Correspondence between

michizan.goy)" "Lytle, Darren" <Lytle.Darren@epa.gov>, "Fiedler, Jay (CDC michigan.zay)" <fiedleri@michigan.gov>, "LaRocco, Toni™ <tlarocea@pchd.us>, "Henry, James" <ihanry@egchd.us>, "Johnson, Mark (ATSDR/DCHI/CB)" <rnki5@ede.gov>, "'Valacak, Mark" <MYALACAK@echdus>, "Johnson, Shannon (DHHS)" "Miller, Corinne (CDC michizan.gov)" <MilerC39@michigan.gov>

(CDC/ONDIEH/NCEH) <zse1. Gicele.gov>; Johnson, Mark (ATSDR/DCHI/CB) <mkjis@edc.goy>; Valacak, Mark <MVALACAK @echd.us>; Henry, James <ihenry@achd.us>; LaRocco, Toni <tlaracco@gehd.us>; 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

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

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

Thanks, Jim. i'm concerned about the hospital. | can get our folks together for a call to discuss next week if you'd Hike. Bo you have the details of what they've bean doing to address the colonization there?

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 jnenrv@achd.y

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