Environmental Health Section

Program on Health Equity and Sustainability

Water Epidemiology--Chloramine

• PHES Home Page
• DPH Water Epidemiology Publications
• Other Publications
  • SFPUC Water Quality Fact Sheets
  • American Water Works Association Fact Sheets

Cryptosporidiosis Surveillance Project

The drinking water epidemiology program has been providing information and support to the SFPUC since the conversion to monochloramine for residual disinfection in 2004, to ensure a safe drinking water supply.

SFDPH continues to support the use of chloramine for secondary disinfection in the SFPUC water system. We continue to follow the recommendations of the California Conference of Local Health Officers in our routine activities, including tracking customer complaints , staying apprised of emerging research, communicating with our expert colleagues and following national and international regulatory and legislative developments. We are committed to identifying and evaluating important research or policy developments in a timely manner. Based on our comprehensive and continuing activities, we continue to support the use of chloramine for secondary disinfection in the SFPUC water system.

Chloramine Links, Fact Sheets and Manuscripts

Heterogeneous dermatitis complaints after change in drinking water treatment: a case report (external link)

Chloramine: The Correct Public Choice

Chloramine Presentation to California Conference of Local Health Officers: July 2004 - (pdf)

On Chloramine: June Weintraub Letter to the SF Chronicle Editor Oct 15 2005

In Depth Chloramination Q&A revised 2007 - (pdf)

SFPUC Main Chloramine Page - (external link)

Reducing Legionella Colonization of Water Systems with Monochloramine (external link)

Pie Chart:  Type Of Residual Disinfectant Used in the 25 Largest Cities in California - (pdf)

SFDPH Chloramine Abstract Review 2007 - (pdf)

Epidemiologic Study Critique: Blood lead and water treatment - (pdf)

Trihalomethanes and Birth Outcomes

The primary objective for the SFPUC switch to monochloramine was to reduce the formation of trihalomethanes (THMs) and haloacetic acids (HAAs). These chemical by-products of disinfection may cause adverse health effects. Chloramine is very effective at limiting the formation of these by-products. Follow the links below for additional information on selected studies of the potential association between THMs and adverse birth outcomes.

Abstract Presented at APHA (June Weintraub)

Summary and Critique of Study by Cedergren et al - fact sheet (pdf)

Summary and Critique of Study by Hwang et al - fact sheet (pdf)