Valley Fever

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Valley Fever

• Edward Moreno, MD, MPH
• Director and Health Officer
• Fresno County Department of Public Health
• David Luchini, PHN
• Division Manager of Community Health
• Fresno County Department of Public Health

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Overview

• What causes Valley Fever
• What are the symptoms
• Should I get checked
• Who gets it
• What is being done about Valley Fever
• Can I protect myself

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What causes Valley Fever

• Cause
• Coccidioides immitis is a mold that grows in the
  dirt during the wet season and spreads through
  the air during dry warm season
• Exposure
• People inhale the spores of the fungus

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What are the symptoms

• Disease
• Most people have no symptoms
• 40 have flu symptoms including pneumonia
• 1 have disseminated infection
• Bones, skin and brain
• Valley Fever is not contagious

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What are the symptoms

• Treatment and recovery
• Treatment is available
• Most individuals recover over several weeks
• Few develop chronic illness
• Rarely leads to death
• Lifelong immunity

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Should I get checked

• Healthy individuals
• No need to be checked
• No vaccine or medicine to prevent valley fever
• Individuals with symptoms
• Tell health provider that you live in endemic area

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Who gets Valley Fever

• Endemic regions
• San Joaquin Valley
• Sonora Desert
• South America

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Who gets Valley Fever

• Risk factors for severe or disseminated disease
• Age, gender, race, chronic disease, prior exposure

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Valley Fever in Fresno County
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Coccidioidomycosis in S/W Fresno County
Coalinga
PVSP

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Coccidioidomycosis Cases and Incidence Rates in
Fresno
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Total Cases of Coccidioidomycosis in Fresno
County/Coalinga for the last 5 Years
Year Fresno County
Coalinga
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County, Coalinga and PVSP Coccidioidomycosis
Total Cases by Year
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County, Coalinga and PVSP Coccidioidomycosis
Incidence Rates by Year
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Outbreak Investigation

• Several agencies involved
• Fresno County Department of Public
• California Department of Corrections and
  Rehabilitation
• California Department of Public Health

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Investigation Findings

• Clinical Epidemiology
• 60 Pulmonary Disease
• 7 Disseminated Disease
• 24 Hospitalized
• 4 Deaths

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Investigation Findings

• Environmental considerations
• Construction of facilities and housing
• Wet winters followed by arid summers

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Investigation Findings

• Health considerations
• Growing population
• Individuals with no prior exposure
• Enhanced screening by physicians

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Department of Public Health Recommendations

• Mitigate environmental factors
• Relocate high risk inmates
• Enhance surveillance and epidemiology
• Continue vaccine research

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CDC Findings

• MMWR February 13, 2009
• Increase in Valley Fever cases in CA
• 2000-2006 Incidence rate tripled
• Highest incidence rate in Kern County
• Highest hospitalization rate among non-Hispanic
  blacks
• 76 of Californias cases were reported from San
  Joaquin Valley

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CDC Findings

• People at risk for severe or disseminated disease
• Older persons
• Pregnant women
• Immunocompromised persons
• African American
• Filipino ancestry

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CDC Recommendations

• People living in endemic areas
• Avoid exposure to outdoor dust as much as
  possible
• Wet soil and use masks
• Close windows and use air conditioning

• People traveling to endemic areas
• Tell physician that you will visit or live in
  endemic area
• Learn about the disease
• Avoid exposure to outdoor dust
• Close windows and use air conditioning

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Thank You