Correspondence between

www. 504857 7 pdf | thought we agreed - no unfiltered tap water for washing food or cooking. Where did this one minute flush before using tap water recommendations come from. See attached document linked to the Genesee county website- simple steps you can take ,bullet point 7. We cannot use this in Flint without editing. My plan was to use this ina Community Ed talk since the pictures and layout were so eye appealing .We will have to review all handouts. Believe me, | am not interested in playing gotcha. We need a consistent ,accurate message for Flint residents on all water materials, not general advice. xxxEND_PAGE:dhhs02_b0428_1621_1622_2

case management resources continue for families You are correct, Larry, that the MDHHS data is pulled out of the Data Warehouse by Flint zip. Eden

g xxxEND_PAGE:dhhs03_b0303_1121_1126_2 001123 Reynolds, Lawrence; Laura Carravallah; Marc Edwards; Valacak, Mark; Andy Leavitt; Base Camp Email; Lasher, Geralyn (DHHS); Eisner, Jennifer (DHHS); Dykema, Linda D. (DHHS)

case management resources continue for families Eden, i support frequent updates. Mona and her tearm can continue to de the GIS work and track progress {or lack thereof} in the blood leads. i think that overall, the latest data implies we are on the right track. We can use the upclates to reinforce the importance of using the Hiters and bottled water that are being provided... Kast Regards,

case management resources continue for families Hi Dr. Reynolds, | just got done with an email with Mona--- This is a general public report that is high level--not a technical report, and was not meant to represent a technical report. This is general information--of course our surveillance program is tracking by zip, Medicaid, locality, etc. We can discuss further what type of reporting may be useful to a technical audience---as long as not identifiable (some zips have to be suppressed) | don't see why this can't be done (probably not every two weeks like this public one would be) Warm Regards, Eden Michig. 201 Towns: lreys2@email. com> Sent: Thursday, December 3, 2015 3:25 PM

case management resources continue for families This is a good start but maybe lacking context . Would GIS software identify clusters ? |! am disappointed to see, at this moment , thatDr. Edward's study and Dr. Mona's study which have more granular reporting are given no credence. Is there a reason ? wonsenae == Forwarded message ----------

Bob, | hope you are well and back in the office. Since we have been unable to obtain recent MCIR blood lead data for Flint kids in response to the lead in water concerns, we looked at all the blood lead levels that were processed through Hurley Medical Center from Jan 1, 2013. It turns out that most providers in Genesee county run their leads through our institution. Attached Is a presentation that includes our striking pre-water switch {2013} and post-water switch results (2015) for kids less than Syears living in the city of Flint (2.1% EBL to 4.0% EBL). Our pre and post periods included the same months considering the expected seasonal summer increase in lead levels. The results are most concerning for the kids that live in the zip codes where the water lead levels were found to be the highest (2.5% EBL to 6.3% EBL). No statistical change in %EB1 for kids out of the city. Similar results were seen for kids Jess than 15 months. (Please do not share the presentation.} Our sample size was large and our results were statistically significant; and we followed the same research methods conducted in the literature for similar lead exposures (most notably the DC lead in water issue). However, an even larger sample size which includes MCIR lead data would be very helpful as we continue to advocate for primary prevention. If we do have the MCIR data, for consistency and comparability to published research, we would like to conduct the analysis the same way as our above research. | am available via email or phone (cell EE) if you have any questions about our data/methods/results and how best to move forward. Thanks so much! Mona Mona Hanna-Attisha MD MPH FAAP Director, Pediatric Residency Program Hurley Children's Hospital at Hurley Medical Center Assistant Professor, Department of Pediatrics and Human Development Michigan State University College of Human Medicine Office: 810-262-7257 mhannal @hurleymc.com

The CDO's and Michigan’s “reference level” for blood lead is 5 ug/di-—-with the understanding that there i¢ no safe level of lead.

Dr. Reynolds, I'll be happy to slice up the data in that way, including the most recent months available. I'll be out of the office for the next few days, but will work on it when I get back. it’s my understanding that the State will develop a fact sheet as well as a tip sheet on lead-safe water use for parents. I’m not sure how they'll be made public. Thanks, Bob Robert L. Scott xxxEND_PAGE:dhhs02_b0942_3364_3430_66 003430 Childhood Lead Poisoning Prevention Program Michigan Department of Health & Human Services (517) 335-8178 fax (517) 335-8509