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Using the Toxic Exposure Surveillance System To Detect Potential Chemical Terrorism Events

Amy B. Funk,1 J. Schier1, M. Belson,1 M. Patel,1 C. Rubin,1 W. Watson,2 T. Litovitz,2 E. Kilbourne3
Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC; 2American Association of Poison Control Centers, Washington, D.C.; 3National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, CDC

Corresponding author: Amy B. Funk, CDC, 4770 Buford Hwy., MS F-46, Atlanta, GA 30341-3717. Telephone: 770-488-3402; Fax: 770-488-3450; E-mail:


Introduction: CDC and the American Association of Poison Control Centers are using the Toxic Exposure Surveillance System (TESS) to improve public health surveillance of health hazards associated with chemical exposures. TESS is a national real-time surveillance database that records all human exposures to potentially toxic substances reported to U.S. poison control centers.

Objectives: TESS is used to facilitate early detection of illness associated with a chemical release by monitoring daily clinical effects reported to the database.

Methods: Computer-generated surveillance is conducted daily on each clinical effect (n = 131). The frequency of each clinical effect during a 24-hour interval is compared with a historic baseline. The historic baseline is defined as the mean frequency for each clinical effect during the 2-week period surrounding the 247-hour interval, during the preceding 3 years. An aberration is identified when the observed number of cases with a given clinical effect exceeds the expected limit (historic baseline plus 2 standard deviations). Cases identified through this system are evaluated, and respective poison control centers are contacted when unusual patterns in location, substance, or outcome are noted.

Results: Aberrations have identified clusters of clinical effects occurring within a 24-hour period. Further investigation has identified clusters with a single etiology (e.g., 16 cases of severe gastrointestinal illness from intentional tampering of coffee with arsenic at a church picnic).

Conclusions: Detection of these aberrations indicates that conducting surveillance by using TESS can identify illnesses resulting from intentional or unintentional chemical releases that occur at a single site or, potentially, across multiple locations.

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