 189 | ||
| 11.4 Environmental Public Health Risk Assessment | 190 | ||
| 11.4.1 Source–Pathway–Receptor | 192 | ||
| 11.4.2 Risk Communication During Emergencies | 192 | ||
| 11.5 Case Study | 195 | ||
| References | 198 | ||
| Chapter 12 - Public Health Preparation and Response to Chemical Incident Emergencies | 200 | ||
| 12.1 Introduction | 200 | ||
| 12.2 Constructing Chemical Incident Emergency Plans | 204 | ||
| 12.2.1 Development and Contents of a Chemical Incident Emergency Plan | 204 | ||
| 12.2.2 Communication | 207 | ||
| 12.2.3 Notification Authority | 207 | ||
| 12.2.4 Special Populations | 208 | ||
| 12.2.5 Mental Health | 209 | ||
| 12.3 Alerting and Notification | 209 | ||
| 12.3.1 Public Information Before an Incident | 210 | ||
| 12.3.2 Public Information After an Incident | 211 | ||
| 12.3.2.1 The STARCC Principle | 212 | ||
| 12.3.3 Notifying Emergency Responders and Other Organisations | 213 | ||
| 12.4 Evacuation Versus Shelter-in-Place | 214 | ||
| 12.4.1 Taking Decisions About Evacuation During a Chemical Incident | 214 | ||
| 12.4.2 What “Sheltering in Place” Means | 214 | ||
| 12.4.3 How to Prepare to Shelter in Place During a Chemical Incident | 214 | ||
| 12.4.4 How to Know if You Need to Evacuate | 215 | ||
| 12.4.5 What to Do | 216 | ||
| 12.4.6 Evacuees | 216 | ||
| 12.4.7 Returning Following an Evacuation | 217 | ||
| 12.5 Post Disaster Health Care, Remediation and Restoration After a Chemical Incident | 217 | ||
| 12.5.1 Post Disaster Health Care and Welfare Support | 217 | ||
| 12.5.2 Remediation and Restoration | 218 | ||
| 12.6 Conclusion | 220 | ||
| References | 221 | ||
| Chapter 13 - Chemical Incident Management: An Overview of Preparedness, Response and Recovery | 224 | ||
| 13.1 Introduction | 224 | ||
| 13.2 Alerting and Event-based-surveillance | 225 | ||
| 13.3 Planning and Preparedness | 229 | ||
| 13.4 Incident Response | 230 | ||
| 13.4.1 Initial Response by Emergency Responders | 230 | ||
| 13.4.2 Evacuation and Disrobing | 231 | ||
| 13.4.3 Decontamination (People) | 232 | ||
| 13.5 Recovery and Remediation | 233 | ||
| 13.5.1 Principles of Developing a Recovery Strategy | 236 | ||
| 13.6 Conclusion | 238 | ||
| References | 239 | ||
| Chapter 14 - Investigating Outbreaks of Unknown Aetiology | 240 | ||
| 14.1 Introduction | 240 | ||
| 14.2 The Chemical Burden of Disease | 243 | ||
| 14.3 Investigating Outbreaks of Unknown Aetiology | 245 | ||
| 14.3.1 Preparedness and Response Plans | 245 | ||
| 14.3.2 Recognising an Incident – The Importance of Surveillance | 246 | ||
| 14.3.3 The Descriptive Phase – Defining Cases | 250 | ||
| 14.3.3.1 The Importance of Robust Pathological Analysis | 251 | ||
| 14.3.4 Testing the Hypothesis – The Epidemiological Approach | 252 | ||
| 14.3.5 Testing the Hypothesis – The Toxicological Approach | 253 | ||
| 14.3.6 Challenges in Establishing a Chemical Aetiology | 254 | ||
| 14.3.7 The Intervention Phase – Prevention and Control | 255 | ||
| 14.3.7.1 Strengthening Surveillance | 256 | ||
| 14.3.7.2 Exposure Assessment | 256 | ||
| 14.3.7.3 Communication and Education | 257 | ||
| 14.4 Alerting and Reporting Mechanisms | 258 | ||
| 14.4.1 European Reporting Systems | 258 | ||
| 14.4.2 The International Health Regulations (IHR) | 259 | ||
| 14.5 The Importance of International Cooperation | 259 | ||
| 14.6 Conclusions | 260 | ||
| References | 260 | ||
| Appendix 1 - Case Study: Methanol Mass Poisoning Outbreak in the Czech Republic: Diagnosis, Treatment and Outcome | 263 | ||
| A1.1 Introduction | 263 | ||
| A1.2\rEpidemiology of the Czech Methanol Mass Poisoning Outbreak | 264 | ||
| A1.3 Diagnosing Methanol Poisoning: Role of Serum Formate Measurement | 265 | ||
| A1.4 Antidote Treatment to Block Methanol Metabolism: Ethanol Versus Fomepizole | 266 | ||
| A1.5 Role of Extracorporeal Treatments in Elimination of Formic Acid and Methanol: Intermittent Versus Continuous Modalities of D... | 267 | ||
| A1.6 Prevalence and Character of Long-term Visual Sequelae of Acute Methanol Poisoning | 267 | ||
| A1.7 Prevalence and Character of Long-Term CNS Sequelae of Acute Methanol Poisoning | 268 | ||
| References | 268 | ||
| Appendix 2 - Case Study: Fentanils: A Serious Threat to Public Health in Europe | 271 | ||
| A2.1 Introduction | 271 | ||
| A2.2 Re-emergence of the Fentanils on the Drug Market | 272 | ||
| A2.3 The Public Health Risk Posed by Fentanils | 275 | ||
| A2.3.1 Naloxone as an Antidote | 276 | ||
| A2.4 A Case Study: Acryloylfentanyl | 276 | ||
| A2.5 Conclusion | 278 | ||
| Acknowledgements | 279 | ||
| References | 279 | ||
| Appendix 3 - Case Study: Enschede Fireworks Disaster: Lessons Learned | 283 | ||
| A3.1 Introduction | 283 | ||
| A3.1.1 Background and Implementation of the Enschede Fireworks Disaster Study | 284 | ||
| A3.2 Overall Design of Health Monitoring | 284 | ||
| A3.3\rMain Outcomes of the Surveys | 285 | ||
| A3.3.1 Blood and Urine Study in the First Survey Two to Three Weeks Post-event | 285 | ||
| A3.3.2 Acute Physical and Mental Health Effects after the Disaster | 285 | ||
| A3.3.3 Main Outcomes of Surveys Among the Affected up to 10 Years Post-event | 286 | ||
| A3.4 Main Outcomes from General Practice Health Records | 287 | ||
| A3.4.1 Self-reported Symptoms and GP-reported Symptoms Immediately after the Disaster | 287 | ||
| A3.5 Lessons Learned | 287 | ||
| Acknowledgements | 288 | ||
| References | 288 | ||
| Appendix 4 - Case Study 4: The ANDE Fire, Paraguay, 2015 | 290 | ||
| A.4.1 The Fire – Public Health and Environmental Concerns | 290 | ||
| A.4.2 The Expert Mission | 292 | ||
| A.4.3 Characterisation of the Affected Area | 292 | ||
| A.4.4 Evaluation of Immediate Response Measures | 294 | ||
| A.4.5 Characterisation of the Routes of Exposure | 294 | ||
| A.4.5.1 Potential Environmental Contamination | 294 | ||
| A.4.5.2 Exposure Pathways | 296 | ||
| A.4.6 Identification of Contaminants and Toxic Effects on Health | 297 | ||
| A.4.7 Results and Observations | 298 | ||
| A.4.8 Environmental Public Health | 298 | ||
| A.4.9 Conclusions and Recommendations from the Expert Mission | 299 | ||
| Acknowledgements | 302 | ||
| References | 302 | ||
| Subject Index | 303 |