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Health Advisory: Significantly Higher Number of Coccidioidomycosis Infections During Current Valley Fever Season

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Published on February 15, 2018. Last modified on July 05, 2020

Health Advisory

February 15, 2018


From:  Edward L. Moreno, MD, MPH                                                            Kristy Michie, MS
            Health Officer & Director of Public Health   831-755-4585                Epidemiologist   831-755-4503


Significantly Higher Number of

Coccidioidomycosis Infections During Current Valley Fever Season

Current Situation

Coccidioidomycosis, also known as Valley Fever, results from inhalation of Coccidioides immitis and Coccidioides posadasii spores.  Monterey County is a Coccidioides endemic area, particularly the Salinas Valley and South County regions.  A significantly higher number of cocci cases among Monterey County residents have been reported recently.  Over 100 cases of cocci have been reported between October 2017 and December 2017, compared to 39 in 2016 and 20 in 2015 during the same timeframe.  In several instances, patients were misdiagnosed and appropriate treatment was delayed, contributing to severe complications. Monterey County Public Health officials urge medical providers to include coccidioidomycosis in their differential diagnoses when evaluating patients with persistent cough and progressive respiratory illness.

Recommendations for Health Care Providers

  • Be aware of initial symptoms and risk factors for severe disease.
    • Following an incubation period of one to four weeks, clinical manifestations occur in 40% of infected individuals and include one or more of the following:influenza-like illness, pneumonia or other pulmonary lesion, erythema nodosum or erythema multiforme rash.
    • Disseminated infection, which can be fatal, most commonly involves skin and soft tissues, bones, joints, and the central nervous system.
    • Once infected, African-Americans, Filipinos, and other Asians are at higher risk of developing more serious or disseminated illness. Women in their third trimester of pregnancy, diabetics, and immunocompromised individuals are also at high risk of serious disease.
  • Take a risk history that includes occupation.
    • Certain occupational groups including agricultural workers, construction workers, military personnel, and wildland firefighters may be at increased risk for exposure.
  • Test for cocci.
    • Fungal cultures and/or coccidioidal serologic testing using immunodiffusion and complement fixation should be considered.These are available at most commercial labs and through the University of California Davis’ Coccidioidomycosis Serology Laboratory.Monterey County Public Health Laboratory offers Nucleic Acid Amplification (NAA) testing for cocci (e.g., sputum and bronchial wash specimens).

  • Report all confirmed, probable, and suspect cases to Public Health.
    • Blank Confidential Morbidity Report (CMR) forms can be downloaded at: www.mtyhd.org, along with educational brochures for your patients in English, Spanish, and Tagalog (www.mtyhd.org/cocci).

For more information about testing, diagnosing, and reporting, please contact the Monterey County Health Department’s Communicable Disease Unit at 831-755-4521.  For information about submitting patient specimens to the Monterey County Public Health Laboratory, call 831-755-4516.  Additional information is available at www.mtyhd.org/cocci and http://www.cdc.gov/fungal/diseases/coccidioidomycosis/index.html


PDF version of Health Advisory

Health Alert: Warrants immediate action or attention.

Health Advisory: Provides information for a specific incident or situation; may not require immediate action.

Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.