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Valley fever hit epidemic proportions last year and experts are wondering if 2002 will be a repeat.

If the disease infects anywhere near the same number of Kern County residents as it did in the early 1990s, the cost could be staggering. During the epidemic years of 1991-93, valley fever costs mounted to more than $56 million. A similar outbreak now could mean even greater costs.

Researchers are making progress toward a vaccine, but the going has been slow. The Californian examines the impact of the disease and the efforts of those ìFighting the Fever.î

Officials fear epidemic will persist for years

By MICHELLE TERWILLEGER Californian staff writer e-mail: mterwilleger@bakersfield.com

Monday April 22, 2002, 01:00:00 AM

Valley fever hit Kern County hard last year, creating an epidemic.

Now experts are wondering whether the epidemic will continue this year.

In 2001, Kern had 995 reported cases -- more than double the previous year. And there were 11 deaths.

So far this year, there's been a 225 percent increase in cases compared with this time last year and five valley fever deaths.

This year's cases could be leftovers from 2001 or they could signal the repeat of the multiyear valley fever epidemic that infected thousands in the early 1990s.

Predicting valley fever

Trying to predict the number of valley fever cases in a given year is an inexact science at best and a guessing game at worst.

A group of local doctors who saw valley fever patients would run an annual pool, trying to guess the number of valley fever cases the county would record each year.

"I used to win the pot all the time," said Dr. Tom Larwood, a Bakersfield internist.

Larwood wasn't just lucky; he has researched the relationship between valley fever and the weather.

Weather may play a role because valley fever is caused by a fungus that grows in the foothills of the San Joaquin Valley and, just like plants, it needs certain conditions to grow.

The fungus, Coccidioides immitis, known as cocci (KAHK-see) for short, appears to prefer dry, alkaline soils near fossil beds.

Larwood and others believe cocci flourishes when there is higher-than-average rainfall in the early months of the year, particularly when it follows a drought.

The theory is based on the fact that heavy spring rains have preceded major valley fever peaks over the years.

There was double the average rainfall in the late winters from 1991 to 1994. During those same years, Kern County had its most recent valley fever epidemic, averaging 2,100 cases each year.

There was significant winter rain early last year, which may have spurred the high number of cases during the last half of the year.

This past winter, however, was different.

Bakersfield had less-than-normal rainfall last winter, which, based on the weather theory, would mean no spike in valley fever cases this year, according to Ronald Talbot, who recently retired from the Kern County Department of Public Health.

But there is another factor: The high number of cases last year may not be a one-year aberration.

"Everyone's holding their breath," Talbot said.

New County Laboratory Director Thomas Rush believes last year's rise could be the beginning of a new epidemic cycle.

"We're bracing up for a big year," Rush said. "We might see high numbers for a few years and then see a decline."

Because Kern County experienced high rainfall in past years, Rush believes it could affect numbers this year.

Rush is basing some of his predictions on the early '90s epidemic.

The first year of the epidemic, the case numbers jumped to 1,181 and by the second year, the figure hit more than 3,300.

Dr. Hans Einstein, a longtime valley fever physician and researcher, doesn't believe that necessarily means anything for predicting the future.

He doesn't claim to know what will happen this year and is waiting until late summer or early fall to see.

Most cases usually hit during the last half of the year when the ground is dry and the wind picks up and scatters the cocci spores.

"It's up in the air -- literally and figuratively," Einstein said.

Protecting yourself

There isn't much people can do to prevent getting valley fever because the spores are in the air.

Certain activities, however, do bring with them a higher risk of infection.

High-risk activities include fossil digging in the San Joaquin foothills, working outdoors in dusty areas, spending time outside during windstorms and off-roading in dry, dusty areas.

People who must expose themselves to outdoor dust and dirt are advised to wear dust mist masks. The masks have finer holes than regular dust masks and do a better job of filtering out the spores.

While anyone working outside might be at higher risk, farm laborers are not at particular risk. The fungus does not grow well in soils that are well irrigated, fertilized and used for growing crops.