Guevara Ramon E, Motala Tasneem, Terashita Dawn
Emergency Preparedness and Response Program, Department of Public Health, County of Los Angeles, Los Angeles, California, United States of America.
Acute Communicable Disease Control Program, Department of Public Health, County of Los Angeles, Los Angeles, California, United States of America.
PLoS One. 2015 Aug 27;10(8):e0136753. doi: 10.1371/journal.pone.0136753. eCollection 2015.
Coccidioidomycosis, also known as Valley Fever, is often thought of as an endemic disease of central California exclusive of Los Angeles County. The fungus that causes Valley Fever, Coccidioides spp., grows in previously undisturbed soil of semi-arid and arid environments of certain areas of the Americas. LA County has a few large areas with such environments, particularly the Antelope Valley which has been having substantial land development. Coccidioidomycosis that is both clinically- and laboratory-confirmed is a mandated reportable disease in LA County. Population surveillance data for 1973-2011 reveals an annual rate increase from 0.87 to 3.2 cases per 100,000 population (n = 61 to 306 annual cases). In 2004, case frequency started substantially increasing with notable epidemiologic changes such as a rising 2.1 to 5.7 male-to-female case ratio stabilizing to 1.4-2.2. Additionally, new building construction in Antelope Valley greatly rose in 2003 and displayed a strong correlation (R = 0.92, Pearson p<0.0001) with overall LA County incidence rates for 1996-2007. Of the 24 LA County health districts, 19 had a 100%-1500% increase in cases when comparing 2000-2003 to 2008-2011. Case residents of endemic areas had stronger odds of local exposures, but cases from areas not known to be endemic had greater mortality (14% versus 9%) with notably more deaths during 2008-2011. Compared to the 57 other California counties during 2001-2011, LA County had the third highest average annual number of cases and Antelope Valley had a higher incidence rate than all but six counties. With the large number of reported coccidioidomycosis cases, multi-agency and community partnering is recommended to develop effective education and prevention strategies to protect residents and travelers.
球孢子菌病，也被称为山谷热，通常被认为是加利福尼亚州中部（不包括洛杉矶县）的一种地方病。引起山谷热的真菌球孢子菌属，生长在美洲某些地区半干旱和干旱环境中未受干扰的土壤里。洛杉矶县有一些具有此类环境的大片区域，尤其是羚羊谷，那里一直在进行大规模的土地开发。临床和实验室确诊的球孢子菌病在洛杉矶县是法定报告疾病。1973 - 2011年的人口监测数据显示，发病率从每10万人0.87例逐年上升至3.2例（每年病例数从61例增至306例）。2004年，病例频率开始大幅上升，出现了显著的流行病学变化，如男女病例比从2.1上升至5.7，后稳定在1.4 - 2.2。此外，羚羊谷的新建筑建设在2003年大幅增加，与1996 - 2007年洛杉矶县的总体发病率显示出很强的相关性（R = 0.92，皮尔逊p<0.0001）。在洛杉矶县的24个卫生区中，将2000 - 2003年与2008 - 2011年进行比较时，19个区的病例数增加了100% - 1500%。地方病流行区的病例居民有更强的本地暴露几率，但来自未知地方病流行区的病例死亡率更高（分别为14%和9%），在2008 - 2011年期间死亡人数显著更多。与2001 - 2011年期间加利福尼亚州的其他57个县相比，洛杉矶县的年均病例数排名第三，羚羊谷的发病率高于除六个县之外的所有县。鉴于报告的球孢子菌病病例数量众多，建议多机构和社区合作制定有效的教育和预防策略，以保护居民和旅行者。
