Impact of Valley Fever on Arizonans

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Impact of Valley Fever on Arizonans

• Rebecca Sunenshine, MD
• Deputy State Epidemiologist for Infectious
  Diseases
• Arizona Department of Health Services

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Rates per 100,000 population of Reported Valley
Fever in Arizona by Year, 1993-2006
Lab-reportable
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Valley Fever Rates per 100,000 by Age and Year,
Arizona, 2000 - 2006
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Reported Valley Fever Rates per 100,000
population in Arizona Older Persons by Year,
2000-2006
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What is ADHS doing about it?

• Interviewing Valley Fever (VF) cases to learn
• Risk factors
• Information about diagnosis
• Treatment
• Duration of symptoms
• Were they admitted to a hospital?
• Impact on work, school, daily living
• Knowledge about VF

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Who was interviewed?

• 3268 (VF) cases reported to ADHS from January
  through August 2007
• Goal interview every tenth person (327 persons)
• Thus far, 262 persons with Valley Fever have been
  interviewed

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About the cases

• Age (years)
• Mean 51
• Older than 60 49
• Female 51
• Insured 93

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What Weve Learned So Far

• Cases waited average of 49 days between symptom
  onset and seeking care
• Average of 2.8 visits to a healthcare provider
  before VF test ordered
• 18 (48 people) had to ask provider to order a VF
  test

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Treatment and Hospitalization

• Cases received average of 1.7 antibiotic courses
  (not effective for VF)
• 60 treated with anti-fungal drugs
• 40 hospitalized overnight for VF

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How long did it last?

• Symptoms lasted an average of 62 days
• Influenza typically lasts 2-7 days
• Mononucleosis lasts 1-3 weeks

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How does VF impact peoples lives?

• 48 (126) were employed at diagnosis
• 76 (96) missed average of 32 work days due to VF
• 78 (203) said VF interfered with daily
  activities
• Average of 94 days when patients could not do
  what they normally do

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Potential Risk Factors

• Cases lived in AZ a median of 16 years before
  diagnosis (range 0-71 years)
• 16 (41) reported having cancer or other
  malignant disease
• 55 (144) had ever smoked cigarettes

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Knowledge of Valley Fever

• Only 64 heard of VF before diagnosis
• How did cases hear of VF?
• 3 learned from a healthcare provider
• 9 learned from TV or radio
• 52 heard from someone else
• 20 of people with VF did not know how you
  contract the disease

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What Else is ADHS Doing?

• Working with healthcare providers
• 10,000 physicians surveyed to find out knowledge,
  attitudes and practices regarding VF
• Educating providers to test for VF, especially
  among patients with pneumonia

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And...

• Public education
• To seek care sooner for VF symptoms
• Encouraging patients to ask for VF test if they
  have a cough, fever and/or fatigue
• Producing a VF video about impact
• New and improved website
• www.valleyfeverarizona.org

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And...

• Mapping 2006 VF cases
• Looking for geographic patterns
• Looking for dust correlation
• Continued collaboration with partners at
  University of Arizona and VFCE
• Education campaigns
• Drug and vaccine development
• Climate investigations

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Special thanks to

• Barbara Casimir
• Christine Wampler
• Sanny Chen
• Patty Gast
• Laura Erhart
• Shoana Anderson
• Tina Wesoloski
• Dan Bronson-Lowe
• Anne Vossbrink
• Dallas Teat
• Wes Kortuem

• Peter Kelly
• Ken Komatsu
• John Galgiani
• Susan Hoover
• Mark Wright
• Melanie Deboer
• Orion McCotter
• April Johnson
• Cheryl Compton
• ADHS BIDS
• CDC Mycotic Diseases