An epidemic of coccidioidomycosis in Arizona associated with climatic changes, 1998-2001.
BACKGROUND
Reports of coccidioidomycosis cases in Arizona have increased substantially. We investigated factors associated with the increase.


METHODS
We analyzed the National Electronic Telecommunications System for Surveillance (NETSS) data from 1998 to 2001 and used Geographic Information Systems (GIS) to map high-incidence areas in Maricopa County. Poisson regression analysis was performed to assess the effect of climatic and environmental factors on the number of monthly cases; a model was developed and tested to predict outbreaks.


RESULTS
The overall incidence in 2001 was 43 cases/100,000 population, a significant (P<.01, test for trend) increase from 1998 (33 cases/100,000 population); the highest age-specific rate was in persons > or =65 years old (79 cases/100,000 population in 2001). Analysis of NETSS data by season indicated high-incidence periods during the winter (November-February). GIS analysis showed that the highest-incidence areas were in the periphery of Phoenix. Multivariable Poisson regression modeling revealed that a combination of certain climatic and environmental factors were highly correlated with seasonal outbreaks (R2=0.75).


CONCLUSIONS
Coccidioidomycosis in Arizona has increased. Its incidence is driven by seasonal outbreaks associated with environmental and climatic changes. Our study may allow public-health officials to predict seasonal outbreaks in Arizona and to alert the public and physicians early, so that appropriate preventive measures can be implemented.
Park
Benjamin J
BJ
Mycotic Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. bip5@cdc.gov
Sigel
Keith
K
Vaz
Victorio
V
Komatsu
Ken
K
McRill
Cheryl
C
Phelan
Maureen
M
Colman
Timothy
T
Comrie
Andrew C
AC
Warnock
David W
DW
Galgiani
John N
JN
Hajjeh
Rana A
RA
D000328:Adult; D000367:Age Factors; D000368:Aged; D001130:Arizona / Q000453:epidemiology; D002980:Climate; D003047:Coccidioidomycosis / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012621:Seasons