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Hi there! Thank you all for your help! On the suppressed zip code file-can the far right column in the right ( zip 01-07) be changed to 03-07? | don't think 01 and 02 have residences... Sent from my iPhone xxxEND_PAGE:dhhs03_b0176_0734_0734_1

Hi Sarah, Let's just go with what Bob used for 2012- 2013 for the state ?? See reporter's query below. She just wants a spreadsheet version of what the report is on line as a pdf, which she already has? See what Bob forwarded to Jen yesterday???

Thank you! shall forward to Nick with some highlights, and caveats about adjusting. What he cans see is that these are not greatly huge numbers... Eden

Dear Eden — lam sorry the answer to a simple question is taking so long. The “number of excess cases” is derived from the Poisson regression formula, which controls for age and season as well. If we use the available data as our comparison period, the model picks up the excess in cases for the high risk zip codes in Flint, but not for the remaining city. If limit the comparison period to immediately prior to water switch (Jan 2013- March 2014), which is similar but not identical to the Hurley time period, the model identifies excess cases in both geographies. Comparing to January 2010 thru March 2014: ears oe ar aerate Hehae ae no (here were 20 mare positive tests Ue period afte) ie ewitch ta Fin River Wi He i ees) ees oe ot fom the onuen shen Ieee . rr (Apt 70le Avs - is ee Ce ee petites ye beats) During the post period, 7.65% of tests were positive each quarter (controlling for age and season). In the period before the switch (January 2010-March 2014), 6.43% of tests were positive each quarter. FOL the remaining Ent 2ip cudes, no Geese were detected By (Be mide! The positive test rate prior to and after the switch to the Flint water system are similar (4.85% and 4. ‘A7%), although significantly higher than the remainder of Genesee county. Comparing to January 2013 thru March 2014: 4 phe bleh ee ee Sea ae OF a Hine Ress were 36 sassreusooresasnoestiis Ei Bh ie ee tor ee ci 25) on eo ine Co ” Lee posibve tere, SEES EM Se eer During the post period, 8.46% of tests were positive each quarter (controlling for age and season). In the period immediately before the switch January 2013-March 2014), 6.17% of tests were positive each quarter. xxxEND_PAGE:dhhs02_b0339_1280_1281_1 001281 o ie ey eB EH pees as eee : au a thanexpected, During the post period, 4.78% of tests were positive each quarter. In the period before the switch to Flint River water, 4.39% of tests were positive each quarter. Sarah Lyon-Callo, MA, MS Director, Lifecourse Epidemiology and Genomics Division Bureau of Disease Control, Prevention and Epidemiology Population Health and Commmunity Services Administration Michigan Department of Health and Human Services 201 Townsend St., 4" Floor Capitol View Building PO Box 30195 Lansing, MI 48909 PH: 517-335-9315 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 any confidential and/or privileged information contained in this e-mail 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. Please note: Michigan has a public records law. Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications and any attachments to them may be subject to public disclosure. xxxEND_PAGE:dhhs02_b0339_1280_1281_2

Forwarding- Sent from my iPhone Begin forwarded message:

Attached is our prelim geococled analysis of the data we received on Friday. We can talk through it an the phone, especially the map. Thanks! Mona Hanna-Aitisha MD MPH Directar, Paediatric Residency Program Hurley Children’s Hospital at Hurley Medical Center Assistant Professor, Department of Pedistrics and Human Development Michigan State University College of Hurnan Medicine Office: 610-262-7257 [email protected]

Hat is why | need to lead he call- | already have our talking points on that Sent from my iPhone On Oct 5, 2015, at 12:01 PM, LyonCallo, Sarah (DHHS) <!

Sent from my iPhone Begin forwarded message:

So | can take a deep breath now? | nearly keeled over...Rashmi- he may want to explain that to her if rounding is CDC protocol if that is tuneup, because she needs confidence in our processes. Sent from my iPhone

| sent an email that is portraying a real concern--- Sarah would having tenths have helped the sensitivity of our data?????? Sent from my iPhone

Eden, More analysis and review has been done by Sarah’ staff. Here are the talking points: The high risk Zip codes (48503 and 48504} Blood lead level rates among children under six years of age in the high risk Zip codes (48503, 48504} were 2.7 times higher than the rest of Genesee County before the switch to Flint River Water (o<0.0001}, After the switch to Flint River Water, rates in the high risk Zip codes were 3.2 times that of the rest of Genesee County {p<f.0001). Thus, compared to rates during 2040-2013, the rates after the switch to Flint River water in the high risk Zip codes increased 18 percent, although this difference did not reach statistical significance. xxxEND_PAGE:dhhs02_b0025_0147_0149_1 000148 Other Zip codes in Hint Rates of elevated blood lead levels among children under six years of age In other narts of the city of Hint were 2 times that of the rest of Genesee County before the switch to Flint River Water (p<0.0001). The magnitude of the elevated rate remained roughly the same during the period after the water source switch.

Date: Thursday, October 01, 2015 2:18:30 PM More analysis and review has been done by Sarah’s staff. Here are the talking points: The high risk Zip codes (48503 and 48504) Blood lead level rates among children under six years of age in the high risk Zip codes (48503, 48504} were 2.7 times higher than the rest of Genesee County before the switch to Flint River Water (p<0.0001}. After the switch to Flint River Water, rates in the high risk Zip codes were 3.2 times that of the rest of Genesee County (p<0.0004}. Thus, compared to rates during 2010-2013, the r: risk Zip codes increased 18 percent, although this difference did not reach statistical sig Other Zip codes in Flint Rates of elevated blood lead levels among children under six years of age in other parts of the city of Flint were 2 times that of the rest of Genesee County before the switch to Flint River Water (p<0.0001}. The magnitude of the elevated rate remained roughly the same during the period after switch. s after the switch to Flint River water in the high icance, the water source

Importance: High 2 things: 8 Leaded gasoline has been banned for use in road vehicies since 1996, so it’s not likely that Flint kids would be exposed that way 8 The sentence “Mast of the iead In household water usually comes from the slumbing in your house, not frarn the local water supply” is not completely accurate and could be challenged. On the call v EPA today | heard that maybe 50% of the city’s lead supaly lines are lead..these are outside the house and would include i portion of the run ow d by the resident and the portion owned by the city water s

"Miller, Corinne (DHHS)" Dear Eden My apologies if this is duplication. You had asked for percent testing positive far children under age 6 for City of Flint zip codes after the switch for a sip code map. 48503 48504 48505 48506 48507 Post Flint River 5.9% 5.2% 4.6% 3.2% 1.9%

That sounds about right. May bash, is ii CLPP’s usual process to collect the lead data on an ongoing basis.if so, at what level is the data usually analyzed (by Epi?} iS it daily nmonthly? Quarterly? Annually? How would we normally detect/know if there is an issue in a particular iocality---do you look at it at county ievel ar smaller when you peruse your data? This question may arise. E