Changes in blood lead levels associated with use of chloramines in water treatment systems

Environ Health Perspect. 2007 Feb;115(2):221-5. doi: 10.1289/ehp.9432. Epub 2006 Nov 7.


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.

Objectives: 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Chloramines / toxicity*
  • Disinfectants / toxicity*
  • Environmental Monitoring
  • Housing / standards
  • Humans
  • Lead / blood*
  • North Carolina
  • Time Factors
  • Water Pollutants / blood*
  • Water Purification*


  • Chloramines
  • Disinfectants
  • Water Pollutants
  • Lead