At a glance
The goal of the Toxicological Outbreak Investigation Course is to provide information, resources, and learning activities to impart the knowledge and skills needed to investigate a toxicological outbreak.
Toxicological Outbreak Investigation Course
Investigating toxicological outbreaks requires some unique considerations and skills that are different from those used to investigate infectious disease outbreaks.
To help public health agencies investigate non-infectious disease outbreaks, CDC's National Center for Environmental Health (NCEH) developed this course on Toxicological Outbreak Investigations.
The purpose of the course is to train public health staff to recognize and respond to an outbreak caused by a toxic agent and to provide a refresher on outbreak investigation.
The course consists of 7 modules, including 2 case study modules. The modules can be used as part of facilitator-led training, or as a self-study resource.
Module 1. Course Introduction and Overview
Module 1 provides an overview of the course and describes the contents of the Toxicological Outbreak Investigation Toolkit.
Module 2. Toxicological Principles
After completing this module, you will be able to
- Identify characteristics of an outbreak that suggest that it might be caused by a toxic agent
- Define toxidromes
- Identify factors affecting toxicity
- Describe the principles of toxicodynamics and toxicokinetics
- Describe the toxicokinetic principles of absorption, distribution, metabolism, and elimination
Module 3. Toxicological Laboratory Principles
After completing this module, you will be able to
- Explain the importance of early sample collection
- Identify information needed in sample collection protocols
- List laboratory testing considerations
- Discuss collecting comparison samples in an outbreak scenario
Module 4. Analyzing and Interpreting Laboratory Results
After completing this module, you will be able to
- Describe limit of detection (LOD) and two constant values that can be substituted for values less than LOD
- Identify two common examples of making adjustments to laboratory results
- Identify and analyze data that have a log-normal distribution
- Describe information needed to interpret laboratory results, specifically toxic levels associated with illness and comparison values
Module 5. Steps of a Toxicological Outbreak Investigation
Module 5 includes the steps in an outbreak investigation. The module is separated into 3 parts.
After completing Module 5, Part 1, you will be able to
- Recognize indications that an outbreak might be occurring
- Identify reasons to consider investigation of an outbreak
- Recognize factors indicating that an outbreak is potentially caused by a toxic agent
- Identify steps to prepare for fieldwork
Download Module 5 Part 1 slides.
After completing Module 5, Part 2, you will be able to
- Construct a working case definition
- Find cases systematically and record information
- Perform descriptive epidemiology
- Develop a hypothesis
- Evaluate the hypothesis
Download Module 5, Part 2 slides.
After completing Module 5, Part 3, you will be able to
- Refine hypotheses and perform additional studies
- Reconcile epidemiologic data with lab data
- Implement control and prevention measures
- Initiate or maintain surveillance measures
- Communicate findings
Download Module 5, Part 3 slides.
Module 6. Domestic Case Study
In Module 6 you will practice what you have learned in Modules 1-5 by completing a domestic case study.
After completing Module 6, you will be able to
- Apply toxicological outbreak investigation steps
- Interpret lab results
- Describe relevant toolkit resources
Module 7. International case study
In this module, you will practice what you have learned in Modules 1-5 by completing an international case study.
After completing Module 7, you will be able to
- Apply toxicological outbreak investigation steps
- Interpret lab results
- Describe relevant toolkit resources
Toxicological Outbreak Investigation Toolkit
The Toxicological Outbreak Investigation Toolkit is a collection of sample customizable documents that can be used during an outbreak investigation, including:
- Qualitative epidemiological questions
- Sample line list
- Sample log
- Sample medical record abstraction form
- Sample questionnaire
- Toxidrome chart
Download the toolkit.
Toxicological Outbreak Investigation Interactive Online Training
This interactive online training is designed to impart the knowledge and skills needed to investigate a toxicological outbreak.
Launch Module 5 Part 1, Part 2, and Part 3
The interactive online training was last updated in 2019. The overall course content and activities are still accurate and relevant; however, for the most up-to-date materials, please refer to Toxicological Outbreak Investigation Course Module PDFs listed above, which were updated in 2026.
Note: Module 2 of the interactive online training is not available at this time.