Implementation of systematic reviews in EFSA scientific outputs workflow

An update on the hazard of and exposure to diethyl hexyl phthalate (DEHP) alternatives used in medical devices

The use of the plasticizer diethyl hexyl phthalate (DEHP) in PVC medical devices is being questioned due to its potential reprotoxic effects in patients exposed as a result from migration from the device. This article reviews new information on migration and toxicity data of eleven alternative plasticizers that have previously been evaluated by the Danish EPA and the EU SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks). The new toxicity data did not justify the reconsideration of the critical NOAELs as established by SCENIHR and Danish EPA. The dataset on oral toxicity studies is rather complete for most substances; however, in particular for reproductive toxicity and endocrine disruption, data gaps still exist for many alternatives. Toxicity data on intravenous exposure are lacking and these are essential to conclude on hazard characteristics of alternatives that are poorly absorbed via the oral exposure route. Migration data are emerging for a few alternatives but still sparse for the majority of the alternatives. Taking all data on migration and toxicity in consideration, 1,2-cyclohexanedicarboxylic acid, diisononylester (DINCH), and tris(2-ethylhexyl)benzene-1,2,4-tricarboxylate display a more favorable profile compared to DEHP. For these promising alternatives, a risk assessment for use in medical devices should be conducted. As a next step, we recommend the (further) generation of relevant migration data and, where needed, relevant toxicity data for the alternative substances, in order to be able to conduct a benefit-risk analysis of DEHP and the alternatives as obligatory in the new European Union Medical Device Regulation.

A validated search filter for the identification of endocrine disruptors based on the ECHA/EFSA guidance recommendations

A guidance document for the identification of endocrine disruptors (EDs) in the regulatory assessment of plant protection products (PPP) and biocidal products (BP) has been published by the European Chemical Agency (ECHA) and the European Food Safety Authority (EFSA). The ECHA/EFSA guidance, mainly addressing EATS (estrogen, androgen, thyroid, steroidogenesis) modalities, is intended to guide applicants and assessors of the competent regulatory authorities on the implementation of the scientific criteria for the determination of ED properties pursuant to the recently implemented PPP (EU 2018/605) and BP (EU 2017/2100) EU Regulations. In this study, a search filter for targeted literature search in context of assessing if a substance can be identified as an ED relevant for human health was developed and validated. Development of the search filter was based on the search strategy presented in the ECHA/EFSA guidance and using the estrogenic chemical Bisphenol AF (BPAF) as a model substance. Information specialists from two independent institutions developed refined search filters based on the suggested original search strategy published (ECHA/EFSA guidance - Appendix F). Articles identified by a systematic literature search for BPAF were screened for relevance with inclusion and exclusion criteria by two independent reviewers obtaining positive (relevant) and negative (irrelevant) controls. The developed search filter was quantitatively evaluated in terms of sensitivity, specificity and precision based on the positive and negative controls. The developed filter was then validated for T modality by its application to the known thyroid-disruptor perchlorate. The result is a sensitive search filter with sufficient specificity, which can be applied for all chemicals where a targeted literature search is needed to assess and identify ED properties of chemicals with relevance for humans. Future application of the filter to a broader range of chemicals may identify further points of improvement.

The Emergence of Systematic Review in Toxicology

The Evidence-based Toxicology Collaboration hosted a workshop on "The Emergence of Systematic Review and Related Evidence-based Approaches in Toxicology," on November 21, 2014 in Baltimore, Maryland. The workshop featured speakers from agencies and organizations applying systematic review approaches to questions in toxicology, speakers with experience in conducting systematic reviews in medicine and healthcare, and stakeholders in industry, government, academia, and non-governmental organizations. Based on the workshop presentations and discussion, here we address the state of systematic review methods in toxicology, historical antecedents in both medicine and toxicology, challenges to the translation of systematic review from medicine to toxicology, and thoughts on the way forward. We conclude with a recommendation that as various agencies and organizations adapt systematic review methods, they continue to work together to ensure that there is a harmonized process for how the basic elements of systematic review methods are applied in toxicology.

Assessing the potential spread and maintenance of foot-and-mouth disease virus infection in wild ungulates: general principles and application to a specific scenario in Thrace

Foot-and-mouth disease (FMD), due to infection with serotype O virus, occurred in wild boar and within eleven outbreaks in domestic livestock in the south-east of Bulgaria, Thrace region, in 2011. Hence, the issue of the potential for the spread and maintenance of FMD virus (FMDV) infection in a population of wild ungulates became important. This assessment focused on the spread and maintenance of FMDV infection within a hypothetical wild boar and deer population in an environment, which is characterized by a climate transitional between Mediterranean and continental and variable wildlife population densities. The assessment was based on three aspects: (i) a systematic review of the literature focusing on experimental infection studies to identify the parameters describing the duration of FMDV infection in deer and wild boar, as well as observational studies assessing the occurrence of FMDV infection in wild deer and wild boar populations, (ii) prevalence survey data of wild boar and deer in Bulgaria and Turkey and (iii) an epidemiological model, simulating the host-to-host spread of FMDV infections. It is concluded, based on all three aspects, that the wildlife population in Thrace, and so wildlife populations in similar ecological settings, are probably not able to maintain FMD in the long term in the absence of FMDV infection in the domestic host population. However, limited spread of FMDV infection in time and space in the wildlife populations can occur. If there is a continued cross-over of FMDV between domestic and wildlife populations or a higher population density, virus circulation may be prolonged.