The Public Health Impact of Coccidioidomycosis in Arizona and California

The numbers of reported cases of coccidioidomycosis in Arizona and California have risen dramatically over the past decade, with a 97.8% and 91.1% increase in incidence rates from 2001 to 2006 in the two states, respectively. Of those cases with reported race/ethnicity information, Black/African Americans in Arizona and Hispanics and African/Americans in California experienced a disproportionately higher frequency of disease compared to other racial/ethnic groups. Lack of early diagnosis continues to be a problem, particularly in suspect community-acquired pneumonia, underscoring the need for more rapid and sensitive tests. Similarly, the inability of currently available therapeutics to reduce the duration and morbidity of this disease underscores the need for improved therapeutics and a preventive vaccine

Arizona Review of Reported Binational Cases with Mexico

This presentation will review the methods established for sharing reported cases of disease across an international boundary. Will review the cases identified and describe follow up actions by public health

Arizona Review of Reported Binational Cases with Mexico

This presentation will review the methods established for sharing reported cases of disease across an international boundary. Will review the cases identified and describe follow up actions by public health

Using soil survey data to model potential Coccidioides soil habitat and inform Valley fever epidemiology.

Coccidioidomycosis, also known as Valley fever, is a disease that can result in substantial illness and death. It is most common in the southwestern United States and areas of Latin America with arid climates, though reports increasingly suggest its range is wider than previously recognized. The natural habitat of the causative organisms, Coccidioides spp., have been associated with certain soil properties and climatic conditions. Current understanding of its geographic range is primarily defined by skin test studies and outbreak locations. We developed a fuzzy system model to predict suitable soil habitats for Coccidioides across the western United States based on parameters (electrical conductivity, organic matter content, pH, water holding capacity, temperature, and precipitation) from sites where soil sampling has confirmed the presence of Coccidioides. The model identified high coccidioidomycosis incidence areas as having high suitability and identified pockets of elevated suitability corresponding with outbreak locations outside the traditional range. By providing high-resolution estimates of Coccidioides suitability, including areas without public health surveillance for coccidioidomycosis, this model may be able to aid public health and clinical provider decision making. Awareness of possible Coccidioides soil habitats could help mitigate risk during soil-disturbing activities and help providers improve coccidioidomycosis diagnosis and treatment

Assessment of Vulnerability to Coccidioidomycosis in Arizona and California

Coccidioidomycosis is a fungal infection endemic to the southwestern United States, particularly Arizona and California. Its incidence has increased, potentially due in part to the effects of changing climatic variables on fungal growth and spore dissemination. This study aims to quantify the county-level vulnerability to coccidioidomycosis in Arizona and California and to assess the relationships between population vulnerability and climate variability. The variables representing exposure, sensitivity, and adaptive capacity were combined to calculate county level vulnerability indices. Three methods were used: (1) principal components analysis; (2) quartile weighting; and (3) percentile weighting. Two sets of indices, “unsupervised” and “supervised”, were created. Each index was correlated with coccidioidomycosis incidence data from 2000–2014. The supervised percentile index had the highest correlation; it was then correlated with variability measures for temperature, precipitation, and drought. The supervised percentile index was significantly correlated (p < 0.05) with coccidioidomycosis incidence in both states. Moderate, positive significant associations (p < 0.05) were found between index scores and climate variability when both states were concurrently analyzed and when California was analyzed separately. This research adds to the body of knowledge that could be used to target interventions to vulnerable counties and provides support for the hypothesis that population vulnerability to coccidioidomycosis is associated with climate variability

Burden of HIV-associated histoplasmosis compared with tuberculosis in Latin America: a modelling study

International audienceBackground Fungal infections remain a major contributor to the opportunistic infections that affect people living withHIV. Among them, histoplasmosis is considered neglected, often being misdiagnosed as tuberculosis, and isresponsible for numerous deaths in Latin America. The objective of this study was to estimate the burden ofHIV-associated histoplasmosis compared with tuberculosis in Latin American countries.Methods For this modelling study, we estimated prevalence of previous exposure to Histoplasma capsulatum, HIVassociatedhistoplasmosis annual incidence, and number of deaths in 2012 in Latin American countries based onhistorical histoplasmin skin test studies in the general population, with an antigen dilution level of more than 1/10.Studies were identified in a literature search. Data on HIV-associated tuberculosis were extracted from the WHOnotifications and outcomes tables and data on people living with HIV were extracted from the UNAIDS report for theyear 2012. We systematically propagated uncertainty throughout all the steps of the estimation process.Findings Among 1310 articles identified as of June 1, 2015, 24 articles were included in the study, representing129 histoplasmin skin test studies led in the general population of Latin American countries. For the year 2012, weestimated a range of 6710 (95% CI 5680–7867) to 15 657 (13 254–18 357) cases of symptomatic HIV-associatedhistoplasmosis in Latin America. Hotspot areas for histoplasmosis prevalence (>30%) and incidence (>1·5 cases per100 people living with HIV) were Central America, the northernmost part of South America, and Argentina. Accordingto realistic scenarios, we estimated a range of 671 (95% CI 568–787) to 9394 (7952–11 014) deaths related tohistoplasmosis, compared with 5062 (3777–6405) deaths related to tuberculosis reported in Latin America.Interpretation Our estimates of histoplasmosis incidence and deaths are high and consistent with published data. Forthe first time, the burden of histoplasmosis is estimated to be equivalent in incidence and even higher in deaths whencompared with tuberculosis among people living with HIV in Latin America

Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA

Coccidioidomycosis is an emerging fungal infection in Washington, USA, and the epidemiology of the disease in this state is poorly understood. We used whole-genome sequencing to differentiate locally acquired cases in Washington on the basis of the previously identified phylogeographic population structure of Coccidioides spp. Clinical isolates from coccidioidomycosis cases involving possible Washington soil exposure were included. Of 17 human infections with epidemiologic evidence of possible local acquisition, 4 were likely locally acquired infections and 13 were likely acquired outside Washington. Isolates from locally acquired cases clustered within the previously established Washington clade of C. immitis. Genetic differences among these strains suggest multiple environmental reservoirs of C. immitis in the state

Enhancing Respiratory Infection Surveillance on the US/Mexico Border - Arizona BIDS Program Sentinel Surveillance Data

This presentation will cover the enhancement of Severe Acute Respiratory Surveillance in Arizona-Mexico Border region from 2010 through present. It will discuss the process of establishing the surveillance, comparibility between the countries data, analysis, and lessons learned

Enhancing Respiratory Infection Surveillance on the US/Mexico Border - Arizona BIDS Program Sentinel Surveillance Data

This presentation will cover the enhancement of Severe Acute Respiratory Surveillance in Arizona-Mexico Border region from 2010 through present. It will discuss the process of establishing the surveillance, comparibility between the countries data, analysis, and lessons learned

Enhancing Surveillance for Arboviral Infections in the Arizona Border Region

OBJECTIVE: To enhance arboviral surveillance and laboratory capacity to establish a surveillance baseline for the emerging threat of Dengue fever in the Arizona-Mexico border region. INTRODUCTION: West Nile Virus (WNV) and dengue virus (DENV) are both arboviruses which are transmitted to humans by an infected mosquito bite during blood-meal feeding. The clinical presentations of non-neuroinvasive WNV and dengue fever are similar, and symptoms may include acute onset of high fever, headache, myalgia, arthralgia, nausea, vomiting, and often a maculopapular rash. More serious manifestations of these viruses include fatal encephalitis and meningitis in WNV patients and fatal hemorrhagic disease in dengue patients. Over the last decade, WNV has spread rapidly across North America, reaching Arizona in 2004, and has become a significant cause of human illness since that time. Even though dengue has been described as primarily a disease of the tropics and sub-tropical areas, there is a small but significant risk for dengue outbreaks in the continental United States as evidenced by surveillance efforts in Texas that identified local dengue transmission in 2005. In recent years, outbreaks of dengue have occurred in Mexico border states, most notably Sonora in 2010. That same year, Arizona had the highest incidence of WNV cases in the U.S. including number of neuroinvasive disease cases, total cases, and number of deaths per state. The emergence of DENV and WNV as important public health problems maybe have been due to non-effective mosquito control, global demographic changes (urbanization and population growth), increased air travel, and inadequate surveillance. METHODS: Vector mapping: Mapping techniques will be utilized to visually depict Aedes aegypti populations captured from previous seasonal public health environmental vector trapping programs. Laboratory capacity: Multi-state laboratory training by CDC Dengue Branch was held in October 2012. Surveillance: The WNV cases that present to medical services for WNV testing and reported to public health officials are the most severe nueroinvasive cases. Much less is understood about the non-neuroinvasive cases with often present with non-descript symptoms. RESULTS: Vector mapping: Comparative densities of Ae. aegypti with academic partners of the Entomology and Public Health conducting a study capturing Ae. aegypti may help to enhance environmental programs. Laboratory Capacity: The laboratory training will cover conventional serological methods as well as recently FDA cleared molecular RT-PCR. Participants will include public health laboratory personnel working in molecular and serology diagnostics and other binational partners. Surveillance: A convenient seroprevalence study at sentinel-hospital site of symptomatic patients presenting in Arizona border hospital sites will be performed to better understand circulating levels of arboviral infections. CONCLUSIONS: Appropriate and timely response to surveillance data is the key to identification human and animal disease associated with WNV, DENV, and other arboviruses. The mosquito vector Ae. aegypti is well established widespread and thriving in Arizona yet there is no autochthonous transmission of DENV identified to date. The results from this study will identify gaps and potential prevention and control measures for emerging infectious diseases including WNV and DENV in Arizona