title: A coccidioidomycosis outbreak following the Northridge, Calif, earthquake.
abstract: OBJECTIVE
  To describe a coccidioidomycosis outbreak in Ventura County following the January 1994 earthquake, centered in Northridge, Calif, and to identify factors that increased the risk for acquiring acute coccidioidomycosis infection.
  
  
  METHODS
  Epidemic investigation, population-based skin test survey, and case-control study.
  
  
  METHODS
  Ventura County, California.
  
  
  RESULTS
  In Ventura County, between January 24 and March 15, 1994, 203 outbreak-associated coccidioidomycosis cases, including 3 fatalities, were identified (attack rate [AR], 30 cases per 100,000 population). The majority of cases (56%) and the highest AR (114 per 100,000 population) occurred in the town of Simi Valley, a community located at the base of a mountain range that experienced numerous landslides associated with the earthquake. Disease onset for cases peaked 2 weeks after the earthquake. The AR was 2.8 times greater for persons 40 years of age and older than for younger persons (relative risk, 2.8; 95% confidence interval [CI], 2.1-3.7; P<.001). Environmental data indicated that large dust clouds, generated by landslides following the earthquake and strong aftershocks in the Santa Susana Mountains north of Simi Valley, were dispersed into nearby valleys by northeast winds. Simi Valley case-control study data indicated that physically being in a dust cloud (odds ratio, 3.0; 95% CI, 1.6-5.4; P<.001) and time spent in a dust cloud (P<.001) significantly increased the risk for being diagnosed with acute coccidioidomycosis.
  
  
  CONCLUSIONS
  Both the location and timing of cases strongly suggest that the coccidioidomycosis outbreak in Ventura County was caused when arthrospores were spread in dust clouds generated by the earthquake. This is the first report of a coccidioidomycosis outbreak following an earthquake. Public and physician awareness, especially in endemic areas following similar dust cloud-generating events, may result in prevention and early recognition of acute coccidioidomycosis.
authors.affiliation: Epidemic Intelligence Service (EIS), Community Disease Control, County of San Diego Department of Health Services, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Schneider
authors.forename: R A
authors.initials: RA
authors.lastname: Hajjeh
authors.forename: R A
authors.initials: RA
authors.lastname: Spiegel
authors.forename: R W
authors.initials: RW
authors.lastname: Jibson
authors.forename: E L
authors.initials: EL
authors.lastname: Harp
authors.forename: G A
authors.initials: GA
authors.lastname: Marshall
authors.forename: R A
authors.initials: RA
authors.lastname: Gunn
authors.forename: M M
authors.initials: MM
authors.lastname: McNeil
authors.forename: R W
authors.initials: RW
authors.lastname: Pinner
authors.forename: R C
authors.initials: RC
authors.lastname: Baron
authors.forename: R C
authors.initials: RC
authors.lastname: Burger
authors.forename: L C
authors.initials: LC
authors.lastname: Hutwagner
authors.forename: C
authors.initials: C
authors.lastname: Crump
authors.forename: L
authors.initials: L
authors.lastname: Kaufman
authors.forename: S E
authors.initials: SE
authors.lastname: Reef
authors.forename: G M
authors.initials: GM
authors.lastname: Feldman
authors.forename: D
authors.initials: D
authors.lastname: Pappagianis
authors.forename: S B
authors.initials: SB
authors.lastname: Werner
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003045:Coccidioides / Q000302:isolation & purification; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000453:epidemiology*; D004190:Disasters; D004196:Disease Outbreaks; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D012698:Serologic Tests; D012882:Skin Tests