O-chlorobenzylidene malononitrile (CS riot control agent) associated acute respiratory illnesses in a U.S. Army Basic Combat Training cohort

Mil Med. 2014 Jul;179(7):793-8. doi: 10.7205/MILMED-D-13-00514.


Acute respiratory illnesses (ARIs) are among the leading causes for hospital visits in U.S. military training populations and historically peak during U.S. Army Basic Combat Training (BCT) following mandatory exposure to the riot control agent o-chlorobenzylidene malononitrile (CS). This observational prospective cohort studied the association between CS exposures and ARI-related health outcomes in 6,723 U.S. Army recruits attending BCT at Fort Jackson, South Carolina from August 1 to September 25, 2012 by capturing and linking the incidence of ARI before and after the mask confidence chamber to CS exposure data. Recruits had a significantly higher risk (risk ratio = 2.44; 95% confidence interval = 1.74, 3.43) of being diagnosed with ARI following exposure to CS compared to the period of training preceding exposure, and incidence of ARI after CS exposure was dependent on the CS exposure concentration (p = 0.03). There was a significant pre-/postexposure ARI difference across all CS concentration levels (p < 0.01), however, no significant differences were detected among these rate ratios (p = 0.72). As CS exposure is positively associated with ARI health outcomes in this population, interventions designed to reduce respiratory exposures could result in decreased hospital burden and lost training time in the U.S. Army BCT population.

Publication types

  • Observational Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Disease
  • Follow-Up Studies
  • Humans
  • Incidence
  • Military Personnel / education*
  • Occupational Exposure / adverse effects*
  • Prospective Studies
  • Respiratory Tract Diseases / chemically induced*
  • Respiratory Tract Diseases / epidemiology
  • Riot Control Agents, Chemical / adverse effects
  • Risk Factors
  • United States / epidemiology
  • o-Chlorobenzylidenemalonitrile / adverse effects*


  • Riot Control Agents, Chemical
  • o-Chlorobenzylidenemalonitrile