Dream Job Turned Nightmare: Valley Fever
Executive Summary

According to the Centers for Disease Control and Prevention (CDC, 2018a), coccidioidomycosis, also known as Valley fever, is an infection caused by the fungus Coccidioides. The fungus is commonly found in the soil in the Southwestern U.S. and Mexico region. When people breathe in the spores of the fungus, which can hang in the dusty air, they can develop Valley Fever. People who already have weakened immune systems are most likely at risk for developing Valley Fever (Woods et al., 2000). Those with healthier immune systems tend to recover within a few weeks, though sometimes it can take months to heal completely and antifungal medication may be provide for treatment. This paper describes how descriptive and analytical epidemiology can be used to provide a response plan for the disease.

Purpose Statement

The purpose of this paper is to provide a discussion on why the fact that several patients have tested positive for coccidioidomycosis is an epidemiological problem, what approach the epidemiologist would take to addressing the issue, and how to develop an outbreak response plan.

A Problem for the Field of Epidemiology

Epidemiology is a field in medicine that deals with the incidence, distribution, and potential control of diseases. Valley Fever is a problem for the field of epidemiology because the rate of incidence is so high and control of the disease is so difficult given the manner in which it is contracted. According to the CDC (2018b), there were 14,364 cases of Valley Fever reported in 2017, and “most of these cases were in people who live in Arizona or California, [where] rates of Valley Fever are typically highest among people age 60 and older.” It is estimated, moreover, that Valley Fever is responsible for approximately 30% of all pneumonia-related cases in the region each year, though researchers have argued that the actual rate may be even higher since testing rates are so low and infrequent themselves (Valdivia et al., 2006). Additionally as McCotter et al. (2019) note, “the incidence of reported coccidioidomycosis in the past two decades has increased greatly; monitoring its changing epidemiology is essential for understanding its burden on patients and the healthcare system and for identifying opportunities for prevention and education” (p. 958). Valley Fever is difficult to diagnose and treat, and because of the high rate of incidence and distribution, its impact on health and the health care system, the potential control of Valley Fever does pose a problem for the field. Prevention, as always, is the best medicine—and that applies in the case of the spread of Valley Fever no less than in other situations.

Approach

The epidemiological approach to take for addressing the issue of Valley Fever is to look at trends, the overall burden of disease, and the geographical risk associated with the spread of coccidioidomycosis. As the disease has recently appeared in Washington State, a fresh look at these elements has to be undertaken. Cairns et al. (2000) linked the outbreak in Washington State to a group of travelers to Mexico who returned home; however, this has not been an isolated case and Litvintseva et al. (2014) have shown that though epidemiologic data “suggested that Coccidioides might have been acquired from the local environment, all 3 case-patients [in Washington State] had traveled to endemic regions several years prior to infection; therefore, the possibility of reactivation of latent infection could not be excluded” (p. e1). Litvintseva et al. (2014) collected soil samples, which showed that the fungus was indeed in the soil in Washington. The researchers argued that it was possible that Coccidioides “has been present in WA for an extended time, but because of low human population density in eastern WA, sporadic distribution of the pathogen, and lack of awareness among physicians, human cases of coccidioidomycosis have not been previously recognized in WA” (Litvintseva et al., 2019, p. e2). To understand the reality of the fungus, a proper epidemiological approach is therefore necessary.

Surveillance is a top priority in any epidemiological approach. Laboratory tests are used to confirm cases and incidence of the disease is recorded, monitored and analyzed. Severity, seasonality, geographical associations and so on are all examined during surveillance. Interviews with people who have been infected can be helpful in...…earthquakes, windstorms, and even military training exercises—all of which have the potential to disrupt the soil and spread the fungus in the air so that it is inhaled by many people (Brown, Benedict, Park & Thompson, 2013). This will allow for a prevention or response plan to be developed appropriately.

Second, in the event of an outbreak or in the event of foreknowledge of an event that could trigger an outbreak, appropriate warnings should be provided to the public to remain indoors or to wear breathing masks if they must be out of doors in the immediate time frame at which infection is most likely. This will be serve to prevent the spread of infection and to limit the risk of infection at times in which outbreak is most likely to occur.

Third, persons with known weak immune systems should be immediately contacted and monitored for safety so as to prevent the individual from developing pneumonia. People with known weak immune systems should have contact information up to date and on file with health care records for this purpose. To control for the outbreak, one must engage in preventive medicine and this is a primary way of doing just that.

Fourth, in the event of an outbreak, the area should be monitored and health care providers should be on high alert for testing for the disease so that it can be spotted and treated. Incidences should be recorded and communicated to a central command so that the etiology of the disease can be known and analyzed. In this manner, an effective outbreak plan can be implemented.

Conclusion

Understanding the role the epidemiologists play in the managing, prevention and control of disease is helpful in realizing just how important it is to research the spread of disease and to engage in both descriptive epidemiology and analytical epidemiology. The former helps one look at the evidence and to formulate a hypothesis; the latter allows one to test the hypothesis and to see whether the theories are valid or not. Maintaining a surveillance system is important for this effort as it can assist in the development of…