title: An epidemic of coccidioidomycosis in Arizona associated with climatic changes, 1998-2001.
abstract: 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.
authors.affiliation: Mycotic Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. bip5@cdc.gov
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.forename: Victorio
authors.initials: V
authors.lastname: Vaz
authors.forename: Ken
authors.initials: K
authors.lastname: Komatsu
authors.forename: Cheryl
authors.initials: C
authors.lastname: McRill
authors.forename: Maureen
authors.initials: M
authors.lastname: Phelan
authors.forename: Timothy
authors.initials: T
authors.lastname: Colman
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Comrie
authors.forename: David W
authors.initials: DW
authors.lastname: Warnock
authors.forename: John N
authors.initials: JN
authors.lastname: Galgiani
authors.forename: Rana A
authors.initials: RA
authors.lastname: Hajjeh
mesh_terms: 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