# Presentation: 225169

##     What is Valley Fever? 

    How do you know if you are at Risk?

    What are the Symptoms and how long does it take to develop symptoms

   Facts and Myths about Valley Fever

    Is there a cure for Valley Fever?  
    Other facts and Links about Valley Fever

**    ****What is Valley Fever? **
**    ****How do you know if you are at Risk?**
**    ****What are the Symptoms and how long does it take to develop symptoms**
**   ****Facts and Myths about Valley Fever**
**    ****Is there a cure for Valley Fever? **** **
**    ****Other facts and Links about Valley Fever**

- Valley Fever

##      Valley Fever is a lung infection. A fungus becomes airborne when dust around construction areas and agricultural areas is transported by the wind. When spores are inhaled, Valley Fever can result. The medical name for Valley Fever is coccidioidomycosis. 

     Coccidioidomycosis was first discovered in the early 1890’s in Domingo Ezcurra, an Argentinean soldier.  Some pathologists believed his skin conditions were the result of cancer.  After tissue biopsies his illness was thought to resemble the protozoan coccidia, often found in chickens -- and to this day the name of coccidioidomycosis still represents this early misdiagnosis. The Ezcurra case was followed for eleven years and he ultimately died of his illness.  

Valley Fever is found mostly in the Southwestern U.S. 
     where temperatures are high and the soils are dry. 

Ref:  http://www.valleyfeversurvivor.com/

-      Coccidioidomycosis was first discovered in the early 1890’s in Domingo Ezcurra, an Argentinean soldier.  Some pathologists believed his skin conditions were the result of cancer.  After tissue biopsies his illness was thought to resemble the protozoan coccidia, often found in chickens -- and to this day the name of coccidioidomycosis still represents this early misdiagnosis. The Ezcurra case was followed for eleven years and he ultimately died of his illness.
- Valley Fever is found mostly in the Southwestern U.S.
-      where temperatures are high and the soils are dry.
- Ref:  http://www.valleyfeversurvivor.com/

- What is Valley Fever?

##   
Valley fever is spread through the air.  The fungus spores get into the air when construction, natural disaster, like earthquakes, or wind disturbs the soil contaminated with the Valley Fever fungus.  People breathe in the spores and then can get Valley Fever.

Valley Fever doesn't seem to play favorites, with all kinds of people at equal risk. Once infected, however, certain groups seem to have more instances of it spreading to other parts of their bodies; as far as gender is concerned, men are more likely than women, and African Americans and Filipinos are more likely when considering race. People with problem immune systems or woman who are pregnant are at increased risk of becoming seriously ill with Valley Fever.

Construction workers, farm workers or others who spend time working in dirt and dust are most likely to get Valley Fever. You are also at higher risk if you are caught in dust storms, or if your recreation, such as biking or 4-wheeling, takes you to dusty areas.  Also after a earthquake there is a danger of contacting valley fever.  Construction, earthquakes or any recreation where you are in the dirt and dust.   One thing you can do to minimize your risk of getting Valley fever is to wear a mask if you have to be out in blowing dust – but this is not completely effective since the spores are quite small.   Basically, anyone who disturbs infected soil is at increase risk of contacting Valley Fever.  Valley Fever is not spread from person to person. Although soil-disturbing activities put people at a higher risk, people could be infected by airborne spores at any time. Walking outdoors and leaving vents open in a car could even cause a lifelong infection.

- Valley fever is spread through the air.  The fungus spores get into the air when construction, natural disaster, like earthquakes, or wind disturbs the soil contaminated with the Valley Fever fungus.  People breathe in the spores and then can get Valley Fever.
- Valley Fever doesn't seem to play favorites, with all kinds of people at equal risk. Once infected, however, certain groups seem to have more instances of it spreading to other parts of their bodies; as far as gender is concerned, men are more likely than women, and African Americans and Filipinos are more likely when considering race. People with problem immune systems or woman who are pregnant are at increased risk of becoming seriously ill with Valley Fever.
- Construction workers, farm workers or others who spend time working in dirt and dust are most likely to get Valley Fever. You are also at higher risk if you are caught in dust storms, or if your recreation, such as biking or 4-wheeling, takes you to dusty areas.  Also after a earthquake there is a danger of contacting valley fever.  Construction, earthquakes or any recreation where you are in the dirt and dust.   One thing you can do to minimize your risk of getting Valley fever is to wear a mask if you have to be out in blowing dust – but this is not completely effective since the spores are quite small.   Basically, anyone who disturbs infected soil is at increase risk of contacting Valley Fever.  Valley Fever is not spread from person to person. Although soil-disturbing activities put people at a higher risk, people could be infected by airborne spores at any time. Walking outdoors and leaving vents open in a car could even cause a lifelong infection.

- How do you get Valley Fever
-  and who is at Risk?

##     The Bakersfield area in California is considered “hyperendemic” to Valley Fever.  Most victims suffer without an adequate diagnosis, antifungal medications are frequently ineffective at resolving symptoms, and reactivations are common. 
Additionally, It is estimated that about one third of the people in the lower desert areas of Arizona have had Valley Fever at some point. Your chances of getting Valley Fever are about 1 out of 33, but the longer you live in the Desert Southwest the higher your chances of infection. There are about 100,000 new cases of Valley Fever each year. You don't have to live here to get it--people visiting or traveling through the area have been infected, too. 
The spores can also be blown hundreds of miles beyond an endemic region and can therefore infect people in other regions of the states. An endemic area map can be found at http://www.valleyfeversurvivor.com/ has a website that shows the endemic areas – they also note the following information:  

A)   Two thirds of all VF cases are in Arizona, with Phoenix and Tucson as the two most affected cities* B)   Kern County (Bakersfield) is the most endemic area in California C)   There are also endemic areas in Mexico, Central America, and South America   D)   Environmental conditions have been  known to blow spores hundreds of miles out of  their original endemic areas  
Note:  While the information above has been cited historically, doctors have noted that the rate of Valley Fever infections have risen faster than population growth in endemic areas.*  Year-to-date statistics of diagnosed infection in California are 60% higher in 2006 over 2005 and the CDC's provisional year-to-date statistics show a doubling of infections in 2006 over 2005.  In Arizona 2006 has been called "The Year of the Spore.“  [Minutes of the Arizona State Senate Committee on Health.  Phoenix, AZ 4 Feb 2002.<http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/legtext/46leg/1R/comm_min/Senate/0213+HEA%2EDOC.htm> Accessed 8/01/2003.]

-     The **Bakersfield area in California** is considered “hyperendemic” to Valley Fever.  Most victims suffer without an adequate diagnosis, antifungal medications are frequently ineffective at resolving symptoms, and reactivations are common.
- Additionally, It is estimated that about one third of the people in the **lower desert areas of Arizona** have had Valley Fever at some point. Your chances of getting Valley Fever are about 1 out of 33, but the longer you live in the Desert Southwest the higher your chances of infection. There are about 100,000 new cases of Valley Fever each year. You don't have to live here to get it--people visiting or traveling through the area have been infected, too.
- The spores can also be blown hundreds of miles beyond an endemic region and can therefore infect people in other regions of the states. An endemic area map can be found at _http://__www.valleyfeversurvivor.com__/_ has a website that shows the endemic areas – they also note the following information:
- A)   Two thirds of all VF cases are in Arizona, with Phoenix and Tucson as the two most affected cities* B)   Kern County (Bakersfield) is the most endemic area in California C)   There are also endemic areas in Mexico, Central America, and South America   D)   Environmental conditions have been  known to blow spores hundreds of miles out of  their original endemic areas
- Note:  While the information above has been cited historically, doctors have noted that the rate of Valley Fever infections have risen faster than population growth in endemic areas.*  Year-to-date statistics of diagnosed infection in California are 60% higher in 2006 over 2005 and the CDC's provisional year-to-date statistics show a doubling of infections in 2006 over 2005.  In Arizona 2006 has been called "The Year of the Spore.“  [Minutes of the Arizona State Senate Committee on Health.  Phoenix, AZ 4 Feb 2002.<_http://__www.azleg.state.az.us/FormatDocument.asp?inDoc__=/legtext/46leg/1R/comm_min/Senate/0213+HEA%2EDOC.htm_> Accessed 8/01/2003.]

- Where is Valley Fever Found?

## Symptom of valley fever range from no symptoms (about 60% of the people)*  to flu-like symptoms that can last a month. A small percentage of people (<1%) develop disease that that spreads outside the lungs to the brain, bone and skin.  Without proper treatment, Valley Fever can lead to severe pneumonia, meningitis and death.  

About two thirds of the people who are infected never notice any symptoms, or experience mild symptoms and never even get treatment. Those who have sought treatment showed symptoms including fatigue, cough, chest pain, fever, rash, headache and joint aches. Sometimes people develop red bumps on their skin. In about 5% of the cases, nodules develop on the lungs which might look like lung cancer in a chest x-ray. A biopsy or surgery may be necessary to determine if the nodule is a result of Valley Fever. Another 5% of people develop what is referred to as a lung cavity. This is most common with older people, and more than half of the cavities disappear after a while without treatment. If the lung cavity ruptures, however, there may be chest pain and difficulty breathing. 

It usually takes one to four weeks to develop symptoms of Valley Fever.

       * Note:  Recent data suggests 50% of cases are symptomatic and shows higher infection rates and disease severity.[Cole GT, Xue JM, Okeke CN, Tarcha EJ, Basrur V, Schaller RA, Herr RA, Yu JJ, Hung CY. A vaccine against coccidioidomycosis is justified and attainable. Med Mycol. 2004 Jun;42(3):189-216.]
        It is also believed that over 30% of pneumonia cases in Arizona are caused by Valley Fever.
        [Ref: Valdivia L, Nix D, Wright M, Lindberg E, Fagan T, Lieberman D, Stoffer T, Ampel NM, Galgiani JN. Coccidioidomycosis as a common cause of community-acquired pneumonia. Emerg Infect Dis. 2006 Jun;12(6):958-62.]

- About two thirds of the people who are infected never notice any symptoms, or experience mild symptoms and never even get treatment. Those who have sought treatment showed symptoms including fatigue, cough, chest pain, fever, rash, headache and joint aches. Sometimes people develop red bumps on their skin. In about 5% of the cases, nodules develop on the lungs which might look like lung cancer in a chest x-ray. A biopsy or surgery may be necessary to determine if the nodule is a result of Valley Fever. Another 5% of people develop what is referred to as a lung cavity. This is most common with older people, and more than half of the cavities disappear after a while without treatment. If the lung cavity ruptures, however, there may be chest pain and difficulty breathing.
- It usually takes one to four weeks to develop symptoms of Valley Fever.
-        * Note:  Recent data suggests 50% of cases are symptomatic and shows higher infection rates and disease severity.[Cole GT, Xue JM, Okeke CN, Tarcha EJ, Basrur V, Schaller RA, Herr RA, Yu JJ, Hung CY. A vaccine against coccidioidomycosis is justified and attainable. Med Mycol. 2004 Jun;42(3):189-216.]
-         It is also believed that over 30% of pneumonia cases in Arizona are caused by Valley Fever.
-         [Ref: Valdivia L, Nix D, Wright M, Lindberg E, Fagan T, Lieberman D, Stoffer T, Ampel NM, Galgiani JN. Coccidioidomycosis as a common cause of community-acquired pneumonia. Emerg Infect Dis. 2006 Jun;12(6):958-62.]

- What are the Symptoms?

## There is no known cure for Valley Fever.  However, In most cases of acute coccidioidomycosis, the body's own immune system is adequate to bring about recovery without medical intervention. Fever and pain can be treated with non-prescription drugs.

Chronic and disseminated coccidioidomycosis often requires treatment with potentially toxic prescription drugs. Fluconazole (Diflucan) is often the first drug of choice. Amphotericin B is a powerful fungistatic drug with several formulations (Fungizone, Ambisome, and others). It has been nicknamed "Ampho-Terrible" for its famously frequent side effects. As a result of these side effects, hospitalization may be required in order to monitor patients. Patients may also receive other drugs to minimize the side effects of the amphotericin B.

Currently there are several petitions to study and find a cure for Valley Fever.   Current legislative activities include a bill introduced by Congressman Bill Thomas ( H R 5416) to authorize funds for Valley Fever vaccine research.  (ref.  http://www.valleyfever.com/)  

There are three valley fever vaccines currently under research, by Richard Hector, project director of the Valley Fever Vaccine Project and staff member at the University of California, San Francisco. – these include*;  the first vaccine would be made of one of two "live" substances, the second vaccines would be made of the actual fungus that causes valley fever, the third is a vaccine which is made up of proteins.   They are currently trying to conduct trails – the purpose of the trials are to find a group of people who have a high rate of the disease to test vaccines on later.  In April of this year, researcher brought the skin test to Fort Irwin, an Army base near Barstow.   Of the 101 soldiers tested, nine have had valley fever.  This particular trial showed that about 5 percent of the soldiers are infected a year – (double the rate of Bakersfield's general population).  Though researchers gleaned some meaningful data from this trial, there aren't enough valley fever cases among Fort Irwin soldiers to conduct a vaccine test, so the Researchers are talking to the Lemoore Naval Air Station about conducting a trial there. *Ref article by Emily Hagerdorn, Bakersfield Californian staff writer

- Chronic and disseminated coccidioidomycosis often requires treatment with potentially toxic prescription drugs. Fluconazole (Diflucan) is often the first drug of choice. Amphotericin B is a powerful fungistatic drug with several formulations (Fungizone, Ambisome, and others). It has been nicknamed "Ampho-Terrible" for its famously frequent side effects. As a result of these side effects, hospitalization may be required in order to monitor patients. Patients may also receive other drugs to minimize the side effects of the amphotericin B.
- Currently there are several petitions to study and find a cure for Valley Fever.   Current legislative activities include a bill introduced by Congressman Bill Thomas ( H R 5416) to authorize funds for Valley Fever vaccine research.  (ref.  _http://www.valleyfever.com/_)
- There are three valley fever vaccines currently under research, by Richard Hector, project director of the Valley Fever Vaccine Project and staff member at the University of California, San Francisco. – these include*;  the first vaccine would be made of one of two "live" substances, the second vaccines would be made of the actual fungus that causes valley fever, the third is a vaccine which is made up of proteins.   They are currently trying to conduct trails – the purpose of the trials are to find a group of people who have a high rate of the disease to test vaccines on later.  In April of this year, researcher brought the skin test to Fort Irwin, an Army base near Barstow.   Of the 101 soldiers tested, nine have had valley fever.  This particular trial showed that about 5 percent of the soldiers are infected a year – (double the rate of Bakersfield's general population).  Though researchers gleaned some meaningful data from this trial, there aren't enough valley fever cases among Fort Irwin soldiers to conduct a vaccine test, so the Researchers are talking to the Lemoore Naval Air Station about conducting a trial there. *Ref article by Emily Hagerdorn, Bakersfield Californian staff writer

- Is There a Cure for Valley Fever?

## 
MYTH:  Valley Fever is a benign disease.
FACT:  It is not benign.  It can destroy lives and it causes an estimated $120 million in expenses in the United States (Cocci Study Group Meeting, March 2001) and is also considered the world's most virulent fungal parasite. (Fromtling RA, Shadomy HJ.  An overview of macrophage-fungal interactions.  Mycopathologia 1986 Feb;93(2):77-93)

MYTH: Valley Fever only affects the people and animals of the desert Southwest. FACT: With millions of travelers from the United States 
     and around the world entering this area, Valley Fever 
     takes a global toll. With 300,000 members of the United 
     States Armed Forces stationed in endemic areas, 
     Valley Fever threatens military readiness.  Animals are also at risk.  

MYTH:  There already is a cure for Valley Fever.
FACT:  There is presently no cure for Valley Fever, nor significant funding for the research to find a cure. Once the fungal parasite has infected a person, it remains with that person for life. The drug nikkomycin Z may be promising, but to date has not received funding sufficient to determine whether it will be a successful cure. If symptoms of the disease have stopped, it is not truly cured but in remission or dormant. Reactivations are common so a cure could stop Valley Fever in all those already infected.

- MYTH:  Valley Fever is a benign disease.
- FACT:  It is not benign.  It can destroy lives and it causes an estimated $120 million in expenses in the United States (Cocci Study Group Meeting, March 2001) and is also considered the world's most virulent fungal parasite. (Fromtling RA, Shadomy HJ.  An overview of macrophage-fungal interactions.  Mycopathologia 1986 Feb;93(2):77-93)
- MYTH: Valley Fever only affects the people and animals of the desert Southwest. FACT: With millions of travelers from the United States
-      and around the world entering this area, Valley Fever
-      takes a global toll. With 300,000 members of the United
-      States Armed Forces stationed in endemic areas,
-      Valley Fever threatens military readiness.  Animals are also at risk.
- MYTH:  There already is a cure for Valley Fever.
- FACT:  There is presently no cure for Valley Fever, nor significant funding for the research to find a cure. Once the fungal parasite has infected a person, it remains with that person for life. The drug nikkomycin Z may be promising, but to date has not received funding sufficient to determine whether it will be a successful cure. If symptoms of the disease have stopped, it is not truly cured but in remission or dormant. Reactivations are common so a cure could stop Valley Fever in all those already infected.

- Facts and Myths about Valley Fever

## MYTH:  A person or animal can only contract Valley Fever at certain 
                   times of the year.
FACT:  Although some weather patterns make Valley Fever outbreaks more likely, the spores can infect anyone at any time, 365 days a year. In addition to the VF spores that are blown about during dust storms, the spores are microscopic and can float unseen for a long time.  These spores are a risk at any time of day, no matter how sunny and clear the sky may be. (Galgiani JN.  Coccidioidomycosis.  West J Med. 1993 Aug;159(2):153-71)

MYTH:  Since I am very healthy and have a great immune system, I don't have to worry about contracting VF.
FACT:  Valley Fever can harm anyone just by taking in the wrong breath of air.  All it takes is the inhalation of one spore to cause a Valley Fever infection.  (Nicas M, Hubbard A. A risk analysis for airborne pathogens with low infectious doses: application to respirator selection against Coccidioides immitis spores. Risk Anal 2002 Dec;22(6):1153-63 and VFCE personal communication)

MYTH:  Only immunocompromised people have severe cases of Valley Fever.
FACT:  Even entirely healthy people can suffer, be debilitated and die from this disease.  (Pappagianis D.  Clinical presentation of Infectious Entities.  In Einstein, Hans E, Catanzaro, Antonio. (Eds)  Coccidioidomycosis.  Proceedings of the 5th International Conference on Coccidioidomycosis.  Stanford University, 24-27 August, 1994.  Washington DC:  National Foundation for Infectious Diseases, 1996: p9-11)

-                    times of the year.
**FACT:**  Although some weather patterns make Valley Fever outbreaks more likely, the spores can infect anyone at any time, 365 days a year. In addition to the VF spores that are blown about during dust storms, the spores are microscopic and can float unseen for a long time.  These spores are a risk at any time of day, no matter how sunny and clear the sky may be. (Galgiani JN.  Coccidioidomycosis.  West J Med. 1993 Aug;159(2):153-71)
**MYTH:**  Since I am very healthy and have a great immune system, I don't have to worry about contracting VF.
**FACT:**  Valley Fever can harm anyone just by taking in the wrong breath of air.  All it takes is the inhalation of one spore to cause a Valley Fever infection.  (Nicas M, Hubbard A. A risk analysis for airborne pathogens with low infectious doses: application to respirator selection against Coccidioides immitis spores. Risk Anal 2002 Dec;22(6):1153-63 and VFCE personal communication)
**MYTH:**  Only immunocompromised people have severe cases of Valley Fever.
**FACT:**  Even entirely healthy people can suffer, be debilitated and die from this disease.  (Pappagianis D.  Clinical presentation of Infectious Entities.  In Einstein, Hans E, Catanzaro, Antonio. (Eds)  Coccidioidomycosis.  Proceedings of the 5th International Conference on Coccidioidomycosis.  Stanford University, 24-27 August, 1994.  Washington DC:  National Foundation for Infectious Diseases, 1996: p9-11)

- Facts and Myths about Valley Fever

## MYTH:  I can't contract Valley Fever unless I visit an endemic region to VF.
FACT:  Spores can rest on objects like cotton, food, and clothing, resulting in infections thousands of miles away from endemic areas.  (Drutz DJ, Catanzaro A: Coccidioidomycosis. Part I. Am Rev Respir Dis 1978 Mar; 117(3): 559-85)

MYTH:  You can't contract VF just by driving through an endemic region.
FACT:  We have encountered several reports of people who had simply driven through the endemic regions and contracted serious and chronic cases of Valley Fever. We recommend people keep their windows and vents closed while driving through an endemic region. Please set your car's air conditioner to "inside air."  

MYTH:  You can't contract VF by flying on a plane that has stopped in an endemic region.
FACT:  The Department of Transportation noted that “passengers and cabin crew members boarded on an aircraft could be exposed [to Valley Fever] when the aircraft is grounded and the doors are opened for unloading passengers, baggage, and other materials.” (Ref:  Geomet Technologies. Airliner cabin environment: contaminant measurements, health risks and mitigation options. Washington: US Department of Transportation, 1989). 

**FACT:**  Spores can rest on objects like cotton, food, and clothing, resulting in infections thousands of miles away from endemic areas.  (Drutz DJ, Catanzaro A: Coccidioidomycosis. Part I. Am Rev Respir Dis 1978 Mar; 117(3): 559-85)
**MYTH:**  You can't contract VF just by driving through an endemic region.
**FACT:**  We have encountered several reports of people who had simply driven through the endemic regions and contracted serious and chronic cases of Valley Fever. We recommend people keep their windows and vents closed while driving through an endemic region. Please set your car's air conditioner to "inside air."
**MYTH:**  You can't contract VF by flying on a plane that has stopped in an endemic region.
**FACT:**  The Department of Transportation noted that “passengers and cabin crew members boarded on an aircraft could be exposed [to Valley Fever] when the aircraft is grounded and the doors are opened for unloading passengers, baggage, and other materials.” (Ref:  Geomet Technologies. Airliner cabin environment: contaminant measurements, health risks and mitigation options. Washington: US Department of Transportation, 1989).

- Facts and Myths about Valley Fever

## MYTH:  I must have had Valley Fever years ago.  Everybody who lives here gets it so there’s nothing anyone can do and therefore nothing to worry about.
FACT:  Unfortunately there is something to worry about because, once inhaled, there is no cure.  Even if the infection is dormant it can activate at any time to sicken, debilitate, or kill a person who is infected.  Also, proper dust control measures have proven that the number and severity of infections can be reduced, so there is definitely something people can do besides moving away from the endemic region.  (Ref:  Werner SB, Vugia DJ, Duffey P, Williamson J, Bissell S, Jackson RJ, Rutherford GW.  California Department of Health Services' Policy Statement on Coccidioidomycosis. In Einstein, Hans E, Catanzaro, Antonio. (Eds)  Coccidioidomycosis.  Proceedings of the 5th International Conference on Coccidioidomycosis.  Stanford University, 24-27 August, 1994.  Washington DC:  NFID, 1996: p363-372)

MYTH:  If I wear a bandanna or dust mask it will protect me from contracting Valley Fever.
FACT:  The microscopic spores that cause Valley Fever are approximately the same size as the spores that cause anthrax.  They can slip through the tiny holes in a bandanna or a standard dust mask like marbles can pass through a fishing net.  Only a NIOSH-approved N95 mask or better can provide some protection from the inhalation of spores this size.

**FACT:**  Unfortunately there *is* something to worry about because, once inhaled, there is no cure.  Even if the infection is dormant it can activate at any time to sicken, debilitate, or kill a person who is infected.  Also, proper dust control measures have proven that the number and severity of infections can be reduced, so there is definitely something people can do besides moving away from the endemic region.  (Ref:  Werner SB, Vugia DJ, Duffey P, Williamson J, Bissell S, Jackson RJ, Rutherford GW.  California Department of Health Services' Policy Statement on Coccidioidomycosis. In Einstein, Hans E, Catanzaro, Antonio. (Eds)  Coccidioidomycosis.  Proceedings of the 5th International Conference on Coccidioidomycosis.  Stanford University, 24-27 August, 1994.  Washington DC:  NFID, 1996: p363-372)
**MYTH:**  If I wear a bandanna or dust mask it will protect me from contracting Valley Fever.
**FACT:**  The microscopic spores that cause Valley Fever are approximately the same size as the spores that cause anthrax.  They can slip through the tiny holes in a bandanna or a standard dust mask like marbles can pass through a fishing net.  Only a NIOSH-approved N95 mask or better can provide some protection from the inhalation of spores this size.

- Facts and Myths about Valley Fever

## MYTH:  My VF infection was asymptomatic or mild so it can't come back again.
FACT:  Valley Fever has been known to activate or reactivate even four and a half decades after the initial infection, causing severe illness and death (Cocci Study Group, April 2002).  It can reactivate many times.

MYTH:  Places like Arizona and California, where Valley Fever is endemic, are healthy places to visit and live.
FACT:  Valley Fever is estimated to infect well over 250,000 people annually in America's five most endemic counties. People in “hyper endemic” areas like Bakersfield, California are most likely to contact Valley Fever.  Additionally, before 2006, 65% of America’s Valley Fever cases said to be contracted in Arizona. However, Arizona's caseload in 2006 is shaping up to be the worst Valley Fever epidemic in recorded history. 

     Note - The fungus that causes Valley Fever is regulated as a biological weapon in the Antiterrorism and Effective Death Penalty Act of 1996 and the Public Health Security and Bioterrorism Preparedness and Response Act of 2002.  

**FACT:**  Valley Fever has been known to activate or reactivate even four and a half decades after the initial infection, causing severe illness and death (Cocci Study Group, April 2002).  It can reactivate many times.
**MYTH:**  Places like Arizona and California, where Valley Fever is endemic, are healthy places to visit and live.
**FACT:**  Valley Fever is estimated to infect well over 250,000 people annually in America's five most endemic counties. People in “hyper endemic” areas like Bakersfield, California are most likely to contact Valley Fever.  Additionally, before 2006, 65% of America’s Valley Fever cases said to be contracted in Arizona. However, Arizona's caseload in 2006 is shaping up to be the worst Valley Fever epidemic in recorded history.
-      Note - The fungus that causes Valley Fever is regulated as a biological weapon in the Antiterrorism and Effective Death Penalty Act of 1996 and the Public Health Security and Bioterrorism Preparedness and Response Act of 2002.

- Facts and Myths about Valley Fever

##                       General Information

http://phoenix.about.com/cs/health/a/valleyfever01.htm
http://www.valley-fever.org/valley_fever_org_news_articles.html
http://www.mayoclinic.com/health/valley-fever/DS00695/DSECTION=6
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/coccidioidomycosis_t.htm
http://www.valleyfeversurvivor.com

                                       Veteran’s Information 

http://www.valleyfeversurvivor.com/vetinfo.html

**                      ****General Information**
- _http://phoenix.about.com/cs/health/a/valleyfever01.htm_
- _http://www.valley-fever.org/valley_fever_org_news_articles.html_
- _http://www.mayoclinic.com/health/valley-fever/DS00695/DSECTION=6_
- _http://www.cdc.gov/ncidod/dbmd/diseaseinfo/coccidioidomycosis_t.htm_
- _http://www.valleyfeversurvivor.com_
**                                       ****Veteran’s Information**
- _http://__www.valleyfeversurvivor.com/vetinfo.html_

- Important Links and Information