Susan Bohm

Good marning, First of all, many thanks for your cooperation and Input to date into the ongoing Genesee County legionellosis Investigation. One of the aspects of the investigatian into the increase in legionellosis cases since June 2014 that we at MDCH have been assisting with was to determine the ness onset dates of those cases, which we would now Uke to share with you — please see the attached epi curve. Many of the iNness onset dates are estimates based on information

Seems ike the Flint decs are pushing this ide: /wranw cetroitnews 2015/00/24 jead/72725736/

Passing along. Haven't read the whole thing. Jay Fiedler MDHHS SIDE Section Manager 517/335-9516 Begin forwarded message:

FYI this is continuing. Talked with Jen. We won't confirm individual cases. We also feel that they should be talking to the LHD at this point. Jen is getting back to her but is worried that this may get bigger. She's also going to talk with the PIO at DEQ. Jay Fiedler MDCH SIDE Section Manager 517/335-9516 Begin forwarded message:

Susan]; Johnson, Shannon DCH) Administrative Group Shannon]; Fiedler, Jay (DCH) Administrative Group Jay]; Fialkowski, Veronica DCH) Administrative Group Fi]; Tyndall Snow, Leigh (DCH) Administrative Group Lei]; Collins, Jim (DCH) Administrative Group Jim]; Miller, Corinne (DCH) Administrative Group Corinne]

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

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

Thank you Susari and everyone for your work on this and for sharing your findings thus far, i will forward this te the rest of the group here, and we'll talk to you tornorrow at 9. laurel

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

Shannon and | have worked out estimated illness onset dates for the Legionnaires’ disease cases and these are now displayed in graphs in the attached document. One graph shows the dates by day (keyboard effect) and the second shows the dates by month. When | was speaking with Suzanne C at ELC, she was under the impression that the peak was in September — which it is by MDSS referral date, but plotting by illness onset date shows both August and September were peak months. A lesson is the advantages of why we do epi curves! Lily has successfully completed one interview of the very first case and says she will be doing the second today. Susan xxxEND_PAGE:dhhs03_b0317_1166_1166_1

i have so many words that | would like to say right now that aren’t fit for email. it’s still just our supplemental questionnaire with a few questions tacked an. Excuse me while | ga find a pillow to punch repeatedly.