The Center cites recent preliminary statistics from the Arizona Department of Health Services (ADHS). Kenneth K. Komatsu, MPH, manager, ADHS infectious disease epidemiology section, reports an increase of more than 20 percent in reported cases of valley fever in 2001 over reported cases in 2000.
Of the 2,308 reported cases of valley fever in Arizona in 2001, there were more than 300 cases, respectively, in November and December, compared to an average of 139 reported cases per month from January through October.
"While these are provisional numbers, they do show that there were significant increases in the number of reported cases in November and December," says John N. Galgiani, MD, director of the UA Valley Fever Center for Excellence, which is jointly sponsored by the UA and the Southern Arizona Veterans Affairs Health Care System (SAVAHCS) in Tucson. Dr. Galgiani also is professor of medicine, Department of Medicine, UA College of Medicine, and program director for infectious diseases, Southern Arizona Veterans Affairs Health Care System, Tucson. "The numbers support the need for additional research into the epidemiology, biology and treatment of valley fever - including development of a vaccine."
The overall increase represents a rate of 43 cases per 100,000 population as compared to less than 41 cases per 100,000 in 1999. Most of the reported cases were in Maricopa (slightly more than 74 percent) and Pima (less than 18 percent) counties. Although relatively few infections occurred in Pinal County (less than 4 percent), the rate of 45 cases per 100,000 also was high.
According to the ADHS statistics, people hardest hit with valley fever were age 60 and older. Reported rates for this group (81.5 per 100,000) were almost twice as high as the 20- to 44-year old age group (42.6 cases per 100,000).
First described more than a century ago, valley fever still is considered an "emerging infectious disease" by the Centers for Disease Control and Prevention. In 1998, Arizona alone reported an increase of 236 percent in reported valley fever cases compared to 1996. Central California and west Texas also are areas where valley fever is endemic.
While primarily a regional health problem, it is gaining national importance due to the migration of population to the southwestern United States, according to an article by Dr. Galgiani, published in the Annals of Internal Medicine, Feb. 16, 1999. A growing segment of people in the region are susceptible to the most serious consequences of infection due to chemotherapy, immune suppression for organ transplantation and diseases that impair immunity, such as AIDS. And people who move from the area to others parts of the country subsequently may acquire a condition that suppresses immunity, which permits reactivation of infections acquired years earlier.
The fungus that causes valley fever -- also called coccidioidomycosis, or "cocci" -- is abundant in Southwestern desert soil. The organism tends to be found in the top 6 inches of desert soil and is easily blown about in the wind. When soils containing the fungus are disturbed and dust is raised, the microscopic spores may be inhaled with the dust, sometimes resulting in infection. Those in occupations that involve soil disturbance, such as agriculture, archeology or construction, are at greater risk of contracting the disease. Valley fever is not contagious -- it is not passed from person to person.
In Arizona, the infections are more likely to occur from May through July and in the months following the summer rainy season (October through December). In California, the disease peak occurs from June through November without the summer break.
Valley fever is one of the most difficult illnesses to prevent, detect and treat. Symptoms begin seven to 21 days after the spores are inhaled and typically involve fever, profuse sweating at night, chest pain, cough, loss of appetite, and generalized muscle and joint aches, particularly of the ankles and knees. There also may be a rash that resembles measles or hives but develops more often as tender red bumps on the shins or forearms. Signs and symptoms usually last for days to weeks. Diagnosis is accomplished by specific laboratory tests.
Infection does not always lead to detectable disease. In about 60 percent of cases, the infection is so mild that individuals are unaware they are infected. About 40 percent of those exposed to the spores develop evidence of the disease. Although complete recovery usually occurs, those afflicted may feel tired or have vague aches for up to a year. While it is not often fatal, occasionally the disease develops into a severe, life-threatening disseminated form, which may involve skin, bones, the brain or other parts of the body. Meningitis is the most lethal form. Serious and disseminated cases require antifungal therapy.
Individuals who develop long-lasting flu-like symptoms should contact their physician to determine if the problem is valley fever or some other illness. Winter visitors who develop these symptoms after returning home should mention to their physician that they were in the Southwest where valley fever is common.
The Valley Fever Center for Excellence (VFCE) has been jointly sponsored by the UA and the SAVAHCS since 1996 to promote valley fever education, research and patient care. The Center is located at the SAVAHCS facility in Tucson (formerly known as the Tucson VA Medical Center).
The Center provides information to the public, physician consultations with VFCE physicians, physician referrals for patients, and promotes research into all aspects of the disease. Patients may be seen at the valley fever evaluation and treatment clinic in St. Luke's Clinic, University Medical Center, Tucson. Category A and service connected veterans are eligible for treatment at the valley fever (cocci) clinic at SAVAHCS.
The Center relies solely upon tax-free donations and grants to the Biomedical Research Foundation of Southern Arizona for its continued support. Contributions enable the Center to continue in its mission to reduce risk and improve medical treatment.
For more information about valley fever, contact the UA Valley Fever Center for Excellence, (520) 629-4777, or email vfever@arl.arizona.edu. The Center's website is http://www.arl.arizona.edu/vfce/.
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