Advocating for Coccidioidomycosis to Be a Reportable Disease Nationwide in the United States and Encouraging Disease Surveillance across North and South America

Abstract

Coccidioidomycosis (Valley fever) has been a known health threat in the United States (US) since the 1930s, though not all states are currently required to report disease cases. Texas, one of the non-reporting states, is an example of where both historical and contemporary scientific evidence define the region as endemic, but we don’t know disease incidence in the state. Mandating coccidioidomycosis as a reportable disease across more US states would increase disease awareness, improve clinical outcomes, and help antifungal drug and vaccine development. It would also increase our understanding of where the disease is endemic and the relationships between environmental conditions and disease cases. This is true for other nations in North and South America that are also likely endemic for coccidioidomycosis, especially Mexico. This commentary advocates for US state and territory epidemiologists to define coccidioidomycosis as a reportable disease and encourages disease surveillance in other endemic regions across North and South America in order to protect human health and reduce disease burden.

Coccidioidomycosis-Related Hospital Visits, Texas, USA, 2016–2021

“…C occidioidomycosis, also known as Valley fever, is a fungal disease caused by soil-dwelling Coccidioides spp., which include C. immitis and C. posadasii (1,2). Coccidioidomycosis is considered a nationally notifiable disease in the United States, but only 26 US states have mandatory reporting requirements at the state level, which has led to incomplete surveillance data across the country (1)(2)(3). Since Centers for Disease Control and Prevention (CDC) reporting began in 1998, the number of Valley fever cases has mostly increased.…”

“…Symptoms of coccidioidomycosis include cough, fever, and shortness of breath, which might resemble other respiratory illnesses and might be clinically indistinguishable from community-acquired pneumonia (1). Coccidioidomycosis can result in life-threatening severe pulmonary or disseminated disease, particularly in groups at high risk, and can also result in chronic illness (1)(2)(3). Surveillance data from Arizona and California, as well as previous research, suggests that demographic factors, such as age, sex, race/ethnicity, and occupation, play a role in a person's risk for infection and disease complications (1)(2)(3)(4)7,8).…”

“…Coccidioidomycosis can result in life-threatening severe pulmonary or disseminated disease, particularly in groups at high risk, and can also result in chronic illness (1)(2)(3). Surveillance data from Arizona and California, as well as previous research, suggests that demographic factors, such as age, sex, race/ethnicity, and occupation, play a role in a person's risk for infection and disease complications (1)(2)(3)(4)7,8). Testing practices vary substantially across states, but overall testing is underused, leading to delayed diagnosis and inadequate treatment (1,2).…”

“…The steepest increase in the number of cases occurred during 2009–2011, followed by a decrease during 2012–2014 ( 4 ); prevalence has continued to increase again since 2015 ( 4 ). Valley fever incidence in Texas, a state where coccidioidomycosis is not reportable, is unknown, but historical and contemporary scientific evidence defines West Texas as a coccidioidomycosis-endemic area ( 3 , 5 ). In addition, recent climate models suggest that the coccidioidomycosis-endemic region is expanding as temperatures increase and precipitation patterns shift, which might have an indirect effect on the dynamics of this disease in the United States ( 6 ).…”

“…Although Texas is estimated to be within the geographic range of C. posadasii , surveillance data are limited ( 3 ). We assessed differences in hospital use by patients who had a coccidioidomycosis diagnosis according to demographic and geographic factors.…”