Correspondence among

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

Ps- Is 5 or 10 the cut off lead ?

Good morning Mr. Scott . Thank you for your timely response.I have reviewed the graphs with our GCHD and Dr. Mona Hanna-Attisha of Hurley.Is it possible to stratify the data by age -under 15 months, 16 months to under 6 years of age , over 6 years.Also can we get the most recent data for 2015. At this point we will work with our patients to educate them. Breast feeding is first choice . I understand different filters do different things for lead , and not all get lead clumps from leaching pipes so we will not emphasize them. We will try to get WIC to cover bottled water and encourage using water from outside the city system Our goal is to give the most consistent correct information. Are there any plans for public service announcements from the state ? lam asking you to ce my [email protected] email along with lreyS2@ gmail so I can access from anywhere. Lawrence Reynolds xxxEND_PAGE:dhhs02_b0942_3364_3430_67