The detection and investigation of, and the response to, an outbreak of green tobacco sickness were described. The outbreak was identified by an agricultural surveillance system in Kentucky. During the cutting of tobacco plants throughout harvest, 47 cases of green tobacco sickness occurred in August and September of 1992. The median age of the cases was 29 years, with three cases being under the age of 16. The most frequent symptoms included weakness, nausea, vomiting, dizziness, abdominal cramps, headache, and difficulty breathing. All cases had worked in fields of wet tobacco where their clothes became wet from moisture on the plants. The authors propose that to reduce the burden of occupational nicotine (54115) poisoning in tobacco workers, additional education and research efforts are needed. Health care providers and public health officials in tobacco growing regions need to became aware of GTS so that it might more easily be recognized and treatment improved. Effective and practical protective clothing and skin barriers should be developed. Finally, improvements were sought in occupational health surveillance to identify populations at risk of developing green tobacco sickness particularly children and migrant workers.