Review of the standards of proof (of safety) for FDA regulated consumer products and how the generally recognized as safe criteria could be applied to cosmetics

The Modernization of Cosmetics Regulation Act of 2022 (MoCRA) amends the Food, Drug and Cosmetic Act (FDCA), elevating the standard of proof of safety (better known as a "safety standard") for cosmetics to the standard of a "reasonable certainty … [of] … safe."a standard equal to that of food ingredients. The standards of the proof of safety differ for various classes of FDA-regulated product categories e.g., cosmetics, dietary supplements, food ingredients and food itself. This manuscript describes the various standards of proof, the essential differences between the standards, key elements required to achieve a particular standard and, compares the standards to more familiar legal terms such as "a preponderance of the evidence" or "beyond reasonable doubt." The standards of proof for these product categories are also ranked according to increasing threshold for achievement of "safe" status. Lastly, this manuscript suggests how the requirements for the high standard of a "reasonable certainty of safe" (or "reasonable certainty of no harm") might be met.

The Botanical Safety Consortium: A public-private partnership to enhance the botanical safety toolkit

Botanical dietary supplement use is widespread and growing, therefore, ensuring the safety of botanical products is a public health priority. This commentary describes the mission and objectives of the Botanical Safety Consortium (BSC) - a public-private partnership aimed at enhancing the toolkit for conducting the safety evaluation of botanicals. This partnership is the result of a Memorandum of Understanding between the US FDA, the National Institute of Environmental Health Sciences, and the Health and Environmental Sciences Institute. The BSC serves as a global forum for scientists from government, academia, consumer health groups, industry, and non-profit organizations to work collaboratively on adapting and integrating new approach methodologies (NAMs) into routine botanical safety assessments. The objectives of the BSC are to: 1) engage with a group of global stakeholders to leverage scientific safety approaches; 2) establish appropriate levels of chemical characterization for botanicals as complex mixtures; 3) identify pragmatic, fit-for-purpose NAMs to evaluate botanical safety; 4) evaluate the application of these tools via comparison to the currently available safety information on selected botanicals; 5) and integrate these tools into a framework that can facilitate the evaluation of botanicals. Initially, the BSC is focused on oral exposure from dietary supplements, but this scope could be expanded in future phases of work. This commentary provides an overview of the structure, goals, and strategies of this initiative and insights regarding our first objectives, namely the selection and prioritization of botanicals based on putative toxicological properties.

Incidence of fraud and adulterations in ASEAN food/feed exports: A 20-year analysis of RASFF's notifications

This paper explored the occurrence of food fraud and adulterations (FFA) in exports from the Association of South- East Asia Nations (ASEAN), with implications on food chain and international trade. Data from European Union Rapid Alert System for Food and Feed (EU RASFF) about FFA notifications on ASEAN exports for a period of 20 years (2000–2020) were extracted and analyzed. Results from this study revealed that of all ten ASEAN member countries, seven had cases of FFA notified in the database with Thailand (n = 47, 32%) and the Philippines (n = 37, 26%) receiving the highest frequency of notifications in the region. There was a statistical significance difference in frequency of notifications received on products from these seven countries with herbs and spices ranking highest (n = 22, 15%). Highest notifications of FFA on ASEAN exports came from the United Kingdom (n = 31, 21%). All the seven countries experienced border rejections and consequent destruction of food products especially on exports from Indonesia where 95% of product with FFA were border rejected. Border rejections on products from these countries were significantly different. Therefore, a thorough implementation system, appropriate testing and constantly updating each country’s FFA database could aid actions in curtailing future events.

Attack on Sunscreens Continues

The Food and Drug Administration (FDA) was required to issue and put into effect a final sunscreen monograph by November 26, 2019. On March 27, 2020, President Donald Trump signed into effect H.R. 748, the "Coronavirus Aid, Relief, and Economic Security Act" (CARES). This bill eliminated the November 2019 requirement. The CARES Act includes legislative reforms that modernize the way over-the-counter (OTC) monograph drugs are regulated in the United States. Under this Act, sunscreens will be considered generally recognized as safe and effective (GRASE), if they meet conditions newly defined by the FDA. In addition, the FDA is required to issue a proposal to revise the sun-screen requirements for GRASE not later than 18 months after enactment and will sunset by the end of the fiscal year 2022. The CARES Act also addresses the requirement for a new drug application (NDA).^1-7.

Opinion of the Scientific Committee on Consumer Safety (SCCS) - Final Opinion on propylparaben (CAS No 94-13-3, EC No 202-307-7)

In cosmetic products, the ingredient propylparaben (CAS No 94-13-3, EC No 202-307-7) with the chemical names Propyl 4-hydroxybenzoate and 4-Hydroxybenzoic acid propyl ester is currently regulated as a preservative in a concentration up to 0.14% (as acid) (Annex V/12a). In addition, a safe concentration was established for mixtures of parabens, where the sum of the individual concentrations should not exceed 0.8% (as acid). However, in such mixtures the sum of the individual concentrations of butyl- and propylparaben and their salts should not exceed 0.14%. Propylparaben was subject to different safety evaluations in 2005 (SCCP/0874/05), 2006 (SCCP/1017/06), 2008 (SCCP/1183/08), 2010 (SCCS/1348/10), 2011 (SCCS/1446/11), and in 2013 (SCCS/1514/13). On the basis of the safety assessment of propylparaben, and considering the concerns related to potential endocrine disrupting properties, the SCCS has concluded that propylparaben is safe when used as a preservative in cosmetic products up to a maximum concentration of 0.14%. The available data on propylparaben provide some indications for potential endocrine effects. However, the current level of evidence is not sufficient to regard it as an endocrine disrupting substance, or to derive a toxicological point of departure based on endocrine disrupting properties for use in human health risk assessment. The SCCS mandate does not address environmental aspects. Therefore, this assessment did not cover the safety of propylparaben for the environment. Link to the Opinion (SCCS/1623/20): https://ec.europa.eu/health/sites/default/files/scientific_committees/consumer_safety/docs/sccs_o_243.pdf.

Crash rates of convertible cars

OBJECTIVE

Convertible cars have existed since among the first automobiles, and the lack of substantial roof structure creates some safety concerns. Though crash tests have demonstrated that convertibles can resist excessive intrusion in front and side crashes and that strong A-pillars and roll bars can help maintain survival space in rollovers, little work has been done examining the real-world crash experience of these vehicles. The objective of this study was to compare the crash experience of recent convertibles with nonconvertible versions of the same cars using the most recent crash data.

METHODS

Crash and exposure data were obtained from the U.S. Department of Transportation and IHS Markit, respectively. Rates of driver deaths and police-reported crash involvements were compared for 1- to 5-year-old convertible cars and their nonconvertible versions during 2014-2018. Exposure measures included registered vehicle years (RVY) and vehicle miles traveled (VMT). These rates were compared using the standardized mortality ratio to account for possible differences in exposure distribution. Crash circumstances (e.g., point of impact, rollover, ejection) and behavioral outcomes (e.g., speeding, alcohol impairment, seat belt use) were compared for drivers killed in crashes.

RESULTS

Convertibles had lower driver death rates and police-reported crash involvement rates on the basis of both RVY and VMT. However, the differences in driver death rates were not statistically significant. Driver deaths per 10 billion VMT were 11% lower for convertibles, and driver involvement in police-reported crashes per 10 million VMT was 6% lower. On average, convertibles were driven 1,595 fewer miles per year than the nonconvertible versions of these cars. Among fatally injured drivers, convertibles had slightly higher rates of ejection, and behavioral differences were minimal. The number of rollovers was small and their rate did not substantially differ between convertibles and their nonconvertible versions.

CONCLUSIONS

Safety concerns associated with convertibles' retractable roof structures were not supported by the results of this study.

[How does a new medicine reach the patient?]

The Medicines Evaluation Board (MEB) grants market authorisation for medicinal products in the Netherlands. The European Medicines Agency (EMA) coordinates the evaluation and safeguarding of medicinal products in the European Union. The core task of the MEB is to evaluate the quality of every medicinal product for which marketing authorisation is applied for by the manufacturer, and to assess the risk - efficacy balance of the product concerned. There are three different procedures that a manufacturer can follow: (a) the national procedure; (b) the decentralised procedure or mutual recognition procedure; (c) the centralised procedure. After marketing authorisation has been granted, the MEB ensures pharmacovigilance in cooperation with partners such as the Netherlands Pharmacovigilance Centre (Lareb). The MEB determines the text of the package leaflet, the packaging and the Summary of Product Characteristics (SmPC). The MEB checks the warnings that are sent out by manufacturers if important new information about a medicinal product becomes available.

Risk communication for labeling all ingredients in consumer products

The labeling of all ingredients contained in consumer products has been requested by consumers concerned regarding their safety. Consequently, regulatory agencies have set guidelines for industries on how to provide safety information regarding the ingredients in their products. However, discordant opinions were raised from stakeholders, resulting in the formation of a risk communication forum among industries, regulatory agencies, consumer groups, and academia. There are several methods that might be utilized to provide ingredient information to consumers: (1) listing all ingredients on the label of products, (2) providing major ingredients on the label of products, (3) presenting all ingredients on the websites of each manufacturer, and (4) listing major ingredients on the label of products and the remainder of ingredients (not on the label) on the websites. Each method might have its own advantages and disadvantages with respect to providing the information regarding the names of the ingredients used in consumer products to the consumers. A continuous risk communication forum might be an effective tool to facilitate an improved understanding of chemical information, toxicological science, regulatory guidelines, labeling methods, and consumers' concern. This study suggests that risk communication efforts may be helpful and a good opportunity for stakeholders to exchange opinions and reach a harmonious conclusion on labeling of consumer products ingredients.

Public Opinion on the Sale of Crib Bumpers

This survey study assesses public opinions on banning the sale of unsafe products, their attention to warning labels, and their beliefs about crib bumpers.

Fatal side impact crash scenarios for rear seat and seat belt-restrained occupants from vulnerable populations

Objective: Previous studies have revealed vulnerability of school-age children and older adults in rear seats in motor vehicle crashes. Detailed information about crashes in which these fatalities occur could help improve vehicle and restraint design.Methods: Police accident reports were obtained for crashes from the Fatality Analysis Reporting System data set. Inclusion criteria were crashes in which there was at least one fatally injured restrained rear seat occupant between the ages of 6 and 12 or 55 and older in a passenger vehicle no older than 10 years at the time of the crash. Reports were reviewed for key crash data. Side impacts were selected for analysis.Results: Thirty-nine side impact crashes met the inclusion criteria, resulting in 46 fatalities of interest. Far-side or nondirect impact cases outnumbered near-side cases by 15-11 for juvenile occupants. Sixty-one percent of occupants were in vehicles with side airbags (SABs), all of which deployed for their position, although torso SABs were only present in 3 cases. Head injuries were present in all juvenile cases with injury data available and older occupants suffered equally from head and torso injuries. Impacts with pickup trucks and heavy trucks made up 31 and 22% of all cases, respectively. Three-quarters of cases were judged as survivable for the fatally injured occupant(s), and 5 of 7 cases deemed unsurvivable involved juvenile decedents. Further, of those deemed survivable, two-thirds had damage comparable in magnitude with the same vehicles in consumer information crash tests, evaluated by photo comparison.Conclusions: Older adults suffered thoracic injuries at a higher rate than older children-who suffered predominately head injuries-and most vehicles did not have torso SABs installed, which could have mitigated thoracic injuries. Side impacts in which younger occupants were killed were more severe than impacts that resulted in the death of an older occupant; however, vehicle damage and intrusion in many fatal impacts for both age cohorts appeared similar to that of consumer information testing. Large pickups and heavy vehicles were the striking vehicle in over half of all fatalities; vehicle designs and crash tests should continue to take this into consideration. This research highlights the need for continued work as the automotive safety community seeks to eliminate fatalities in motor vehicle crashes.

[Requirements for CE-marking of apps and wearables]

Depending on the intended use, apps and wearables can be medical devices. In such cases, the manufacturer has to provide evidence that the requirements stated in directive 93/42/EWG are fulfilled. Depending on the classification of the medical device, several so-called conformity assessment procedures are possible. Once the conformity assessment procedure has been finished successfully, the manufacturer attaches the CE-marking to the product. This assures that all requirements of the directive have been fulfilled and the manufacturer is therefore authorized to put the product onto the market in all member states of the European union. In this article, the possible and practical conformity assessment procedures for apps and wearables are described and their implementation is outlined.For medical devices with sufficiently high-risk classification, the manufacturer has to involve a Notified Body. For the conformity assessment procedure according to annex II, the manufacturer implements a full quality management system and compiles technical documentation. These are supervised and evaluated by Notified Body audits. Especially for startups, it is important for the development of apps and wearables to implement a quality management system early and to fulfill the regulatory requirements, for example, related to the software life-cycle model. This also includes considering accompanying processes during development like risk management, usability engineering, and clinical evaluation.Additionally, it should be pointed out, that according to the new medical device regulation almost all apps will fall at least into class IIa. Thus, the involvement of a Notified Body in the related conformity assessment procedures would be required. Apps that have already been put onto the market as class I devices, and are now upgraded to a higher class, need the approval of a notified body starting from 26 May 2020.

Perspectives on trace chemical safety and chemophobia: risk communication and risk management

Safety issues regarding consumer products contaminated with trace amounts of chemicals are of great concern to consumers, with the degree of concern occasionally escalating to the psychological syndrome, chemophobia (i.e., the fear of chemicals). Hazardous substances frequently implicated in safety concerns include heavy metals (arsenic, mercury, cadmium, and lead), volatile organic compounds (VOC) such as benzene and o-toluidine, pesticides, carcinogens, radioactive substances, and endocrine disrupting chemicals (EDC) such as bisphenol A and phthalates. To improve communication of risk to society, members of academia, government, consumer organizations, and industry participated in this workshop to discuss and exchange perspectives on trace chemical safety. From the perspective of academia, integrated risk assessments need to be implemented to encompass various exposure sources and routes. The identification and investigation of new exposure-related biomarkers are also recommended to verify direct causal relationships between specific chemical exposure and effects on human health. As for regulation, governments need to establish and maintain acceptable limits for trace chemicals in products. In addition, harmonized efforts need to be undertaken among government agencies to share regulatory limits and effectively control trace chemicals in consumer products. Manufacturers need to faithfully abide by Good Manufacturing Practice (GMP) guidelines, monitor sources of contamination, and minimize these for consumer safety. To effectively resolve safety issues arising from trace chemicals exposure, collaborative efforts are needed involving academia, government, consumer organizations, and industry. Further, scientific evidence-based risk assessment is a critical approach to effectively manage trace chemical safety issues.

Perspectives on trace chemical safety and chemophobia: risk communication and risk management

Safety issues regarding consumer products contaminated with trace amounts of chemicals are of great concern to consumers, with the degree of concern occasionally escalating to the psychological syndrome, chemophobia, i.e., the fear of chemicals. Hazardous substances frequently implicated in safety concerns include heavy metals (arsenic, mercury, cadmium, and lead), volatile organic compounds (VOC) such as benzene and o-toluidine, pesticides, carcinogens, radioactive substances, and endocrine disrupting chemicals (EDC) such as bisphenol A and phthalates. To improve communication of risk to society, members of academia, government, consumer organizations, and industry participated in this workshop to discuss and exchange perspectives on trace chemical safety. From the perspective of academia, integrated risk assessments need to be implemented to encompass various exposure sources and routes. The identification and investigation of new exposure-related biomarkers are also recommended to verify direct causal relationships between specific chemical exposure and effects on human health. As for regulation, governments need to establish and maintain acceptable limits for trace chemicals in products. In addition, harmonized efforts need to be undertaken among government agencies to share regulatory limits and effectively control trace chemicals in consumer products. Manufacturers need to faithfully abide by Good Manufacturing Practice (GMP) guidelines, monitor sources of contamination, and minimize these for consumer safety. To effectively resolve safety issues arising from trace chemicals exposure, collaborative efforts are needed involving academia, government, consumer organizations, and industry. Further, scientific evidence-based risk assessment is a critical approach to effectively manage trace chemical safety issues.

Childhood trampoline injuries

INTRODUCTION

With the increasing use of recreational trampolines, more injuries are seen in emergency depart-ments (ED). Little is known about the relationship between adherence to safety precautions and injuries. This retro-spective study aims to describe the types of injuries and the precautions taken when using trampolines, and to investigate the relationship between injuries and safety precautions.

METHODS

We reviewed patient lists and the medical records of children younger than 18 years who were treated between 1 April and 30 September 2014 at the ED of Hospital Unit West, Denmark. Demographic data and type of injury were recorded. Patients or guardians were contacted for a structured telephone interview to describe the safety precautions they had taken before the injury occurred. A total of 113 patients were identified, and 100 patients were included in the phone interviews. A total of 13 patients were excluded due to incorrect/missing phone numbers or lack of a Danish home address.

RESULTS

6% of all children treated in the ED had trampoline-related injuries. A total of 58 (51.3%) patients had fracture injuries, and 55 (48.7%) patients had non-fracture injuries. 4% had complied with all five recommended safety precautions.

CONCLUSIONS

This study describes types of injuries and safety precautions related to trampoline use. 6% of all children in the ED had an injury related to trampoline use. 4% complied with all five recommended safety precautions.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

Quantitative screening for endocrine-disrupting bisphenol A in consumer and household products using NanoAptamer assay

The NanoAptamer assay is a bisphenol A (BPA) quantification method that uses magnetic beads, quantum dot nanoparticles, and a BPA-specific aptamer. In this study, screening of various consumer and household products for BPA was demonstrated utilizing the NanoAptamer assay. First, the experimental conditions suitable for BPA detection using the NanoAptamer assay were examined in terms of incubation time, temperature, and buffer composition. The range of BPA quantification via the NanoAptamer assay was determined to be 0.005-1000 ng/mL of BPA. The selectivity was confirmed by detecting BPA in an analog mixture containing bisphenol S and bisphenol F. Finally, a leaching experiment using 20 consumer and household products classified into 4 categories was performed to demonstrate the capability of the NanoAptamer assay for BPA detection. The experiment was validated by high-performance liquid chromatography analysis (correlation coefficient, r = 0.99).

Rollover injury in vehicles with high-strength-to-weight ratio (SWR) roofs, curtain and side airbags, and other safety improvements

PURPOSE

This study investigated trends in severe injury and ejection in rollover crashes involving lap-shoulder-belted drivers and right-front passengers. It was conducted because of changes in 2009 to consumer information programs and regulations related to rollover protection. The data are presented by model year (MY) of the vehicle in groups from 1995 to 2016. NASS-CDS cases with 2010-2016 MY vehicles were also evaluated to determine the crash circumstances and causes for severe injury of belted occupants in vehicles with a high strength-to-weight (SWR) roof, curtain, and side airbags and other safety improvements.

METHODS

1997-2015 NASS-CDS data were evaluated for severe injury and ejection of lap-shoulder-belted front outboard occupants in light vehicles. Crashes were grouped by front, side, rear, and rollover. The injury and ejection data were grouped by vehicle MY: 1995-1999, 2000-2004, 2005-2009, and 2010-2016. Only drivers and right-front passengers were included if they were lap-shoulder belted and 15+ years old. Severely injured occupants were defined as those with Maximum Abbreviated Injury Scale (MAIS) 4-6 or fatality (MAIS 4 + F). National estimates were made with weighted data using the ratio weight in NASS-CDS. All NASS-CDS electronic cases were evaluated for belted occupants with MAIS 4 + F injury in rollovers involving 2010-2016 MY vehicles. The crash circumstances and injuries were studied. These vehicles had high-SWR roofs to meet Insurance Institute for Highway Safety (IIHS) ratings and FMVSS 216.

RESULTS

The 1997-2015 NASS-CDS included 2,083,776 belted front occupants in rollover crashes with 24,466 (1.17%) MAIS 4 + F injuries. The frequency of rollover crashes has decreased with modern vehicles (P < .0001). The 1995-1999 MY vehicles involved in a rollover accounted for 7.03% of all crashes (756,228/10,760,000). The corresponding proportion was 3.57% with 2010-2016 MY vehicles (81,406 vs. 2,282,062). The risk for MAIS 4 + F was 1.325 ± 0.347% in rollover crashes with 1995-1999 MY vehicles. It was 27.2% lower in 2010-2016 MY vehicles at 0.964 ± 0.331% (P < .001). There were 42,567 (2.002%) ejections of belted occupants in rollover crashes, irrespective of injury outcome. The risk for ejection was 3.042 ± 1.44% in rollover crashes with 1995-1999 MY vehicles. It was 43.6% lower in 2004-2009 MY vehicle at 1.715 ± 0.660% (P < .001) and 83.4% lower in 2010-2016 MY vehicle at 0.505 ± 0.336% (P < .001). There were 17 rollovers with MAIS 4 + F in 2010-2016 MY vehicles in NASS-CDS. Their roof strength was SWR =4.15 ± 1.05 based on 15 vehicles. Many of the collisions involved front or side impacts and then a rollover. Four cases involved 16- to 30-year-old drivers in extremely high-speed loss-of-control crashes resulting in >10-cm vertical roof deformation or substantial roof deformation based on photos. The roof strength (SWR) of 4.20 ± 1.0 was not sufficient to prevent roof deformation in these crashes.

CONCLUSIONS

This study found a reduction in severe injury and ejection risk with modern vehicles. It indicates that vehicle safety has improved in response to IIHS and NHTSA efforts to expand the array of safety requirements and increase performance so that newer models are safer than earlier ones. There has been an incremental improvement in safety due to these advances.

A Tiered Approach for the Evaluation of the Safety of Botanicals Used as Dietary Supplements: An Industry Strategy

Exposure to botanicals in dietary supplements is increasing across many geographies; with increased expectations from consumers, regulators, and industry stewards centered on quality and safety of these products. We present a tiered approach to assess the safety of botanicals, and an in silico decision tree to address toxicity data gaps. Tier 1 describes a Threshold of Toxicologic Concern (TTC) approach that can be used to assess the safety of conceptual levels of botanicals. Tier 2 is an approach to document a history of safe human use for botanical exposures higher than the TTC. An assessment of botanical-drug interaction (BDI) may also be necessary at this stage. Tier 3 involves botanical chemical constituent identification and safety assessment and the in silico approach as needed. Our novel approaches to identify potential hazards and establish safe human use levels for botanicals is cost and time efficient and minimizes reliance on animal testing.

Getting to the Root of the Matter: Challenges and Recommendations for Assessing the Safety of Botanical Dietary Supplements

The National Toxicology Program's (NTP) mission is "to evaluate agents of public health concern, by developing and applying the tools of modern toxicology and molecular biology." Botanical dietary supplements (BDS) represent agents of public health concern due to widespread exposure to high doses, a lack of safety data for most products, variable quality, and reports of adverse events. This commentary will address lessons learned in NTP testing activities with BDS and recommendations for moving forward.

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

Listeria, Then and Now: A Call to Reevaluate Patient Teaching Based on Analysis of US Federal Databases, 1998-2016

INTRODUCTION

Listeria monocytogenes is a foodborne pathogen capable of crossing the placental-fetal barrier; infection with the bacterium causes listeriosis. An exposed fetus may suffer blindness, neurological damage including meningitis, or even death. The adverse consequences of listeriosis place the infection on the federally reportable disease list. Primary prevention relies on women avoiding 6 categories of foods most likely to be contaminated with L monocytogenes, as indicated in guidelines developed by the Centers for Disease Control and Prevention (CDC), adapted by the American College of Obstetricians and Gynecologists (ACOG) in 2014, and reaffirmed without changes by ACOG in 2016. This report contains a critical evaluation of United States listeriosis prevention guidelines.

METHODS

Between 1998 and 2016, there were 876 identified listeriosis events documented in the illness and recall databases maintained by the CDC, Food and Drug Administration (FDA), and United States Department of Agriculture - Food Safety and Inspection Service (USDA-FSIS). Each contaminated food was manually compared to the existing listeriosis avoidance guidelines, placing each event within or outside the guidelines. Trends were analyzed over time.

RESULTS

Database analysis demonstrates that prior to the year 2000, abiding by the current guidelines would have prevented all reported listeriosis cases. However, in 2015 and 2016, only 5% of confirmed L monocytogenes infections originated from the 6 food groups listed in the CDC and ACOG guidelines. Similar trends emerged for food processing plant recalls (USDA-FSIS database) and grocery store recalls (FDA database). The total number of listeriosis illnesses in the United States doubled from 2007 to 2014.

DISCUSSION

A gradual shift in detection of L monocytogenes contamination in ready-to-eat meals, frozen foods, and ready-to-eat salads has occurred. Another emerging culprit is pasteurized dairy products. Revision of listeriosis avoidance guidelines by a consensus-seeking, multidisciplinary task force, is needed.

Species Adulteration in the Herbal Trade: Causes, Consequences and Mitigation

The global economy of the international trade of herbal products has been increasing by 15% annually, with the raw material for most herbal products being sourced from South and Southeast Asian countries. In India, of the 8000 species of medicinal plants harvested from the wild, approximately 960 are in the active trade. With increasing international trade in herbal medicinal products, there is also increasing concern about the widespread adulteration and species admixtures in the raw herbal trade. The adverse consequences of such species adulteration on the health and safety of consumers have only recently begun to be recognised and documented. We provide a comprehensive review of the nature and magnitude of species adulteration in the raw herbal trade, and identify the underlying drivers that might lead to such adulteration. We also discuss the possible biological and chemical equivalence of species that are used as adulterants and substitutes, and the consequences thereof to consumer health and safety, and propose a framework for the development of a herbal trade authentication service that can help regulate the herbal trade market.

Concentrations of trace metals, phthalates, bisphenol A and flame-retardants in toys and other children's products in Israel

Trace metals and synthetic chemicals including phthalates, bisphenol A and flame retardants, are widely used in toys and childcare products, and may pose acute or chronic adverse health effects in children. In Israel, certain chemicals are regulated in childcare products, but there are still regulatory gaps. We tested regulated and unregulated contaminants in 174 item parts from 70 childcare items with potentially high oral or dermal exposure, including 22 children's jewelry items, 14 toys, 7 diaper-changing mats, 6 baby mattresses, 7 baby textiles and 14 feeding and bathing items. In children's jewelry, an unregulated product in Israel, 23% of samples exceeded the US standard for lead. In toys, a regulated product, we did not detect trace metals above the Israeli standard. In textiles, baby mattresses and diaper-changing mats, phthalates exceeded the European Union standard in 14-45% of tests with a mean of 6.74% by mass for diisononyl phthalate, and 1.32% by mass for di(2-ethylhexyl) phthalate. BPA migration exceeded the EU standard in 14-45% of tests with a mean of 1.03 ppm. The flame retardants polybrominated biphenyls, pentabromodiphenyl, octabromodiphenyl ether, tris(2,3-dibromopropyl) phosphate and tris-(aziridinyl)-phosphine oxide were not detected. For products regulated in Israel, our findings suggest general compliance with mandatory standards. However, a lack of comprehensive chemical regulation means that there are regulatory gaps, and products not regulated in Israel may contain high levels of chemical contamination, exceeding US or EU regulations. The results of this study have prompted the development of an Israeli safety standard for children's jewelry.

Methods for examining data quality in healthcare integrated data repositories

This paper summarizes content of the workshop focused on data quality. The first speaker (VH) described data quality infrastructure and data quality evaluation methods currently in place within the Observational Data Science and Informatics (OHDSI) consortium. The speaker described in detail a data quality tool called Achilles Heel and latest development for extending this tool. Interim results of an ongoing Data Quality study within the OHDSI consortium were also presented. The second speaker (MK) described lessons learned and new data quality checks developed by the PEDsNet pediatric research network. The last two speakers (JB, RG) described tools developed by the Sentinel Initiative and University of Utah's service oriented framework. The workshop discussed at the end and throughout how data quality assessment can be advanced by combining best features of each network.

Comparative assessment of HPHC yields in the Tobacco Heating System THS2.2 and commercial cigarettes

There has been a sustained effort in recent years to develop products with the potential to present less risk compared with continued smoking as an alternative for adult smokers who would otherwise continue to smoke cigarettes. During the non-clinical assessment phase of such products, the chemical composition and toxicity of their aerosols are frequently compared to the chemical composition and toxicity of the smoke from a standard research cigarette - the 3R4F reference cigarette. In the present study, it is demonstrated that results of these analytical comparisons are similar when considering commercially available cigarette products worldwide. A market mean reduction of about 90% is observed on average across a broad range of harmful and potentially harmful constituents (HPHC) measured in the aerosol of a candidate modified risk tobacco product, the Tobacco Heating System 2.2 (THS2.2), compared against the levels of HPHC of cigarettes representative of selected markets; this mean reduction is well in line with the reduction observed against 3R4F smoke constituents in previous studies.

Comparison of Listeria monocytogenes recoveries from spiked mung bean sprouts by the enrichment methods of three regulatory agencies

Three selective enrichment methods, the United States Food and Drug Administration's (FDA method), the United States Department of Agriculture Food Safety Inspection Service's (USDA method), and the EN ISO 11290-1 standard method, were assessed for their suitability for recovery of Listeria monocytogenes from spiked mung bean sprouts. Three parameters were evaluated; the enrichment L. monocytogenes population from singly-spiked sprouts, the enrichment L. monocytogenes population from doubly-spiked (L. monocytogenes and Listeria innocua) sprouts, and the population differential resulting from the enrichment of doubly-spiked sprouts. Considerable L. monocytogenes inter-strain variation was observed. The mean enrichment L. monocytogenes populations for singly-spiked sprouts were 6.1 ± 1.2, 4.9 ± 1.2, and 6.9 ± 2.3 log CFU/mL for the FDA, USDA, and EN ISO 11290-1 methods, respectively. The mean L. monocytogenes populations for doubly-spiked sprouts were 4.7 ± 1.1, 5.5 ± 1.3, and 4.6 ± 1.4 log CFU/mL for the FDA, USDA, and ISO 11290-1 enrichment methods, respectively. The corresponding mean population differentials were 2.8 ± 1.1, 3.3 ± 1.3, and 3.6 ± 1.4 Δlog CFU/mL for the same three enrichment methods, respectively. The presence of L. innocua and resident microorganisms on the sprouts negatively impacted final levels of L. monocytogenes with all three enrichment methods.

Meat and meat products – analysis of the most common threats in the years 2011-2015 in Rapid Alert System for Food and Feed (RASFF)

BACKGROUND

The key tool used in the European Union in order to eliminate the risks associated with the consumption of potentially hazardous food is RASFF - Rapid Alert System for Food and Feed Safety. The RASFF was established to increase accountability and strengthening cooperation between states of the European Union in the field of food safety control.

OBJECTIVE

The aim of this study was to explore the trends and temporal and spatial distribution of notifications on food safety hazards between January 2011 and December 2015 with a special emphasis on meat and meat products on the basis of notification from RASFF.

MATERIAL AND METHODS

The study analyzed notifications on the annual reports of the RASFF published by the European Commission and requests added to the portal RASFF in the period 01.01.2011 - 31.12.2015 on the category of “meat and meat products (other than poultry) and “poultry meat and poultry meat products”. Analysis included detailed information on each notification, such as the classification and date, hazard category, notifying country, country origin.

RESULTS

The most common classifications of notification were ‘alert’ and ‘border rejection’. Generally, basis of this notifications were ‘company’s own check’ and ‘official control on the market’. Pathogenic microorganisms were the most often hazard of category in which the higher number of notifications concerned with Salmonella spp.

CONCLUSION

Alert notification which is the most dangerous for consumers were the most common type of classification for notifications on ‘meat and meat product’ category. The most of notifications in category ‘poultry meat and poultry meat products’ were the result of border control. Pathogenic microorganisms were the reason for the huge number of notifications in studied product categories. Many of notifications were associated with products which origin countries were outside RASFF member states.

Assessment of organochlorine pesticide residues in raw food samples from open markets in two African cities

This study investigates the level of organochlorine pesticides in the raw food from open markets in Kinshasa, Democratic Republic of Congo (DRC), and Johannesburg, South Africa. It assesses the potential health risks associated with the organochlorine pesticide residues. The Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS) method has been developed for sample preparation. A total of 120 food samples (beans, cabbage, beef, and fish) were obtained from the open markets. The mean concentrations of organochlorine pesticides in raw foods collected from the Johannesburg market were significantly higher (p < 0.05) than those from the Kinshasa market. DDE recorded the highest mean concentration (253.58 ± 4.78 μg kg^-1) in beef from Johannesburg, and α-BHC recorded the lowest mean concentration (38.54 ± 7.46 μg kg^-1) in beans from Kinshasa. The investigation of health risk estimates revealed that the number of organochlorine pesticides exceeded the reference dose in the collected food samples.

A Perspective on the Safety of Cosmetic Products: A Position Paper of The American Council on Science and Health

Over the years, some activist groups have targeted cosmetics as possible human health threats, claiming that cosmetic ingredients are not adequately tested for safety and may pose risks to consumers. The groups allege that industry practices related to safety testing are flawed, that there is little government oversight, and that cosmetics contain cancer-causing chemicals and other toxicants. A critical review of the scientific data related to these claims indicates the following: (1) Industry has the primary responsibility to ensure that all ingredients, preservatives, and coformulants used in products are safe for their intended uses. (2) The U.S. Food and Drug Administration (FDA) has regulatory oversight of the cosmetic industry. Its authority includes the banning or restriction of ingredients for safety reasons. (3) The Cosmetic Ingredient Review (CIR), an independent, scientific review board, critically evaluates chemical ingredients used in cosmetics and publishes the results of its findings in the peer-reviewed literature. (4) Health-related allegations about cosmetic ingredients are generally based on the results of high-dose laboratory testing in animals and have little relevance for humans. As true now as when Paracelsus said it in the 16th century, “It is the dose that makes the poison.” (5) The health-related allegations involving specific chemicals (e.g., phthalates, parabens, and 1,3-butadiene) fail to consider important scientific studies and recent regulatory conclusions about these chemicals, which have found that they are not hazardous. (6) Animal and human physiology differ in crucial ways, further invalidating simplistic attempts to extrapolate rodent testing to human health risks. The cosmetic industry should be encouraged to publish more of its toxicity studies and safety evaluations, which would aid in dispelling the uncertainty that some consumers have about cosmetic safety.

Exposure factors for cleaning, automotive care, and surface protection products for exposure assessments

Accurately measuring the usage patterns of consumer products (CPs) is important to conduct realistic exposure assessments. We determined the exposure factors for 18 consumer products: household bleach, mold stain remover, all-purpose cleaner, washing machine cleaner, air conditioner cleaner, glass cleaner, drain cleaner, adhesive remover, liquid snow chain, tire shine spray, wheel cleaner, rain repellent, car wax spray, leather polish, furniture polish, anti-fog product, fabric waterproofing spray, and rust inhibitor. Field survey staff visited homes and collected product use information via face-to-face interviews. In total, 10,000 participants (5010 men and 4990 women) aged 15 years and older completed the questionnaire. Household bleach had the highest use rate of 47.4% and use rates for the other products ranged from 0.8 to 21.7%. The use rates of many CPs differed by age group and gender. Many household cleaning products were used regularly, but some products, such as air conditioner cleaner and liquid snow chain, were used in specific seasons or for specific purposes; therefore, they were used less frequently compared to cleaning products. These exposure factor data will be useful as input data for exposure and risk assessments and setting safety guidelines.

Do Consumers Want More Nutritional and Health Information on Wine Labels? Insights from the EU and USA

The global strategy to reduce the harmful use of alcohol launched in 2010 by the World Health Organization includes, amongst several areas of recommended actions, providing consumer information about, and labelling, alcoholic beverages to indicate alcohol-related harm. Labelling requirements worldwide for alcoholic drinks are currently quite diverse and somewhat limited compared to labelling on food products and on tobacco. In this context, the current paper contributes to the academic and political debate on the inclusion of nutritional and health information on wine labelling, providing some insights into consumer interest in, and preferences for, such information in four core wine-producing and -consuming countries: Italy, France, Spain, and the United States of America. A rating-based conjoint analysis was performed in order to ascertain consumer preferences for different formats of additional information on wine labels, and a segmentation of the sample was performed to determine the existence of homogeneous groups of consumers in relation to the degrees of usefulness attached to the nutritional and health information on wine labels. Our results highlight the interest expressed by European and United States consumers for introducing nutrition and health information on wine labels. However, the results of conjoint analysis show some significant differences among stated preferences of the information delivery modes in different countries. In addition, segmentation analysis reveal the existence of significant differences between consumer groups with respect to their interest in receiving additional information on wine labels. These differences are not only linked to the geographic origin of the consumers, or to socio-demographic variables, but are also related to wine consumption habits, attitudes towards nutritional information, and the degree of involvement with wine. This heterogeneity of consumer preferences indicates a need for a careful consideration of wine labelling regulations and merits further investigation in order to identify labelling guidelines in terms of the message content and presentation method to be used.

Comparison of rates of safety issues and reporting of trial outcomes for medical devices approved in the European Union and United States: cohort study

OBJECTIVE

 To evaluate safety alerts and recalls, publication of key trial outcomes, and subsequent US approval of high profile medical devices introduced in the European Union.

DESIGN

 Cohort study.

SETTING

 Novel cardiovascular, orthopedic, and neurologic devices approved in the EU through Conformité Européenne marking between 2005 and 2010.

DATA SOURCES

 Public and commercial databases searched up to January 2016 for press releases and announcements of approvals; public Food and Drug Administration and European regulatory authority databases for US approvals and safety alerts and recalls; and Medline, Embase, and Web of Science for peer reviewed publications.

MAIN OUTCOME MEASURES

 We categorized the novelty of the devices in the study sample as a "major innovation" or an "other change," and extracted descriptive data about the devices and information on any safety alerts and withdrawals. Linear regression models examined factors associated with differential EU and US approvals. Cox proportional hazards regression models were used to evaluate factors associated with safety alerts and recalls and the publication of trial outcomes for devices categorized as major innovations. Models controlled for time, therapeutic category, regulatory pathway, size of sponsoring company, and indicator variables for devices approved first in the EU and devices approved only in the EU.

RESULTS

 67% (206/309) of devices identified were approved in both the US and the EU, of which 63% (129/206) were approved first in the EU. The unadjusted rate of safety alerts and recalls for devices approved first in the EU was 27% (62/232) compared with 14% (11/77) for devices approved first in the US. The adjusted hazard ratio for safety alerts and recalls was 2.9 (95% confidence interval 1.4 to 6.2) for devices approved first in the EU. The results of pivotal trials were published for 49% (37/75) of devices categorized as major innovations, with an overall publication rate of 37% five years after approval.

CONCLUSIONS

 Devices approved first in the EU are associated with an increased risk of post-marketing safety alerts and recalls. Poor trial publication rates mean that patients and clinicians need greater regulatory transparency to make informed decisions about treatment.

Support for the revocation of general safety test regulations in biologics license applications

The United States Food and Drug Administration recently removed the requirement for a General Safety Test (GST) for biologics in the Code of Federal Regulations (21 CFR 610.11). The GST, as well as abnormal toxicity (European Pharmacopeia) and innocuity tests (World Health Organization), were designed to test for extraneous toxic contaminants on each product lot intended for human use. Tests require one-week observations for general health and weight following injection of specified volumes of product batches into guinea pigs and mice. At the volumes specified, dose-related toxicity may result when the product is pharmacologically active in rodents. With vaccines, required doses may be > 3 logs higher than intended human dose on a weight-adjusted basis and if an immune modulatory adjuvant is included, systemic immune hyperactivation may cause toxicity. Herein, using the CpG/alum adjuvant combination we evaluated the different test protocols and showed their unsuitability for this adjuvant combination.

Near real-time vaccine safety surveillance using electronic health records-a systematic review of the application of statistical methods

PURPOSE

Pre-licensure studies have limited ability to detect rare adverse events (AEs) to vaccines, requiring timely post-licensure studies. With the increasing availability of electronic health records (EHR) near real-time vaccine safety surveillance using these data has emerged as an option. We reviewed methods currently used to inform development of similar systems for countries considering their introduction.

METHODS

Medline, EMBASE and Web of Science were searched, with additional searches of conference abstract books. Questionnaires were sent to organizations worldwide to ascertain unpublished studies. Eligible studies used EHR and regularly assessed pre-specified AE to vaccine(s). Key features of studies were compared descriptively.

RESULTS

From 2779 studies, 31 were included from the USA (23), UK (6), and Taiwan and New Zealand (1 each). These were published/conducted between May 2005 and April 2015. Thirty-eight different vaccines were studied, focusing mainly on influenza (47.4%), especially 2009 H1N1 vaccines. Forty-six analytic approaches were used, reflecting frequency of EHR updates and the AE studied. Poisson-based maximized sequential probability ratio test was the most common (43.5%), followed by its binomial (23.9%) and conditional versions (10.9%). Thirty-seven of 49 analyses (75.5%) mentioned control for confounding, using an adjusted expected rate (51.4% of those adjusting), stratification (16.2%) or a combination of a self-controlled design and stratification (13.5%). Guillain-Barré syndrome (11.9%), meningitis/encephalitis/myelitis (11.9%) and seizures (10.8%) were studied most often.

CONCLUSIONS

Near real-time vaccine safety surveillance using EHR has developed over the past decade but is not yet widely used. As more countries have access to EHR, it will be important that appropriate methods are selected, considering the data available and AE of interest.

Effects of culture (China vs. US) and task on perceived hazard: Evidence from product ratings, label ratings, and product to label matching

In the current study, 44 Chinese and 40 US college students rated their perceived hazard in response to warning labels and products and attempted to match products with warning labels communicating the same level of hazard. Chinese participants tended to provide lower ratings of hazard in response to labels, but hazard perceived in response to products did not significantly differ as a function of culture. When asked to match a product with a warning label, Chinese participants' hazard perceptions appeared to be better calibrated, than did US participants', across products and labels. The results are interpreted in terms of constructivist theory which suggests that risk perceptions vary depending on the "frame of mind" evoked by the environment/context. Designers of warnings must be sensitive to the fact that product users' cognitive representations develop within a culture and that risk perceptions will vary based on the context in which they are derived.

Crash protectiveness to occupant injury and vehicle damage: An investigation on major car brands

This study sets out to investigate vehicles' crash protectiveness on occupant injury and vehicle damage, which can be deemed as an extension of the traditional crash worthiness. A Bayesian bivariate hierarchical ordered logistic (BVHOL) model is developed to estimate the occupant protectiveness (OP) and vehicle protectiveness (VP) of 23 major car brands in Florida, with considering vehicles' crash aggressivity and controlling external factors. The proposed model not only takes over the strength of the existing hierarchical ordered logistic (HOL) model, i.e. specifying the order characteristics of crash outcomes and cross-crash heterogeneities, but also accounts for the correlation between the two crash responses, driver injury and vehicle damage. A total of 7335 two-vehicle-crash records with 14,670 cars involved in Florida are used for the investigation. From the estimation results, it's found that most of the luxury cars such as Cadillac, Volvo and Lexus possess excellent OP and VP while some brands such as KIA and Saturn perform very badly in both aspects. The ranks of the estimated safety performance indices are even compared to the counterparts in Huang et al. study [Huang, H., Hu, S., Abdel-Aty, M., 2014. Indexing crash worthiness and crash aggressivity by major car brands. Safety Science 62, 339-347]. The results show that the rank of occupant protectiveness index (OPI) is relatively coherent with that of crash worthiness index, but the ranks of crash aggressivity index in both studies is more different from each other. Meanwhile, a great discrepancy between the OPI rank and that of vehicle protectiveness index is found. What's more, the results of control variables and hyper-parameters estimation as well as comparison to HOL models with separate or identical threshold errors, demonstrate the validity and advancement of the proposed model and the robustness of the estimated OP and VP.

Pesticide residues in raw agricultural products from the south-eastern region of Poland and the acute risk assessment

BACKGROUND

The use of pesticide leads to the increase in quantity and quality of yields, but may also result in presence of toxic contaminants in food products.

OBJECTIVE

The aim of this study was to evaluate presence of pesticide residues in raw agricultural products from the south-eastern region of Poland, to verify their compliance with the maximum residue levels' (MRLs) as specified in the EU regulations concerning products present in the market, and to assess the acute risk related to consumption of these products.

MATERIAL AND METHODS

Samples of raw agricultural products were obtained from production farms as a part of an official premarket monitoring of pesticide residues conducted on behalf of the Ministry of Agriculture and Rural Development, implemented in cooperation with the regional Inspectorates of Plant Health and Seed Inspection. The scheduled tests covered determination of 243 chemicals included in residue definitions for purposes of pesticide residues monitoring in or on food of plant origin (229 pesticides).

RESULTS

In 2015, a total of 328 samples of raw commodities collected from the south-eastern region of Poland were analysed for the presence of pesticide residues. Pesticide residues were detected in 84 samples (25.6%), while in 7 samples (2.1%) they exceeded MRLs. Violations of MRLs concerned 2 samples of Peking Cabbage, 3 samples of dill, 1 sample of raspberry and 1 sample of spinach. The pesticide residues were most often found in: fruit (38.3% of all fruit samples), herbs (35.3%) and vegetables (20.0%). The assessed acute exposure did not exceed the 100% acute reference dose (ARfD) in any sample.

CONCLUSIONS

Monitoring of pesticide residues in the agricultural crops prevents penetration of products with MRLs exceeded or containing unacceptable pesticide residues into the market, thus protecting consumers' health.

KEY WORDS

pesticide residues, agricultural products, risk assessment, multiresidue method.

Opinion of the Scientific Committee on Consumer Safety (SCCS)--Opinion on the safety of the use of β-arbutin in cosmetic products

CONCLUSION OF THE OPINION

The SCCS considers the use of β-arbutin to be safe for consumers in cosmetic products in a concentration up to 7% in face creams provided that the contamination of hydroquinone in the cosmetic formulations remain below 1 ppm. A potential combined use of β-arbutin and other hydroquinone releasing substances in cosmetic products has not been evaluated in this Opinion.