title: Changes in blood lead levels associated with use of chloramines in water treatment systems.
abstract: BACKGROUND
  More municipal water treatment plants are using chloramines as a disinfectant in order to reduce carcinogenic by-products. In some instances, this has coincided with an increase in lead levels in drinking water in those systems. Lead in drinking water can be a significant health risk.
  
  
  OBJECTIVE
  We sought to test the potential effect of switching to chloramines for disinfection in water treatment systems on childhood blood lead levels using data from Wayne County, located in the central Coastal Plain of North Carolina.
  
  
  METHODS
  We constructed a unified geographic information system (GIS) that links blood lead screening data with age of housing, drinking water source, and census data for 7,270 records. The data were analyzed using both exploratory methods and more formal multivariate techniques.
  
  
  RESULTS
  The analysis indicates that the change to chloramine disinfection may lead to an increase in blood lead levels, the impact of which is progressively mitigated in newer housing.
  
  
  CONCLUSIONS
  Introducing chloramines to reduce carcinogenic by-products may increase exposure to lead in drinking water. Our research provides guidance on adjustments in the local childhood lead poisoning prevention program that should accompany changes in water treatment. As similar research is conducted in other areas, and the underlying environmental chemistry is clarified, water treatment strategies can be optimized across the multiple objectives that municipalities face in providing high quality drinking water to local residents.
authors: Nicholas School of the Environment and Earth Sciences, Duke University, Durham, North Carolina 27708, USA. mmiranda@duke.edu
authors: Marie Lynn
authors: ML
authors: Miranda
authors: Dohyeong
authors: D
authors: Kim
authors: Andrew P
authors: AP
authors: Hull
authors: Christopher J
authors: CJ
authors: Paul
authors: M Alicia Overstreet
authors: MA
authors: Galeano
mesh_terms: D002700:Chloramines / Q000633:toxicity*; D004202:Disinfectants / Q000633:toxicity*; D004784:Environmental Monitoring; D006798:Housing / Q000592:standards; D006801:Humans; D007854:Lead / Q000097:blood*; D009657:North Carolina; D013997:Time Factors; D014873:Water Pollutants / Q000097:blood*; D018508:Water Purification
chemical_list: D002700:Chloramines; D004202:Disinfectants; D014873:Water Pollutants; D007854:Lead