California Valley Fever cases highest on record

Jul 24 2017

The number of Valley Fever cases in California rose to a record level in 2016, with 5,372 reported — a jump of 71 percent from the previous year. Historically, about three-quarters of cases have been in the state's heavily agricultural San Joaquin Valley.

The fungal infection, known as coccidioidomycosis, or "cocci," is most common in the southern portion of the Valley and along the Central Coast of California. State health officials say they're not sure what caused the recent increase, the largest since 2011, but "climatic and environmental factors" could have increased the risk of exposure to the airborne spores that cause the disease, according to the California Department of Public Health.

Climatologists and other researchers have theorized that intensified dust storms or heat waves linked to global warming can fuel Valley Fever infection. Human activities that stir dust into the air, such as farming and construction, also contribute.

An influx of new people in areas where the fungus is most prevalent, along with better reporting of the disease, also may have contributed to the increase, according to the public health department, which has tracked Valley Fever since 1995.

Nationally, more than 11,000 cases of Valley Fever were reported in 2015, the latest year for which data are available, according to the U.S. Centers for Disease Control and Prevention. That was up from 8,232 cases the previous year. Arizona and California account for the vast majority of cases. In 2015, Arizona had 7,622 cases, the most of any state. California had the second-highest number, with 3,053. Nevada, Utah and New Mexico, among other states, had smaller numbers of Valley Fever cases in 2015.

Deaths from Valley Fever averaged 200 a year from 1990 to 2008, according to the CDC. And since 1997, the number of deaths has changed very little from year to year.

The California Department of Public Health does not regularly track Valley Fever. But it said a review of death certificates found that 1,098 people in the state died of the disease from 2000 to 2013. The state's overall incidence rate of Valley Fever in 2016, 13.7 per 100,000 people, was up sharply from the 2015 rate of 8 per 100,000.

"We're horrified but not surprised when the cases increase," said Sandra Larson, former executive director of the Valley Fever Americas Foundation, who lives just outside Bakersfield, in the San Joaquin Valley. "We're known as endemic for Valley Fever."

People contract the illness by breathing in tiny spores stirred up from dusty soil. The illness echoes the flu in its symptoms, which can include cough, severe fatigue, fever, headaches and rashes. In many cases, people recover on their own. But the infection can also spread beyond the lungs into other parts of the body, including joints, reproductive organs and teeth. In rare cases it can lead to hospitalization, and even death.

Kern County, an agricultural area that encompasses Bakersfield and stretches into the Mojave Desert, had the highest number of cases in 2016, with about 40 percent of the statewide total.

Dr. Royce Johnson, chief of infectious diseases at Kern Medical Center, said people have long tried to understand what causes spikes in Valley Fever, but with little success.

"There are so many variables — temperature, rainfall, humidity, wind — you have to have a pretty fancy computer model to try to study this," said Johnson, who has been treating Valley Fever since 1975.

Although the number of California cases last year were the highest on record, Johnson said, he doubts it was the worst year for "cocci" in history. The infection also surged in the early 1990s, before the state starting following it.

Nonetheless, Johnson said 2016 "was a very big year" for Valley Fever in his practice, and many patients came in with the typical symptoms. The disease can be "devastating," leaving some people disabled or unemployable, he said.

If Valley Fever causes severe knee swelling, for example, "you're not going to build houses or pick grapes or be an auto mechanic," Johnson said.

Juan Perez, 55, who lives in San Diego County, said he's been unable to work since coming down with the illness, which prompted him to sell his house and sign up for disability payments.

Perez believes he contracted Valley Fever in 2014 while working as a power and utilities inspector in the Bakersfield area. His co-workers were digging up pipes that had been buried for 50 or 60 years, and dust was flying everywhere, he said.

Soon after, pneumonia-like symptoms set in.

"I started feeling exhausted, started having a hard time breathing. I couldn't sleep at night," Perez remembers. "My appetite was just not what it used to be."

Perez eventually was hospitalized, and he underwent surgery to remove a mass under his lungs. Now, he says he has chronic fatigue and pain, and he takes medication to keep the fungus at bay. But there is no cure.  Even going to the grocery store wears him out, Perez says. "I basically have to hold onto the cart."

Though Valley Fever can be very serious, people are far more likely to be injured in a car wreck than to contract a severe case of the disease, said Larson, the former director of the Valley Fever America Foundation.

The organization is trying to build more awareness about the disease. Public understanding of it is still limited, but it has increased significantly in recent years, Larson said.

Twenty years ago, no one knew about Valley Fever, but now "there's a national recognition of it that we never had before," Larson said. That's due in part to celebrities such as Los Angeles Dodgers baseball player Brandon Morrow, who has spoken openly about his protracted battle with the disease.

Denise Smith, director of disease control for Kern County's Public Health Department, said the county has also embarked on a number of public awareness initiatives. It has educated local doctors about it, and recently launched a billboard campaign to inform residents about how to recognize and prevent the illness.

"When people get in treatment early, they have better outcomes," Smith said.