Coccidioidomycosis in Younger Populations, Arizona, 2011

BACKGROUND:   Coccidioidomycosis (Valley Fever) is an emerging fungal disease endemic to the southwestern United States, and parts of Central and South America. Coccidioidomycosis became laboratory reportable in Arizona in 1997, and enhanced surveillance of reported coccidioidomycosis cases was conducted from 2007-2008.  Since implementation of the mandatory laboratory reporting requirement, reports of coccidioidomycosis have drastically increased in Arizona.  In 2008, Arizona received 4,768 reports of coccidioidomycosis.  A major laboratory changed its reporting practices by beginning to report positive coccidioidomycosis enzyme immunoassay results without confirmation, which increased Arizona’s numbers to 10,233 cases in 2009.  In 2011, Arizona’s numbers increased to 16,472 cases.  In 2011, the Arizona Department of Health Services (ADHS) began an investigation to better understand the impact of coccidioidomycosis in younger populations.

METHODS:  Cases reported to ADHS from January through December 2011 that were 25 years old or younger at the time of diagnosis were contacted by telephone and interviewed with a standardized questionnaire.  Data was analyzed using SAS software.

RESULTS:   Data from 294 patients that were ≤25 years old from 2011 were included in the analysis.  The mean age was 16 years and 54% of cases were female.  Whites made up the majority of cases (76%), followed by blacks (5%), Asians (5%), and Native Americans (2%). Hispanics of all races comprised 20% of cases.  Asthma (17%) was the most common comorbidity whereas diabetes was only 2%.  The most common symptoms were fatigue (77%), fever (60%), cough (58%), headache (52%), shortness of breath (49%) and sore throat (44%); 51% of cases experienced 3 or more symptoms.  Symptoms lasted a mean of 76 days.  The mean length of time to seek care for symptoms was 42 days, and it took a mean of 3 visits before a case was tested for coccidioidomycosis. Antifungals were prescribed for only 35% of cases; fluconazole was the most commonly prescribed treatment (29%).

CONCLUSIONS:  The findings of this investigation give us insight into the impact of coccidioidomycosis on younger populations.  We hope that these findings will guide public health in giving recommendations for patient care and treatment of coccidioidomycosis for this population.