Coccidioidomycosis in Tulare County, California, 1991: reemergence of an endemic disease

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Abstract
In 1991, 1208 cases of coccidioidomycosis were reported to the California Department of Health Services, compared with an annual average of 450 during 1986-90. We conducted a study in Tulare County to define the epidemiology of the disease and identify risk factors for severe disease, focusing on the epidemic period September 1991-December 1991. To identify cases, we used data from the Coccidioidomycosis Serology Laboratory at the University of California, Davis, other laboratories, and the Tulare County Health Department's coccidioidomycosis reporting system. We compared patients who were hospitalized with those who were not to determine risk factors for severe disease. We identified 128 cases of acute coccidioidomycosis diagnosed between 1 September and 31 December 1991 (attack rate 41/100,000); south central Tulare County had the highest attack rate. Thirty-five (27%) case-patients were hospitalized. Male sex (relative risk (RR) 2.5, 95% confidence interval (CI) 1.2-5.0), black people and Asian races (RR 4.8, 95% CI 2.4-9.6), and age > or = 20 years (RR 8.3, 95% CI 1.2-57.4) were univariately significant and remained independently associated with hospitalization in multivariate analysis. The 1991 Tulare County outbreak of coccidioidomycosis was part of a much larger outbreak that began in California during 1991 and continued through 1993. The outbreak was preceded by an unusually rainy spring. Although dust reduction measures during times of increased coccidioidomycosis incidence can help reduce exposure, definitive control awaits the development of a safe, effective vaccine.