You say Haboob I say Dust Storm: Cocci Blowing in the Wind · Cocci Blowing in the Wind John N...
Transcript of 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
Center for Excellence
9th Annual Valley Fever Awareness
Week October 31st
thru November 6th
2011
Valley Fever
Center for Excellence
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
Center for Excellence
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
Center for Excellence
Valley Fever Corridor Project
• Initiated by the Valley Fever Center in 2008
• Primary goals – Increase understanding – Improve patient care – Assist clinical research
Valley Fever
Center for Excellence
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
Center for Excellence
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
Center for Excellence
Patient Needing
Help
Primary Care
Clinician Subspecialist
Another Subspecialist
Valley Fever Alliance of Arizona Clinicians (VFAAC)
Valley Fever
Center for Excellence
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
Center for Excellence
Valley Fever Center in Phoenix: January 2012
St. Joseph’s Hospital
Community
The Partnership
COM
Phoenix VFCE
Valley Fever
Center for Excellence
Clinical Network and Research
Valley Fever Corridor Project
Valley Fever
Center for Excellence
Clinical Network and Research
Better Diagnostics
Valley Fever Corridor Project
Valley Fever
Center for Excellence
Clinical Network and Research
New Drugs (Nikkomycin Z)
Better Diagnostics
Valley Fever Corridor Project
Valley Fever
Center for Excellence
Clinical Network and Research
Vaccines
New Drugs (Nikkomycin Z)
Better Diagnostics
Valley Fever Corridor Project
Valley Fever
Center for Excellence
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
Center for Excellence
Phoenix, July 5th, 2011
Valley Fever
Center for Excellence
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
Center for Excellence
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
Center for Excellence
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
Center for Excellence
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
Center for Excellence
-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
Center for Excellence
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?