Increased incidence of valley fever in Arizona is a growing public health concern. The disease, caused by inhalation of fungal spores found in soil, has seen substantial increases in reported cases since 1997 when reporting became mandatory. While seasonal and climate factors influence rates, other risk factors like construction activities, increased at-risk populations, and delays in provider education have also contributed to rising incidence. Improved diagnostics, preventative measures, and development of a vaccine could help address the disease burden.
Corona virus was first identified as the cause of the common cold in 1960. In one study carried out in Canada in 2001, more than 510 patients presented with flu-like symptoms. Virological analyses showed that 3.7% of these cases were positive for the HCoV-NL63 strain by polymerase chain reaction (PCR). Until 2002, the corona virus was considered a relatively simple, nonfatal virus; however, an outbreak in 2002–2003 in the Guangdong province in China, which resulted in spread to many other countries, encompassing Thailand, Vietnam, Taiwan, Hong Kong Singapore, and the United States of America, causes severe acute respiratory syndrome (SARS) and high mortality rates in over 1000 -1100 patients.
Rhinovirus is the most common cause of the common cold. It is a non-enveloped, positive sense RNA virus that primarily infects the upper respiratory tract. Rhinovirus infections are most frequent and widespread during fall and winter. Symptoms include runny nose, sore throat, coughing, sneezing, and body aches. While the common cold is usually self-limiting, complications can occasionally occur such as sinusitis, ear infections, or pneumonia. There is no vaccine or cure for the common cold. Treatment focuses on relieving symptoms through rest, hydration, analgesics, and in some cases decongestants.
The document summarizes the findings of a pathology presentation on COVID-19 pulmonary pathology. It describes the histopathological examination of lung tissue from 38 COVID-19 patient deaths in Italy which found evidence of diffuse alveolar damage, hyaline membrane formation, thrombi in small arteries, and type II pneumocyte hyperplasia. It also discusses the similarities to findings from SARS, MERS, and influenza, including epithelial infection, microvascular damage, and organizing pneumonia that can progress to pulmonary fibrosis.
This document provides an overview of coronaviruses including their viral composition, epidemiology, transmission routes, clinical manifestations, and impact on respiratory and enteric systems. Key points include that coronaviruses are common causes of respiratory illness, especially in winter, and have also been linked to gastrointestinal symptoms in some cases. While they account for a percentage of respiratory infections, evidence also links coronaviruses to conditions like croup, asthma attacks, pneumonia, and some cases of diarrhea.
Rhino virus, corona virus, and enterovirus are common causes of respiratory illness. Rhino virus is the main cause of the common cold and symptoms typically resolve within a week. Corona viruses can cause mild upper respiratory infections or more severe illness like SARS. Enteroviruses are transmitted through oral contact and cause a variety of respiratory symptoms from sore throat to pneumonia. Treatment is usually supportive and prevention focuses on hand hygiene and sanitation.
Bacterial diarrhea remains a major global health problem and common reason for patients seeking medical care. While strategies can improve diagnostic ability, such as increasing stool culture yield and new rapid tests, emerging antimicrobial resistance among common bacterial causes has challenged treatment. Recent studies showing favorable results for rifaximin, a nonabsorbed antibiotic, provide a potential solution as resistance grows to traditionally used antibiotics. However, prudent antibiotic use remains important to slow further development of resistance.
This document provides information about coronaviruses, including the Wuhan coronavirus that emerged in 2019. It defines coronaviruses as enveloped RNA viruses that commonly infect mammals and birds, causing respiratory or intestinal illness. It describes the taxonomy and structure of coronaviruses, as well as their replication process and pathogenesis. The document also discusses previous coronavirus outbreaks, such as SARS and MERS, and examines scenarios for the Wuhan outbreak, investigating its potential origin from bats or snakes.
Kawasaki disease is a childhood vasculitis that causes inflammation of blood vessels. It is the leading cause of acquired heart disease in children in the US and Japan. The disease is characterized by prolonged fever and changes in the mouth, hands, and feet. Untreated, approximately 20% of patients develop coronary artery abnormalities like aneurysms which can lead to thrombosis, heart attack, or sudden death. While the cause is unknown, evidence supports an infectious origin. Proper diagnosis is based on symptoms, and treatment seeks to prevent cardiac complications through administration of intravenous immunoglobulin and aspirin.
Corona virus was first identified as the cause of the common cold in 1960. In one study carried out in Canada in 2001, more than 510 patients presented with flu-like symptoms. Virological analyses showed that 3.7% of these cases were positive for the HCoV-NL63 strain by polymerase chain reaction (PCR). Until 2002, the corona virus was considered a relatively simple, nonfatal virus; however, an outbreak in 2002–2003 in the Guangdong province in China, which resulted in spread to many other countries, encompassing Thailand, Vietnam, Taiwan, Hong Kong Singapore, and the United States of America, causes severe acute respiratory syndrome (SARS) and high mortality rates in over 1000 -1100 patients.
Rhinovirus is the most common cause of the common cold. It is a non-enveloped, positive sense RNA virus that primarily infects the upper respiratory tract. Rhinovirus infections are most frequent and widespread during fall and winter. Symptoms include runny nose, sore throat, coughing, sneezing, and body aches. While the common cold is usually self-limiting, complications can occasionally occur such as sinusitis, ear infections, or pneumonia. There is no vaccine or cure for the common cold. Treatment focuses on relieving symptoms through rest, hydration, analgesics, and in some cases decongestants.
The document summarizes the findings of a pathology presentation on COVID-19 pulmonary pathology. It describes the histopathological examination of lung tissue from 38 COVID-19 patient deaths in Italy which found evidence of diffuse alveolar damage, hyaline membrane formation, thrombi in small arteries, and type II pneumocyte hyperplasia. It also discusses the similarities to findings from SARS, MERS, and influenza, including epithelial infection, microvascular damage, and organizing pneumonia that can progress to pulmonary fibrosis.
This document provides an overview of coronaviruses including their viral composition, epidemiology, transmission routes, clinical manifestations, and impact on respiratory and enteric systems. Key points include that coronaviruses are common causes of respiratory illness, especially in winter, and have also been linked to gastrointestinal symptoms in some cases. While they account for a percentage of respiratory infections, evidence also links coronaviruses to conditions like croup, asthma attacks, pneumonia, and some cases of diarrhea.
Rhino virus, corona virus, and enterovirus are common causes of respiratory illness. Rhino virus is the main cause of the common cold and symptoms typically resolve within a week. Corona viruses can cause mild upper respiratory infections or more severe illness like SARS. Enteroviruses are transmitted through oral contact and cause a variety of respiratory symptoms from sore throat to pneumonia. Treatment is usually supportive and prevention focuses on hand hygiene and sanitation.
Bacterial diarrhea remains a major global health problem and common reason for patients seeking medical care. While strategies can improve diagnostic ability, such as increasing stool culture yield and new rapid tests, emerging antimicrobial resistance among common bacterial causes has challenged treatment. Recent studies showing favorable results for rifaximin, a nonabsorbed antibiotic, provide a potential solution as resistance grows to traditionally used antibiotics. However, prudent antibiotic use remains important to slow further development of resistance.
This document provides information about coronaviruses, including the Wuhan coronavirus that emerged in 2019. It defines coronaviruses as enveloped RNA viruses that commonly infect mammals and birds, causing respiratory or intestinal illness. It describes the taxonomy and structure of coronaviruses, as well as their replication process and pathogenesis. The document also discusses previous coronavirus outbreaks, such as SARS and MERS, and examines scenarios for the Wuhan outbreak, investigating its potential origin from bats or snakes.
Kawasaki disease is a childhood vasculitis that causes inflammation of blood vessels. It is the leading cause of acquired heart disease in children in the US and Japan. The disease is characterized by prolonged fever and changes in the mouth, hands, and feet. Untreated, approximately 20% of patients develop coronary artery abnormalities like aneurysms which can lead to thrombosis, heart attack, or sudden death. While the cause is unknown, evidence supports an infectious origin. Proper diagnosis is based on symptoms, and treatment seeks to prevent cardiac complications through administration of intravenous immunoglobulin and aspirin.
Here, I present the recent updates about n-CoV known as " Corona Virus".
History of Corona virus
Introduction of corona virus
Types of corona virus (CoV)
Pathogenesis of nCoV
Diagnosis
treatment
This document provides information about the 2019 Novel Coronavirus (2019-nCoV) outbreak that originated in Wuhan, China in December 2019. It discusses that coronaviruses can be transmitted from animals to humans and between humans. The 2019-nCoV was identified as the cause of the outbreak with many early cases linked to a seafood market, but human-to-human transmission has since been observed. It describes the clinical presentation, diagnosis, treatment and prevention measures for 2019-nCoV infection.
This document provides an overview of pandemics throughout history, including definitions, examples of major pandemics, mathematical models used to study infectious diseases, and features of the current COVID-19 pandemic. It discusses pandemics from 430 BC to present day, historical models for understanding pandemics, and key concepts like the basic reproduction number and pandemic stages. The document concludes with statistics on COVID-19 cases worldwide and in India/West Bengal as of September 2020.
The document summarizes information about protecting families and workplaces during a pandemic flu outbreak. It discusses what a pandemic is, compares seasonal flu to pandemic flu, reviews past pandemics, and outlines infection control basics and a CDC workforce protection plan. The plan includes guidance on personal and family readiness, keeping the workplace safe, managing illness, and mental health during a pandemic.
Viral infection of the respiratory tract (2)Ravi Teja
The document discusses several viruses that can cause respiratory infections, including adenoviruses, respiratory syncytial virus, and parainfluenza viruses. It provides details on the structure, transmission, clinical manifestations, diagnosis, and treatment of infections caused by these viruses. Adenoviruses can cause pharyngitis, pneumonia, conjunctivitis and other syndromes. RSV is a major cause of bronchiolitis and pneumonia in infants. Parainfluenza viruses commonly cause croup in young children.
Name : Renathan Agustianus
NIM : 20190900012
Major : Industrial Engineering
Faculty : Science and Technology
Courses : Bahasa Inggris 2
Lecturer : Harisa Mardiana
FInal Exam
Coronaviruses are a family of viruses that cause illnesses ranging from the common cold to more severe diseases. Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a coronavirus called MERS-CoV. The first case was reported in Saudi Arabia in 2012. Additional cases were found in several Middle Eastern countries. Research indicates that camels are a reservoir for the virus and may transmit it to humans. Transmission between humans occurs through close contact. Symptoms include severe pneumonia and kidney failure. There is no vaccine or specific treatment, though supportive care can be given.
This document provides guidance for cytopathology laboratories handling samples from patients with suspected or confirmed COVID-19. It outlines precautions to take during procedures like fine needle aspiration, sample processing, disposal, and spill management. Proper personal protective equipment and disinfection protocols are emphasized. Reporting and staff training procedures are adapted to minimize risk of virus transmission.
This document provides information about coronaviruses and the 2019 novel coronavirus. It discusses that coronaviruses cause common colds in humans and infect the respiratory and gastrointestinal tracts. Four to five strains commonly infect humans, including SARS. The novel coronavirus was discovered in 2012 in the Middle East and has caused over 150 cases and 64 deaths globally. Clinical signs include flu-like symptoms and cough after one week. Prevention focuses on hand washing and avoiding those with coughs. Treatment involves oxygen therapy, specimen collection, empiric antibiotics, and monitoring for deterioration.
The document provides information about Coronavirus (COVID-19). It describes how COVID-19 is caused by SARS-CoV-2 virus and spreads mainly through respiratory droplets from infected individuals. Common symptoms include fever, cough and shortness of breath. While most cases are mild, it can progress to pneumonia and multi-organ failure in some cases. The mortality rate is around 2%. Currently there is no vaccine, though some antiviral medications are being tested. Prevention relies on hand washing and hygiene measures.
Assessing Differential Impacts of COVID-19 on African Countries: A Comparativ...oyepata
The document compares the impact of COVID-19 across different African countries and to the United States. Data from 55 randomly selected countries based on cases was analyzed against US data. Results show that with the exception of South Africa, African countries have been less affected by the virus overall with fewer total cases, higher recovery rates, and fewer deaths compared to indexes from the US and other continents. This difference may be due to factors like a more robust immune response in Africa.
COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The first cases were seen in Wuhan, China in December 2019 before spreading globally. The current outbreak was recognized as a pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or organizing pneumonia, often with a bilateral, peripheral, and basal predominant distribution. No effective treatment or vaccine exists currently (March 2020).
Covid-19 Pandemic, where are we now? Latest update on Covid-19 Second Wave 20...Shivam Parmar
Disclaimer -
The Content belongs to WHO (World Health Organisation). Sharing here is just to spread awareness about Covid-19.
https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update51_pandemic_overview_where_are_we_now.pdf?sfvrsn=709278aa_5
Respiratory viruses 8 november 2014 wagdyWagdy Amin
This document discusses various epidemic viruses including SARS, avian influenza (H5N1), and influenza (H1N1, H3N2). It provides details on the origins, symptoms, treatment and global spread of these viruses. SARS originated in China in 2002 and had a mortality rate of around 10%. Avian influenza (H5N1) is endemic in birds and can be transmitted to humans, with a high mortality rate of 59%. Influenza viruses such as H1N1 have caused past pandemics and continue to mutate and spread globally.
Coronaviruses can cause illness in humans ranging from the common cold to more severe diseases like MERS and SARS. COVID-19 is the most recently discovered coronavirus that causes respiratory symptoms such as fever, cough and tiredness in most people. While most cases are mild, around 20% of cases develop serious breathing difficulties and are at higher risk of severe illness. Herbal treatments may help prevent and treat COVID-19 by strengthening immunity, using as antiviral coatings, disinfecting air, and sanitizing surfaces.
Coronavirus disease (COVID-19) is caused by a newly discovered coronavirus called SARS-CoV-2. Common symptoms include fever, tiredness, and dry cough, with most patients recovering without special treatment. However, older individuals and those with pre-existing medical conditions are more vulnerable to severe illness. While bats were believed to be the original host, the exact origin of SARS-CoV-2 is still unclear. The initial epicenter was Wuhan, China, though person-to-person spread has led to a global situation with rising case numbers and death tolls that vary by age. Preventive measures center around social distancing, quarantines, and maintaining good hygiene.
Measles is a highly contagious viral infection that spreads through the air. It typically causes a rash, fever, and other symptoms. While a safe and effective vaccine exists, measles cases have risen globally due to undervaccination. Treatment focuses on relieving symptoms, while complications can include secondary infections of the lungs, brain, or eyes. Vaccination has significantly reduced measles deaths worldwide.
coronavirus" is derived from the Latin corona, meaning crown or halo, which refers to the characteristic appearance of the virus particles (virions): they have a fringe reminiscent of a royal crown or of the solar.
Corona Coronaviruses are a group of viruses that cause diseases in mammals and birds.
Human coronaviruses are :
Severe acute respiratory syndrome (SARS)
Middle East respiratory syndrome
Novel coronavirus (2019-nCoV)
This document provides an overview of the 2009 H1N1 influenza pandemic from an Indian perspective. It discusses the challenges faced in recognizing and confirming cases of the disease. It also outlines treatment recommendations, including the use of antiviral drugs like Tamiflu and supportive care. Complications tend to be more severe in younger people, possibly due to a 'cytokine storm' immune response, and include pneumonia and acute respiratory distress syndrome.
Soraya Ghebleh - Unwarranted Variation in HealthcareSoraya Ghebleh
Unwarranted variation in healthcare refers to differences in medical practice that cannot be explained by illness, need, or evidence. There are three main drivers of unwarranted variation: effective care, preference-sensitive care, and supply-sensitive care. Shared decision making has the potential to help reduce unwarranted variation related to preference-sensitive care by increasing patient education and involvement in healthcare decisions. Aligning financial incentives through payment models like accountable care organizations could also help by rewarding quality over quantity of services. Improving outcomes research and data sharing between providers may further address unwarranted variation by helping providers determine effective, necessary care based on evidence from different institutions and settings.
Here, I present the recent updates about n-CoV known as " Corona Virus".
History of Corona virus
Introduction of corona virus
Types of corona virus (CoV)
Pathogenesis of nCoV
Diagnosis
treatment
This document provides information about the 2019 Novel Coronavirus (2019-nCoV) outbreak that originated in Wuhan, China in December 2019. It discusses that coronaviruses can be transmitted from animals to humans and between humans. The 2019-nCoV was identified as the cause of the outbreak with many early cases linked to a seafood market, but human-to-human transmission has since been observed. It describes the clinical presentation, diagnosis, treatment and prevention measures for 2019-nCoV infection.
This document provides an overview of pandemics throughout history, including definitions, examples of major pandemics, mathematical models used to study infectious diseases, and features of the current COVID-19 pandemic. It discusses pandemics from 430 BC to present day, historical models for understanding pandemics, and key concepts like the basic reproduction number and pandemic stages. The document concludes with statistics on COVID-19 cases worldwide and in India/West Bengal as of September 2020.
The document summarizes information about protecting families and workplaces during a pandemic flu outbreak. It discusses what a pandemic is, compares seasonal flu to pandemic flu, reviews past pandemics, and outlines infection control basics and a CDC workforce protection plan. The plan includes guidance on personal and family readiness, keeping the workplace safe, managing illness, and mental health during a pandemic.
Viral infection of the respiratory tract (2)Ravi Teja
The document discusses several viruses that can cause respiratory infections, including adenoviruses, respiratory syncytial virus, and parainfluenza viruses. It provides details on the structure, transmission, clinical manifestations, diagnosis, and treatment of infections caused by these viruses. Adenoviruses can cause pharyngitis, pneumonia, conjunctivitis and other syndromes. RSV is a major cause of bronchiolitis and pneumonia in infants. Parainfluenza viruses commonly cause croup in young children.
Name : Renathan Agustianus
NIM : 20190900012
Major : Industrial Engineering
Faculty : Science and Technology
Courses : Bahasa Inggris 2
Lecturer : Harisa Mardiana
FInal Exam
Coronaviruses are a family of viruses that cause illnesses ranging from the common cold to more severe diseases. Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a coronavirus called MERS-CoV. The first case was reported in Saudi Arabia in 2012. Additional cases were found in several Middle Eastern countries. Research indicates that camels are a reservoir for the virus and may transmit it to humans. Transmission between humans occurs through close contact. Symptoms include severe pneumonia and kidney failure. There is no vaccine or specific treatment, though supportive care can be given.
This document provides guidance for cytopathology laboratories handling samples from patients with suspected or confirmed COVID-19. It outlines precautions to take during procedures like fine needle aspiration, sample processing, disposal, and spill management. Proper personal protective equipment and disinfection protocols are emphasized. Reporting and staff training procedures are adapted to minimize risk of virus transmission.
This document provides information about coronaviruses and the 2019 novel coronavirus. It discusses that coronaviruses cause common colds in humans and infect the respiratory and gastrointestinal tracts. Four to five strains commonly infect humans, including SARS. The novel coronavirus was discovered in 2012 in the Middle East and has caused over 150 cases and 64 deaths globally. Clinical signs include flu-like symptoms and cough after one week. Prevention focuses on hand washing and avoiding those with coughs. Treatment involves oxygen therapy, specimen collection, empiric antibiotics, and monitoring for deterioration.
The document provides information about Coronavirus (COVID-19). It describes how COVID-19 is caused by SARS-CoV-2 virus and spreads mainly through respiratory droplets from infected individuals. Common symptoms include fever, cough and shortness of breath. While most cases are mild, it can progress to pneumonia and multi-organ failure in some cases. The mortality rate is around 2%. Currently there is no vaccine, though some antiviral medications are being tested. Prevention relies on hand washing and hygiene measures.
Assessing Differential Impacts of COVID-19 on African Countries: A Comparativ...oyepata
The document compares the impact of COVID-19 across different African countries and to the United States. Data from 55 randomly selected countries based on cases was analyzed against US data. Results show that with the exception of South Africa, African countries have been less affected by the virus overall with fewer total cases, higher recovery rates, and fewer deaths compared to indexes from the US and other continents. This difference may be due to factors like a more robust immune response in Africa.
COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The first cases were seen in Wuhan, China in December 2019 before spreading globally. The current outbreak was recognized as a pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or organizing pneumonia, often with a bilateral, peripheral, and basal predominant distribution. No effective treatment or vaccine exists currently (March 2020).
Covid-19 Pandemic, where are we now? Latest update on Covid-19 Second Wave 20...Shivam Parmar
Disclaimer -
The Content belongs to WHO (World Health Organisation). Sharing here is just to spread awareness about Covid-19.
https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update51_pandemic_overview_where_are_we_now.pdf?sfvrsn=709278aa_5
Respiratory viruses 8 november 2014 wagdyWagdy Amin
This document discusses various epidemic viruses including SARS, avian influenza (H5N1), and influenza (H1N1, H3N2). It provides details on the origins, symptoms, treatment and global spread of these viruses. SARS originated in China in 2002 and had a mortality rate of around 10%. Avian influenza (H5N1) is endemic in birds and can be transmitted to humans, with a high mortality rate of 59%. Influenza viruses such as H1N1 have caused past pandemics and continue to mutate and spread globally.
Coronaviruses can cause illness in humans ranging from the common cold to more severe diseases like MERS and SARS. COVID-19 is the most recently discovered coronavirus that causes respiratory symptoms such as fever, cough and tiredness in most people. While most cases are mild, around 20% of cases develop serious breathing difficulties and are at higher risk of severe illness. Herbal treatments may help prevent and treat COVID-19 by strengthening immunity, using as antiviral coatings, disinfecting air, and sanitizing surfaces.
Coronavirus disease (COVID-19) is caused by a newly discovered coronavirus called SARS-CoV-2. Common symptoms include fever, tiredness, and dry cough, with most patients recovering without special treatment. However, older individuals and those with pre-existing medical conditions are more vulnerable to severe illness. While bats were believed to be the original host, the exact origin of SARS-CoV-2 is still unclear. The initial epicenter was Wuhan, China, though person-to-person spread has led to a global situation with rising case numbers and death tolls that vary by age. Preventive measures center around social distancing, quarantines, and maintaining good hygiene.
Measles is a highly contagious viral infection that spreads through the air. It typically causes a rash, fever, and other symptoms. While a safe and effective vaccine exists, measles cases have risen globally due to undervaccination. Treatment focuses on relieving symptoms, while complications can include secondary infections of the lungs, brain, or eyes. Vaccination has significantly reduced measles deaths worldwide.
coronavirus" is derived from the Latin corona, meaning crown or halo, which refers to the characteristic appearance of the virus particles (virions): they have a fringe reminiscent of a royal crown or of the solar.
Corona Coronaviruses are a group of viruses that cause diseases in mammals and birds.
Human coronaviruses are :
Severe acute respiratory syndrome (SARS)
Middle East respiratory syndrome
Novel coronavirus (2019-nCoV)
This document provides an overview of the 2009 H1N1 influenza pandemic from an Indian perspective. It discusses the challenges faced in recognizing and confirming cases of the disease. It also outlines treatment recommendations, including the use of antiviral drugs like Tamiflu and supportive care. Complications tend to be more severe in younger people, possibly due to a 'cytokine storm' immune response, and include pneumonia and acute respiratory distress syndrome.
Soraya Ghebleh - Unwarranted Variation in HealthcareSoraya Ghebleh
Unwarranted variation in healthcare refers to differences in medical practice that cannot be explained by illness, need, or evidence. There are three main drivers of unwarranted variation: effective care, preference-sensitive care, and supply-sensitive care. Shared decision making has the potential to help reduce unwarranted variation related to preference-sensitive care by increasing patient education and involvement in healthcare decisions. Aligning financial incentives through payment models like accountable care organizations could also help by rewarding quality over quantity of services. Improving outcomes research and data sharing between providers may further address unwarranted variation by helping providers determine effective, necessary care based on evidence from different institutions and settings.
Soraya Ghebleh - Use of Financial Incentives PaperSoraya Ghebleh
This document discusses using financial incentives to influence clinical decision-making by healthcare providers. It notes that while incentives aim to improve quality and reduce costs, their effectiveness depends on many factors. The document examines key determinants like a provider's biology, behaviors, social environment and physical setting. It recommends incentives be used cautiously and only in defined settings, populations and problems where results can be clearly measured. Both small and large provider groups may respond to some incentives like those targeting directly measurable outcomes.
Soraya Ghebleh - Iranian Land Reform and the 1979 RevolutionSoraya Ghebleh
This document provides background information on land reform in Iran prior to the 1979 revolution. It discusses the feudal land ownership system dominated by large landlords prior to 1962. Land reform laws were implemented between 1962-1971 to redistribute land from landlords to peasants. However, the results of land reform were mixed - while it achieved the political goal of weakening landlords, it failed to improve conditions for many peasants due to issues like land fragmentation and lack of infrastructure. Ultimately, land reform contributed to social and economic instability in rural areas that helped enable the 1979 revolution.
Coccidioidomycosis, also known as valley fever, is a fungal infection caused by inhaling spores of the Coccidioides fungus. It is most common in the dry, dusty regions of the southwestern United States. Rates of the disease are highest in Arizona and California, especially in the hot summer and fall months when dust storms can spread the spores. While most cases are mild, it can develop into more serious chronic or disseminated forms if not treated. Those at highest risk include the elderly, pregnant women, diabetics, and people with weakened immune systems. There is no vaccine, but antifungal medications can be used to treat cases and prevent more serious outcomes.
Coccidioidomycosis, also known as Valley Fever, is a fungal infection caused by inhaling spores of the Coccidioides fungus. It was originally discovered in 1892 in Argentina in a patient who had a fungal-like mass on his cheek. While the causative agents were later determined to be the fungi Coccidioides immitis and Coccidioides posadasii, it took several decades of research to understand that it is a fungal infection. Valley Fever is found primarily in the southwestern United States, Mexico, and parts of Central and South America. Prevention efforts focus on limiting exposure to the fungal spores found in soil in endemic regions
this ppt is made by shrikrishna kesharwani , student of urban planning,4th year, Manit , Bhopal,
in this ppt, I have discussed how to do pandemic or epidemic management in detail.,
Dermatological health in the COVID-19 erakomalicarol
COVID-19 and its impact on dermatological health was reviewed
from theoretical and statistical frameworks in the present study. A
cross-sectional and retrospective work was documented with a selection of sources indexed to Scopus, considering the period from
2019 to 2022, as well as the search by keywords. Approaches were
discussed in order to outline a comprehensive model that considered the differences between the parties involved, as well as their
relationships in a risk context. The proposal contributes to the state
of the question in terms of the prediction of contingencies derived
from the probability and affectation of dermatological health
LIVING WITH THE EARTHCHAPTER 7EMERGING DISEASES.docxcroysierkathey
LIVING WITH THE EARTH
CHAPTER 7
EMERGING DISEASES
Esherichia coli on EMB plate
Objectives for this chapter
A student reading this chapter will be able to:
1. Differentiate the emerging infectious diseases in the United States and those occurring worldwide.
2. List and recognize the 6 major reasons associated with the emergence of infectious diseases.
3. Explain the likely reasons for the emergence of specific infectious diseases.
Objectives for this chapter
A student reading this chapter will be able to:
4. Identify, list, and explain the etiological agents, the epidemiology, and the disease characteristics of the major emerging infectious diseases including: influenza, hanta virus, dengue fever, ebola, AIDs, Cryptosporidiosis, Malaria, Lyme disease, Tuberculosis, Streptococcal infections, and E. coli infections.
Objectives for this chapter
A student reading this chapter will be able to:
5.Recognize and explain the practical approaches to limiting the emergence of infectious diseases.
EMERGING DISEASES
INTRODUCTION
Infectious diseases continue to be the foremost cause of death worldwide.
The Centers for Disease Control and Prevention (CDC) reported a 58 percent rise in deaths from infectious diseases since 1980.
Emerging Diseases in the United States
Cryptosporidium
AIDS
Escherichia coli
Hanta Virus
Lyme Disease
Group A Strep
Emerging Diseases Worldwide
What is an Emerging Infectious Disease
The term "emerging infectious diseases" refers to diseases of infectious origin whose incidence in humans has either increased within the past two decades or threatens to increase in the near future.
REASONS FOR THE EMERGENCE OF INFECTIOUS DISEASE
There are a number of specific explanations responsible for disease emergence that can be identified in most all cases (Table 7-1a-d).
Table 7-1a
Viral
Viral diseases that have been identified since 1973
1977 Ebola, Marburg
Origin undetermined. (Importation of monkeys associated with outbreaks in these primates in Europe and the United States)
1980 HTLV Influenza (pandemic)
Pig-duck agriculture thought to contribute to reassortment of avian and mammalian influenza viruses
1983 HIV
Transmission by intimate contact as in sexual transmission, contaminated hypodermic needles, transfusions, organ transplants. Contributing condition that spread the disease include war or civil conflict, urban decay, migration to cities and travel
1989 Hepatitis C
Transmission in infected blood such as by transfusions, contaminated hypodermic needles, and sexual transmission
1993 Hantaviruses
Increased contact with rodent hosts because of ecological or environmental changes
Adapted from Morse.24
Table 7-1b
Viral Diseases that have re-emerged
Argentine, Bolivian hemorrhagic fever
Agricutural changes that promote growth of rodents
Bovine spongiform encephalopathy (cattle)
Alterations in the rendering of meat products
Dengue, dengue hemorrhagic fever
...
This document discusses factors responsible for emerging and re-emerging infectious diseases. It argues that while pathogens, hosts, vectors, and environment have traditionally been seen as the main determinants of infectious disease emergence and transmission, human intervention through progress in science and technology should be considered a fifth key determinant. It provides examples of how various aspects of scientific and technological progress, such as intensive agriculture, antibiotic overuse, bioterrorism, and changes in food processing and transportation, have contributed to disease emergence and spread in recent decades.
There is generally a positive relationship between the wealth of a country and the quality of healthcare available. Wealthier countries, known as MEDCs, typically spend a higher percentage of their total expenditures on healthcare and have greater access to resources. However, some exceptions exist, such as the United States, which has high healthcare spending but many uninsured citizens who lack access. Less wealthy LEDCs often have less access to healthcare, though countries like Cuba provide universal healthcare through socialized medicine despite lower spending per person.
Emergency management 11
Emergency Management
Abstract:
In the month of December, 2019 there was outbreak of pneumonia with unknown reason in Wuhan, China. Wuhan is the center of attention because of the respiratory disorder cause by a virus called Corona and also known as Novel COVID – 19. Validate the existence of this virus was also diagnosed in Wuhan. Then it start spreading all over the world due to the social gatherings. It ultimately take thousands of people towards death. Then after its huge destruction a final step of lockdown is taken up by the government of each country. The animal-to-human transmission was presumed as the main mechanism. It was concluded that the virus could also be transmitted from human-to-human, and symptomatic people are the most frequent source of COVID-19 spread. The virus-host interaction and the evolution of the epidemic, with specific reference to the times when the epidemic will reach its peak.
Introduction:
There is scanty knowledge on the actual pandemic potential of this new SARS-like virus. It might be speculated that SARS-CoV-2 epidemic is grossly underdiagnosed and that the infection is silently spreading across the globe. There are no comparable analogies to corona virus. This virus is not like any of the other epidemiological threats that have emerged in recent decades; it is less fatal but much more contagious.
Distribution of cases by the following:
· Time: The outbreak of 2019 novel coronavirus disease (COVID-19) was first reported on December 31, 2019.
· Place: the epidemiology of 2019 novel coronavirus disease (COVID-19) in a remote region of China, far from Wuhan, we analyzed the epidemiology of COVID-19 in Gansu Province
Explanation of the research topic (corona virus):
As the outbreak of coronavirus disease 2019 (COVID-19) is rapidly expanding in China and beyond, with the potential to become a world-wide pandemic, real-time analyses of epidemiological data are needed to increase situational awareness and inform interventions. The current most likely hypothesis is that an intermediary host animal has played a role in the transmission. Identifying the animal source of the 2019-nCoV would help to ensure that there will be no further future similar outbreaks with the same virus and will also help understanding the initial spread of the disease.
Numerator (cases of corona virus):
Deaths divided the total of deaths plus recoveries. In early days because of the exponential increase new cases significantly outpace recoveries. You’re dividing by new cases but the numerator hasn’t had a chance to catch up to the death toll yet to be associated with those cases. If you look at COVID 19 on Feb 17, you get the 2% number only if dividing by total cases. If you look vs recovered cases, it’s 13%.
The WHO’s fatality percentage, announced March 17, 2020, is based simply on the number of deaths g.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
1-What are the challenges in combating emerging and reemerging disease.docxKevinjrHWatsono
1.What are the challenges in combating emerging and reemerging diseases?
2.Discuss some of the examples given your book.
3.Some steps we can take to prevent an outbreak of the diseases.
Emerging Infectious Diseases LEARNING OBJECTIVE 14-19 List several probable reasons for emerging infectious diseases, and name one example for each reason. Emerging infectious diseases (EIDs) are diseases that are new or changing, are showing an increase in incidence in the CHAPER 14 . Princlples of Disease and Epidemiologg 411. recem past, or show a potential to increase in the near future (see Chapter 1). An emerging disease can be caused by a virus. a bacterium, a fungus, a protonoan, or a helminth. About 75% of emerging infectious diseases are zoonotic, mainly of viral origin, and are likely to be vecton borne. Several criteria are used for identifyiog an HiD, For exam. ple, some diseases present symptoms that are cleady disinctive from all other diseases. Some are recogrized because improved diagnostic techniques allow the identification of a new parbogen. Others are identified when a local disease becoines widespread, a rare diskase becomes common, a mild diseas becomes more severe, or an increase in life span permits a alow. disease to develop. Examples of emerging infectious diseases are listed in Table 14.5 and described in the boses in Chapters 8 and 13 (pages 218 . and 367 ) . A variety of factoss contribute to the emerpence of nicw infectious diseases: - New srains, such as E. coli 0157417 and avian influcaza (H5N1). may result from genetic recoenbination between organisms. - A new serovar, sich as Videio dolerae O139, may resulh from changes in or the evolution of existing microorga niams. - The widespread, and sometimes unwarranted, use of antiblotics and pesticides encourages the growth of mote resistant populations of microbes and the vectors (mosquitoes, lice, and eicks) that carry then. - Clobal warming and changes in weather patterns mayy increase the distribution and survival of reervairs and vectors. resulting in the insrodaction and dissemination of diseases. such as malaria and Handavines palmonary syndrome. - Known diseases, such as Zika virus discase, chikungganya. dengue, and West Nile encephalitis, may spread to new geographic areas by modern transportation. This was less likely 100 years ago, when tavel took vo long that infected traveless either died or recovered during passage - Insect vectors transported to new areas can transmit infections brought by human traveles. The African yellow fever mosquito. Aedes aedppli came to the Anecicas with the first European explorers. Yellow ficver yinus was also. brought to the Americas with those first exploren, and A aegypti transmitted the disease to native populations and immigrants alike. The A sian eiger mosquito, A . allopitrie, was. inadvertently brought to Texas on a cargo ship from lapan in 1985. Both Ades ypecies are now estaklished throughout the southem and southwestern stares..
Migrating Diseases
Our second ‘World in 2030’ foresight focuses on the growing threat from migrating diseases that are being enabled by the escalating implications of global warming.
The fast-developing view is that with 2oC of global warming probable and 4oC possible, health systems will struggle to address the growing impact of climate change. The increased spread of vector-borne diseases is joining poor air quality as a major public health threat.
More anticipate an extension of the reach and duration of tropical disease alongside the re-emergence of old infections. Certainly, warmer conditions and changes in precipitation are facilitating the expansion of disease-carrying vectors, such as mosquitoes and ticks. Dengue fever has joined malaria and Lyme’s on the list of fast-spreading diseases that are, most significantly, entering countries with little or no prior experience of them. To stem the tide, improved surveillance, enhanced HCP education and better public understanding are all being called for.
This foresight is one of 50 looking at the key issues for the next decade that are being shared throughout 2020.
https://www.futureagenda.org/foresights/migratingdiseases/
After months of deliberation, the World Health Organization has
declared COVID-19 a pandemic. As it seemed clear for quite some time, the virus will likely spread to most (if not all) countries on the globe. However, actions can still limit its impact.
1) Tuberculosis is a major cause of death worldwide caused by the bacterium Mycobacterium tuberculosis. It usually affects the lungs but can affect other organs in up to one-third of cases.
2) If properly treated with drugs, tuberculosis is curable in virtually all cases, but if untreated it can be fatal within 5 years in 50-65% of cases. It is transmitted through the airborne spread of droplet nuclei produced by infectious patients.
3) Mycobacterium tuberculosis is an acid-fast, rod-shaped bacterium that is difficult to treat due to its waxy cell wall containing mycolic acids and other lipids.
This document discusses epidemics and provides several examples:
- It defines an epidemic as the occurrence of new disease cases in a human population at a rate that exceeds normal expectations. An epidemic may become a pandemic if it spreads globally.
- Recent epidemics in India include the ongoing COVID-19 pandemic, which was first reported in January 2020 and has since infected over 6 million people and killed more than 95,000.
- Epidemics can be caused by factors like temporary population settlements after disasters, pre-existing diseases, ecological changes supporting disease transmission, and interruptions to public health services. Adopting safety measures like improved sanitation, health education, and vaccination programs can help prevent or control epidemics.
Dengue Fever in Southern Florida 1
Change in Mosquito Ecology Leading to Increase in Dengue Fever in Southern Florida Comment by Zohir Chowdhury: Add the word climate change somewhere in the title since that’s the main focus of the paper
National University: Public Health
COH400: Environmental Health
February 21, 2021
Abstract Comment by Zohir Chowdhury: Refer to grading rubric. Multiple elements are missing that will lead to points deduction.
By influencing mosquito behavior, vector growth, and mosquito/human encounters, the environment affects the dengue ecosystem. Although these relationships are established, it is unknown what effect climate change would have on transmissions. Statistical and method temperature simulations have been used to improve our understanding of these interactions and forecast the impact of predicted climate change on dengue fever incidence, however, these simulations have yielded conflicting findings.
We identified critical environmental impacts on the dengue virus's ecology and assessed temperature dengue models' capacity to explain climate-dengue interactions, predict outbreaks, and forecast climate change consequences. We study the proof through lab experiments, field research, data analysis of correlations among proxies, dengue disease occurrence, and environmental conditions linked directly and indirectly to climate and dengue.
Health effects of dengue fever can range from a major drop in blood pressure leading to shock to internal bleeding and organ damage. In some cases, dengue can even lead to death. In pregnant women, dengue can be dangerous because it can be spread to the baby during childbirth. In the region of Southern Florida, most cases of dengue fever are brought in from individuals who have traveled to places such as the Caribbean, South America, or Asia. While traveling to areas where Dengue is widespread is the most common cause for seeing it here in the U.S., there have recently been 26 cases that were locally acquired.
Table of Contents
Background 4
Aedes Mosquitoes 5
Control of Aedes Mosquitoes 5
Geographical Location 6
Dengue Occurrence in Florida 7
Health Effects 8
Causes of Dengue Fever 9
Weather and Climate Variability 10
Clinical Diagnosis 12
Dengue Fever Symptoms 13
Dengue Fever Treatment 13
Clinical Management 14
Laboratory Diagnosis 15
Public Health Response 15
Conclusion 17
References 18
Tables 20
Table 1 20
Figures 21
Figure 1 21
Figure 2 22
Figure 3 23
Figure 4 24
Change in Mosquito Ecology Leading to Increase in Dengue Fever in Southern Florida Comment by Zohir Chowdhury: All over the paper, check for sentences that do not have a reference. You cannot JUST have a reference at the end of the paragraph, you need to reference “sentences” and then follow-up with transitional words that connect that reference to additional content from that same reference to build your paragraph. Of course, it’s never a good idea to ONLY have one reference in a single p ...
This document discusses how climate change is contributing to an increase in dengue fever cases in Southern Florida. Warmer temperatures associated with climate change are causing changes in mosquito ecology that allow disease-carrying mosquitoes like Aedes aegypti and Aedes albopictus to thrive and expand their ranges. This has increased encounters between mosquitoes and humans, leading to more dengue virus transmission and outbreaks in Southern Florida in recent decades after the disease was previously eliminated in the 1930s. The effects of climate change like rising temperatures, heavier rainfall, and sea level rise are expected to further exacerbate the dengue situation by creating more favorable conditions for mosquito growth and survival.
1. An unexpected epidemic of H1N1 influenza began in Mexico in March 2009, first appearing as influenza-like illnesses in various states. By April 23rd, over 800 cases and 59 deaths had been reported in Mexico City alone.
2. The Mexican government initially said the situation was under control but suddenly closed schools and recommended masks and handwashing on the evening of April 23rd as cases rose rapidly.
3. By April 25th, over 1000 cases and 68 deaths had been reported across Mexico, with the CDC also reporting 20 cases across the US, as the pandemic emerged.
The document provides information on the COVID-19 pandemic as of April 2020. It discusses the epidemiology and spread of the virus globally. Key points include:
- COVID-19 originated in Wuhan, China in late 2019 and has since spread to over 210 countries. As of April 2020, there were over 29 lakh confirmed cases and 200,568 deaths worldwide, with the US becoming the new epicenter.
- The virus spreads mainly person-to-person via respiratory droplets. Common symptoms include fever, cough and shortness of breath, though many cases are asymptomatic. Chest CT scans show bilateral lung involvement like ground-glass opacities or consolidation.
- While most cases are mild, the elderly and those
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1. Soraya Ghebleh
18 March 2013
ECS 151
Increased Incidence of Valley Fever in Arizona
Executive Summary
Infectious diseases are consistently an issue for public health departments around
the country and around the world. Coccidioidomycosis, colloquially known as valley
fever, is an infectious disease that has adverse health effects and is increasing in
incidence. Although the exposure to coccidioidoymocis is difficult to measure because of
the inhalation pathway, it estimated that infection rates are approximately 3% in Southern
Arizona.1
An estimated 150,000 people a year become infected with coccidioidomycosis
and of those approximately one third develop symptomatic disease. Those infected in
Arizona account for 60% of the afflicted population, indicating a serious need for
attention to be paid to this problem.2
Since 1997 when coccidioidomycosis became a reportable disease, incidence has
increased substantially. While this may be partly explained by an increase in reporting,
other risk factors have been determined to clearly be contributing to the increase in
disease. These risk factors include construction and soil disruption, increased vulnerable
populations in areas with dust, outdoor exposure, climactic change, and other workplace
hazards.
There are a variety of measures that can be taken to help abate the spread of
coccidoidomycosis. Because individuals become infected as a result of inhalation, it is a
very difficult disease to prevent even when care is taken to increase risk factors. This
points to a solution derived in a permanent solution such as development of a vaccine.
2. This is the most attractive and appropriate policy option as strides have been made
towards developing vaccines and it provides a stronger solution for the public.
Introduction of the Problem
The environmental health exposure being studied is the inhalation of airborne
spores from Coccidioides immitis, a fungus found in soil in arid, desert climates.
Infection occurs usually after activities or natural events that disrupt the soil, resulting in
aerosolization of the fungal arthrospores.
The human health effects of concern are infection with coccidioidomycosis, more
commonly known as valley fever. This disease has a very high rate of infection and is
one of the most common infectious diseases despite the fact that it is not well known
outside of the Southwest and California regions. Approximately 40% of infections result
in symptomatic disease, typically arising one to four weeks after exposure, and can
resemble ordinary influenza but also have many more severe symptoms.
The individuals bringing this issue forward are a patient support group for valley
fever victims and family members who want more research to be done for a vaccination
as well as more preventative measures to be put in place to reduce disease incidence of
coccidioidomycosis.
Since 1995, there has been a substantial increase in coccidioidomycosis incidence
in Arizona. While many of these cases are attributed to seasonal peaks and climate
change, there is an increasing concern that the expansion in the Metropolitan area of
Phoenix and the expansion in construction also has a role in the increased incidence of
coccidioidomycosis. This is one example of where policy could be implemented to
reduce disease incidence.
3. Should legislation be passed in the greater Metropolitan Area of Phoenix to
require more preventative measures and research be put in place to assist in reduction of
coccidioidomycosis incidence?
Background of Coccidioidomycosis Incidence in Arizona
Coccidioidomycosis, more commonly known as valley fever, is a systemic
infection that occurs upon airborne inhalation of Coccidioides, a soil-dwelling fungus
found in the southwestern United States, parts of Mexico, as well as Central and South
America.3
Coccidioides immitis is the species that is geographically limited to the San
Joaquin Valley and Coccidioides posadasii inhabits all other coccidioidal endemic
regions.4
The first patient to be described with coccidioidomycosis was an Argentinean
soldier in 1893, however until 1935 patients identified with this disease were still
extremely rare. Not much was known about the disease and due to lack of
epidemiological knowledge it was thought to always be a rare and severe infection. New
observations from the 1930s on, however, indicated that a large proportion of those who
undergo a coccidioidal infection do not develop symptoms or their symptoms resolve
without further issue.5
In Arizona, coccidioidomycosis immitis is the prevalent form of species that
causes infection. Coccidioidomycosis has been linked to climate change as one of the risk
factors. In order to grow, Coccidioides species need suitable temperatures and soil
moisture for growth making the most likely period for infection during the fall, winter,
and spring as opposed to the summer months in Arizona.6
Inhalation leads to infected
cases and the incidence of these cases oscillates with climactic change.6
While climate
has explained a large amount of differences in incidence in coccidioidomycosis, overall
4. trends cannot only be explained by climate. There are other non-climactic issues related
to the increased incidence of disease in Arizona.
The presentation of coccidioidomycosis is difficult to diagnose, as so many
patients are asymptomatic. Those patients who present will present with primary
pulmonary coccidioidomycosis. Of these, around one will develop extrathoracic
dissemeniation. Approximately four will develop chronic complications such as a nodule,
cavity, or chronic pneumonia.1
A definitive diagnosis is difficult without serologic testing
and frequently cannot be made on clinical observations alone. In approximately five
percent of cases, a rash such as erythema multiforme may appear and painful nodules of
erythema nodosum may appear on the lower extremities.1
Often many of these findings
are overlooked and this has led to misdiagnosis and underdiagnosis of the disease. The
clinical indications are also very similar to bacterial community-acquired pneumonia and
there is a strong correlation between those infected with coccidioidomycosis and those
who develop community-acquired pneumonia.
The Arizona Department of Health Services (ADHS) monitors
coccidioidomycosis and has attempted to increase knowledge and minimize disease
burden but incidence continues to increase.2
Valley fever incidence in Arizona has shown
a considerable increase since reporting requirements were instituted.6
Arizona has the
highest number of reported cases and accounts for sixty percent of all national cases.2
From 1990 to 1995, the number of annually reported cases doubled leading to increased
reporting in 1997.2
Since then, the number of cases has increased considerably from
approximately 16 per 100,000 to 155 per 100,000 in 2009.2
The highest rates of cases
occur in the most populated counties in Arizona as these areas experience arid to semiarid
5. climates with mild winters and hot summers.2
Coccidioidomycosis is associated with
community-acquired pneumonia (CAP) as well and a substantial portion of patients with
CAP had confirmed coccidioidomycosis.9
Economic analysis of the effects of
coccidioidomycosis has also revealed that there is an economic burden associated with
lack of effective preventive measures and a vaccine. A delay in education of the public
and of providers has also contributed to reduced delays in diagnosis that could lead to
earlier detection and treatment of valley fever.2
Another risk factor involves the recent
growth in population and influx of individuals who were never in areas endemic to
coccidioidomycosis. These individuals become at risk for primary infection. Another
environmental risk is local dust production associated with construction. The last twenty
years has seen tremendous growth in Arizona and this is also an associated work hazard
risk factor.10
Another area of change that may describe the rise in incidence could result
from increased reporting. Because coccidioidomycosis became a reportable disease in
1997, the increase in the number of reported cases could be a reason behind increased in
incidence as coccidioidomycosis may have been underreported more frequently previous
to this change in policy.10
The current system of surveillance in place in Arizona accurately reflects the
disease burden but there is a significant symptom duration and delayed diagnosis for
patients leading to suboptimal care and treatment.2
There also are considerable legal
barriers for those exposed to coccidioidomycosis in the workplace. For example,
construction workers who are exposed to excessive amounts of dust and soil and contract
valley fever are not privy to worker’s compensation. Case law has developed in contrast
to development of California case law that recognizes statistically increased probability
6. of contracting Valley Fever but that this is not sufficient for a worker to be
compensated.11
Evidence Table
Study Name Study Design Study Size Findings
Increase in
coccidioidomycosis
—Arizona, 1998-
200112
CDC data analysis
of Surveillance and
Hospitalization,
environmental and
climactic data, as
well as a cohort
study conducted by
the CDC of a
random sample of
patients with
coccidioidomycosis
- Surveillance (data
gathered by
Arizona
Department of
Health Services
(ADHS) compared
cases reported
between 1998
(1,551) and 2001
(2,203).
- Cohort study
looked at 208
randomly selected
persons contacted
by telephone
Indicate that the
recent Arizona
coccidioidomycosis
epidemic is
attributed to seasonal
peaks in incidence
that are probably
related to climate.
Health-care
providers in AZ
should be aware that
peak periods of
coccidioidomycosis
incidence occur
during winter and
should consider
testing patients
The Spectrum and
Presentation of
Disseminated
Coccidioidomycosis1
3
Retrospective
analysis
150 cases with
extrapulmonary
nonmeningeal
disease seen from
1996-2007 at a
referral medical
center in endemic
region
- Hematogenous
dissemination was
associated with high
mortality and
occurred primarily in
immunocompromise
d patients
- Serology was
frequently negative
in
immunocompromise
d patients- diagnosis
established by
isolation of organism
in culture
Coccidioidomycosis:
A Review of Recent
Advances4
Review of
resurgence of
Coccidioidomycosi
s in the southwest
United States
focusing on recent
N/A Reviews the
discovery, history,
organism, ecology
and climate,
epidemiology,
immunology,
7. publications of
importance
diagnosis, special
hosts, clinical
presentation, and
therapy
- Enhanced
surveillance starting
in 2007 by ASDH
has demonstrated
profound effect
disease has had on
state and on
individuals
What’s Behind the
Increasing Rates of
Coccidioidomycosis
in Arizona and
California?10
Journal Article N/A - Recent increase in
cases of
symptomatic disease
is multifactorial
- Predominant
factors include:
Climate change,
increased local
exposure, influx into
endemic region of
susceptible persons
with higher risk of
developing
symptomatic illness,
heightened
awareness and
reporting of the
disease
Coccidioidomycosis
in Elderly Persons14
Retrospective
review of data for
all patients with
coccidioidiomycosi
s treated at the
Mayo Clinic in
Scottsdale, AZ that
compared clinical
manifestations of
coccidioidomycosis
in patients >60
years with those in
patients <60 years
- 210 patients aged
>60 years
- 186 patients
aged<60 years
-
Coccidioidomycosis
is a serious illness in
all patients, but its
different
manifestations in
older-aged persons,
compared with those
in younger-aged
persons, may be
related to
immunosuppression
rather than age alone
Testing for
Coccidioidomycosis
among Patients with
- Descriptive
Epidemiology
performed by
- Descriptive
Epidemiology
calculated country-
-
Coccidioidomycosis
is a common cause
8. Community-
Acquired
Pneumonia9
analyzing data from
the National
Electronic
Telecommunication
s System for
Surveillance
- Retrospective
Cohort Study of 2
healthcare systems
in metropolitan
Phoenix with
different patient
demographics
- Case-Control
Study -
specific and age
group-specific
incidence rates for
1999-2004
- Retrospective
Cohort Study: 132
sampled for system
A and 159 were
sampled from
system B for chart
review
- Case-Control
Study: 60 case
patients and 76
control patients
of community-
acquired pneumonia
(CAP) in disease-
endemic areas like
metropolitan
Phoenix
- The proportion of
CAP caused by
coccidioidomycosis
is substantial but
because testing
among CAP patients
was infrequent,
reportable-disease
data greatly
underestimate the
true disease
prevalence
Assessment of
Climate-
Coccidioidomycosis
Model: Model
Sensitivity for
Assessing
Climatologic Effects
on the Risk of
Acquiring
Coccidioidomycosis6
Sensitivity of
seasonal modeling
approach is
examined as it
relates to data
quality control, data
trends, and
exposure
adjustment
methodologies
N/A - Overall increasing
trend in incidence is
beyond explanation
through climate
variability alone but
that climate accounts
for much of the
coccidioidomycosis
incidence variability
about the trend from
1992 to 2005
- Dual “grow and
blow” hypothesis for
climate-related
coccidioidomycosis
incidence risk
Compensability of,
and Legal Issues
Related to,
Coccidioidomycosis1
1
Report on legal
issues that may
develop when
treating patients
with
coccidioidomycosis
that include
allegations of
medical
malpractice, claims
for workers’
compensation
N/A - Medical
practitioners must
understand legal
liability around
treating
coccidioidomycosis
patients
- Failure to diagnose
is the number one
reason that gives rise
to medical
negligence and
9. benefits, and civil
actions against
businesses. Arizona
(as of 2007) did not
recognize
coccidioidmycosis
as a compensable
condition.
under AZ law,
medical practitioners
are at risk of being
accused
- AZ case law has
developed such that
it is not possible for
employees to sustain
their burden of
proving Valley
Fever resulted from
working conditions,
therefore workers’
compensation claims
have been denied
- Claimed that work
exposure only
“statistically
increased”
probability of
contracting Valley
Fever but does not
meet required
standards for proof
to show causal link
The Public Health
Impact of
Coccidioidomycosis
in Arizona and
California2
Review of data and
literature that
addresses the public
health impact of
coccidioidomycosis
in two endemic
regions
N/A - Increases in
incidence,
disproportionate
incidence in
racial/ethnic groups,
lack of early
diagnosis, the need
for more rapid and
sensitive tests, and
the inability of
currently available
therapeutics to
reduce duration and
morbidity of the
disease
- Highlights need for
improved
therapeutics and a
preventive vaccine
- Total economic
costs associated with
10. increases in
symptomatic disease
have substantially
increased
- Need greater
provider education
leading to stringent
surveillance and
timely use of
diagnostics
Expanding
Understanding of
Epidemiology of
Coccidioidomycosis
in the Western
Hemisphere15
Report synthesizing
data to improve
understanding of
how
coccidioidomycosis
spreads
N/A - Recent years, the
incidence of
coccidioidomycosis
has increased in
California/Arizona,
may be partially due
to massive migration
of Americans to
these states
- From 1997 to 2004,
there was a 281%
increase in incidence
New perspectives on
coccidioidomycosis1
Report reviewing
newer tests and
studies and
evaluating new
therapies
N/A - Growing problem
in endemic regions
of AZ & CA
- Presentation as
pulmonary process
makes accurate
diagnosis difficult
and serologic
sensitivity has not
been established
- Suggests that
antifungal therapy
may lead to
subsequent
complications once
this therapy is
discontinued
compared to those
who receive no
therapy at all
Coccidioidomycosis:
Changing
perceptions and
creating
Review that looks
at revisiting and
changing
perceptions formed
N/A - Information and
limited therapies
have influenced
perceptions around
11. opportunities for its
control5
by understanding of
coccidioidomycosis
as a medical
problem to improve
care of patients
coccidiodomycosis
and are limiting
development of new
therapies
- Suggests that new
therapies for Valley
Fever are likely to
hinge upon whether
or not they are
perceived to be
needed because such
a large portion of
patients are
asymptomatic
Coccidioidomycosis-
associated deaths,
United States, 1990-
200816
- Retrospective
analysis of multiple
cause-coded death
records for 1990-
2008 for
demographics,
secular trends, and
geographic
distribution
- Found 3,089
coccidioidomycosis
-associated deaths
among US
residents
- Analysis suggests
that the number of
deaths from
coccidioidomycosis
are greater than
currently appreciated
- Highest risk for
death were men,
persons over the age
of 65, Hispanics,
Native Americans,
and residents of
California and
Arizona
- Common
concurrent
conditions were HIV
and other
immunosuppressive
conditions
Coccidioidal
pneumonia, Phoenix,
Arizona, USA, 2000-
20048
- Prospective
evaluation of
patients with
community-
acquired
pneumonia in the
Phoenix, Arizona
area
- 59 patients with
CAP, 35 for whom
paired cocidioidal
serologic testing
was performed
- Coccidioidal
pneumonia can only
be identified with
appropriate
laboratory studies in
the absence of
distinguishing
clinical features
- Identified
coccidioidal
infection in at least 1
of 6 patients who
12. sought treatment for
radiologically
confirmed CAP in an
endemic area
underscores the
likelihood that this
infection is a
common cause of
CAP
Risk Factors for
Acute Symptomatic
Coccidioidomycosis
among Elderly
Persons in Arizona,
1996-199717
- Case-control study
conducted to look
at risk factors for
disease among the
elderly in Arizona
in response to the
increase in
incidence of
coccidioidomycosis
between 1990 and
1996
- Cases (89),
persons over 60
years with
laboratory-
confirmed
coccidioidomycosis
- 2 separate control
groups: (91)
selected by use of
random-digit
dialing and (58)
selected by use of
lists of persons
with negative
serologic
coccidioidomycosis
tests
- Elderly persons
with
coccidioidomycosis
had spent
significantly less
time in AZ than
persons in control
group
- Elderly persons
who recently move
to AZ or who have
chronic illness are at
a higher risk
- Recent migrations
to AZ and various
underlying medical
conditions are
associated with
increased risk
- Smoking is a
preventable cause of
acute symptomatic
coccidioidomycosis
in this at risk
population
- Costly public
health problem in
this age group
An Epidemic of
Coccidioidomycosis
in Arizona associated
with Climatic
Changes, 1998-
200118
- Statistical analysis
of NETSS data
from 1998 to 2001
performed to map
high-incidence
areas in Maricopa
County to assess
the effect of
climatic and
- Incidence in 2001
was 43/100,000
with a significant
increase from 1998
(33/100,000)
- Coccidioidomyc
osis in AZ has
increased
- Part of increase in
incidence is driven
by seasonal
outbreaks associated
with environmental
and climatic changes
13. environmental
factors on the
number of monthly
cases; model
developed and
tested to predict
outbreaks
- Study may allow
public health
officials to predict
seasonal outbreaks
in AZ and to alert
the public and
physicians early so
that appropriate
measures can be
implemented
Coccidioidomycosis
among Scholarship
Athletes and Other
College Students,
Arizona, USA19
- Medical chart
review for serologic
testing and coding
- Charts were
reviewed from
1998 to 2006 for
serologic testing
and for ICD-9
coding for
coccidioidomycosis
- More complete
testing for
community acquired
pneumonia
associated with
valley fever results
in considerably
higher estimates of
case rates for this
fungal infection
- Case rates among
scholarship athletes
were
underrepresented in
oudoor sports and
spectrum of disease
severity was in line
with that found in
past studies of
student population as
a whole
- Many scholarship
athletes come from
regions where
coccidioidomycosis
is not endemic
- Findings
underscore the need
to routinely test
patients for
coccidioidomycosis
Coccidioidomycosis
incidence in Arizona
predicted by seasonal
precipitation20
- Study utilizing
Arizona
coccidioidomycosis
case data for 1995-
2006 to generate a
- N/A - Revealed a
seasonal
autocorrelation
structure for
exposure rates where
14. timeseries of
monthly estimates
of exposure rates in
Marcipoa County
and Pima County in
AZ
exposure rates are
strongly related from
fall to the spring and
relationship abruptly
ends near the onset
of summer
precipitation
- Builds on previous
studies examining
the causes of
fluctuations in
coccidioidomycosis
rates in AZ and
corroborates the
“blow and grow”
hypothesis
- Recognizes that
human factors such
as construction may
play a role
Coccidioidomycosis
in African
Americans21
- PubMed review of
English-language
medical literature
on
coccidioidomycosis
in African
Americans and
summarized
pertinent literature
N/A - Increased
predilection for
severe
coccidioidomycosis,
coccidioidomycosis-
related
hospitalizations, and
extrapulmonary
dissemination in
persons of African
descent
- Immunologic
mechanism for
predilection is
unclear
- Suggests a
prospective,
controlled,
epidemiological
study to give a
clearer picture of the
true risk of
complicated
coccidioidomycosis
among racial groups
- Clinicians should
15. have high index of
suspicion in persons
with recent travel or
resident within the
Southwest
A risk factor study of
coccidioidomycosis
by controlling
differential
misclassifications of
exposure and
susceptibility using a
landscape ecology
approach22
- Stratified, two-
stage, cross-
sectional study
evaluating inherent
socio-economic,
and environmental
risk factors of
coccidioidomycosis
from information
collected during an
address-based
telephone survey
- Describes
individual and
group-level risks of
coccidioidomycosis
using a cross-
sectional sample
stratified by
location of resident
on the landscape
using geomorphic
types and
neighborhood
ethnicity
- Survey of 5460
households
containing 14,105
individuals in the
greater Tucson area
of Arizona
- Consistent with
findings on known
risk factors such as
cigarette smoking,
older age groups,
and being African
American
- Association
between disease and
geomorphic strata in
multivariate analysis
was weak and did
not indicate a
significant
relationship between
disease and
residence locations
by soil types
- Assertion was
supported that
geographic-based
stratification can
reduce differential
misclassification
- Strong associations
of disease and
residence locations
by neighborhood
ethnicity and
anthropogenic soil
disturbances support
use of a landscape
epidemiological
approach for
diseases with strong
environmental
determinants such as
valley fever
Coccidioidomycosis
in human
immunodeficiency
- Case-control study
to evaluate risk
factors for
- 77 cases - Much higher
incidence of
coccidioidomycosis
16. virus-infected
persons in Arizona,
1994-1997:
incidence, risk
factors, and
prevention23
coccidioidomycosis
in HIV-infected
persons
- HIV cohort
determined
retrospectively
using HARS
Registry of AZ
in HIV-infected
persons than
Arizona’s general
population
- Population
attributable risk
estimates for blacks
and persons with
previous fungal
infections account
for nearly half of
HIV-infected
persons who develop
coccidioidomycosis
in AZ
- Future studies need
to address efficacy
of different agents in
a prospective faction
and cost-effective
analysis of various
therapies need to be
conducted
Summary of the Evidence
The evidence overwhelmingly indicates that there has been an increase in
incidence of coccidioidomycosis in the Arizona region that has been noted from the early
1990s and continues to increase now. There are different risk factors associated with the
increase in incidence. Arizona is an endemic region for coccidioidomycosis and the risk
of incidence increases from the fall to the spring with an abrupt decline in the summer,
indicating that there is a climatic component to the increase in incidence. There are
specific populations that are more susceptible and at a higher-risk of infection. These
include elderly individuals, individuals who have spent limited time in endemic regions,
HIV-infected patients, individuals who are exposed to dust and the outdoors, and certain
ethnic minorities such as African Americans.
17. The increase in coccidioidomycosis has been clearly established by the evidence
and the lack of a disproportionate public health, research, and policy initiative to address
this increase in incidence has also been made clear. Many of the different research
initiatives suggest that there is a need for more prospective analysis of the risk factors,
therapies, and preventative measures associated with coccidioidomycosis.8
There is local
attention placed on coccidioidomycosis in blogs, support groups, and increased research
efforts but the importance of this disease has not been addressed by many health
policymakers.27
Although this is a disease endemic to the Arizona and other areas in the
Southwest, individuals who travel through this area or recently migrate are at a increased
risk of infection making this a disease relevant to the nation, not just endemic regions.
Misdiagnosis and underdiagnosis is widespread and associations with other diseases are
not well-understood and the evidence clearly reflects that there needs to be more attention
placed on the policies associated with the prevention and diagnosis of this disease and
that there is a cost-burden associated with increased incidence that is important in the
current climate of unmanageable healthcare costs.
Characterization of the Risk
Arizona represents sixty percent of nationally reported cases of
coccidioidomycosis. Living in the region and going outside automatically places
individuals in a position to inhale the spores that cause infection. Individuals that have
lived in the region for a long time are not as susceptible to infection as those who move to
the region.24
Over the last two decades, Arizona has experienced an influx of individuals
moving to the region and this has corresponded with an increase in coccidioidomycosis
infection. While this recorded increase in incidence can be correlated to
18. coccidioidomycosis becoming a reportable disease in 1997, the numbers cannot be
ignored and there are various factors that are contributing to this increase in risk.10
The
increase is incidence has not only changed from the time period before reporting was
required but has also increased in the last fifteen years as data has been collected from
reporting.10
Because coccidioidomycosis is associated with many different forms of
exposure, it is difficult to accurately assess a specific measure of exposure. It is relevant,
however, to assess the risk factors associated with exposure as well as the increase in
incidence among vulnerable populations and from these factors policy recommendations
can be made.1
Arizona has experienced variations in climate over the last two decades that may
be the cause of increased exposure. Environmental reports have indicated an increase in
the occurrence of dust storms during periods where there is a lack of precipitation,
consequently creating the perfect conditions for the spores to be kicked into the
atmosphere and increasing risk of inhalation.29
Connecting the increase in dust storms
directly to increases in exposure is difficult to measure but it is known that these climatic
situations cause an increase in dust in the air and dust is the main risk factor in inhaling
spores that cause coccidioidomycosis. Some believe that certain human activities like an
increase in agricultural land use and a rise in construction also contribute to the dust in
the air.29
Work place hazards provide another risk factor. Construction workers, for
example, work outside and are directly exposed to increased amounts of dust due to the
shifting of land occurring at the construction site.11
Other workers that have a potentially
increased risk may include electricians, cable workers, landscapers, physical education
19. teachers, and any other occupation that involves spending an extensive amount of time
outside regardless of season.
Arizona has experienced an influx of individuals who are not endemic to the
region and this increases an individual’s chance of being infected. Many of these
individuals are elderly which also increases risk.
The Landscape
There are a variety of stakeholders who would be interested in implementing
policy aimed at reducing coccidioidomycosis incidence in the Arizona area. Patient
advocacy groups for victims of valley fever and loved ones of those infected are active
and strong in Arizona. Some of these groups include the Valley Fever Survivor Patient
Advocacy Group, AZ Victims of Valley Fever, and the Valley Fever Alliance.27
The
medical community at large is also extremely important in pressuring to increase funding
and affect policy change. This includes physicians who treat coccidioidomycosis, resident
physicians, nurses and other providers who encounter this disease. The medical
community also extends to the research community who need funding to continue
developing vaccinations and improved therapeutic agents. Arizona has recently begun
taking steps towards increased attention and collaboration directed at treating
coccidioidomycosis with the opening of the University of Arizona Valley Fever Center
for Excellence. More funding and legislative policies are needed, however, to support the
findings of the Center for Excellence.30
Because of the high costs associated with hospital
stays, diagnosis, and treatment of valley fever, taxpayers are relevant because their tax
dollars are paying for the high cost of care associated with coccidioidomycosis.
The most relevant governmental agency that deals with coccidioidomycosis
20. incidence is the Arizona Department of Health. They have been very involved in
increasing awareness of incidence and data collection.31
Another governmental agency is
the Center for Disease Control and Prevention because coccidioidomycosis is one of the
top infectious diseases in the country and they are also concerned with monitoring,
prevention, and treatment. Government healthcare payers, such as Medicare and
Medicaid, should also be concerned about an increase in incidence because
hospitalization, misdiagnosis, and immune-compromised patients who are infected are a
cost burden to the system.
Options and Recommendations
There has been an increasing amount of attention paid to valley fever in the
Southwest that has corresponded with the increased reporting in incidence. There are a
variety of policy options that could inform next steps to reducing the incidence of valley
fever that range from individual protective measures to large-scale policy action that
requires funding and political support.
The first recommendation would be to improve education about individual
measures that can be taken to reduce exposure. This could include reducing the amount
of time spent outside during months of increased exposure. It could also involve
increasing awareness around the risk factors and the symptoms associated with valley
fever so the general public can be more aware and see a provider more quickly if they
believe they may have valley fever. Another area where education could play a key role
is in the school systems. Information about valley fever risks and symptoms could be
disseminated during health education classes, in parent meetings, and to the general
community.
21. The second area where policy could be affected is where workplace hazards are
concerned. Implementing dust reduction measures, specifically in work environments
that involve soil disruption such as construction work or electricians that perform work
outside has the potential to reduce the risk of obtaining valley fever.
The third area where policy could be affected is in the research space. Finding a
vaccination for valley fever has been spoken about for some length of time in Arizona
and with the opening of the University of Arizona Valley Fever Center for Excellence
there is a real opportunity to work towards developing a vaccination. If funding can be
found to support the Center’s initiatives and a vaccine is developed, it will be a very way
to curb increased incidence of the disease.
The most promising of all of these potential policy recommendations is to raise
money for researching a vaccination. Because the risk of exposure to valley fever is
difficult to quantify and the actual dose-response relationship is difficult to assess, there
is more potential in determining an effective preventative measure in the form of
vaccination compared to education. This will be more effective in the long run and will
be a more effective way of utilizing resources. The cost of treating valley fever and the
hospitalizations associated with valley fever are high and if a vaccine can be produced it
has the potential to greatly reduce costs, which is an attractive policy option in the current
healthcare space.31
While for many diseases there are substantial barriers and difficulties
in approaching vaccine development, strides have already been made towards developing
a vaccine and the University of Arizona Center for Excellence is committed to solidifying
the development of the Nikkomycin Z vaccine meant to prevent against infection.31
References