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More people are getting tested for Valley fever in Arizona. This doctor says it's not enough

The Arizona Department of Health Services says as of mid-June, there were nearly 6,800 confirmed and probable cases of Valley fever reported in Arizona so far this year.

Arizona is a hotspot for the fungus that causes Valley fever; and half of all U.S. infections are in Maricopa County. There’s now a new tool that aims to help track those cases.

Dr. John Galgiani is a physician and professor of medicine at the University of Arizona College of Medicine in Tucson; he’s also the founding director of the Valley Fever Center for Excellence there.

Galgiani spoke more with The Show about the new tracking tool.

Full conversation

DR. JOHN GALGIANI: Well, your question is really interesting and the idea that is underlying your question is that Valley fever is sort of seasonal and I have actually been thinking that it pretty much was seasonal. But it's, it is, it turns out seasons are like influenza, you get seasons of influenza. It turns out Valley fever does come and go.

There are periods when it's a lot more intensely in the community than other times. But that depends on the year and it, it's driven primarily by weather factors. Although other factors come into that as well. And since the weather is different from year to year, it turns out when Valley fever occurs throughout the year is quite variable.

And I think what has been seen with the data coming into Maricopa County in the past eight or 10 months, is there was an unexpected rise in cases late in 2023 and carried on through the front end of 2024. But then over the last two or three months, and I think, although this is unproven, I think it might be because of the rains.

We had the unexpectedly high rains back in March or something like that, that it blocked it and, and evidence that I have, which we'll talk about in a little bit, is that really patients with new infections actually have been going un undetected for the last six weeks or so.

MARK BRODIE: So what are the weather factors that you're looking for? I mean, is it mostly the rain or lack of rain that is the determining factor?

GALGIANI: Right. Well, there's, there's a theory that is kind of talked about as the blow and grow theory. And basically the idea that when it rains, it rains on the Sonoran Desert. And the fungus, which causes Valley fever, lives in basically desert Sonoran soils. And so the idea is when it rains, there's a bloom of the fungus, which then results in an increased crop of spores that can get into the air when things dry out.

And so we see typically the increased activity of infections occurring when things get dry.

Now there's an incubation time of one to three weeks. So if it's dry and you get infected, you don't start feeling ill for, you know, two weeks on average. And then it's a week or two before you actually seek medical attention.

So it's often through the monsoons that people are being diagnosed with Valley fever, but those are infections that occurred maybe a month or six weeks earlier.

BRODIE: Which is interesting because if you think about, for example, monsoon season, it's pretty dry leading up to it.

GALGIANI: Right. And so right now you would think because it's been dry now for a period of time, this would be a very good time to see increasing numbers of infection. And I'm watching to see if that's the case.

BRODIE: Are we seeing more people actually getting tested for Valley fever? I know in the past it's been something that a lot of physicians have maybe struggled to recognize or diagnose. Is that getting better?

GALGIANI: Yes, it is. And I think it gets better with attention. This has not been happening just by chance. Because we have at the University of Arizona in the Colleges of Medicine have now affiliated with Banner Health. I've had the opportunity in the Valley Fever Center. People had the opportunity to work with that large practice and start impacting their testing practices.

And so over the last four years, I've been actually focused on urgent care, which when we started thinking about this, their testing of people with pneumonia, which is a very common presentation of Valley fever, was like 1% or 2% of those patients being tested. And we've now gotten that up this last two or three months. It's over 30%. But that's still not quite as good as I'd like it. We like it more up towards 60%. I think that would be a good target.

BRODIE: And how reliable are the tests?

GALGIANI: The tests are very specific when they're positive. However, they are designed to be very reliable, which means they typically miss cases. So people who have negative blood tests and that's what we're really talking about here, is a blood test. And that is typically positive, you got to diagnose …, the State Department of Health considers any positive case definition. But if it's negative, you still might have it and a repeat test may pick that up.

BRODIE: So you've mentioned the issue of awareness of Valley fever and I want to ask you about something that Banner is doing, this new dashboard to basically keep track of what's going on. How significant is that? And I guess why hasn't this happened in the past?

Dr. John Galgiani
Katherine Davis-Young/KJZZ
Dr. John Galgiani is a professor with the University of Arizona College of Medicine and director of the Banner Health Valley Fever Center.

GALGIANI: Well, I think it hasn't happened because the Valley Fever Center for Excellence is now working with a large group, Banner Health, and we have the opportunity to do this. It's having an advocate for this disease, was the Valley Fever Center is, is how it works. And it's a small disease compared to many others. The FDA calls it an orphan disease. And so if you really don't have people working on this, it just doesn't happen. So that's, that's why I think it's happening now.

The dashboard was my idea to, to move from this 25%, 30% testing to give more feedback to the clinicians in urgent care. We're actually now extending it to Banner emergency rooms, which has implications for the hospital as well.

So this idea of giving almost real time data because the dashboard gets updated daily and that then can be given to the urgent care docs and other clinicians in Banner. And we're actually making this public as well on the Valley Fever Center website.

And that's very important because public health, Arizona Department of Health Service, actually showed that people who knew about Valley fever before they got sick got a diagnosis sooner than people that didn't because they asked their clinician, don't you think I should be tested? So people knowing about this is just as important as having the clinicians know about it.

BRODIE: How are the treatment plans working? Like, do we have an effective treatment for Valley fever at this point?

GALGIANI: We have oral medicines that the good news is, they're not by intravenous injection, they're oral and they are relatively safe. They have drug interactions. There's some problems with them. They have side effects, but we've been using them now for 35 years.

The downside and the limitation is that they don't cure this disease. So people who get some of the most complicated Valley fever, those patients are recommended to never stop treatment for the rest of their lives. So they have lifelong treatment with that diagnosis. So we don't have a cure. So that would be really wonderful if we could find that there's some possibles, but they're way, way in the future at the moment.

BRODIE: And in terms of potential vaccines, I know there have been trials on dogs. How have those gone? And are we potentially closer to having something for people?

GALGIANI: Well, the idea of a vaccine has been around since the 1950s because it's been known that people who get over Valley fever essentially never get second infections. So why not do the same kind of effect from a vaccine without having to wait for the infection?

And that, that's been going on, I've been involved with trials and research ever since the 1970s, very recently, very recently, over the last decade at the University of Arizona, a vaccine has been discovered, which actually is very well along to become a product for veterinary use to prevent Valley fever in dogs. And this has involved National Institutes of Health support. We have a partner company, a Anivive Life Sciences in California, who has developed this along with us helping them and, and that's very exciting.

But the idea that I have is the same vaccine. There's really no, no based on the science, no reason it couldn't also be for humans. And we have submitted a grant or at least Anivive and their collaborators which includes us, have submitted a grant to the NIH requesting support to take the vaccine from where it is now into human trials that was submitted last year. It's under consideration and we're hopeful we'll hear something about that in the very near future.

KJZZ's The Show transcripts are created on deadline. This text is edited for length and clarity, and may not be in its final form. The authoritative record of KJZZ's programming is the audio record.

Mark Brodie is a co-host of The Show, KJZZ’s locally produced news magazine. Since starting at KJZZ in 2002, Brodie has been a host, reporter and producer, including several years covering the Arizona Legislature, based at the Capitol.
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