Valley Fever in Arizona What Public Health is Doing

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Valley Fever in Arizona What Public Health is
Doing

• Rebecca Sunenshine, MD
• Deputy State Epidemiologist for Infectious
  Diseases
• Arizona Department of Health Services

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Coccidioidomycosis (Valley Fever)

• Respiratory infection caused by a fungus in the
  soil
• Also called Valley Fever (VF)
• Primary illness lung infection
• Cough, Fever, Fatigue
• Disseminated illness spreads to other parts of
  the body
• No licensed vaccine available
• Reportable disease in Arizona

Spherules (Hematoxylin-Eosin stain)
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Valley Fever Epidemiology

• Endemic areas Southwestern US, Mexico, parts of
  Central and South America
• 60 of US disease in AZ
• Mode of transmission
• Inhalation of spores from soil and dust
• Incubation period 1 to 4 weeks (primary
  infection)
• Usually found in soil 2-8 inches from the surface

P. Q. Edwards and C. E. Palmer. Prevalence of
sensitivity to coccidioidin, with special
reference to specific and nonspecific reactions
to coccidioidin and to histoplasmin. Dis.Chest
3135-60, 1957
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Rates of Reported Valley Fever in Arizona,
1993-2007
Lab-reportable
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Reported Valley Fever Rates per 100,000
Population in Arizona Older Persons by Year,
2000-2007
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What is ADHS doing about it?

• Interviewed 1 in 10 Valley Fever (VF) cases
• Risk factors
• Diagnosis
• Treatment
• Duration of symptoms
• Were they admitted to a hospital?
• Impact on work, school, daily living
• Knowledge about VF
• Interviewed almost 500 cases

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What Weve Learned So Far Delays in Diagnosis

• Cases waited average of 45 days before seeking
  care for VF
• Average of 3 visits to a healthcare provider
  before VF test ordered
• 16 asked their provider to order a VF test

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How long did it last?

• Symptoms lasted an average of 6 months
• Influenza typically lasts 2-7 days
• Mononucleosis lasts 1-3 weeks

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Common Symptoms of Valley Fever Cases
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How does VF impact peoples lives?

• 74 missed work due to illness
• Average of 1 month of missed work
• 74 said VF interfered with daily activities
• Average of 3 months when patients could not do
  what they normally do

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Healthcare

• 44 went to the emergency room
• 40 hospitalized overnight for VF
• 28 saw their healthcare provider(s) more than 10
  times for their disease

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Knowledge of Valley Fever

• Only 65 heard of VF before diagnosis
• 1 in 5 people with VF did not know how Valley
  Fever is contracted

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What Else is ADHS Doing?

• Healthcare Provider Education
• 10,000 physicians surveyed to find out knowledge,
  attitudes and practices regarding VF
• Using survey data to design continuing medical
  education for healthcare providers
• Educating providers to test for VF, especially
  among patients with pneumonia

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Public Education Campaign

• Encourage people to
• Seek earlier care for VF symptoms
• Ask for a VF test if they have a cough, fever
  and/or fatigue
• New educational brochure with Valley Fever Center
  for Excellence
• Producing a VF video about impact for TV
• New and improved website
• www.valleyfeverarizona.org

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Mapping of Valley Fever Cases

• Geographic patterns
• Changes over time
• Looking at areas with highest rates
• Accounting for age of population

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Mining Analysis in Maricopa County

• Divided Phoenix Metro area into 4 areas
• Compared VF rates in US Census block groups near
  mines to those of block groups further from mines
• Accounted for age
• Living near a mine is not associated with higher
  rates of Valley Fever
• Consistent with ecology of the fungus which only
  grows in the top soil layers

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Sun City and Sun City West

• Why do Sun City and Sun City West have higher
  Valley Fever rates?
• Is it real?
• Is there more VF awareness and therefore more
  testing?
• Is there something unique about the people who
  live there?
• Is there something unique about the environment?

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To Answer These Questions

• Maricopa County Department of Public Health
• Arizona Department of Health Services
• Centers for Disease Control and Prevention
• Special CDC task force (Epi-Aid)
• To investigate increased VF in these areas

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Other Collaborative Activities

• Continued collaboration with partners at
  University of Arizona, T-Gen, and the Valley
  Fever Center for Excellence
• Education campaigns
• Drug and vaccine development
• Improved diagnostic testing
• Climate investigations

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Disclaimer

• The findings and conclusions in this presentation
  are those of the author(s) and do not necessarily
  represent the views of the Centers for Disease
  Control and Prevention or the Arizona Department
  of Health Services.