Valley Fever, A Regional Health Concern Health Journalism 2018 - - PowerPoint PPT Presentation

Valley Fever, A Regional Health Concern

Health Journalism 2018 April 15th

John N Galgiani MD Valley Fever Center for Excellence University of Arizona

Valley Fever Center for Excellence

What Is Valley Fever?

• Caused by soil fungi

Coccidioides immitis Coccidioides posadasii

• Other names:

– Coccidioidomycosis (cocci) – Desert Rheumatism

• Infection results from

inhaling a spore

• Severity varies

– Mild: 60% – Moderate: 30% – Complicated: 10%

• After infection,

most (All?) persons develop life-long immunity to reinfection

Valley Fever Center for Excellence

Spores of Coccidioides Spores of Anthrax

Sun SH. Ezzell J, USAMRIID

1μm

Valley Fever Center for Excellence

Valley Fever Center for Excellence

Valley Fever in the U.S.

150,000- 15,000- 1,500- 150- 15-

Total Infections Seek Medical Attention Diagnosed/Reported Disseminated Infection Deaths 75% Stopped working, Lost time > 2 weeks 50% Illness >6 months 40% Hospitalized Cost=$200M (2012) Total US Impact: $0.5B/year

Valley Fever Center for Excellence

Impact: Polio vs Valley Fever

Rates per 100,000 Polio (1955) Coccidioides All Reported 18 20 Paralytic 1 Disseminated 1

Valley Fever Center for Excellence

Impact: Polio vs Valley Fever

Rates per 100,000 Polio (1955) Coccidioides Population In billions World 7.5 AZ & CA only .04 All Reported 18 20 Paralytic 1 Disseminated 1

Valley Fever Center for Excellence www.vfce.arizona.ed u

The Valley Fever Corridor: 2/3 of all reported U.S. disease occur here

Valley Fever Center for Excellence

22nd Anniversary of the UA VFCE

• Education

– 2002 Valley Fever Awareness Program

15th Annual Valley Fever Awareness Week November 11th – 19th 2017

Valley Fever Center for Excellence

22nd Anniversary of the UA VFCE

• Education

– 2002 Valley Fever Awareness Program – 2016 Primary Care Tutorial, 2nd Edition

Valley Fever Center for Excellence

22nd Anniversary of the UA VFCE

• Education

– 2002 Valley Fever Awareness Program – 2016 Primary Care Tutorial, 2nd Edition – CME Programs: Live and Online

• New VFCE website, ATS, MedScape

Valley Fever Center for Excellence

22nd Anniversary of the UA VFCE

• Education

– 2002 Valley Fever Awareness Program – 2016 Primary Care Tutorial, 2nd Edition – CME Programs: Live and Online

• New VFCE website, ATS, MedScape
• Research

– $25-35 million in funding: Epi., Immunol., Genetics, Diagnostics, Drugs, Vaccines

• Clinical Care (?)

Valley Fever Center for Excellence

How bad is it?

Ariz CAP

– ~25%-30% due to Coccidioides BUT – <15% are tested for Coccidioides.

~1,000 new Az medical licenses/yr

– 12% received MD in Az; 40% no Az GME

80% didn’t know: VF is reportable; Vaccine does not exist 40% of clinicians not confident to treat VF

• Chang, 2008; Chen, 2011

Valley Fever Center for Excellence

Consequences of Current Standard Practices

• Delays in diagnosis of early coccidioidal

infections: In BUMC-T, 30% > 1 month*

– Unnecessary anti-bacterial drug use – Protracted patient anxiety and fear – Over-utilization CT scans and bronchoscopies, even thoracotomies

• Hypothesis: Earlier diagnosis would

improve outcomes and reduce cost.

*Donovan et al, Cocci Study Group 2018

Valley Fever Center for Excellence

Clinical Network and Research

Vaccines

New Drugs (Nikkomycin Z) Better Diagnostics; Genetics of Risk Clinical Care/Clinical Platform; Do Better with the tools we have

Valley Fever Center for Excellence

Valley Fever Costs

Educate patients and doctors $100 thousand/year Referral network and case management $300 thousand/year Diagnostic test development $1.5 million Nikkomycin Z development $40-$60 million Vaccine development

• - Protein vaccine: $40 M

just to start clinical trials

• - Live attenuated vaccine:

Safety????? Dogs then Humans. $??

Doing nothing

$ 0.5 Billion/yr

Valley Fever Center for Excellence

Valley Fever Center for Excellence

Questions?