H5N1

MMWR: Coccidioidomycosis outbreak among workers constructing a solar power farm — Monterey County, California, 2016–2017

Via MMWR: Coccidioidomycosis Outbreak Among Workers Constructing a Solar Power Farm — Monterey County, California, 2016–2017. The summary:

What is already known about this topic?  

Workers performing soil-disturbing activities are at risk for coccidioidomycosis, an infection caused by inhaling the soil-dwelling fungus Coccidioides. 

What is added by this report?  

Nine confirmed coccidioidomycosis cases were identified among 2,410 solar farm workers in California. The incidence among workers (1,095 per 100,000 persons/year) was 4.4 to 210.6 times higher than background county rates, providing evidence that illness was work-related.  

What are the implications for public health practice? 

Employers should take measures to protect workers from dust exposure in areas where Coccidioides is endemic, involvement of public health practitioners is needed in the review of proposed construction that might expose workers to coccidioidomycosis, and clinicians should suspect coccidioidomycosis in patients with a clinically compatible illness who work outdoors.

US: California jury awards $12 million in valley fever suit against Caltrans

Via The Los Angeles Times: Jury awards $12 million in valley fever suit against Caltrans. Excerpt:

A Northern California jury awarded five construction company workers nearly $12 million in damages in a lawsuit alleging the California Department of Transportation did not warn them about the risks of being exposed to a dangerous fungus at a work site.  

The Solano County jury on Thursday found that Caltrans knew the risks of the fungus and concealed its presence. The crew was excavating and expanding a culvert in Kern County in 2008, according to the complaint. 

During the trial, jurors learned Caltrans employees not only knew the Kern County project was in a high-risk area, but had a map from the county health department showing places where the fungus previously had been in the soil.  

The fungus causes a potentially deadly respiratory disease commonly known as valley fever. 

Peter Alfert, lead attorney on the case, said Caltrans warned all of its employees in Kern County by email about the risk of the fungus and told them how to prevent exposure. That warning, however, was not given to independent contractors and their employees, he said.   

"They weren't advising people of the risk that they would get an incurable disease," he told The Times. "On a real, common-sense level, the case came down to the fact that it was clear that Caltrans knew about the risk. They warned their own people about the risk. It would be so easy to warn the plaintiffs about this."  

US: A young lion dies of valley fever in Arizona

Via tucson.com: Lion Bakko, nearly 2, dies at Reid Park Zoo. Excerpt:

Bakko — one of the male lions born at Reid Park Zoo in December 2013 — died Wednesday night of issues related to valley fever and kidney disease, said the zoo's veterinarian. 

"He was diagnosed this summer with valley fever and kidney disease and was treated aggressively for months," said veterinarian Alexis Moreno. The treatment included a combination of oral medication and IVs of medications and fluids, Moreno said. 

It was not known if the valley fever brought on the kidney disease. "It could have been two separate conditions," said Moreno. 

The University of Arizona in partnership with veterinarians from the zoo conducted a necropsy, which revealed that Bakko "had significant inflammation and ulceration throughout his stomach," according to officials. Further results are pending tissue sample tests. 

All of Bakko's treatment took place at the zoo, and he was not in isolation. He was kept with his brothers, Jelani and Sango, and his sister, Nayo, because they do better with companionship, explained Moreno. Their mother is Kaya and their father is Shombay. 

Valley fever is not contagious among animals. Animals get it from the environment. "It is a fungus that lives in the soil everywhere in Southern Arizona, so you really can't avoid exposure to valley fever," said Moreno.

US: Five cases of valley fever reported in Washoe County, Nevada

Via the Reno Gazette-Journal: 5 cases of valley fever reported in Washoe County. Excerpt:

Health officials are blaming the four-year drought after five cases of valley fever were recently reported in Washoe County—an illness that is common in southwestern states, but rare in Northern Nevada. 

Since 2008, a yearly average of two to three cases of valley fever have been reported in the region, said Randall Todd, Washoe County Health District director of epidemiology and public health preparedness. Most of those individuals become infected while traveling to other neighboring states, he said. 

This year, infected individuals in two of the five cases said they haven’t traveled out of the county, Todd said. Although concerning, it doesn’t prove anything, he said. 

“When we identify a case, (infected individuals) almost always report traveling to areas that have more cases than we do like in California or Arizona,” Todd said. “So having a couple of people with confirmed valley fever, but have reportedly not traveled outside the area, it’s interesting.” 

Valley fever, also known as coccidioidomycosis, is soil-borne fungus that causes lung infection, according to the Center for Disease Control and Prevention. People become infected when they breathe in the spores. 

Although 60 percent of infected people don’t show symptoms, about 5 to 10 percent may have long-term breathing problems, Todd said. 

The illness could also spread to other areas outside the lungs and cause meningitis in about 1 percent of infected people. The fungus might also affect the nervous system and spinal cord and cause bone and joint problems in others. 

Valley fever is common in southern Nevada, Arizona, New Mexico and in the San Joaquin Valley in California. It’s also found in Texas, Mexico and most recently in south central Washington. It’s considered highly endemic in southern Arizona and central California. 

“It kind of just stops shy of us here,” Todd said. “The Las Vegas area sees more cases than we do up here. Every time we get one of these cases (in Washoe County), my question to staff is, ‘Where have they have been?’ ”

US: California drought may be slowing valley fever

Via Capital Public Radio: Drought May Be Slowing Valley Fever Outbreak - capradio.org.

California health experts are surprised that the incidence of Valley Fever has gone down during the drought. The fungal infection is commonly spread in arid, dusty conditions. But, even though the state is drier, the number of cases continues to drop. 

Valley Fever peaked in 2011 with more than 5,000 cases in California. Last year there were fewer than half that. 

Dr. James Watt is the Chief of the Division of Communicable Diseases for the California Department of Public Health. 

"This disease is caused by a fungus that lives in the soil," he says. "When things are dry that makes it harder for that fungus grow and it goes into a dormant state. We think that after a dry spell, when there's some rainfall the fungus wakes up and starts to multiply and can cause more disease." 

If rain returns, Watt expects the number of cases to rise, but more research is necessary. 

Valley Fever generally causes flu-like symptoms. However, it can lead to serious infections and even cause death. 

Most of the state's cases have been reported in the southern half of the Central Valley.

US: Water officials hear predictions of looming crisis at Salton Sea

Via The Los Angeles Times: Water officials hear predictions of looming crisis at Salton Sea. Excerpt:

To sell water to San Diego County, Imperial Valley farmers have had to fallow land – 50,000 acres last year. A reduction in water used for irrigation means less runoff water into the Salton Sea; runoff is a major source of replenishment for the sea. 

The sea is shrinking, which exposes more ground to the air. As the sea recedes, dust storms swirl with a suddenly exposed sea bed laden with agricultural pesticides. The Imperial Valley and Coachella Valley areas have a high rate of asthma and other breathing problems.

Under the water deal approved in 2003, the irrigation district is required to put water directly into the sea, slowing but not halting its decline. But that requirement lapses in 2017, when the rate of shrinkage is expected to increase dramatically without the extra water. 

Dr. Stephen Munday, Imperial County health officer, said that he has already seen the effect of unhealthy air on his patients. “I’m gravely concerned for their health in the future,” he said. 

 In 2012, westward winds brought a rotten-egg stench from the Salton Sea over much of Southern California. In 2014, the Pacific Institute, a Northern California environmental think-tank, predicted the stink storm was only a small taste of what will become commonplace if the Salton Sea continues to shrink. 

At the Sacramento board meeting, several speakers made ominous comparisons to the dust storms at Owens Lake, which had considerable water until much of it was diverted for use in Los Angeles. 

“The Salton Sea is three times larger than Owens Lake and the destruction caused by inaction will likely be three times worse,” said Imperial County Supervisor Ryan Kelley. 

While there is nothing approaching an overall plan for the Salton Sea, there are several smaller projects, mostly to preserve the sea as a place for fish and migratory birds.

The story doesn't mention Valley fever, but it could be a possible hazard as well. Elsewhere in the Times today, California Governor Jerry Brown is asking for $1 billion in emergency drought relief. 

Plague and climate

Via The New Yorker: Of Rats, Gerbils, and Men. Excerpt:

The black rat—also known as the ship rat, the roof rat, and the house rat—is actually gray. It has large ears and a tail that’s longer than its body. The black rat (Rattus rattus) probably evolved in tropical Asia, and then was spread around the world by humans—first by the Romans and later by European colonists. According to Juliet Clutton-Brock, the author of “A Natural History of Domesticated Mammals,” it has been blamed for causing “a greater number of deaths in the human species than any natural catastrophe or war.” But perhaps the rat has gotten a bad rap? 

A paper published the other day in the Proceedings of the National Academy of Sciences, which quickly made headlines all around the world, argues that the prevailing theory of how the Black Death spread is unfair to rats. Really, the authors of the study contend, the animal responsible was a Central Asian species like the great gerbil. (Great gerbils are only distantly related to the fuzzy rodents that American kids keep as pets, though they may look a lot alike to parents.) 

The authors of the study were trying to address one of the mysteries about the Black Death. Why, after killing something like twenty-five million people in Europe in the mid-fourteenth century, did outbreaks of plague keep flaring up and then dying down again? (The Great Plague of London, in the mid-seventeenth century, killed roughly a fifth of the city’s population.) 

The prevailing theory is—or was—that bacteria responsible for the plague, Yersinia pestis, lived on Europe’s black-rat population. The rats transmitted the bacteria to fleas, which, episodically, transmitted them to humans. But the scientists who conducted the PNAS study concluded that there were no “permanent plague reservoirs in medieval Europe.” 

Instead, they posit, the plague bacterium kept being reintroduced to Europe from Asia, where it lived on the native rodent populations. They came to this conclusion after comparing tree-ring records from Europe and Asia with records of plague outbreaks. 

What they found was that plague seemed to show up at port cities in Europe several years after climate conditions favored a burst of population growth among rodents in Central Asia. (This theory does not completely exonerate black rats, as they would still have helped their Asian rodent brethren spread the disease once it reached Europe.) 

“We show that, wherever there were good conditions for gerbils and fleas in Central Asia, some years later the bacteria shows up in harbor cities in Europe and then spreads across the continent,” one of the authors of the study, Nils Christian Stenseth, a biologist at the University of Oslo, told the BBC. 

Plague is no longer a worry in Europe, although there are still occasional outbreaks in other parts of the globe. What’s perhaps the most important insight from the study has little to do with Yersinia pestis or giant gerbils. It’s that climate and human health are, in significant though often roundabout ways, related. As the climate changes, this has important—and, at the same time, hard to predict—implications. 

The list of diseases (and disease vectors) that could potentially be affected by climate change is a long and various one. It includes tick-borne diseases, such as Lyme disease, and mosquito-borne diseases—dengue fever, West Nile virus, malaria. It also includes waterborne diseases, such as cholera, and fungal diseases, such as valley fever. An upcoming issue of Philosophical Transactions B, a journal of Britain’s Royal Society, is wholly devoted to the subject of “climate change and vector-borne disease."

US: Skin tests identify inmates for Valley fever-stricken prisons

Via The Los Angeles Times: Skin tests identify inmates for valley fever-stricken prisons. Excerpt:

Skin tests conducted by California prison officials this month show thousands of inmates have been exposed to valley fever, making them candidates for placement at two prisons stricken by the sometimes deadly fungus.

Officials with the court-appointed medical receiver's office said Thursday that as a result of the massive $5-million screening conducted two weeks ago -- more than 36,000 prisoners consented to the tests -- the state has a better grasp of who can safely be held at Pleasant Valley and Avenal state prisons.  

The tests were recommended last year by the federal Centers for Disease Control and Prevention, which argued that identifying inmates already immune to valley fever would do more to save lives than the state's policy of excluding African Americans and other higher-risk populations from prisons where the disease was prevalent. 

The fungus exists in the soil throughout much of Central California and other western states. Most individuals develop only minor, cold-like symptoms when infected and then become immune, but in some individuals the fungus spreads throughout the body, killing its victim. 

Joyce Hayhoe, a spokeswoman for the medical receiver's office, said skin tests were offered to more than 94,500 inmates in mid-January. She said 36,600 agreed to be tested. Of those, Hayhoe said, more than 3,000 tested positive, suggesting they had previously been exposed to the fungus and therefore are unlikely to become ill from it. 

The positive test makes them eligible to be housed at Avenal or Pleasant Valley, prisons that hold more than 8,000 inmates. 

Among those who tested negative were 1,350 inmates already at Avenal and 815 inmates at Pleasant Valley. Hayhoe said they will have to be moved. 

Women, inmates on death row and others who are not eligible for transfer to one of the valley fever-stricken prisons were not tested.

US: Drought conditions, travelers can spread Valley fever into California’s northern counties

Via The Sacramento Bee: Drought conditions, travelers can spread Valley fever into California’s northern counties. Excerpt:

Don Hopkins, a former Davis police officer and professional ballroom dancer, is having some trouble staying on his feet. 

Hopkins, 67, is still physically drained from an early May trip to Mercy Hospital at Folsom, where doctors pumped him with pneumonia antibiotics for more than a week before accurately diagnosing his Valley fever. 

As Hopkins’ temperature soared and he began to hallucinate, his wife, Lizette, insisted the doctors test for the disease, which is historically more prevalent in the southern Central Valley. Though Hopkins’ test results would surprise many in the Sacramento region, experts say the fever is not constrained to the south state and can be carried to other regions via travelers and drought conditions. 

“When doctors see somebody with what they think is pneumonia, they immediately give them antibiotic,” said Hopkins, who lives in the El Dorado County foothills. “Often the patient gets worse and the doctors don’t think about Valley fever. It can basically disable a person for the rest of their life.” 

Valley fever is caused by a species of fungus called coccidioides, which lives in the soil in Southern California, Arizona, Mexico and parts of Central America and can be brought to the surface by construction, agricultural work and other activities that disrupt the terrain, said Dr. George Thompson, director of the Coccidioidomycosis Serology Lab at the UC Davis Medical Center. 

Once airborne, the spores can travel beyond these endemic regions on a mere gust of wind. Thompson called the assumption that the disease is only a Southern California problem a “total misconception.” 

“The maps of where it is are well done, but those were in the ’40s,” Thompson said. “I think we’re going to see it all the way up through Oregon into Washington, maybe into Idaho and Nevada ... I think the region of it being endemic is going to expand a few hundred miles.”

US: Test inmates for immunity to deadly Valley fever, experts say

Via The Fresno Bee, a report by The Associated Press: Test inmates for immunity to deadly Valley fever, experts say. Excerpt:

Federal experts are recommending that California test inmates for immunity to Valley fever before incarcerating them at two central San Joaquin Valley state prisons where the disease has killed nearly three dozen inmates, according to a report obtained Friday by The Associated Press. 

A federal judge last fall ordered the state to move nearly 2,600 susceptible inmates out of Avenal and Pleasant Valley state prisons because of the deaths and illnesses. 

The Centers for Disease Control and Prevention recommended the state go further by using hypersensitivity skin tests that could identify inmates who already were exposed to Valley fever, a soil-borne fungus. Those inmates could thus safely be housed at the two state prisons on the west side of the Valley because they largely are immune to repeat infections. 

The experts said that is a better option than the current practice of screening out black and Filipino inmates and others who statistically are more susceptible to the fungus, which grows naturally in the soil in the San Joaquin Valley and other dry locations such as Arizona and Mexico. 

They project that system-wide testing would find 13% of the prison population is immune because the inmates previously were exposed. 

Joyce Hayhoe, a spokeswoman for the federal court-appointed receiver who controls prison medical care, said the office is reviewing the report. 

Don Specter, director of the nonprofit Berkeley-based Prison Law Office, said the state should start testing inmates as soon as possible. His firm persuaded U.S. District Judge Thelton Henderson of San Francisco to order vulnerable inmates removed from the two prisons last year. 

Skin tests would sharply reduce the number of infections, the experts said. 

About 5% of inmates at the two prisons would be expected to be infected annually if no steps were taken, according to the 52-page report. Using the skin tests would reduce that to about 2%, preventing a projected 268 cases each year. 

With the commercially available skin test, approved this month by the U.S. Food and Drug Administration, inmates would be injected with a noninfectious strain and evaluated 48 hours later. 

Inmates would have the right to refuse to be tested, Hayhoe said. 

The steps the state already has taken, including removing black and Filipino inmates, should reduce annual infections only slightly, preventing 44 infections annually, the experts projected. 

At their peak in 2011, Valley fever infections at the two prisons were up to 153 times higher than surrounding areas, researchers found. The two prisons combined to produce 83% of Valley fever cases in the entire prison system, which includes about 135,500 inmates in 34 state prisons as well as private prisons in California and other states. 

The same year, more than 20,000 cases were reported nationwide among the general population, most of them in Arizona and California.