Valley fever is on the rise and in the dust in SLO County

tstrickland@thetribunenews.comOctober 26, 2013 

Correction: An earlier version of this story incorrectly stated that patients on work crews at Atascadero State Hospital could wear respirators to prevent infection. There are no patient work crews at ASH. The crews are made up of hospital employees.

It was the summer of 2009 when Paso Robles resident John Osman was pestered by one of his chronic inner ear infections.

But this time was different.

He felt rundown, and the sickness changed and lingered for almost three weeks. Eventually, he thought he must have caught the flu.

“I just couldn’t breathe, I couldn’t catch my breath,” Osman, 60, recalled. “So I went to the doctors and they did chest X-rays. By the time I drove home from Templeton to Paso Robles, the doctor called and said, ‘Get to the hospital. Now.’”

The scans showed that fungus had invaded his lungs. The local advertising sales representative had no idea he’d soon encounter one of the most pivotal moments of his life — a diagnosis of valley fever.

“They told me at the hospital that on a scale of one to 10 — 10 being you’re dead — I was a nine,” Osman said.

Valley fever is a fungus that can lead to chronic respiratory problems and serious infections. It stems from microscopic spores in the soil that can be inhaled by people and animals when it becomes airborne in dust. It’s transmittable in many ways, such as at construction sites, on farms where soil is being tilled and even driving in your car down a dirt road. In rare cases, spores can enter the body through cuts in the skin.

It’s usually treated with antifungal medications, although state health officials say mild infections don’t require treatment.

In San Luis Obispo County, reported cases of the disease are on the rise. The county Department of Public Health is updating the number of reported cases here, last published in 2008.

The new data will show that reported cases of valley fever ballooned from 35 cases in 2000 to 175 cases in 2011 and 100 cases in 2012, predominantly in the North County. Initial data summaries for this year show 46 cases reported through Sept. 30.

Reports of the disease from local correctional facilities have also grown in the same time span, although it’s unclear whether those cases were contracted here or elsewhere because of the way the data was historically collected.

While part of the increases in the county are due to new laws governing how the disease is reported, local health officials say valley fever is clearly well established in the area.

San Luis Obispo County is among eight California counties with the highest rates of valley fever, state health officials say.

It is endemic, or native and common, in many areas of the southwestern United States and Mexico. That includes San Luis Obispo County. Environmental sampling conducted at Camp Roberts near San Miguel detected the fungus decades ago, during World War II.

Initial symptoms are often flu-like with fever, cough and chest pain and can last from days to months. Once someone breathes in the tiny spores, the fungus stays with them indefinitely — though most will fight off the infection naturally and not experience symptoms again, state health officials say. In rare cases, the disease is fatal.

Ever-present threat

Valley fever, also called coccidioides or cocci for short, isn’t contagious but certain groups of people are at a higher risk of getting a severe form of the illness: People with weakened immune systems, African Americans, Asians, and women in their third trimester of pregnancy.

“Anyone who lives in the region can get it. You and I could have been exposed to it,” said Cindy Kellerman, a registered nurse at Twin Cities Community Hospital in Templeton.

Nearly 60 percent of patients don’t know they have it, according to the county Public Health Department. In less than 1 percent of cases the disease can lead to death.

In 2012, four people had cocci listed as a cause of death on their death certificates, county epidemiologist Ann McDowell said.

Osman says he isn’t sure where he contracted the fungus. He wonders if it was in the 1980s, when he worked in the Bakersfield oil fields, or in 2003 when he built his Paso Robles home, or during his many days spent riding motorcycles through the San Joaquin Valley, where the disease gained its name for its prevalence there.

The county’s overall increase in reported cases may be due in part to new regulations. In 2010, labs were mandated by the state to report positive cases of cocci to county public health departments while only clinical providers, such as doctors, were required to do so before.

“This probably contributes to our higher numbers, as labs are much better reporters than doctors,” McDowell said.

Climate pared with dusty bouts of drought is another likely culprit. And although the fungus is always transmittable, late spring rains tend to bring more cocci in the fall, McDowell said.

“After you have several dry years and then a heavy rainfall, you get a tremendous rise of spores in soil,” she added.

Water in the soil allows the spores to thrive. Then, when the soil dries out in the summer, it gets kicked up in the autumn winds making it easy to breathe in, she said.

“Construction zones can also be a potential source, but because we live in such a big agriculture area, that’s our primary source of cases we’ve seen,” Kellerman, the nurse, added.

Large outbreaks in such industries are known to occur here. The latest was identified in March when state health officials found 28 workers had been diagnosed with valley fever while working to build the Topaz Solar Farm and California Valley Solar Ranch projects in the Carrizo Plain. An investigation is underway to determine whether that number has grown.

In 2010, Camp Roberts also saw an outbreak when 10 out of 12 workers developed valley fever after digging a ditch on site.

Both cases involved people breaking up dirt that’s long been untouched, which McDowell says is a major risk factor.

Local agriculture groups have anecdotally said they discuss valley fever risks with their memberships, but none could provide The Tribune with specific examples of recent outreach programs in San Luis Obispo County.

The county’s Agriculture Commission says it refers those interested to the county Public Health Department’s information pamphlet on the disease.

Safety measures

Some residents prefer to take precautions into their own hands.

Kellerman, a Templeton resident, wears gloves when she gardens and knows others who wear masks. At work, she sees patients who have the disease in some of its worst forms — since their symptoms are sending them to the hospital.

“Once you develop valley fever, your body can develop immunities, but sometimes people suffer relapses,” she said. “The people who are more susceptible are the people who aren’t as healthy to begin with.”

More serious cases lead to pneumonia and infections that can affect the brain, joints, bone, skin or other organs, health officials say.

Osman, who spent six months bedridden and lost about 75 pounds before he improved with medication, said he knows many who have been hit hard with the disease. Among them: a woman who constantly gets dozens of sores on her arms and legs, a man who became paralyzed after the disease led to a spinal infection and a friend who recently died from heart failure after battling the disease for years.

“It just touches everybody differently,” Osman said. “It messed with my shoulder joints. With my right one, I can’t even throw a baseball.”

For Osman, dealing with the disease for the last five or so years has taught him to be more aware of his body.

“Every day is a new day — you either have a good day or a bad day,” he said. “And I think you’ll hear that a lot with valley fever. Every day that’s a good day, you just appreciate.”

VALLEY FEVER AT LOCAL CORRECTION INSTITUTIONS

The San Luis Obispo County Department of Public Health is updating its statistics on valley fever, an airborne fungus that can lead to upper respiratory problems and more serious infection.

New data shows that reported cases at local correctional facilities — the California Men’s Colony near San Luis Obispo, Atascadero State Hospital in Atascadero and the El Paso de Robles Youth Correctional Facility in Paso Robles before it closed in 2008 — have increased between 2000 and 2012.

There were nine reported cases in 2000 and 38 cases in 2012, the new report shows. The county declined to identify how many cases were at each facility.

While the state is making efforts to move inmates susceptible to valley fever out of the spore-prone Central Valley, officials at ASH and CMC say they aren’t seeing high numbers of inmates catching the disease here.

Such anecdotes can be confusing, considering the way counties historically have tracked cases.

Before the first half of 2011, an older computer system prevented any county from seeing if an inmate previously reported having the disease in another county. The state, however, could track such duplicate data but that information often didn’t trickle down to county reports.

“Some of the numbers were double-reported (here),” county epidemiologist Ann McDowell said of the old system. “Now, we have a system that’s much better at identifying previously reported cases before we duplicate them.”

For this reason, reported cases from the county’s communities, outside of its correctional facilities, “are more indicative to what’s actually going on,” McDowell said.

Still, officials at the correctional facilities say precautions are taken.

Atascadero State Hospital, a mental hospital that treats males from the courts and correctional systems, looks for valley fever by evaluating patient histories, conducting physicals on new patients and doing ongoing medical evaluations, according to the California Department of State Hospitals.

Employee work crews can wear respirators when doing projects such as repairing broken underground lines using a backhoe, shovels and picks. ASH has had five cases of valley fever this year, including four patients who had the infection prior to admission, state officials said.

California Men’s Colony works to educate the inmate population about the disease and waters the grounds to keep the dust down. The prison, northwest of San Luis Obispo near the coast, is listed as one of the institutions eligible for Central Valley inmates to be transferred to, spokeswoman Lt. Monica Ayon said.

CMC “has experienced a few isolated cases over the years, but it’s very rare,” Ayon said in an email. One case, she recalled, occurred about two years ago when an inmate became ill after helping with a firefighter work crew in the Central Valley.

TIPS TO REDUCE THE RISK OF VALLEY FEVER

• Avoid breathing in dirt or dust in areas where valley fever is common.

• Stay inside and keep windows and doors closed during dusty conditions.

• Keep car windows shut and use the recirculating air conditioning option when driving through windy or dusty areas.

• Consider wearing an N95 mask or respirator, available at drug and hardware stores, while outdoors.

• Wet down soil before disturbing it to reduce dust.

• Cover open dirt areas around your home with grass, plants, or other groundcover.

• After work or play, change out of clothes if covered with dirt.

• Don’t shake out clothing and breathe in the dust before washing.

Source: California Department of Public Health

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