Laurel Garrison

Senior Epidemiologist at CDC, Legionellosis Surveillance and Outbreak Response / CDC

26

Emails

Feb 2015–Dec 2015

Archive range

26 emails found.

RE: Action items from yesterday's call

michizan.goy)" "Lytle, Darren" <[email protected]>, "Fiedler, Jay (CDC michigan.zay)" <[email protected]>, "LaRocco, Toni™ <[email protected]>, "Henry, James" <[email protected]>, "Johnson, Mark (ATSDR/DCHI/CB)" <[email protected]>, "'Valacak, Mark" <MYALACAK@echdus>, "Johnson, Shannon (DHHS)" "Miller, Corinne (CDC michizan.gov)" <[email protected]>

(No subject)

(CDC/ONDIEH/NCEH) <zse1. Gicele.gov>; Johnson, Mark (ATSDR/DCHI/CB) <[email protected]>; Valacak, Mark <MVALACAK @echd.us>; Henry, James <[email protected]>; LaRocco, Toni <[email protected]>; Fiedler, Jay (CDC michigan.gov) <fledieri@ michigan. goy> OK, fet’s go ahead and schedule for Thurs Bec, 10 at 9:00 AM Eastern. ode: i. Here is a proposed agenda... fed free to weigh iron other items we should discuss. Specific to Legionnaires’ disease: What type of assistance Uf any} is being requested? (State and County HD) -jAihat is the role of £PA and what assistance has bean provided so far? {EPA} What is the role of ATSDR and what assistance has been provided so far? (ATSDR) if additional federal assistance is needed, what can COC offer? (COC) Thanks everyone! Laurel xxxEND_PAGE:dhhs03_b0210_0805_0807_3

RE: Legionellosis Outbreak Investigation

4 conference call sounds great. We have 4 good rapport with the hospitals and same details of their activities. McLaren sampled, identified Legionella and hyper chlorinated, which brought most levels to “less thar 1". Hurley has increased filtration {reverse asmiosis} and ion exchange in certain areas, but are not sampling, Vl try to get an update of their activities on Manday. Have a good weekend, dir Jim Henry RS, MBA Environmenial Heatth Supervisor 430 S. Saginaw St., Suite 4 Flint, MI 48502-1540 Phone {810} 257-3418 Fax (810) 257-3125 xxxEND_PAGE:deq16_b5_0892_4900_3965

RE: Legionellosis Outbreak Investigation

trecalled the original ernail. i didn't consider hackers or intended recinients may allow others {unintended recipients) to access their email. It won’t happen again. [hope the statement below is appropriate and adequately conveys the message, Sincerely, din Jim Henry RS, MBA Environmenial Health Supervisor 830 S. Saginaw St, Suite 4 Flint, MI 48502-1540 Phone {810} 257-3618 Fax (810) 257-3125

Legionellosis Outbreak Investigation

Hella Team, The executive suramary regarding the Legionella outbreak is appreciated, but! don’t know if there is consensus that it is over, We have been collabearating with our local, state and federal partners regarding the next stens and efforts to improve mathads to obtain adequate clinical and environmental isolates. Genesee County has had three confirmed Legionella cases, since the beginning of May 2015, The mast recent cases have provided soutum samples to Mclaren Hospital for analysis. We have discussed concerns regarding the hospitals’ lack of success isolating the bacteria and MBCH and CDC have expressed interest to assist with the pracess. Below is a brief summary of the recent cases. Patient #1 was admitted to McLaren Hospital. Approximately one week after being discharged, returned to McLaren and wes diagnosed with Legionella, McLaren attempted, but was unable to collect an adequate respiratory specimen. Patient #1 does net receive Flint water at residence, xxxEND_PAGE:deq16_b5_0892_4900_3966 Patient #2 MDSS 7208825134 Patient #2 was admitted to McLaren Hospital. Anproximately 10 days after being discharged, returned ta Mclaren and was dlagnosed with Legionella, Patient #2 does not receive Flint water at residence. Patient #3 MRSS 7202952800 Patient #2 was admitted to Hurley Hospital. Apnroximately two months after being discharged, went to McLaren and was diagnosed with Legionella. Patient #3 resides anproximately 2-3 miles North of MeLarer Hospital and receives Flint water. A family memeber of Patient #3, indicated that flinesses lingered after returning hore fram Hurley Haspital and also mentioned that there has been low water pressure events at their residence. GCHD is prepared to collect environmental sarnples, as previously discussed, but without the clinical isolate the anvironimental samples may not have much value. if there are recommendations, questions or concerns, please reply to the group, a3 we all have differant roles with the investigation. Thanks Jim Jim Henry RS, MBA Environmenial Health Supervisor Genesee County Health Department www.gehd.us 630 S. Saginew St, Suite 4 Flint, MI 48502-1540 Phone {810} 257-3618 Fax (810) 257-3125 E-mail [email protected]

Flint, Michigan - Legionellosis Outbreak Investigation Summary

Good Afternoon, xxxEND_PAGE:deq16_b5_0892_4900_3967 As we enter summer (finally) here in Michigan, | wanted to share a summary of the analysis of the data around this past year’s increase in legionella cases identified in proximity to the city of Flint. As you'll recall, while there were no clinical specimens available for testing from the 45 cases included in the investigation, there was a significant outreach to gather more patient information from cases. I’ve attached an executive summary of the investigation and analysis to this post. Please feel free to contact us is you have any questions, Jim dim Coiling MPH, RS tHrector, CD Division MIBHHS confidential ¢ and/or privile od informat re 2 closure = or dist 4 sof any cont fidentiai and/or t privileged inforrnation contained in this email is expressiy acon od. aRG are not the intended recipient, please contact the sender by reply e-mail and destroy any and ali copies of the original message xxxEND_PAGE:deq16_b5_0892_4900_3968

water complaint resources

irritation and tap water quality UK Drinking Water.pdf; SF Water 2013 Chloramines and skin irritation.pdf; Weintraub 2006 Hetergeneous dermatitis complaints after change in DW treatment Env Hith.pdf Hi Suzanne Thank you for the information on Legionella. For the non-lagionaila water issues, here are same documerts that might assist with thinking about complaints related to drinking water. The 2007 investigation in Vermont has some questions designed to assess health effects such as darrnatitis that might be helpful. However that investigation was very difficult, partly because some members of the community and outside groups attempted to Influence the results of the investigation. If you want te discuss that investigation further, | can contact the staff whe participated for their feedback. Hf you want to pursue these other complaints, it would be good to gather standard inforrnation on each cornplaint and categorize by syndrome, time, location, etc. You might already being doing this. We previously discussed syndramic surveillance; lam glad to discuss that further if you are interested. We don’t have experience doing that type of analysis in this situation but there might be athers who da. Regards Jonathan

RE: Follow-up Information

Attached is additional information Shurood prepared yesterday to supplement cur conversation Information, it includes the number of canfirmed Legionella cases in Genesee County by calendar year. To clarify, the number we quoted for 2013 yesterday reflects our fiscal year which is October 2012-3013 and included confirmed and suspect cases. 1 xxxEND_PAGE:dhhs03_b0323_1188_1196_1 001189 Suzanne Cupal, M.PLH. Public Health Superviser Genesee County Health Department 630 S. Saginaw Street Suite 4 Flint, Mi 48502 (819) 788-7970

RE: CDC-GCHD Call, 9:00am Apr 30th

Hello, Attached please find the survey data of cases interviewed by MDHHS and Genesee Co HD so far (Epiinfo analysis} and updated info on the investigation (MDHHS Prelim Stats}. We've included an agenda to help guide tomarraw morning's cali. Call dgenda Summarizing the ® Prehminary Statistics MBHHS (Shannon & Susan} e interview Data MDHHS {Lily & Meghan} o EPI info Analysis @ £Pi Curve GCHD e © Biscussion of Current investigation Au Environmental investigation e Environmental Sampling Protocal cb xxxEND_PAGE:dhhs03_b0323_1188_1196_2 001190 e Piscussic All Additional Recommendations # Additional Recornmendatians COC/AH THi tomorrow then, Susan Bohm, M5 Manager, Enteric & Respiratory Hinesses Epidemiology Unit Surveillance and infectious Disease Epicerniology Division of Communicable Disease Michigan Department of Health and Hurnan Services 201 Townsend 3t, Sth Fir Lansing, Mi 48933 (sh and may iden sd fcs ithe senda! nf vephy e-rail ard

RE: CDC-GCHD Call

Thanks, Suzanne. in just looking at this quickly, Pr wondering Hf you can you break down the epi curve in the following ways: -~Colar code the cases with exposure to McLaren during their incubation periods --Color code by sorne kind of indicator of exposure to Flint water (maybe G.3?). You've probably already looked at this in several different ways, and | think there are other ways to took at it as well, but perhaps that might help us. Thanks!

RE: CDC-GCHD Call

Hello, Yes, 9:00 or 9:30 on Thursday works for us. Let us know the final details when they're decided. O# the topics mentioned below, at this point in time it would be best to focus or: » the current investigation, e® CDC walk-through of the environmental sarnniing protecal, @ anda discussion of any additional recommendations. it's very likely that these topics wil fil our allotted time. There’s no need te discuss the clinical specimen collection and guidance that has already been provided to GCHD and sent te local providers. The syndramic surveillance data project 4 xxxEND_PAGE:dhhs03_b0323_1188_1196_4 001192 would be better handied at the focal/state level and should not take away from the ongoing epi investigation that we're currently assisting GCHD with. Thanks, and we look forward te hearing from you. --fay Jay Fiedler, MS Section Manager Surveillance and Infectious Disease Epidemiology Bureau of Disease Control, Prevention, and Epidemiology Michigan Department of Health and Hurnan Services 201 Townsend St - PO Box 301795 - Lansing, ME 48909 P) 517, 335.9516 - E: fledleriGimichigan.gov Confidentiality Notice: This message, including any attachments, is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure or distribution of this communication(s) is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message.

RE: CDC-GCHD Call

Hi Suzanne, lmet with colleagues and leadership at CDC, and we are very concerned about this Legionnaires’ disease outkreak. it’s very large, one of the largest we know of in the past decade, and community-wide, and in our opinion and experience it needs a comprehensive investigation. i know you all have been working on this for quite a while, but we are unclear 6 xxxEND_PAGE:dhhs03_b0323_1188_1196_6 001194 about which steps have been taken and what is currently known, and we feel a sense of urgency. is it possible to meet before May 8? it's difficult to give advice when we don’t have ali the information, but we are eager to help. You may have already taken several of these steps, but we recornmend a full investigation including the following steps: ~-Generate an epi curve, man the cases, interview ali cases with a hypothesis-generating questionnaire, analyze results

RE: CDC-GCHD Call

Hello Suzanna, Looking at our schedules, we have limited availability of our core staff here at DHHS an Friday May 8°. In order to help prioritize or to determine if we should iook fer an alternate meeting time, can we get an idea of what the agenda will be for this call? Thanks, -lay Jay Fiedler, MS Section Manager xxxEND_PAGE:dhhs03_b0323_1188_1196_7 001195 Surveillance arid Infectious Disease Epidemiciogy Bureau of Disease Contra, Prevention, and Epidernicioay Michigan Departraent of Health and Human Services 204 Townsend Sk - PO Box 30795 - Lansing, MF 48909 Confidentiality Notice: This message, including any attachments, is intended solely for the use of the named recipient(s) and may contain confidential and/or privileged information. Any unauthorized review, use, disclosure or distribution of this communication(s) is expressly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy any and all copies of the original message.

Re: CDC-GCHD Call

Hi Suzanne af al., Hf you are interested in discussing the Legionella action items in more detail, please let me know your availability for a conferance call involving the county, state, and RDB. Rest regards, Laurel Laurel Garrison, MPH Legionellosis Surveillance & Outbreak Resporse NCIRD/DBD/Respiratory Diseases Branch Centers for Disease Control and Prevention 1600 Cifton Rd, ME MS C-25 Atlanta, GA 30333 404.639.3434 fLaes@icde gov xxxEND_PAGE:dhhs03_b0323_1188_1196_8 001196

Re: CDC-GCHD Call

From
Yoder, Jonathan S
Hi Suzanne It was good to speak to you yesterday. | am copying Laurel on this email as the contact for the legionella program. She will coordinate with the state to make sure you have the protocols. We are glad to assist. Jonathan Sent from my iPhone Jonathan- Thank you and your team for the opportunity to speak yesterday. We appreciate your comments about a measured response. We recognize we do not have the data we need for further action. We were grateful for the opportunity to share with you and our state colleagues our concerns based on the information we do have. We are doing everything we can to mitigate risk to our residents. We look forward to receiving the sampling protocols and advice related to syndromic surveillance. Our concerns have now been communicated which opens the door to further communication as events unfold. We are dealing with complex and confounding information. We appreciate your assistance in gathering the facts. We want to be prepared to protect the health and safety of our residents and provide appropriate information. Thank you again. Your Genesee County Colleagues Suzanne Cupal, M.P.H. Public Health Supervisor Genesee County Health Department 630 S. Saginaw Street Suite 4 Flint, MI 48502 (810) 768-7970 xxxEND_PAGE:dhhs03_b0323_1188_1196_9

FW: Legionella Investigation Guidance

Hi Shuroog, i'm forwarding to Shannon in case she hasn't had an opportunity to review. | spoke with her this morning, and it sounds like she has some good ideas about haw to preceed with the investigation and interviewing patients. |’d advise working directly with her on this and then | can review a close to final draft if needed. Thanks! Laurel xxxEND_PAGE:dhhs02_b0554_2097_2100_1 002098

RE: Legionella Investigation Guidance

Hi Shuroog, Lauri isn’t working on legionellosis anymore and she forwarded your email. i'm happy to help brainstorm and/or review your questionnaire. rm also ccing my contacts at the state so they are in the loop. | didn’t get the attachment...can you send again? Best regards, Laurel Laure! Garrison, MPH xxxEND_PAGE:dhhs02_b0554_2097_2100_2 002099 Legionellosis Surveillance & Outbreak Response NCIRD/DBD/Respiratory Diseases Branch Centers for Disease Control and Prevention 1606 Clifton Rd. MS C-25 Atlanta, GA 30333 Tel: 404.639.3424 Fax: 464.315.4680 E-mail: [email protected]

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