We’ve got a fever

Valley Fever took six local lives last year, and that number may be wildly low, due to the widespread and chronic problems of misdiagnosis, underreporting and awareness related to this disease. The California Department of Public Health (CDPH) reports that the number of Valley Fever cases are up. In Kern County, Valley Fever infected nearly 2,000 people in 2016. Now, with the introduction of AB 1279, authorized by Assemblymember Rudy Salas of Bakersfield, Kern County and the rest of California may have a new weapon to help fight the disease. Over the next three years, AB 1279 would put $6 million towards boosting Valley Fever educational awareness in California, as well as aiding early detection efforts, which would in turn translate to life-saving early treatment. The bill would also establish a group made up of local health officers from the top five counties most affected by the disease to improve the way infections are reported. The state Assembly recently approved the “Valley Fever Bill” with a unanimous bipartisan vote. Salas said the fact that the bill had no opposition in the Assembly shows the importance of this statewide issue. “It’s a great place to start, but there’s no magic pill for this. There are a lot of things that have to be working together,” Salas says. The bill next heads to the State Senate for approval.

So what is Valley Fever, exactly? First, let’s call it what it is – Coccidiodomycosis, or “Cocci” for short, and it’s a spore/fungus that survives and grows underneath the topsoil. Think of it like spores that you see when you turn over a fern frond, except that the Cocci spore is microscopic – small enough to float through a surgical mask. The windy, dry topsoil so prevalent in much of the Southwestern United States is the perfect environment for Cocci to thrive. The spore just sits and waits for an event to disturb its slumber, like wind, an earthquake, or a construction project, so it can be released into the atmosphere. And once released, it can survive in the atmosphere for months, just waiting for a host to walk by and breathe it in. Human, canine, feline – yes, cases of Valley Fever have been discovered in our four-legged friends as well. But even though it needs dry soil to flourish, it can even survive in saltwater. Cases of Valley Fever have shown up in sea otters and sea lions off our Central Coast.

“If you breathe in just one spore, it can morph into the disease,” states Sandra Larson of the Valley Fever Americas Foundation, an organization founded in 1995 by Rotarians concerned about the impact of Valley Fever on our community and on all endemic regions. Once Cocci makes its way into the lungs, it becomes a “spherule” where it starts feeding on organic matter, grows, reproduces and spreads, not unlike a cancer gobbling up healthy tissue, and this is when the disease can become serious and even life threatening.
The Cocci spore is spread throughout the entire Southwestern United States, including New Mexico, Arizona, California, Nevada, and has a reach documented as far as Utah, and Texas. Additionally, cases have been reported in the Eastern drier parts of Washington and Oregon, some Midwestern states, and as far South as Argentina, with no discernable epicenter or “ground zero.” The first case reported in the world was in 1892 by an Argentinian soldier. Two years later two researchers recognized a similar case in a Portuguese immigrant farm laborer working in the San Joaquin Valley of Central California. In Kern County, the first case recognized and reported occurred in August, 1901, by a 19-year-old man who worked as a canner and been a resident for only 12 days.

Many wonder if Cocci is “contagious.” While it is not communicable from person to person, it can be carried on things like luggage, cotton, clothing and cars, which has helped it spread across the United States and into Central and South America. Cataclysmic weather events that disturb the topsoil can cause an outbreak, like the 1977 Tehachapi Dust Storm, which resulted in spores and cases being discovered as far north as Redding, and the 1994 Northridge earthquake that caused a massive spike in Simi Valley. But here’s an interesting fact: two recorded “Great Epidemic” spikes in cases were in 1991 and 2010/11, neither of which appear to have had any related identifiable environmental causes.

A frustrating problem for those trying to combat the spread of Valley Fever is that it’s almost impossible to keep it contained. With viruses like Zika or West Nile, which are carried via mosquitoes, well, “you can spray for mosquitoes. You’d have to pave over the entire Southwestern United States to keep it from spreading,” says Larson, adding, “Everyone in our area has been exposed to it, and if you haven’t breathed in a spore, it’s really just fortune.”

60 percent of those exposed to the spore will never even know it. They’ll get mild or no symptoms and their immune systems simply fight it off. Unfortunately, the remaining 40 percent will suffer the effects to such an extreme point that they’ll need medical attention, and in really severe cases, they will contract pneumonia or meningitis, which can result in death if left untreated. And once contracted, the virus, similar to herpes, can go dormant for years, waiting to take hold at a point when someone’s immune system becomes suppressed, which is why Valley Fever often afflicts the elderly and those who become infected with other autoimmune diseases or cancer.

The most common symptoms of Valley Fever are:

  • Fever
  • Cough
  • Extreme fatigue
  • Shortness of Breath
  • Skin lesions/rash
  • Chills
  • Night Sweats
  • Muscle and joint pain
  • Lack of appetite
  • Weight loss

But this list is by no means comprehensive. If you think you may have Valley Fever, ask your doctor to test for it.

While all residents in our area are at the same risk of exposure, researchers have found that some ethnicities and groups have shown a higher incidence of the disease becoming more serious and deadly. Higher risk populations include black males, Filipinos, women in the third trimester of pregnancy, and the elderly. Surprisingly, farm workers are not necessarily at higher risk because they tend to work in fields where the soil is continuously irrigated and wet, however, anyone with a job requiring them to spend a lot of time outdoors working in and amongst the soil, including oil field workers, construction and solar field workers, the CHP, and firefighters, are at risk.

Bakersfield resident Julie Solis found this out the hard way. Her husband was a construction manager for twelve years, always out in the field, disturbing the soil and breathing the air. After starting on a new construction project in Shafter, he suddenly developed a persistent cough and other flu-like symptoms. “He was told to take a pill and he’d be fine,” Solis recalls. “He didn’t go on worker’s comp. He didn’t want to lose his job.” But soon, Solis’ husband became too ill to work. “He was misdiagnosed for over six months. Now, this 42-year-old man has the brain of an 80-year-old,” Solis says, tears welling up in her eyes. “The medicine he’s taking is a poison, so it’s killing him slowly instead of the disease killing him quickly, but even with the treatment, I won’t be able to grow old with my husband. My children are going to lose their father.”

While a simple skin test can tell if you’ve been exposed to the fungus, it’s not a definitive diagnostic tool. It can only tell you’ve been exposed, not that it’s spread or that you’re at risk for more serious effects of the disease. A blood test can tell if the disease has become more acute, but it is not standardized and is far more intricate. There are only two labs currently set up in California to do this kind of testing: Kern County Public Health (KCPH) and UC Fresno. A far more invasive biopsy of tissue can tell if the spores have spread to the lungs. Both of these tests are clearly more extensive and relatively more expensive as well but should be covered by most insurance plans. The question is whether or not your physician and therefore your insurance company will think these tests are necessary.

Since early detection is so crucial to stemming the virus’ growth, it begs the question as to why more doctors don’t automatically test for it. Outside of Kern County and other widely affected areas, “many doctors simply don’t know about Valley Fever, and therefore, it just doesn’t occur to them to test for it,” says Larson.

Additionally, since Valley Fever symptoms mimic so many other diseases, from the common cold, flu, and fibromyalgia, to pneumonia, rheumatoid arthritis and even cancer, it is often misdiagnosed.

Considering that researchers have been working on Valley Fever for almost a hundred years, there are remarkably few advanced treatment options. Once diagnosed, the standard initial treatment protocols are antifungals that have been around and used for over half a century, including Diflucan, Sporanox, Nizoral and Funizone. The problem with antifungals is that they can help keep the fungus from reproducing, but they can’t eliminate it from the body. When antifungals don’t help, as with the more serious cases of pneumonia, doctors will often introduce oral drugs like Fluconazole. In 2016, a new trial began at Kern Medical Center, involving the National Institutes of Health, the Centers for Disease Control and Prevention, and Duke University. It is the first major research study to come out of a national valley fever symposium held in Kern County in 2013. The study will run over 72 months and require 1,000 adults exhibiting signs of pneumonia to participate. Half of those individuals will be given Fluconazole, a medication used to treat other fungal ailments, commonly given to valley fever patients, but without careful study of its effectiveness. The remainder will receive placebos.

Patients suffering from acute cases of Valley Fever induced meningitis, fatal if left untreated, usually start receiving regular injections of a drug called Amphotericin B. The problem with this and similar treatment protocols is that, like chemotherapy, you are introducing a poison into the body to fight the disease. “It’s like gassing for termites. The poison kills everything in there, not just the termites,” says Larson.

The problem with all current treatments on the market is that they can help the symptoms, even keep the spores from reproducing and spreading further, but there is currently no real cure for the disease. The scientific community has determined that of all the fungal diseases, Valley Fever is the best one suited for the development and application of a vaccine. There is a possible Valley Fever vaccine being developed in Arizona, one that, as Larson says, “has the potential to kill the termites.” It is called NikkomycinZ and has been shown to eradicate the Cocci spores from mice, which means this vaccine could potentially do the same for humans. So what is keeping this possible life-saving treatment from going forward to human trials?

“Money. Only Money,” Larson sighs. How much money? “We need a couple million to get it going,” Larson says, adding, “The benefits of a vaccine for those living and visiting areas where Valley Fever is found will be huge.”

So, what needs to be done? What can be done? “Right now, awareness is the only weapon we really have,” Larson says, adding, “If you know the symptoms, you may save a life.” Along with their year-round efforts, the VFAF holds an annual “Valley Fever Walk” to help spread the word and raise funds for academic research into a cure, including the experimental vaccine in Arizona. This year’s walk will be held on August 19 at Pioneer Village in Bakersfield. There are also new billboards sponsored by the KCPH going up in targeted areas of the County to help raise awareness as well. “This is something we need to focus on, this is something we need to put our resources to, and I’m just so happy that people have joined us in this fight, and we will continue to keep fighting until we see this all the way through,” Salas says. Of course, the real work will come from finding a cure, which will require adequate attention, dedicated resources and major funding efforts if we hope to stamp out Valley Fever in our lifetime.

For more information and ways to help combat Valley Fever, check out the Valley Fever Americas Foundation website, www.valleyfever.com and the dedicated Kern County Public Health Department site www.kerncountyvalleyfever.com.