Border Infectious Disease Surveillance (BIDS)

Valley Fever (Coccidioidomycosis)

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Valley Fever at a glance

  • Valley Fever, or Coccidioidomycosis, is caused by a fungus that exists in the soil
  • Various soil disturbances cause these spores to become airborne and make a formidable pathogen
  • Approximately 40% of people infected with the disease will have symptoms of influenza-like illness such as cough, fever, fatigue, etc. (Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA, et al.)
  • The clinical presentation of primary pulmonary Valley Fever is a nonspecific syndrome that overlaps with community acquired pneumonia (CAP)
  • Valley Fever misdiagnosis as a viral or bacterial pneumonia can frequently lead to inappropriate and ineffective treatment
  • The rate of reported Valley Fever in Arizona has been increasing over the previous decade, with over 16,000 cases reported in 2011.

BIDS program efforts in regards to Valley Fever: Four Corners Project, BIDS CAP Study, and Continuing Medical Education (CME).

Four Corners Project

In 2009, the “Four Corners” coccidioidomycosis project brought together the four states of Arizona, New Mexico, Sonora, and Chihuahua in order to:

  • Enhance binational surveillance of coccidioidomycosis
  • Utilize existing resources and experiences in the border region
  • Implement and transfer new valley fever diagnostic technologies

Laboratory Capacity

  • In 2011, laboratory training for coccidioidomycosis diagnostics was carried out at the Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) in Mexico City, Mexico.
  • This training was offered by CDC Mycotic Diseases Branch hosted at InDRE laboratory along with Sonora and Chihuahua States laboratories personnel.
  • Through collaboration with CDC and the Offices of Border Health of Arizona and Nuevo Mexico were able to support the LESP of Sonora and Chihuahua with the equipment and reagents required to develop the analytical framework for local confirmation of coccidioidomycosis


  • Knowledge, Attitude, and Practices (KAP) Survey
    The first ever healthcare provider’s survey of Knowledge, Attitude, and Practices of Valley Fever was conducted in Arizona in 2007. Since then, New Mexico adapted and replicated the KAP survey in 2010
  • Binational Continuing Medical Education (CME) workshops
    Colleagues from Servicios de Salud de Sonora (including the local jurisdictional epidemiologists and laboratory staff) attended Continuing Medical Education (CME) workshops for Primary Care Physicians and also Advanced Clinical Aspects of coccidioidomycosis in November of 2010 and 2011. The information at these events were recorded and translated into Spanish.

Epidemiologic Surveillance

Enhanced Valley Fever surveillance efforts in 2007 in Arizona gave more insight about coccidioidomycosis cases in this region.

Currently, Sonora and Chihuahua are working toward the implementation of a surveillance model for coccidioidomycosis using previously established syndromic surveillance programs for Tuberculosis and Influenza.

Four Corners Coccidioidomycosis Work Group Representatives

  • Sonora State Health Services
  • Chihuahua State Health Services
  • State Laboratories of Sonora and Chihuahua (LESP)
  • Arizona Department of Health Services-Office of Border Health
  • New Mexico Department of Health -Office of Border Health
  • Center of Disease Control and Prevention (CDC)/Mycotics Branch
  • Division of Global Migration Quarantine (DGMQ) U.S.- Mexico Unit
  • The Mexico General Directorate of Epidemiology/Dirección General de Epidemiología (DGE)
  • The Mexico Institute of Epidemiological Diagnosis and Reference/ Instituto Nacional de Diagnóstico y Referencias Epidemiológicos (InDRE)

BIDS CAP study

In 2008, Arizona BIDS began a special surveillance study focused on Valley Fever. Some of the accomplishments from this study include:

  • Providing education to providers and the public in order to increase awareness of this disease
  • Using interventions to encourage physicians to perform tests on patients
  • Evaluating the proportion of patients diagnosed with community-acquired pneumonia (CAP) that were tested for Valley Fever

Online Valley Fever Continuing Medical Education (CME) in Spanish

In order to provide information about Valley Fever to the Spanish-speaking population, videos about Valley Fever epidemiology, treatment, and laboratory diagnosis have been translated into Spanish. The following online CME has Spanish subtitles with English audio. For more information about the accredited version of the CME (in English), please visit Valley Fever Center for Excellence.

This online CME was produced by the Arizona Department of Health Services- Office of Border Health and presented by the University of Arizona- Valley Fever Center for Excellence. The Videography was from a Nonprofit News Source.

Educación Médica Continua ( EMC ) en Fiebre del Valle (Coccidioidomicosis) en Español

Esta versión en español de educación médica continua para médicos generales fue grabado en el Primer Simposio Binacional (Sonora - Arizona) de Coccidioidomicosis en noviembre 2011 en Tucson, Arizona.

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