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Rates:
Coccidioidomycosis, also called valley fever after originating from San Joaquin Valley of
California. Valley fever is an air-borne fungal infection of the lungs which is inhaled by the host
and the dust particles maneuver into the lungs, mutate into a larger structure and once it is big
enough, the complex soil will explode. Which results in the chemical release of endorphins and
the process will repeat itself. The particle, in particular, that causes coccidioidomycosis
develops, “when soils containing the fungus are disturbed and dust is raised, spores may be
inhaled with the dust. Dust disturbing activities include, the wind, construction, farming, among
others” (University of Arizona, 1999). This does not mean general dust of everyday life; it’s the
soil-developing fungus called Coccidioides, which is mainly found in dry, humid areas.
Coccidioidomycosis can have cold-like symptoms and is treated accordingly. Those who are
infected can expect full recovery within two to three months. It becomes deadly when the dust
particles metastasize into the bloodstream, the dermis, bones or the sheath enclosing the brain,
resulting in meningitis. Rates that result in fatal situations are almost less than one compared to
less than moderate situations which are more than fifty percent. In total, record stated 3,089
coccidioidomycosis-related deaths, which coccidioidomycosis was a primary cause of death,
took place in the United States during 1990 to 2008, which are less than 200 deaths per year. The
number of coccidioidomycosis-related deaths every year has been quite steady since 1997.
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1. Number of reported coccidioidomycosis: Centers of Disease Control and Prevention
(2014)
This bar graph illustrates the number of reported incidence rates in increments of 5,000 along
with the year the cases were reported from 1998 until 2012 in Arizona, California, Nevada, New
Mexico and Utah. Reports for coccidioidomycosis was shown to be stagnate from 1998 to 2008;
drastic increase began in 2009 and was on a continuous rise until 2011. In 2012, there seems to
be an estimated decrease of 4,000 people.
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Signs and Symptoms:
Once infected with coccidioidomycosis, signs and symptoms will become noticeable like
any other infectious disease. These signs include, fever dry coughs Chest angina, chills, night
sweats, migraines, fatigue joint aches and red, spotty rashes. Even though, more than half of the
people who have had valley fever, experiences are asymptomatic. It varies from individual to
individual on how long it takes for valley fever to start showing symptoms. Usually, it takes one
to three weeks after acquaintance with valley fever which is most commonly known as the
incubation period. For others, one or two months could go by before they detect any unusual
signs that coccidiodidomycosis might have taken effect. The infection of valley fever is not
propagated, it’s air-borne from a common source. In general, “Valley fever is the first type of
coccidioidomycosis contamination. The beginning, acute illness can be transformed into a more
severe form of this disease, such as chronic and disseminated coccidioidomycosis” (Mayo Clinic
Staff, 1998-2014). Chronic coccidiodiomycosis, a progressive, reoccurring flu-like form, results
if the introductory valley fever does not fully clear the body. The symptoms for chronic
coccidiodiomycosis are similar to the original valley fever. Except the symptoms are far more
severe and weight loss and coughing blood are involved with chronic valley fever. Another
branch of valley fever, disseminated coccidioidomycosis, consists of the most severe form of
valley fever. This is when Coccidioides move to other parts of the body outside of the lungs
causing fatal results such as meningitis. These symptoms can involve angina in the joints and
bones or agonizing gashes. In addition, “Valley fever is not contagious. You cannot get it from
another person or from animals” (WebMD, 2005-2014). Although like the flu, once contracted,
the body builds immunity against that particular strain of infection. Coccidioidomycosis can
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reoccur and also become deadly for those who have very weak immune systems such as people
with HIV/AIDS.
Person Factors:
Coccidioidomycosis is targeted toward people who either live or return from traveling to
the southwestern region of the United States. People of the elderly group starting at age 65, those
with weaker immune systems, which are caused by other factors such as HIV/AIDS, are at
highest risk of being affected by coccidioidomycosis. Pregnant women in their third trimester,
diabetics and people of African-American and Filipino descent are also in the category for high
risk of developing valley fever. Men are more susceptible than women to have valley fever.
Workers with outside jobs such as construction and agricultural labor have greater chances of
exposure than someone working indoors. The army workforce training in the area of high risk
valley fever and people who enjoy leisure events such as biking or riding an all-terrain vehicle
(ATV) in the dessert are more susceptible to coccidioidomycosis. The occurrence for contracting
valley fever depends on where a person lives in the southwest region of the United States. For
instance, “In Arizona, the highest pervasiveness of infections occurs June through July and from
October through November. In California, the risk of infection is highest from June through
November, without the late summer break” (The University of Arizona, 2010). The fungal spores
are most likely found in profusion in the dirt near rodent holes, Native remains and burial
grounds. In these sites, illness from valley fever is higher and can be severe because of
concentrated exposure to a great amount of spores.
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Place Factors:
When talking about where coccidioidomycosis is most prevalent, dry and humid areas
such as states in the southwestern region of the United States come to mind. “About 4 million
people reside in regions where coccidioidomycosis fungus is common (or "endemic") in the dirt.
An estimated 80% of these people exist in southern Arizona, specifically in Phoenix and Tucson
city vicinities” (The University of Arizona, 2010). Valley Fever develops in the dry desert dirt of
southern Arizona, Nevada, northern Mexico and California's San Joaquin Valley. They're also
endemic to New Mexico, Texas, and parts of Central and South America. Basically places with
moderate winters and parched summers. In addition, “In areas where coccidioidomycosis is
endemic and most recorded are (Arizona, California, Nevada, New Mexico, and Utah), overall
prevalence in 2011 was 42.6 cases per 100,000 population and was highest for persons aged 60-
79 years (69.1/100,000). In highly endemic regions such as the Phoenix and Tucson modern
ranges of Arizona, coccidioidomycosis causes an estimated 15% to 30% of societal gained
pneumonias, but low testing percentage suggest that valley fever may be under-
recognized”(Centers for Disease Control and Prevention, 2014). Other states such as Washington
and Maryland are also affected by valley fever but they are less prevalent than the major tropical
territories. So the chances of anybody in Arkansas or Tennessee being infected is drastically low
but it’s not impossible; if the environment were to change to something similar to southwestern
America. To elaborate, “The 16,467 cases recorded from Arizona and 5,697 cases from
California in the course of 2011 stand for a 61% and 129% inflation, respectively, compared
with 2009. Valley Fever is presently the second most frequently conveyed illness in Arizona, and
the fourth in California” (Morbidity and Mortality Weekly Report, 2013). In general, the places
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at highest risk of Valley Fever becoming an endemic case are areas with dry, humid weather and
short winters which are the southwestern regions of the United States of America.
2. Summary of Notifiable Diseases( Morbidity and Mortality)
This photo describes where coccidioidomycosis is most prevalent and where it is less common
during 2009. In the southwestern part of the US, the number of reported cases is higher than all
the cases combined in other regions of the US.
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Time Factors:
As I once stated, similar to the flu influenza which surfaces once a year seasonally in
specific areas, valley fever has a certain time it comes around for those most affected in the
southwestern region but is year round for less prevalent areas. During the two hottest months,
June and July, and in the fall months of October and November, Arizona experiences a high
incidence rate from coccidioidomycosis. In California, for six months, June until November,
valley fever is at its highest. The incubation period usually is one week to three weeks after
infection but can also be asymptomatic until after the first month. After contraction of
coccidioidomycosis, a person can expect to have the fungal infection for at least two to three
months after signs and symptoms. After three months have passed and the symptoms have gotten
worse, it is important to get clinical help due to its possible advancement to chronic or
disseminated coccidioidomycosis. Either one of these could have fatal results that can be treated
or prevented. Natural disasters are another factor that plays into the forming of
coccidioidomycosis. Such as, “Earthquakes that have taken place in endemic regions of
California have also ended in influx cases of raised cases of Valley Fever” (The University of
Arizona, 2010). Endemic places where the soil is disrupted by natural causes, such as
earthquakes or tornados, or human induced causations can result in the development of
coccidioidomycosis. Valley fever would be considered cyclic or seasonal because its timing is
predictable in endemic states. Coccidioidomycosis is not epidemic or pandemic; it is a contained
fungal disease affecting the larger part of the southwest in America.
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Prevention and treatment:
Treatment and prevention are mostly used for persons experiencing lingering symptoms
from primary coccidioidomycosis. For the more severe cases such as chronic and disseminated
forms of valley fever, “Surgical removal or debridement may sometimes be employed in
disseminated cases or expanding pulmonary cavity abrasions” (Center for food security and
public health, 2010). In most cases, there is no treatment or procedure done because in over half
of the people who are infected by coccidioidomycosis, resolve their signs and symptoms before
it gets into an advance form. Although, anti-fungal medications are prescribed with possible side
effects and they shorten the duration of valley fever as well as lower the severity of the
condition. The people with weaker immune systems, HIV/AIDS patients, who develop
coccidioidomycosis are advised to take anti-fungal prescriptions over the course of their lifetime
in prevention of fatal cases. Coccidioidomycosis, valley fever, is hard to avoid particularly in
endemic regions; although, minimizing contact to airborne dust particles may possibly be
beneficial. Dust control proceedings such as flooring dirt roads, seeding turfs and dampening
dust with oil have been announced to lessen the number of cases in the military workforce. Also,
“People at risk for harsh disease might, in some cases, be given prophylactic drug therapy.
Transplant viewing in endemic areas arrange screening programs for coccidioidomycosis. If the
receiver or contributor has been contaminated, prophylaxis or treatment may be endorsed.
Although vaccinations are in development, no vaccine is presently available” (Center for food
security and public health, 2010). There are not any over the counter medications for valley fever
so if an individual is suspected to have coccidioidomycosis, it is advisable they see a clinical
physician. Even though there is no preventative vaccination, there are always precautions and
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treatments for those who have been infected with the fungal infection. In recent news, there was
a valley fever outbreak in two prisons located in California. So the Centers for Disease Control
and Prevention recommended both prisons, 175 miles away from each other, move all of their
prisoners within 90 days. As they saw this to be unrealistic, the persons at highest risk were
considered to be first priority to move temporarily out of the prison in California. Those 55 years
or older were on the list as first priority then the prisoners based ultimately on ethnicity has led to
concerns that the move could produce extra security complications. The article goes on to read,
“Department spokesperson Deborah Hoffman told The Associated Press that moving the
prisoners could create a racial imbalance, which could worsen gang violence in prisons”
(Mohney, Gillian, 2013). So the concern still holds, do California corrections move their most at
high risk inmates which could possibly led to more difficulties or is the health of the inmates
ignored and chances are taken on those at high risk? Pleasant Valley and Avenal prisons inmates
chose for themselves whether they wish to decline or accept the move out of the prison. In
relations to prevalence rates and mortality, “According to an April report by the Receiver's
Public Health and Quality Management Units, the Pleasant Valley State Prison had a valley fever
infection rate that was 400 times higher than its county's” (Mohney, Gillian, 2013). During the
earlier years in the new millennium, there were an estimated 30 inmates who died from valley
fever in California. In southwestern US, Arizona, California, Nevada, New Mexico and Utah, the
number of cases reported are steadily rising by the thousands within the last 15 years. It is
unknown why certain groups of ethnicity are targeted but it’s better to be aware of the higher
risks groups, who are more susceptible and take preventative measures.
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The graph created by Cayla Skinner: Valley Fever reports
The graph illustrates the reported valley fever cases from 2008-2012 in Arizona. In 2008
there were about 5500 cases, 2009 around 11000, 2010 estimated 13000. In 2011 there were
roughly 17000 cases and 2012 estimated about 13000.
Coccidioidomycosisreportedcases from
2008-2012 in Arizona
2008
2009
2010
2011
2012
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Centers for Disease Control and Prevention (2014). Fungal Diseases. Definition of Valley Fever
(Coccidioidomycosis). Retrieved from
http://www.cdc.gov/fungal/diseases/coccidioidomycosis
Centers for Disease Control and Prevention: MMWR (2013). Morbidity and Mortality Weekly
Report. Retrieved from http://www.cdc.gov/mmwr/PDF
MOHNEY, GILLIAN (2013). Valley Fever Outbreaks Lead California to Move Inmates.
Retrieved from http://abcnews.go.com/Health/california-corrections-department-move-
inmates-risk-valley-fever
Mayo Clinic Staff (1998-2014). Diseases and conditions: Valley Fever. Retrieved from
http://www.mayoclinic.org/diseases-conditions/valley-fever
The Center for Food Security and Public Health (2010). Iowa State University.
Coccidioidomycosis. Retrieved from http://www.cfsph.iastate.edu/Factsheets
The University of Arizona (1999). What is Valley fever? Retrieved from
http://www.casa.arizona.edu/~peter/valleyfever
The University of Arizona ( 2010). Valley Fever center for excellence. Coccidioidomycosis.
Retrieved from www.vfce.arizona.edu/ValleyFeverInPeople
WebMD (2005-2014). Valley Fever. What is Valley Fever? Retrieved from
http://www.webmd.com/a-to-z-guides/valley-fever-topic-overview
