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Boudet-Berquier J, Demattei C, Guldner L, Gallay A, Manouvrier S, Botton J, Philippat C, Delva F, Bloch J, Semaille C, Odent S, Perthus I, Randrianaivo H, Babajko S, Barjat T, Beneteau C, Brennetot N, Garne E, Haddad G, Hocine M, Lacroix I, Leuraud K, Mench M, Morris J, Patrier S, Sartelet A, Verloes A, Bonaldi C, Le Barbier M, Gagnière B, Pépin P, Ollivier R, Bitoun M, King L, Guajardo-Villar A, Gomes E, Desenclos JC, Regnault N, Benachi A. A multidisciplinary and structured investigation of three suspected clusters of transverse upper limb reduction defects in France. Eur J Epidemiol 2024:10.1007/s10654-024-01125-5. [PMID: 38671254 DOI: 10.1007/s10654-024-01125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Between 2019-2021, facing public concern, a scientific expert committee (SEC) reanalysed suspected clusters of transverse upper limb reduction defects (TULRD) in three administrative areas in France, where initial investigations had not identified any risk exposure. We share here the national approach we developed for managing suspicious clusters of the same group of congenital anomalies occurring in several areas. METHODS The SEC analysed the medical records of TURLD suspected cases and performed spatiotemporal analyses on confirmed cases. If the cluster was statistically significant and included at least three cases, the SEC reviewed exposures obtained from questionnaires, environmental databases, and a survey among farmers living near to cases' homes concerning their plant product use. RESULTS After case re-ascertainment, no statistically significant cluster was observed in the first administrative areas. In the second area, a cluster of four children born in two nearby towns over two years was confirmed, but as with the initial investigations, no exposure to a known risk factor explaining the number of cases in excess was identified. In the third area, a cluster including just two cases born the same year in the same town was confirmed. DISCUSSION Our experience highlights that in the event of suspicious clusters occurring in different areas of a country, a coordinated and standardised approach should be preferred.
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Affiliation(s)
- Julie Boudet-Berquier
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France.
| | - Christophe Demattei
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), Centre Hospitalier Universitaire de Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Laurence Guldner
- Environment and Work Department, Santé Publique France, Saint Maurice, Health, France
| | - Anne Gallay
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | - Sylvie Manouvrier
- Reference Centre of Developmental Anomalies and Defect Syndromes, RADEME Maladies Rares du Développement Et du Métabolisme, Université Lille, 7364, Lille, EA, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Claire Philippat
- Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, University Grenoble Alpes, Grenoble, France
| | - Fleur Delva
- INSERM, BPH, UMR1219, EPICENE Team, University of Bordeaux, Bordeaux, France
- Environmental and Occupational Health Department, Bordeaux University Hospital, 33000, Bordeaux, France
| | | | | | - Sylvie Odent
- Reference Centre of Developmental Anomalies and Defect Syndromes, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Isabelle Perthus
- Auvergne registry of congenital anomalies (CEMC-Auvergne), Department of clinical genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Hanitra Randrianaivo
- La Réunion registry of congenital anomalies, Centre Hospitalier Universitaire de La Réunion, Île de la Réunion, France
| | - Sylvie Babajko
- Molecular Oral Pathophysiology Laboratory, Centre de Recherche des Cordeliers, INSERM UMRS, Université Paris Cité, Sorbonne Université, 1138, Paris, France
- Fédération Hospitalo-Universitaire DDS-ParisNet, INSERM, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- UR2496, Biomedical Research in Odontology, Université Paris Cité, Montrouge, France
| | - Tiphaine Barjat
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
- INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
| | - Claire Beneteau
- Department of Human Genetics, University Hospital Hôtel Dieu, Nantes, France
| | - Naima Brennetot
- French National Reference for Children Limb Defect, Hôpitaux de Saint-Maurice, Saint Maurice, France
| | - Ester Garne
- Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | | | - Mounia Hocine
- Conservatoire National des Arts et Métiers, Paris, France
| | - Isabelle Lacroix
- REGARDs Network, Pharmacologie Médicale et Clinique, CERPOP INSERM UMR 1295-SPHERE team, Faculté de Médecine Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Klervi Leuraud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Michel Mench
- INRAE, BIOGECO, UMR 1202, University of Bordeaux, F‑33615, Pessac, France
| | - Joan Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Arnaud Sartelet
- Clinical Department of Ruminant, University of Liège, 4000, Liège, Belgium
| | - Alain Verloes
- Genetics Department, APHP, Robert-Debré University Hospital, Paris, France
| | - Christophe Bonaldi
- Methodology and Biostatistics Department, Santé Publique France, Saint Maurice, France
| | - Mélina Le Barbier
- Environment and Work Department, Santé Publique France, Saint Maurice, Health, France
| | | | - Philippe Pépin
- Cellule Auvergne-Rhône-Alpes, Santé Publique France, Clermont-Ferrand, France
| | - Ronan Ollivier
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | - Monique Bitoun
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | - Lisa King
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | | | - Eugenia Gomes
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | | | - Nolwenn Regnault
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé des femmes et des nouveau-nés, Hopital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Clamart, France
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Gnansia E, Michon L, Amar E, Estève J. Evidence for a cluster of rare birth defects in the Ain department (France). Birth Defects Res 2021; 113:1015-1025. [PMID: 33565281 DOI: 10.1002/bdr2.1876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND REMERA (REgistre des Malformations En Rhône-Alpes) is a registry of congenital malformations that covers 58,000 births annually in Central-East France. In 2010, the registry raised an alarm to the health authorities (Santé publique France, SpF) about three cases of a unilateral isolated transverse upper limb reduction defect (UITULRD) in a small subarea; the general prevalence of this defect is one case in 10,000 births. In the following years, more infants were born with the same malformation in the same territory of the Ain department. Public health authorities, supported by an expert committee, rejected the existence of a cluster, but we aim here at providing evidence for this cluster. METHODS Geocoded data for all UITULRD cases (ICD-10 codes Q71.2 and Q71.3) were extracted from the REMERA database. We conducted a Kulldorff cluster analysis of these data, using the spatial SaTScanTM algorithm. RESULTS The analysis found a cluster of eight cases of UITULRD among the 8,204 births occurring between 2009 and 2014 within a circle of 16.24 km radius centered on a village of the Ain department, whereas 0.82 cases were expected under a uniform probability of such a birth throughout the registry territory. This represents an almost 10fold excess over the expected number of cases (p = .0057). CONCLUSIONS The arguments used to deny the cluster are disputed and we present the evidence supporting its reality. The controversy that has followed the alarm has compromised the search for the cause(s) of this excess of rare malformations.
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Affiliation(s)
| | | | | | - Jacques Estève
- Hospices Civils de Lyon, Université Lyon 1, CNRS, UMR 5558, Lyon, France
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Thompson JA, Bissett WT, Sweeney AM. Evaluating geostatistical modeling of exceedance probability as the first step in disease cluster investigations: very low birth weights near toxic Texas sites. Environ Health 2014; 13:47. [PMID: 24906417 PMCID: PMC4063235 DOI: 10.1186/1476-069x-13-47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The first step in evaluating potential geographic clusters of disease calls for an evaluation of the disease risk comparing the risk in a defined location to the risk in neighboring locations. Environmental exposures, however, represent continuous exposure levels across space not an exposure with a distinct boundary. The objectives of the current study were to adapt, apply and evaluate a geostatistical approach for identifying disease clusters. METHODS The exceedance probability for very low birth weight (VLBW; < 1.5 kg) infants was mapped using an Intrinsic Conditional Autoregressive model. The data were applied to a 20 by 20 grid of 1 km2 pixels centered on each of the 13 National Priority List Superfund Sites in Harris County, Texas. RESULTS Large clusters of VLBW were identified in close proximity to four of the 13 Superfund Sites. Three of the Superfund Sites, associated with disease clusters, were located close together in central Houston and these sites may have been surrounded by a single, confluent disease cluster. CONCLUSIONS Geostatistical modeling of the exceedance probability for very low birth weights identified disease clusters of varying size, shape and statistical certainty near Superfund Sites in Harris County, Texas. The approach offers considerable potential as the first step for investigating potential disease clusters.
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Affiliation(s)
- James A Thompson
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4475, USA
| | - Wesley T Bissett
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4475, USA
| | - Anne M Sweeney
- Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, College Station, TX 77843-1266, USA
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