Valley Fever In the Central Valley

Valley fever is considered, by most people in the health industry, a silent epidemic because the spread of the disease is not clearly detected. Most people who might have the disease show no symptoms or display symptoms that are identical to other diseases like the flu, pneumonia, and sometimes even as cancer. Valley fever has become an increasing problem in the US, but namely in the Central Valley. The main behaviors contributing to the rising valley fever problem in the Central Valley include not enough groups raising awareness in the community about the disease and misdiagnosis from health care professionals.

So what is valley fever? Valley fever is a fungal disease caused by the soil-dwelling fungus called Coccidioides immitis. The fungus prefers to reside within hot, dry, and dusty regions and is therefore prominent in the Central Valley. It is saprobic in soil, meaning that it will eat dead matter, and it becomes parasitic once it enters the body. The fungus tends to be located in rodent burrows. It is not known why exactly but it is theorized that this is because desert rodents are resistant carriers of the pathogen and are able to spread the spores of the fungus throughout the burrows and the fungus is able to live off the rodents’ excrements. When the rodents die, the fungus can then colonize in their body, use it as food, and also utilize the body as a source for the spreading of spores. Normally, these fungal spores can be inhaled through dust when soil is disturbed and will settle within the lungs where they then transform into larger, multicellular structures called spherules. Spherules leech off the nutrients in the lungs and grow until they burst, releasing more spores. These spores repeat the process, causing the fungus to vastly multiply within the lungs. This multiplication may lead to spreading of the spores outside of the lungs and throughout the skin, bones and the membranes surrounding the brain, causing meningitis. When the fungus spreads outside of the lungs, it is known as disseminated valley fever.

There are certain groups of people in the Central Valley who are more severely afflicted by valley fever. This includes individuals 23 to 55 years of age, people who work outside in the fields or at construction sites and definitely field workers who speak little English. Hispanic farm workers are greatly affected due to lack of awareness and resources. This is a grand problem because the Central Valley has a vast population of field workers who are Hispanic with limited English capability. This dilemma causes structural violence because the poor immigrant field workers lack awareness of the disease and their employers do not provide them with the proper protective gear and information, putting the field workers in high risk conditions. Employers themselves may not know or are simply trying to save money. However, the groups of people most likely to develop disseminated valley fever are African Americans and Asian/Pacific Islanders. Studies on lab mice has shown that overexpression of the cytokine IL-10, a cytokine responsible in suppressing hyperactive immune responses in the body, led to mice who got injected the disease to acquire disseminated valley fever. Humans also express IL-10 so it is speculated that African Americans and Asian/Pacific Islanders may produce a lot of IL-10, allowing the fungus to proliferate in their bodies while remaining undetected by the immune system.

Research evidence shows 111,717 reported cases in the US between 1998 – 2011. The Centers for Disease Control and Prevention (CDC) estimates about 150,000 cases of valley fever go unreported each year due to lack of awareness. California Department of Public Health reported 4,094 valley fever cases in California in 2012. Over 75% of valley fever cases from California come from the people who live in the Central Valley. Just recently, 3,000 prisoners in San Joaquin Valley had to be transferred due to risk of valley fever after some other inmates contracted the disease, indicating the possibility of the fungus harboring close to the jail.

There are certain current behaviors in the Central Valley that have led to the valley fever becoming such a big problem. At the individual level, workers find it easy and a convenience to not use proper masks when working outside in areas with coccidioidomycosis (scientific name of valley fever) spores. At the organizational level, organizations like the United Farm Workers have not been able to fight hard enough to come to agreement with farmers to provide proper protection for their workers. The San Joaquin Valley Air Pollution Control District also does not have enough restrictions established on how much farmers are allowed to disrupt soil, which does not set a limit to the amount of coccidioidomycosis spores released. Regulating this would help prevent and lower cases of Valley Fever. A major behavioral problem is that healthcare providers are not knowledgeable about the disease thus leading to many misdiagnoses.