Epidemiology of Pediatric Coccidioidomycosis in California


Gail L. Sondermeyer, MPH; Lauren A. Lee, MD, MPH; Debra Gilliss, MD, MPH; James M. McCarty, MD; Duc J. Vugia, MD, MPH


Pediatr Infect Dis J. 2016;35(2):166-171. 

In This Article

Abstract and Introduction


Background: Reported coccidioidomycosis cases have increased in the southwestern US since 2000. However, there are few publications on pediatric coccidioidomycosis. We sought to describe the epidemiology of coccidioidomycosis in the California pediatric population during 2000–2012.

Methods: We reviewed surveillance and hospitalization datasets for years 2000–2012 and death datasets for years 2000–2010 to identify coccidioidomycosis-associated cases, hospitalizations and deaths in pediatric (17 years old) California residents. We calculated rates and described demographic characteristics of cases and hospitalized patients and, using Poisson regression, calculated bivariate relative risks to identify potential demographic risk factors. We identified immunocompromising conditions associated with hospitalization and death and calculated hospitalization charges.

Results: We identified 3453 cases, 1301 hospitalizations and 11 deaths associated with coccidioidomycosis in the California pediatric population. During 2000–2012, annual case and hospitalized patient rates increased and were highest in males, those in the 12–17 age group, and residents of the California endemic region. Compared with White children, African-American children were significantly more likely to be hospitalized (relative risk = 1.4, P = 0.01). Approximately 12.0% of those hospitalized and 27% of those who died had an immunocompromising condition. Hospitalized patients accrued $149 million in total hospital charges.

Conclusions: Similar to recent increases among adults, reported pediatric coccidioidomycosis cases and hospitalizations have increased in California since 2000, disproportionately affecting certain demographic groups. The burden of coccidioidomycosis among California children emphasizes the need for more awareness and research into this reemerging fungal disease in endemic and nonendemic areas.


Coccidioidomycosis, also known as valley fever, is an infection caused by inhaling spores of Coccidioides fungi, which are endemic in dirt and soil of certain areas including the southwestern US.[1–4] Approximately 40% of those infected develop symptoms that can last for weeks to months and range from influenza-like illness to severe, disseminated disease such as meningitis.[5,6] Since 2000, the numbers and rates of reported coccidioidomycosis cases have increased in southwestern states.[7–10] Most cases are reported from Arizona and California but expanding areas of potential endemicity have been recently identified including in eastern Washington.[7,10,11] In California, the rates of reported cases per 100,000 population increased nearly 5-fold from 2.4 in 2000 to 10.8 in 2012.[12,13]

Published literature on coccidioidomycosis in the pediatric population (age 17 years) is limited and recent reports have focused on the clinical description and treatment.[14–17] The objective of this study was to describe the recent epidemiology and burden of coccidioidomycosis in the California pediatric population.