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Mycobacterium avium complex organisms (i.e. M. avium and M. intracellular) are opportunistic pathogens that have been isolated from natural waters and drinking water systems throughout the United States. M. avium complex organisms are capable of surviving in distribution system biofilms and have been found to persist as long as 41 months. Due to the opportunistic nature of these organisms, their presence in distribution systems could have significant health implications, especially for immunocompromised individuals. In an attempt to characterize the occurrence and control of M. avium in drinking water distribution systems, pilot-scale experiments and full-scale monitoring of 8 well characterized distribution systems were conducted.