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

Valley Fever, A Regional Health Concern Health Journalism 2018 April 15 th John N Galgiani MD Valley Fever Center for Excellence University of Arizona

What Is Valley Fever? • Caused by soil fungi • Severity varies – Mild: 60% Coccidioides immitis – Moderate: 30% Coccidioides posadasii – Complicated: 10% • Other names: • After infection, – Coccidioidomycosis (cocci) most (All?) persons develop – Desert Rheumatism life-long immunity • Infection results from to reinfection inhaling a spore Valley Center for Fever Excellence

Spores of Spores of Anthrax Coccidioides 1 μ m Sun SH. Ezzell J, USAMRIID Valley Center for Fever Excellence

Valley Center for Fever Excellence

Valley Fever in the U.S. 150,000- 75% Stopped working, Total Infections Lost time > 2 weeks Seek Medical Attention 50% Illness >6 months 40% Hospitalized 15,000- Diagnosed/Reported Cost=$200M (2012) Total US Impact: $0.5B/year 1,500- Disseminated Infection 150- Deaths 15- Valley Center for Fever Excellence

Impact: Polio vs Valley Fever Rates per 100,000 Polio (1955) Coccidioides All Reported 18 20 Paralytic 1 Disseminated 1 Valley Center for Fever Excellence

Impact: Polio vs Valley Fever Rates per 100,000 Polio (1955) Coccidioides Population World AZ & CA only In billions 7.5 .04 All Reported 18 20 Paralytic 1 Disseminated 1 Valley Center for Fever Excellence

The Valley Fever Corridor: 2/3 of all reported U.S. disease occur here Valley Center for www.vfce.arizona.ed Fever Excellence u

22 nd Anniversary of the UA VFCE • Education – 2002 Valley Fever Awareness Program 15 th Annual Valley Fever Awareness Week November 11 th – 19 th 2017 Valley Center for Fever Excellence

22 nd Anniversary of the UA VFCE • Education – 2002 Valley Fever Awareness Program – 2016 Primary Care Tutorial, 2 nd Edition Valley Center for Fever Excellence

22 nd Anniversary of the UA VFCE • Education – 2002 Valley Fever Awareness Program – 2016 Primary Care Tutorial, 2 nd Edition – CME Programs: Live and Online • New VFCE website, ATS, MedScape Valley Center for Fever Excellence

22 nd Anniversary of the UA VFCE • Education – 2002 Valley Fever Awareness Program – 2016 Primary Care Tutorial, 2 nd 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 Center for Fever 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 Center for Fever 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 Center for Fever 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 Center for Fever Excellence

Valley Fever Costs Educate patients and Nikkomycin Z development doctors $40-$60 million $100 thousand/year Vaccine development Referral network and case -- Protein vaccine: $40 M management just to start clinical trials $300 thousand/year -- Live attenuated vaccine: Safety????? Diagnostic test Dogs then Humans. $?? development Doing nothing $1.5 million $ 0.5 Billion/yr Valley Center for Fever Excellence

Questions? Valley Fever Center for Excellence Valley Center for Fever Excellence