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Abstract: Between 1997 and 2002, 16 cases of acute childhood leukemia were diagnosed in children who either lived in Churchill County, Nevada at the time of diagnosis or had lived in the county before their diagnosis. The cases were characterized as a cluster of like illnesses and the probability of having such a cluster occur by chance was estimated to be very small (approximately one in 2.33×108). This suggested that the cluster could be linked to one or more physical, limnological, chemical, or biological agents. This review discusses the setting in which the cluster took place, the epidemiological investigations carried out by the Nevada Bureau of Health Protection Services, the National Center for Environmental Health Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry, and subsequent investigations supported by a special allocation of federal funds through the US Environmental Protection Agency’s Region IX office in San Francisco, CA. This review is meant as background for the papers in this special issue that report results from multi- and interdisciplinary research into environmental and biological factors potentially related to the Churchill County leukemia cluster. [Copyright &y& Elsevier]

Abstract: It is well known to the public in Lahontan Valley in rural Nevada, USA, that local aquifers produce water with varied, but sometimes very high concentrations of arsenic (>4 ppm). As a result, many residents of the area have installed household reverse-osmosis (RO) systems to produce drinking water. We examined performance of RO systems and factors associated with arsenic removal efficiency in 59 households in Lahontan Valley. The sampling results indicated that RO systems removed an average of 80.2% of arsenic from well water. In 18 of the 59 households, arsenic concentrations exceeded 10 ppb in treated water, with a maximum in treated water of 180 ppb. In 3 of the 59 households, RO treatment had little effect on specific conductance, indicating that the RO system was not working properly. Two main factors lead to arsenic levels in treated water exceeding drinking-water standards in the study area. First, arsenic concentrations were high enough in some Lahontan Valley wells that arsenic levels exceeded 10 ppb even though RO treatment removed more than 95% of the arsenic. Second, trivalent As+3 was the dominant arsenic species in approximately 15% of the wells, which significantly reduced treatment efficiency. Measurements of specific conductance indicated that efficiency in reducing arsenic levels did not always correlate with reductions in total dissolved solids. As a consequence, improvements in taste of the water or simple measurements of specific conductance made by technicians to test RO systems can mislead the public into assuming the water meets safety standards. Actual measurements of treated water are necessary to assure that household RO systems are reducing arsenic concentrations to safe levels, particularly in areas where groundwater has high arsenic concentrations or where As+3 is the dominant species. [Copyright &y& Elsevier]