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					Does 2010 signal the start of
another coccidioidomycosis
epidemic in Kern County?

Kirt W. Emery, M.P.H., Kimberly Hernandez, M.P.H.,
Michael Lancaster, Ph.D., Matthew Constantine, Claudia
Jonah, M.D., Pam McMasters, Sandra Morales, Jorge
Talamantes, Ph.D.
   Outline
 Review the history of coccidioidomycosis cases
  and the reporting system used in Kern County
  from 1983 – 2010
 Present the preliminary descriptive epidemiology
  for 2010 coccidioidomycosis cases
 Present some GIS on the coccidioidomycosis
  cases
                                      Coccidioidomycosis Cases by Year,
                                    Rate Per 100,000 and Number of Deaths,
                                           Kern County 1983 – 2010
     3,600

     3,300                      Reported by Number                                                                     1995 Reported by Case                                                                       2010
     3,000
                                                                                                                                                                                                                   Labs
     2,700

     2,400

     2,100

     1,800

     1,500

     1,200

       900

       600
                                                                                                                                                                                                  Private labs
       300

         -
                 1983   1984   1985   1986   1987   1988   1989   1990   1991    1992    1993    1994    1995   1996   1997   1998   1999   2000   2001    2002    2003    2004    2005    2006    2007    2008    2009   2010
       Cases     150    232    223    240    273    291    276    275    1,181   3,342   2,608   1,304   523    382    307    328    504    406    994     1,055   1,281   1,540   1,584   1,081   1,229   1,128   595    2,051
       Cases     150    232    223    240    273    291    276    275    1,181   3,342   2,608   1,304   523    382    307    328    504    406    994     1,055   1,281   1,540   1,584   1,081   1,229   1,128   595    2,051
       Rate      33.6   50.5   47.1   49.4   54.8   56.9   52.6   50.0   207.3   566.9   435.8   213.9   84.8   61.2   48.6   50.6   76.2   61.0   145.8   150.9   177.7   206.3   205.6   135.2   151.7   138.0   71.3   244.3
       Deaths^    1      2      1      3      5      6      1      3      10      25      10      10      11     11     8      5      7      2      11      12      11      10      11      10      12      7       9      12




^Coccidioidomycosis Deaths for 2010 are preliminary
                                         Coccidioidomycosis Cases by Year,
                                       Rate Per 100,000 and Number of Deaths,
                                              Kern County 1983 – 2010
3,600

3,300                                                              Epidemic Years                                                                               Epidemic Years

3,000
                  1980-1990; 1995 – 2000                                                                                                        1991-1994; 2001 – 2008
2,700

2,400
                   Average                                                                                                                           Average
           Cases Deaths Rate/100,000                                                                                                         Cases Deaths Rate/100,000
2,100

1,800       302                  5                   55.9                                                                                    1,527                   12                    227.9
1,500

1,200

 900                     Endemic Years                                                                    Endemic Years
 600

 300

   -
           1983   1984   1985   1986   1987   1988   1989   1990   1991    1992    1993    1994    1995   1996   1997   1998   1999   2000   2001    2002    2003    2004    2005    2006    2007    2008    2009   2010
 Cases     150     232   223    240    273    291    276    275    1,181   3,342   2,608   1,304   523    382    307    328    504    406     994    1,055   1,281   1,540   1,584   1,081   1,229   1,128   595    2,051
 Cases     150     232   223    240    273    291    276    275    1,181   3,342   2,608   1,304   523    382    307    328    504    406     994    1,055   1,281   1,540   1,584   1,081   1,229   1,128   595    2,051
 Rate      33.6   50.5   47.1   49.4   54.8   56.9   52.6   50.0   207.3   566.9   435.8   213.9   84.8   61.2   48.6   50.6   76.2   61.0   145.8   150.9   177.7   206.3   205.6   135.2   151.7   138.0   71.3   244.3
 Deaths^    1       2     1      3      5      6      1      3      10      25      10      10     11     11      8      5      7      2      11      12      11      10      11      10      12      7       9      12




 ^Coccidioidomycosis Deaths for 2010 are preliminary
  Population Characteristics and Components of Change
                Kern County, 1980 - 2010
                                                1980      1990     2000         2010

  Total Population                              403,089 543,477     661,645     839,631
  Median Age                                       28.3    29.7        30.6        30.3*
  Race/Ethnicity
     Black                                          5%       5%            6%       5%
     Hispanic                                      22%      28%           38%      49%
     Other                                          3%       4%            6%       7%
     White                                         70%      63%           50%      39%

  Births**                                        8,077   11,977     11,556      14,911

  Deaths**                                        3,140    3,991      4,475       5,404

  Net Migration**                                 3,829   14,914      4,827       1,202

  Housing Units                                 155,702 198,636     231,564     284,367
*American Community Survey
**California Department of Finance E-6 Report
US Census
Regions of Kern County
                Cases by Region
1,600
1,400                                                  Desert

1,200
                                                       Mountain
1,000
 800
                                                       Val Central
 600
 400
                                                       Val North
 200
   0
                                                       Val West
        2001 2002 2003 2004 2005 2006 2007 2008 2010
          Cases and Case Rates by Region
                      2010
                                              Desert
                                             Mountain
Setting         2005                2006               2007             2008                2010
           N        Rate        N         Rate     N      Rate      N       Rate        N      Rate
Com.          35
              15     29.2
                     48.2          49
                                   17      65.5
                                           31.8    23
                                                   28     37.4
                                                          42.8        32
                                                                      19    34.6
                                                                            42.0         56
                                                                                         41    71.5
                                                                                               71.8
                           N=299
Inst.           2
                3    90.9
                     53.5      1 43.5
                               5 79.6
                        R=292.9/100,00              0
                                                    3      0.0
                                                          50.0          0      0.0          3 36.4
                                                                                            2 130.4
                        0
              N=85                      N=1405
              R=357.2/100,000           R=254.1/100,000
                                                                 N=41
                                                                 R=71.8/100,000



                                           Valley North
                                           Valley West
                                          Valley Central
Setting       2005
               2005                 2006
                                   2006              2007
                                                      2007              2008      N=56     2010
                                                                                  R=71.5/100,000
          N         Rate
                    Rate      NN         Rate
                                        Rate      N
                                                  N       Rate      N       Rate        N      Rate
Com.      157
          117
          829       168.0 704 132.8 817 154.1
                    179.5 149 168.7 136 158.5
                     521.6  50 212.4 27 115.9                       117 128.6
                                                                     24 102.3   299 292.9
                                                                                 85 357.2
                                                                    586 108.9 1,405 254.1
Inst.       6
            *
           43       36.2
                    2,584
                       *         36 1800 11 488.9
                                 *
                                42 214.9 157 710.8
                                       *   *     *                     3 150.0
                                                                       *
                                                                      69 315.3
                                                                             *           42 2,100
                                                                                          *     *
                                                                                        103 476.7
                  Cases by Month
450
400
350
300
250
200
150                                          121%

100
50
  0
      Jan   Feb   Mar   Apr     May        Jun   Jul   Aug Sep   Oct   Nov Dec
                              Avg. 9 yrs                  2010
              Cases by Gender
1,400                                                  70%

1,200                                                  60%

1,000                                                  50%

 800                                                   40%

 600                                                   30%

 400                                                   20%

 200                                                   10%

   0                                                   0%
        2001 2002 2003 2004 2005 2006 2007 2008 2010
                     Male   Female   % Male
      Percentage of the Cases by
              Age Group
40%

35%                                                  0 - 14
30%                                                  15 - 29
                                                     30 - 44
25%                                                  45 - 59
20%                                                  60+

15%

10%

5%

0%
      2001 2002 2003 2004 2005 2006 2007 2008 2010
       Cases by Race/Ethnicity
80%

70%                                                  Black
60%                                                  Hispanic
                                                     White
50%                                                  Other
40%                                                  Unknown

30%

20%

10%

0%
      2001 2002 2003 2004 2005 2006 2007 2008 2010
           Laboratory Testing in Kern County
                                                                                                 2010                                                                    2011
Laboratory                               Jan        Feb       Mar        Apr        May       Jun Jul               Aug       Sep    Oct   Nov   Dec   Total      Jan
KCDPH
New Positive Patients*                      202    93 111      96    58    93 100 177 247 336 226 163                                                    1,902            284
Total Tests                               1,465 1,285 1,542 1,353 1,223 1,412 1,394 1,501 1,710 1,925 1,814 1,784                                       18,408          2,096

Percent Positive                          13.8% 7.2% 7.2% 7.1% 4.7% 6.6% 7.2% 11.8% 14.4% 17.5% 12.5% 9.1%                                                10.3%         13.5%

Physicians Automated Lab
New Positive Patients*                       13     4    11                  10         12    15    18    39    80 162      80    64                       508             32
Total Tests                               1,100 1,082 1,177                 889        977 1,037 1,046 1,080 1,315 1,642 1,562 1,555                    14,462          1,572

Percent Positive                            1.2% 0.4% 0.9% 1.1% 1.2% 1.4% 1.7% 3.6% 6.1% 9.9% 5.1% 4.1%                                                    3.5%          2.0%

Total
Positive Tests*                             215    97 122 106        70 108 118 216 327 498 306 227                                                      2,410            316
Total Tests                               2,565 2,367 2,719 2,242 2,200 2,449 2,440 2,581 3,025 3,567 3,376 3,339                                       32,870          3,668

Percent Positive                            8.4% 4.1% 4.5% 4.7% 3.2% 4.4% 4.8% 8.4% 10.8% 14.0% 9.1% 6.8%                                                  7.3%          8.6%
 *Previously reported cases are removed from the total positive tests. Out-of-county positive tests are included in these numbers.
 Total tests reflects every test performed and accepted by the aforementioned labs. This would include previously reported
 patients and patients that have had multiple tests in a given month.
 Laboratory Tests by Month for Kern County Public Health
   Services Department and Physician’s Automated Lab
              January 2010 – January 2011
2,500


2,000                                                          KCDPH


1,500
                                                               PAL

1,000


 500


   0
        Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
                              2010                      2011
Percentage of Laboratory Tests Resulting in New Valley
     Fever Cases by Month for KCPHSD and PAL
            January 2010 – January 2011
20%
18%
16%                                                          KCDPH
14%
12%
                                                             PAL
10%
8%
6%
4%
2%
0%
      Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
                            2010                      2011
                                 Percent of Lab Tests Resulting in
                           New Valley Fever Cases, with 95% CI, 1995-2003,
                                       Kern County Residents
                    6.0%


                    5.0%


                    4.0%


                    3.0%                                                        5.0%

                    2.0%                   3.1%


                    1.0%


                    0.0%
                                        1995-2000                             2001-2003



Sources: Kern County Department of Public Health Laboratory and Epidemiology and Vital Statistics Section
Community Valley Fever Case Rates per 100,000
    by Census Tract, Kern County, 2010
    Community Valley Fever Case Rates per 100,000
by Census Tract, Kern County, 2001-2008 Nine-Year Avg.
Community Valley Fever Case Hot Spot Analysis
    by Census Block, Kern County, 2010
    Conclusion
 The increase in coccidioidomycosis in 2010 was
  real. Without mandatory laboratory reporting Kern
  County would have still reported over 1,500 cases.
 Submission of specimens for coccidioidomycosis
  testing continue to increase in 2011. May see
  another year of more than 2,000 cases reported.
 Further analysis of the 2010 reported cases is
  necessary to further understand the spatial
  patterns of the 2010 cases.

				
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posted:3/30/2012
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