1. 1 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

2. 2 Overview What causes Valley Fever What causes Valley Fever What are the symptoms What are the symptoms Should I get checked Should I get checked Who gets it Who gets it What is being done about Valley Fever What is being done about Valley Fever Can I protect myself Can I protect myself

3. 3 What causes Valley Fever Cause 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 Exposure –People inhale the spores of the fungus

4. 4 What are the symptoms Disease Disease –Most people have no symptoms –40% have flu symptoms including pneumonia –1% have disseminated infection Bones, skin and brain Bones, skin and brain –Valley Fever is not contagious

5. 5 What are the symptoms Treatment and recovery Treatment and recovery –Treatment is available –Most individuals recover over several weeks –Few develop chronic illness –Rarely leads to death –Lifelong immunity

6. 6 Should I get checked Healthy individuals Healthy individuals –No need to be checked –No vaccine or medicine to prevent valley fever Individuals with symptoms Individuals with symptoms –Tell health provider that you live in endemic area

7. 7 Who gets Valley Fever Endemic regions Endemic regions –San Joaquin Valley –Sonora Desert –South America

8. 8 Who gets Valley Fever Risk factors for severe or disseminated disease Risk factors for severe or disseminated disease –Age, gender, race, chronic disease, prior exposure

9. 9 Valley Fever in Fresno County

10. 10 Coccidioidomycosis in S/W Fresno County Coalinga PVSP  

11. 11 Coccidioidomycosis Cases and Incidence Rates in Fresno Year County Population Total Cases Cases per 100,000 2004846,91212214 2005848,22629034 2006895,91976085 2007918,10745050 2008931,09831034

12. 12 Total Cases of Coccidioidomycosis in Fresno County/Coalinga for the last 5 Years 2004 122 12276 2005290142 2006776674 2007450342 2008310244 Year Fresno County Coalinga

13. 13 County, Coalinga and PVSP Coccidioidomycosis Total Cases by Year

14. 14 County, Coalinga and PVSP Coccidioidomycosis Incidence Rates by Year

15. 15 Outbreak Investigation Several agencies involved Several agencies involved –Fresno County Department of Public –California Department of Corrections and Rehabilitation –California Department of Public Health

16. 16 Investigation Findings Clinical Epidemiology Clinical Epidemiology –60% Pulmonary Disease –7% Disseminated Disease –24% Hospitalized –4 Deaths

17. 17 Investigation Findings Environmental considerations Environmental considerations –Construction of facilities and housing –Wet winters followed by arid summers

18. 18 Investigation Findings Health considerations Health considerations –Growing population –Individuals with no prior exposure –Enhanced screening by physicians

19. 19 Department of Public Health Recommendations Mitigate environmental factors Mitigate environmental factors Relocate high risk inmates Relocate high risk inmates Enhance surveillance and epidemiology Enhance surveillance and epidemiology Continue vaccine research Continue vaccine research

20. 20 CDC Findings MMWR February 13, 2009 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 California’s cases were reported from San Joaquin Valley

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22. 22 CDC Findings People at risk for severe or disseminated disease People at risk for severe or disseminated disease –Older persons –Pregnant women –Immunocompromised persons –African American –Filipino ancestry

23. 23 CDC Recommendations People living in endemic areas 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 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

24. 24 Thank You