Valley Fever Causes Mass Transfer of Calif. Prison Inmates

May 3, 2013 | Corey Benedum | Outbreak News

A federal official has ordered the transfer of more than 3,000 inmates at two San Joaquin Valley, Calif. state prisons. The order came from J. Clark Kelso, the man in charge of monitoring health in California’s correctional system. Kelso also requested the assistance of the CDC in investigating the near three-dozen deaths caused by coccidioidomycosis, or valley fever, since 2006. The transfer order applies to high-risk inmates: black inmates, Filipino inmates, HIV-positive inmates and inmates that are 55 years of age and older. It is currently unknown why people of African-American and Filipino descent are at higher risk, but the rate of death from valley fever is reportedly twice as high in black inmates as it is in non-black inmates.  

Valley Fever is caused by Coccidioides, a fungus found in the soil found within the southwestern United States. Since 1998, coccidioidomycosis infections have become increasingly common in the United States. Infection typically occurs when fungal spores are disrupted from the soil, through activities such as construction and climatic events such as dust storms, and then inhaled. After infection, approximately 60 percent of people will either be asymptomatic, meaning they won’t show symptoms, or have mild flu-like and pulmonary symptoms. Though on first glance this disease may not sound serious, severe outcomes occur in those with suppressed immune systems. Chronic valley fever, which is about 5 percent of cases, can result in the development of pulmonary nodules and severe pulmonary disease, while disseminated valley fever, another 5 percent of cases, can infect other parts of the body such as the joints, bones, and meninges.

Though most infected people do not progress to a serious form of valley fever, Dr. John Galgiani, a valley fever expert at the University of Arizona, declared the California prison situation a “medical emergency.”  Citing a recent report by the California Department of Corrections and Rehabilitation, Dr. John Galgiani, also declared that the infection rate at Pleasant Valley State Prison was “1,000 times the rate for Californians generally.” 

Most cases also do not receive medicinal treatment, but severe disease is treated with the use of certain antifungals, which aren’t perfect. These antifungals control the fungus, allowing the immune system (if capable), to destroy the fungus. If the immune system is strong enough to destroy the fungus, there can be lifelong immunity against valley fever. When the immune system fails to destroy all the fungus, the patient runs the risk of relapsing. Also, these imperfect drugs can be quite costly. The treatment of these inmates is believed to cost more than $23 million a year.

The prisons are attempting to minimize the spread of infection by controlling dust during construction and giving out surgical masks and educational material to inmates as well as employees. Thus far, these measures have not had enough of an impact and the federal government has had to intervene. The decision to transfer over 3,000 inmates also poses problems as officials are simultaneously attempting to reduce the overcrowding of California’s prisons.

In addition to this outbreak, the prisons find themselves facing legal action from the inmates. The inmates claim that the government has failed to protect them and that they are disproportionately affected by the disease. A federal judge has scheduled a hearing in June.

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