you say haboob i say dust storm: cocci blowing in the wind · cocci blowing in the wind john n...

Valley Fever

Center for Excellence

You say Haboob I say Dust Storm:

Cocci Blowing in the Wind

John N Galgiani MD Valley Fever Awareness Week

BIO5 Institute November 6, 2011

Valley Fever

Center for Excellence www.vfce.arizona.edu

50-70 30-50 10-30 5-10 <5

% Positive Skin Test

Valley Fever in the U.S.

Valley Fever


9th Annual Valley Fever Awareness

Week October 31st

thru November 6th

2011

Valley Fever


Coccidioidomycosis as

Community-Acquired Pneumonia In Southern Arizona

A third of all pneumonia is Valley Fever

Tourists to Arizona (or out-of-state students)

would have the same risk soon after returning home

Valdivia et al, Emerg. Inf. Dis, 2006

Valley Fever


Valley Fever in Arizona Findings from a telephone survey

10% of reported cases in 2007

Impact on People – Illness lasted an

average of 6 months

– 75% of workers off for over 1 month

Impact on Health Care – 25% needed more

than 10 doctor visits

– 40% hospitalized ($86 million in 2007)

Tsang et al., Emerg. Inf. Dis. 2010

Valley Fever

Center for Excellence www.vfce.arizona.edu

The Valley Fever Corridor: 2/3 of all US disease occur here

Valley Fever


Valley Fever Corridor Project

• Initiated by the Valley Fever Center in 2008

• Primary goals – Increase understanding – Improve patient care – Assist clinical research

Valley Fever


Medical Education

• Valley Fever CME for Primary Care clinicians – Phoenix 2008, 2010 – Tucson 2009, 2011 – Alternating each year in the future

• On line CME course: released 2009 • Advanced CME for specialists

– Scottsdale 2010; Tucson 2011

Valley Fever


Organizations Supporting the Valley Fever Corridor Project

Medical Groups Arizona Department of

Health Services Maricopa County Medical

Society Pima County Medical

Society Arizona Infectious Diseases

Society

Non-Medical Groups Maricopa Association of

Governments Marana City Council Oro Valley City Council Tucson City Council

Valley Fever


Patient Needing

Help

Primary Care

Clinician Subspecialist

Another Subspecialist

Valley Fever Alliance of Arizona Clinicians (VFAAC)

Valley Fever


Maricopa Community • 61% of Arizona’s 2010 census

population • Half of all US Valley Fever infections • Large retirement community: VF is more

severe in older persons.

Valley Fever


Valley Fever Center in Phoenix: January 2012

St. Joseph’s Hospital

Community

The Partnership

COM

Phoenix VFCE

Valley Fever


Clinical Network and Research


Valley Fever



Better Diagnostics


Valley Fever



New Drugs (Nikkomycin Z)

Better Diagnostics


Valley Fever



Vaccines

New Drugs (Nikkomycin Z)

Better Diagnostics


Valley Fever


Valley Fever Costs to Arizona Educate Arizona patients

and doctors $100 thousand/year Referral network and case

management $300 thousand/year Diagnostic test

development $1.5 million

Nikkomycin Z development $40-$60 million (if things

go well) Vaccine development $40 million before

clinical trials could begin Doing nothing $86 million per year

just for hospital costs

Reported Valley Fever

0

4000

8000

12000

16000

1990 1995 2000 2005 2011

Arizona California

Infectious Disease Epidemiology

*

* 2011 extrapolated from week 43 MMWR

Climate and Valley Fever

Mycelial growth in soil (seasonal rain)

Wind Dispersion

Symptoms and Clinical diagnosis

Dust Levels and Rain Fall in Relation to Reported Coccidioidomycosis in Tucson

0

0.5

1

1.5

2

2.5

3

3.5

4

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Month

Inci

denc

e (p

er 1

00,0

00)

0

5

10

15

20

25

30

35

40

45

50

PM10

(μg

m-3

) & P

reci

pita

tion

(in)

CoccidioidomycosisPM10Precipitation

AC Comrie. Environ. Health Perspect. March 5, 2005. ehponline.org

Valley Fever


Phoenix, July 5th, 2011

Valley Fever


Kern 1978 vs Maricopa 2011

Kern Maricopa California Arizona County Population 400,000 4 million % of pop. susceptible ~25% ~75% Excess Cocci Cases 120* 3,600 Predicted Disseminated 140*

*Pappagianis, West J Med, 1978

Valley Fever


0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000

10,000 9-

Jan

30-J

an

20-F

eb

13-M

ar

3-A

pr

24-A

pr

15-M

ay

5-Ju

n 26

-Jun

17

-Jul

7-

Aug

28

-Aug

18

-Sep

9-

Oct

30

-Oct

20

-Nov

11

-Dec

1-

Jan

Cas

es to

Dat

e 2010 VF Cases Cumulative

Maricopa

Pima

Pinal

All other Counties

Valley Fever


0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

9-Ja

n 23

-Jan

6-

Feb

20-F

eb

6-M

ar

20-M

ar

3-A

pr

17-A

pr

1-M

ay

15-M

ay

29-M

ay

12-J

un

26-J

un

10-J

ul

24-J

ul

7-A

ug

21-A

ug

4-S

ep

18-S

ep

2-O

ct

16-O

ct

30-O

ct

13-N

ov

27-N

ov

11-D

ec

25-D

ec

Cas

es to

dat

e VF in Maricopa Cumulative

Maricopa 2011

Maricopa 2010

July 5th Haboob

Valley Fever


0

300

600

900

1,200

1,500

9-Ja

n 23

-Jan

6-

Feb

20-F

eb

6-M

ar

20-M

ar

3-A

pr

17-A

pr

1-M

ay

15-M

ay

29-M

ay

12-J

un

26-J

un

10-J

ul

24-J

ul

7-A

ug

21-A

ug

4-S

ep

18-S

ep

2-O

ct

16-O

ct

30-O

ct

13-N

ov

27-N

ov

11-D

ec

25-D

ec

Cas

es to

dat

e VF in Other Counties Cumulative

Pima 2011 Pima 2010 Pinal 2011 Pinal 2010 All other counties 2011 All other Counties 2010

July 5th Haboob

Valley Fever


-0.500 -0.400 -0.300 -0.200 -0.100 0.000 0.100 0.200 0.300 0.400 0.500

2011

com

pare

d to

201

0

Weekly Through Week 43

2011 difference from 2010 Maricopa

Pima

Pinal

Valley Fever


Why More Valley Fever Now?

• July dust storms may have accounted for some but not all of the increase.

• Dust storms may reflect an overall dry year (until September).

• Doctors may be doing a better job of diagnosing Valley Fever.

Valley Fever Center for Excellence

Thank-you And Questions?

you say haboob i say dust storm: cocci blowing in the wind · cocci blowing in the wind john n...

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