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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

Certain groups at greater risk

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

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

Dan Ocampo / The Californian Former Bakersfield construction worker Cleo Cook, 41, contracted valley fever at the age of 21 and hasn't been the same since.

Cleo Cook hasn't been able to do much of anything for 20 years.

At age 21, the former construction worker got a bad case of valley fever and life hasn't been the same since.

No one can say for sure, but it may be that Cook's race had something to do with that. Cook is African-American.

All groups have an equal chance of getting valley fever, but people of certain backgrounds -- including Filipinos and blacks -- are more likely to get severe cases of it. Other factors such as pregnancy and disease also play a role.

Cook, 41, developed meningitis, the most serious form of the disease. He has received anti-fungal injections in the back of his neck and takes pills.

"It's cut me down short a lot," Cook said. "I can't stay out in the sun too long."

He also loses his balance and has to rest a lot.

In study after study, blacks have been shown to fare much worse than other valley fever patients.

The disease spreads to other parts of the body in less than 1 percent of white patients. But in cases in which the patient is black, the disease spreads 10 percent to 20 percent of the time, according to doctors.

Filipinos, American Indians and Asians also have a high risk of serious illness from valley fever.

Data on Hispanics is mixed, but Dr. Navin Amin at Kern Medical Center said that in his practice, Hispanic valley fever patients often develop serious problems.

Genetic factors have not been studied, but doctors suspect certain ethnic groups have a genetic predisposition for succumbing to the disease.

On a group level, socioeconomic factors do not seem to make a difference, nor does access to medical treatment. Some of the studies showing ethnic differences were performed on military personnel who lived in the same area under the same conditions.

In addition to racial background, people with certain health issues are more likely to experience severe cases of valley fever.

Pregnant women are at much higher risk.

Scientists theorize that changes in the immune response during pregnancy make it harder for expectant mothers to fight off the disease. Fatality rates from valley fever in pregnant women are significantly higher than in the general population.

Pregnant women cannot take the most common anti-fungal drugs due to the likelihood of harming the fetus.

When expectant mothers get seriously ill from valley fever, the safest medicine is amphotericin B, given intravenously. However, the drug often causes serious side effects, such as headache, nausea, vomiting, chills, fatigue and kidney damage.

Dr. Royce Johnson, who treats valley fever patients at a weekly Kern Medical Center clinic, said he follows his pregnant patients very closely and gives them medicine only when necessary.

People with immune-compromised conditions, such as diabetes, HIV and cancer, also are at higher risk of becoming very ill from valley fever.

"In HIV people, it is a disaster," Amin said. Most AIDS patients with valley fever die within a year, he said.

The best survivors of valley fever, even of serious cases, are children and people who get diagnosed in the early stages, Amin said.

People with classic valley fever symptoms -- fever, sudden onset of headache and lumps in the neck -- should get checked, Amin said.

"They must go and see the doctor and ask them, 'Can it be valley fever?'"