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Continuous updating of criteria documents and guidelines is helpful in the improvement of recognising and reporting of occupational and work-related diseases. But these documents focus on known exposure-disease combinations. Meanwhile work, work settings and work procedures are continuously changing which can lead to new occupational health risks. In those cases the occupational physician who has to establish an aetiological diagnosis can usually not rely on existing criteria. He needs to go from deductive reasoning – going from the ‘general’ knowledge to the ‘specific’ case – to a more inductive reasoning in which he gets from the observation of a specific case to a more general hypothesis about the potential causal relation with work exposure. This searching for the unknowns in work and health is a process with lots of uncertainties and few underpinning research.Other scientific fields like pharmacovigilance may help us out. Pharmacovigilance is the approach to detect new and emerging adverse effects of drugs after their release in the market. This type of post marketing surveillance is characterised by gathering signals, strengthening signals, validating signals and acting on signals can be copied and used to detect new and emerging health risks in work situations. This could be addressed as occupational safety and health (OSH) vigilance. Within the MODERNET network, several methods and approaches of OSH vigilance are being explored and implemented, such as datamining in existing databases (e.g. French RNV3P), investigating reported cases in sentinel surveillance schemes (e.g. Norwegian RAS, SENSOR-Pesticides USA), investigating unusual events (e.g. French GAST, and HHE-program USA) and reporting and assessing new and emerging risks (e.g. SIGNAAL, OccWatch, and THOR-extra). International collaboration is imperative to detect rare signals earlier, to strengthen and validate signals easier, to have a wider variety of expertise available, to use scarce resources more effectively, and to increase dissemination to relevant stakeholders.