Coccidioidomycosis Cases on the Rise in California

Jennifer Garcia

August 11, 2017

There has been a sharp increase in the annual number of coccidioidomycosis cases reported in California, researchers report in an article published in the August 11 issue of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Despite a drop in incidence rates between 2012 and 2014, 2016 saw the greatest annual number of coccidioidomycosis cases ever reported in California, at 5372 reported cases (13.7 per 100,000).

"Health care providers should be alert for coccidioidomycosis among patients who live in or have traveled to areas where the disease is endemic, especially those who work or participate in activities where dust is generated," write Gail Sondermeyer Cooksey, MPH, from the Infectious Diseases Branch, Center for Infectious Diseases in the California Department of Public Health in Richmond, and colleagues.

Coccidioidomycosis, also known as Valley Fever, is caused by inhalation of Coccidioides spp spores. For most patients, the infection is self-limiting, with influenza-like symptoms. However, it can cause severe pulmonary disease and, in rare cases, disseminated disease including meningitis.

The researchers analyzed data reported to the California Department of Public Health by healthcare providers and laboratories through May 2017.

The majority of the cases were reported in residents of the Central Valley and Central Coast regions, with the highest incidence among patients between 40 to 59 years of age. The sharpest increases from previous years, however, were noted in persons younger than 20 years and those aged 20 to 39 years.

From 1995, when coccidioidomycosis became a reportable disease in California, through 2009, the annual incidence ranged from 1.9 to 8.4 per 100,000. It rose quickly in 2010 and 2011, peaking at 13.8 per 100,000. Rates then declined between 2012 and 2014 to approximately six cases per 100,000, and then rebounded in 2015 and 2016 to 13.7 cases per 100,000.

Of note, whereas incidence rates in Arizona and California often follow similar trends, the incidence of coccidioidomycosis in Arizona in 2016 decreased from 112.8 to 89.3 per 100,000.

The authors recommend that persons living in endemic areas decrease their risk for infection by limiting exposure to outdoor dust and keeping window and doors closed during windy weather. This is especially prudent for persons at increased risk for severe disease such as those with compromised immunity or people of African or Filipino descent.

Although the researchers acknowledge that the exact reason for the increased incidence is unclear, they postulate that environmental factors such as increased rainfall and soil disturbance resulting from construction may have contributed.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2017;66;833-834. Full text

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