title: Follow-up assessment of health consequences after a chlorine release from a train derailment--Graniteville, SC, 2005.
abstract: BACKGROUND
  After a train derailment released chlorine gas in Graniteville, South Carolina, in 2005, a multiagency team performed an epidemiologic assessment of chlorine exposure and resulting health effects. Five months later, participants were resurveyed to determine their health status and needs and to assist in planning additional interventions in the community.
  
  
  METHODS
  Questionnaires were mailed to 279 patients interviewed in the initial assessment; follow-up telephone calls were made to nonresponders. The questionnaire included questions regarding duration of symptoms experienced after exposure and a posttraumatic stress disorder (PTSD) assessment tool.
  
  
  RESULTS
  Ninety-four questionnaires were returned. Seventy-six persons reported chronic symptoms related to the chlorine exposure, 47 were still under a doctor's care, and 49 were still taking medication for chlorine-related problems. Agreement was poor between the first and second questionnaires regarding symptoms experienced after exposure to the chlorine (κ=0.30). Forty-four respondents screened positive for PTSD. PTSD was associated with post-exposure hospitalization for three or more nights [relative risk (RR) = 1.7; 95% confidence interval (CI)=1.1-2.6] and chronic symptoms (RR=9.1; 95% CI=1.3-61.2), but not with a moderate-to-extreme level of chlorine exposure (RR=1.2; 95% CI=0.8-1.8).
  
  
  CONCLUSIONS
  Some victims of this chlorine exposure event continued to experience physical symptoms and continued to require medical care 5 months later. Chronic mental health symptoms were prevalent, especially among persons experiencing the most severe or persistent physical health effects. Patients should be interviewed as soon as possible after an incident because recall of acute symptoms experienced can diminish within months.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA. maduncan@cdc.gov
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Duncan
authors.forename: Daniel
authors.initials: D
authors.lastname: Drociuk
authors.forename: Amy
authors.initials: A
authors.lastname: Belflower-Thomas
authors.forename: David
authors.initials: D
authors.lastname: Van Sickle
authors.forename: James J
authors.initials: JJ
authors.lastname: Gibson
authors.forename: Claire
authors.initials: C
authors.lastname: Youngblood
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Daley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000633:toxicity*; D055884:Chemical Hazard Release; D002648:Child; D002675:Child, Preschool; D002713:Chlorine / Q000633:toxicity*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011041:Poisoning / Q000503:physiopathology* / Q000628:therapy; D011890:Railroads; D013022:South Carolina; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D002713:Chlorine