Valley fever has killed 5 SLO County residents this year, and more sickness is on the way

Until this spring, 12-year-old Morro Bay resident Casey Velte was a vibrant, active kid — playing soccer, biking around town and enjoying weekend sleepovers with friends.

But in March, the Los Osos Middle School seventh-grader was zapped by a prolonged low-grade fever and fatigue so draining that some days it was hard to just get from his bed to the living room couch, said his mother, Stephanie Velte.

Casey missed weeks of school and went through a litany of medical tests to determine his diagnosis.

Finally, it arrived: valley fever.

In April, Casey was admitted to Sierra Vista Regional Medical Center and then had follow-up at Valley Children’s Hospital in Madera, and now he is slowly recovering at home on a 6-month course of antifungal medications. He isn’t allowed to participate in sports for six months.

“I would say the main thing that my son suffered is extreme lethargy,” Velte said. “He would fall asleep in the car, in the waiting room of the hospital and then sleep for long stretches at home. He’s a very active kid. He missed so much school, it’s ridiculous.”

Casey Velte’s case isn’t even close to the most severe San Luis Obispo County has seen this year.

While many people contract valley fever and show mild or no symptoms, five local residents have died from it already in the first six months of 2017. Overall, 74 cases of valley fever have been reported in the county this year (with 17 additional cases under investigation), and that was while the dirt was still moist and the disease-causing spores less airborne, according to the county Public Health Agency.

Now, summer’s here, and a winter of many perfect rainstorms has created the perfect storm of environmental conditions for valley fever to spread.

About the disease

Valley fever’s scientific name is coccidioidomycosis, or cocci for short.

It’s caused the by the fungus coccidioides that grows in moist soil and can then be spread when the dirt dries and is disturbed later in the year by construction work, agriculture, excavation or other digging.

The fungus is prevalent in the southwestern United States, including Central California and Arizona, as well as parts of Mexico and Central and South America.

This year, an abnormally wet winter has created prime conditions for the fungus. When the microscopic spores spread in the air, people can become sick if they inhale the dust.

Because of those conditions, public health officials expect a spike in reported cases this summer and fall.

Last year, also rainier than previous years, 260 county cases of valley fever were reported and two people died, compared with 53 cases in 2015 and 33 in 2014. No deaths were reported those two years.

“It is worth noting that last year at this time, we had had 60 cases reported,” said Ann McDowell, a county epidemiologist. “Thus, the summer and fall months are when we see the most cases reported.”

How it spreads

McDowell said that during periods of unseasonably low rain, the soil is so dry that the fungus is unable to proliferate — thus the significantly lower numbers of reported cases during the drought years.

But with a conducive environment anywhere from a few inches to a few feet under the ground, the fungus can thrive and reproduce rapidly.

“Valley fever tends to be prevalent in areas with higher development where new dust is getting kicked up,” McDowell said. “Agriculture and construction areas have higher risks.”

McDowell added that epidemiologists don’t believe, however, that farmed dirt that gets turned over year after year is as much risk for valley fever as dirt containing spores that has previously been undisturbed, and then gets unearthed.

While the disease has been more prevalent in California’s Central Valley and southwestern states such as Arizona, the local discovery of valley fever dates back to the World War II era when soldiers at Camp Roberts were reportedly infected, McDowell said.

In 2013, health officials reported that 28 workers were sickened by valley fever while working on solar farm projects at two large sites near the Carrizo Plain.

“We’ve seen more cases in the North County, but we’ve seen reported cases of people living in every part of the county,” McDowell said.

People of various ages are among the locals affected, she said. But those who are older or who have weakened immune systems, including prison inmates with HIV, tend to have more serious health complications if they contract valley fever.

County Public Health is working on a campaign to make the general public and medical community more aware of valley fever, so they can catch the disease in the early stages and start treating it sooner.

“We’re taking this extremely seriously,” McDowell said. “We want to raise awareness of the risks of valley fever and the signs and symptoms.”

Signs of valley fever

Common symptoms of valley fever are fatigue, cough, fever, shortness of breath, night sweats, loss of appetite, chest pain, and muscle and joint aches throughout the body, according to the Centers for Disease Control and Prevention.

Rob Purdie, president of the nonprofit Valley Fever Americas Foundation in Bakersfield, contracted the disease in 2012 and began to suffer severe symptoms.

“Mine went to my brain and my central nervous system,” Purdie said. “I had horrible headache, vision problems, and a stiff neck.”

Purdie, 44, said that he was initially misdiagnosed and he’s still on treatment. He said he may have gotten it from freeway construction near his home, but like many who contract it, he’s not sure. He was misdiagnosed three times, and it took five weeks to properly identify his illness.

“If you’re sicker than you’ve ever been and for longer than you’ve ever been, I would recommend getting tested for valley fever,” Purdie said.

About 60 percent of people who contract the disease either have no indications or only very mild flu-like symptoms and don’t visit a doctor, according to County Public Health. Most of the rest will suffer severe flu-like symptoms but will recover without medication.

The disseminated disease will spread to parts of the body other than the lungs and cause serious health problems for about 1 to 5 percent of those who experience symptoms.

The disease is often misdiagnosed initially and confused with pneumonia or the flu, among others.

Antibiotics are often mistakenly prescribed to those with valley fever and aren’t effective, according to county health officials. Antifungal medications can be used to treat the disease.

Determining a diagnosis for valley fever can include specific blood tests to measure antibodies resisting the fungus, chest x-rays, tracing a patient’s travel history to endemic regions, and skin tests under certain circumstances, according to the University of Arizona Valley Fever Center for Excellence.

Untreated, valley fever can cause serious, long-term health problems, if not death.

Morro Bay woman’s story

Morro Bay resident Jen Ford said that her life was upended by valley fever for about two years, which she now refers to as her “mummy days.”

She was living in Bakersfield in 2006 when she began suffering body aches, cold sweats, a loss of appetite, and extremely low energy.

Doctors initially thought she had rheumatoid arthritis or multiple sclerosis. An initial test came back negative for valley fever.

“Some days I couldn’t go from my bed to my couch without my husband’s assistance,” Ford said. “I would wake up with pain in different parts of my body. Some days my entire body was covered in bruises. It was like I was beaten. Some days my vision was blurred.”

After an insurance change, she went to a new doctor who suspected valley fever and put her through rigorous testing.

“The results came back with very high levels of cocci,” Ford said. “We did a second test to confirm. I finally had a name for what was wrong with me.”

Ford said that her memory from those years is foggy. She was often fatigued. She had two young children to take care of and relied heavily on the help of her husband.

She eventually recovered without any medication on the advice of doctors, she said, but it’s not an illness she wishes upon anyone.

“Thankfully, I got better,” Ford said. “My advice would be that if the doctors can’t figure out what’s wrong with you, don’t be afraid to ask for valley fever tests. And maybe do it a couple of times. Don’t discount valley fever for what’s plaguing you.”

Tracking the disease

Assemblyman Rudy Salas, D-Bakersfield, introduced a bill that aims to provide better guidelines for reporting valley fever and increase public awareness.

The bill was co-authored by local Assemblyman Jordan Cunningham and Kern County Assemblyman Vincent Fong, both Republicans.

The bill received widespread support in the Assembly and now is making its way through the Senate.

“We’ve seen discrepancies in the reporting between state and local health cases of valley fever,” Salas told The Tribune. “This bill will address ways to streamline the reporting and accurately document valley fever cases.”

The most recent statewide data for valley fever in 2015 shows that San Luis Obispo County had 59 reported cases (compared with 53 reported by the county). Kern County reported 1,076; other areas with high numbers of valley fever cases included Los Angeles County with 557 and Fresno County with 259. Statewide, 3,064 cases were reported.

Salas said under the current system, doctors are tasked with reporting confirmed cases of cocci. He believes that sometimes they might get busy and never complete the task.

“It’s likely that not every doctor reports it,” Salas said. “How do we increase that reporting? Maybe we do it from the testing labs that confirm the results. They already do that for other diseases.”

The bill also would require the state Department of Public Health to implement a monitoring system that tracks cases of valley fever in California, as well as to develop an outreach program to educate both the public and doctors, so as to better diagnose the disease.

The reported cases would then be compiled on a website and made available to the public.

The incubation period for the disease is one to four weeks and can last for months or years, which can complicate the reporting of cases, said Dawn Terishita, a doctor with the Los Angeles County Public Health Department.

How to avoid valley fever

Though it can be difficult to avoid valley fever is areas where its prevalent, measures can be taken to avoid it.

The CDC advises people to stay away from areas with a lot of dust such as construction or excavation sites. Those who can’t should wear a N95 respirator, a type of face mask.

Other recommendations include staying inside during dust storms; minimizing or avoiding activities with close contact to dirt or dust, including yard work, gardening and digging; and using air filtration measures indoors and cleaning skin injuries well with soap and water, especially if the wound was exposed to dirt or dust.

The California Department of Public Health recommends training workers about the risk of valley fever and taking measures to reduce risk; developing a worksite plan to minimize the area of soil disturbed; suspending work during heavy winds; and using water or soil stabilizers to reduce dust.

Currently no vaccine exists to prevent valley fever.

“I believe valley fever is getting worse year in and year in year out, and the numbers are underreported,” Assemblyman Salas said. “We need to raise awareness and help people.”

This story was originally published July 1, 2017 at 10:57 AM with the headline "Valley fever has killed 5 SLO County residents this year, and more sickness is on the way."