Global Characteristics of Chemical, Biological, and Radiological Poison Use in Terrorist Attacks.

Background: Chemical, biological, and radiological (CBR) terrorism continues to be a global threat. Studies examining global and historical toxicological characteristics of CBR terrorism are lacking.
Methods: Global Terrorism Database (GTD) and RAND Database of Worldwide Terrorism Incidents (RDWTI) were searched for CBR terrorist attacks from 1970 through 2017. Events fulfilling terrorism and poisoning definitions were included. Variables of event date and location, event realization, poisonous agent type, poisoning agent, exposure route, targets, connected events, additional means of harm, disguise methods, poisonings, and casualties were analyzed along with time trends and data gaps.
Results: A total of 446 events of CBR terrorism were included from all world regions. A trend for increased number of events over time was observed (R2 = 0.727; coefficient = 0.511). In these attacks, 4,093 people lost their lives and 31,903 were injured. Chemicals were the most commonly used type of poison (63.5%). The most commonly used poisonous agents were acids (12.3%), chlorine or chlorine compounds (11.2%), riot control agents (10.8%), cyanides (5.8%), and Bacillus anthracis (4.9%). Occurrence of poisoning was confirmed in 208 events (46.6%). Most common exposure routes were skin, mucosa, or eye (57.2%) and inhalation (47.5%). Poison was delivered with additional means of harm in 151 events (33.9%) and in a disguised way in 214 events (48.0%), respectively.
Conclusions: This study showed that CBR terrorism is an on-going and increasingly recorded global threat involving diverse groups of poisons with additional harmful mechanisms and disguise. Industrial chemicals were used in chemical attacks. Vigilance and preparedness are needed for future CBR threats.