Abstract
In California, coccidioidomycosis is a disease acquired by inhaling spores of Coccidioides immitis, a fungus found in certain arid regions, including the San Joaquin Valley, California, USA, where 8 state prisons are located. During 2011, we reviewed coccidioidomycosis rates at 2 of the prisons that consistently report >80% of California's inmate cases and determined inmate risk factors for primary, severe (defined as pulmonary coccidioidomycosis requiring >10 hospital days), and disseminated coccidioidomycosis (defined by hospital discharge International Classification of Disease, Ninth Revision code). Inmates of African American ethnicity who were >40 years of age were at significantly higher risk for primary coccidioidomycosis than their white counterparts (odds ratio = 2.0, 95% CI 1.5-2.8). Diabetes was a risk factor for severe pulmonary coccidioidomycosis, and black race a risk factor for disseminated disease. These findings contributed to a court decision mandating exclusion of black inmates and inmates with diabetes from the 2 California prisons with the highest rates of coccidioidomycosis.
Highlights
Coccidioidomycosis is a disease acquired by inhaling spores of Coccidioides immitis, a fungus found in certain arid regions, including the San Joaquin Valley, California, USA, where 8 state prisons are located
Coccidioidomycosis, commonly called “cocci” or “valley fever,” is an illness caused by Coccidioides immitis and C. posadasii, soil-dwelling fungi found in certain arid regions of the southwestern United States, northern Mexico, and Central and South America
For >5 years, 2 California prisons for adult men experienced rates of coccidioidomycosis that exceeded the rate of Kern County by 1–2 orders of magnitude
Summary
Coccidioidomycosis is a disease acquired by inhaling spores of Coccidioides immitis, a fungus found in certain arid regions, including the San Joaquin Valley, California, USA, where 8 state prisons are located. During 2011, we reviewed coccidioidomycosis rates at 2 of the prisons that consistently report >80% of California’s cases among inmates and determined inmate risk factors for primary, severe, and disseminated coccidioidomycosis. The California Correctional Health Care Services (CCHCS) (the medical arm for California inmates) instituted policies for educating inmates and staff about coccidioidomycosis and for excluding inmates with immunocompromising conditions or severe chronic obstructive pulmonary disease from California prisons in 3 coccidioidomycosis-endemic counties. In December 2011, prison X applied a soil-stabilizing emulsion to most of the grounds within the prison’s perimeter Despite these efforts, high coccidioidomycosis attack rates continued to be reported from these institutions High coccidioidomycosis attack rates continued to be reported from these institutions (CCHCS coccidioidomycosis surveillance system, unpub. data)
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