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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

Farm workers first victims of fungus

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

Saturday June 22, 2002, 12:00:00 AM

Photo courtesy of Kern Trophies Sam Chase captured this aerial image of the dust storm's swarming path from a private plane flying over Arvin in 1977.

Like countless others before him and countless after, Joas Furtado-Silveira came to California to seek his fortune in the state's expansive farmlands.

He left his home in the Azores in the 1880s with a wave of other Portuguese men, in hopes of a better life.

At first, things seemed to be working well as Furtado-Silveira found work on farms outside Modesto.

But then fungal spores changed his life and his legacy.

Furtado-Silveira didn't think much of the sore on his neck until skin lesions spread to his face. He was shunned by his co-workers and moved to San Francisco where, eventually, he was hospitalized.

After more than a year of attempts to treat what doctors thought was a skin condition, Furtado-Silveira died a disfigured man in 1895.

He is remembered as the first documented, North American case of what we now know as valley fever. Three years earlier a similar case occurred in an Argentinian soldier.

Coincidentally, while Furtado-Silveira struggled with his disease at the San Francisco County hospital, another Portuguese man from the Azores was suffering from the same disease at St. Mary's Hospital, in the same city.

Jose Teixara Pereira, also a farm worker, died in 1894 after doctors futilely tried to treat him for a parasite they were convinced was causing his problems.

Furtado-Silveira and Pereira are just a few of the people who make up the history of valley fever in the United States over the last century.

Their stories were pieced together from historical articles by Dr. Stanley Deresinski of Stanford University and from longtime valley fever physicians like Dr. Hans Einstein of Bakersfield and Dr. Demosthenes Pappagianis of University of California, Davis.

Since it was first documented 110 years ago, people of nearly every age, race and walk of life have developed the fungal disease.

But they all had one thing in common: They lived or visited an area where the toxic fungus grows.

The San Joaquin Valley is probably the best-known location for the fungal illness. So it's no surprise the scourge came to be known as valley fever.

First victims

While the doctors treating the Portuguese patients did not recognize the real cause of their disease, by 1900, others studying the cases had.

Pereira's physicians called the parasite they believed they had found, "Coccidioides immitis."

Though it wasn't a parasite, but a fungus that caused his illness, the name stuck. Now, both the fungus and the disease, which has the medical name, coccidioidomycosis, often are called cocci (KAHK-see) for short.

In the first decades of the last century, more farmworkers poured into the growing agricultural valley. They commonly complained of a flulike illness that sometimes caused pneumonia. The phenomenon was termed San Joaquin Valley fever, or just valley fever.

It wasn't until the 1930s that public health officials realized the serious cocci cases and the less severe valley fever cases were the result of the same fungus and the same disease.

Watime victims

The advent of World War II brought a national spotlight to valley fever.

Young men from around the nation were shipped to Kern County, where they trained to fly war planes. Valley fever became an obstacle, sending many trainees to the infirmary.

For scientists, the soldiers were a perfect test group.

Scientists learned that watering down the dust on Taft airfields helped reduce the number of cases. They also found that people who developed and fully recovered from the disease wouldn't get sick from it again.

That was the first evidence of the potential effectiveness of a valley fever vaccine.

Other wartime victims included Japanese-American citizens who were exposed to the fungus when they were forced into internment camps in Arizona. Other prisoners of war in both Arizona and California also became infected.

Valley fever as a weapon

The Cold War again brought valley fever to the forefront, as a possible biological weapon.

"The Korean War was just under way and there was concern about this fungus as a biological weapon," said Pappagianis, a longtime valley fever researcher at UC Davis.

U.S. military leaders wanted to develop cocci as a weapon and find protection against it.

By the 1950s, researchers had learned that blacks often developed more severe cases of valley fever than other groups.

Military leaders feared the nation's enemies might use cocci to attack military bases with large numbers of black workers, according to "Germs," Judith Miller's book on biological warfare, published last year.

The military was so concerned about the fungus that it conducted mock attacks at Navy supply depots in Mechanicsburg, Penn., and in Norfolk, Va., in 1951 with a nonlethal form of cocci, according to the book.

From the test, the military found that cocci attacks could seriously affect its ability to get supplies.

The anti-fungal arsenal

After discovering exposure to cocci led to lifetime immunity, scientists began working on a vaccine.

In the 1950s and '60s, researchers tried out experimental vaccines on mice and monkeys.

In the early 1960s, two UC Berkeley researchers took the risky step of vaccinating themselves. They then vaccinated prisoners at Vacaville State Prison, who appeared to have no problems with it.

New attitudes brought criticism of biological weapons research and under the Nixon administration, rules tightened on research. However, according to "Germs," the CIA retained a cache of potential biological weapons, including 20 grams of cocci fungus.

Epidemics and vaccines

Valley fever spread its wings to other parts of California after a giant windstorm hit the San Joaquin Valley in December 1977.

The windstorm covered Arvin in a thick layer of dust, destroyed buildings and carried cocci-laden dust to the San Francisco Bay area, where people became infected.

For valley dwellers, the storm became as memorable as California's major earthquakes.

Three years later, scientists began the first large-scale vaccine study.

From 1980 to 1984, people received an experimental valley fever vaccine in varying doses.

Volunteers complained of painfully sore arms, fever and illness after getting the vaccine.

Scientists ruled it was not safe and effective in humans.

Then a valley fever epidemic hit in early 1991 and lasted until 1994. The epidemic resulted in more than 8,400 documented valley fever cases in Kern County and 55 deaths.

The epidemic brought valley fever to public attention again and an effort to develop a new vaccine gained momentum.

Through the efforts of valley fever doctors, Bakersfield Rotary clubs, Cal State Bakersfield and many other organizations and individuals, fund-raising efforts began for valley fever vaccine research.

Using new scientific techniques, researchers are testing potential vaccines on mice and monkeys.

Valley fever's future

During the 1990s, physicians received new drugs to treat valley fever patients.

The drugs, while not as effective as amphotericin B -- the first effective valley fever drug created -- which has unpleasant side effects, proved successful in many. They have become the most common treatment.

Newer and possibly more effective treatments are on the horizon.

Researchers believe they are getting closer to a viable vaccine and hope to start human trials in the next few years.

If a safe and effective vaccine does become available, researchers hope to see fewer cases in the years to come.