title: Epidemiology of Pediatric Coccidioidomycosis in California, 2000-2012.
abstract: BACKGROUND
  Reported coccidioidomycosis cases have increased in the southwestern US since 2000. However, there are few publications on pediatric coccidioidomycosis. We sought to describe the epidemiology of coccidioidomycosis in the California pediatric population during 2000-2012.
  
  
  METHODS
  We reviewed surveillance and hospitalization datasets for years 2000-2012 and death datasets for years 2000-2010 to identify coccidioidomycosis-associated cases, hospitalizations and deaths in pediatric (≤17 years old) California residents. We calculated rates and described demographic characteristics of cases and hospitalized patients and, using Poisson regression, calculated bivariate relative risks to identify potential demographic risk factors. We identified immunocompromising conditions associated with hospitalization and death and calculated hospitalization charges.
  
  
  RESULTS
  We identified 3453 cases, 1301 hospitalizations and 11 deaths associated with coccidioidomycosis in the California pediatric population. During 2000-2012, annual case and hospitalized patient rates increased and were highest in males, those in the 12-17 age group, and residents of the California endemic region. Compared with White children, African-American children were significantly more likely to be hospitalized (relative risk = 1.4, P = 0.01). Approximately 12.0% of those hospitalized and 27% of those who died had an immunocompromising condition. Hospitalized patients accrued $149 million in total hospital charges.
  
  
  CONCLUSIONS
  Similar to recent increases among adults, reported pediatric coccidioidomycosis cases and hospitalizations have increased in California since 2000, disproportionately affecting certain demographic groups. The burden of coccidioidomycosis among California children emphasizes the need for more awareness and research into this reemerging fungal disease in endemic and nonendemic areas.
authors.affiliation: From the *Infectious Diseases Branch, California Department of Public Health, Richmond, California; †Division of Infectious Diseases, Valley Children's Hospital, Madera, California; ‡Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Sondermeyer
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Lee
authors.forename: Debra
authors.initials: D
authors.lastname: Gilliss
authors.forename: James M
authors.initials: JM
authors.lastname: McCarty
authors.forename: Duc J
authors.initials: DJ
authors.lastname: Vugia
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003047:Coccidioidomycosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D017722:Hospital Charges; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D016019:Survival Analysis