Simon Camponuri

All Publications

• Epidemiology of Aspergillosis Diagnoses in US Adults Using a National EHR Database, 2013-2023. Open forum infectious diseases Morgan Bustamante, B. L., Martinez, E. G., Lee, A., Kane, N. J., Camponuri, S. K., Reynolds, R. M., Snow, T. T., Bartels, J. G., Hoffman, M., White, T. C., Remais, J. V. 2026; 13 (3): ofag094

  Abstract

  Aspergillosis is a fungal infection associated with rising hospitalizations and substantial morbidity and mortality. In the United States, data remain fragmented due to the absence of centralized surveillance. This study aimed to evaluate demographic, geographic, and temporal trends in aspergillosis diagnoses across the United States and evaluate changes in those patterns following the emergence of COVID-19.We conducted a retrospective cohort study using electronic health record data from 142 US healthcare systems (Oracle Health), including adults aged ≥18 years who received care between 2013 and 2023. The cohort included over 76 million patients and 127 million person-years. Aspergillosis prevalence was calculated using post-stratification weights. Adjusted prevalence ratios (aPRs) were estimated via quasi-Poisson and Bayesian spatiotemporal regression. COVID-19-related shifts were evaluated using estimated marginal means.From 2013 to 2023, aspergillosis prevalence increased by 5% annually, peaking in 2022. Rhode Island had the highest state-level aPR; Utah the lowest. Diagnosis was higher among males (aPR 1.37), older adults (≥65 years vs 18-24 years: aPR 4.95), and urban residents (rural aPR 0.86). Following the emergence of COVID-19, prevalence increased disproportionately among Hispanic or Latino patients and several racial minority groups. A nonsignificant upward trend was also observed among rural residents.This study provides a comprehensive national assessment of aspergillosis diagnosis patterns in the United States, revealing rising prevalence and shifts in affected populations following the emergence of COVID-19. These findings may aid earlier clinical recognition, especially among groups not traditionally considered high-risk, and support efforts to expand diagnostic access and improve fungal disease surveillance.

  View details for DOI 10.1093/ofid/ofag094

  View details for PubMedID 41816001

  View details for PubMedCentralID PMC12973174

• Choice of Downscaled Climate Product Matters: Projections of Valley Fever Seasonality in a Warming Climate. GeoHealth Schollaert, C. L., Camponuri, S., Couper, L., Head, J. R., Heaney, A., Rahimi, S., Remais, J. V., Marlier, M. E. 2026; 10 (1): e2025GH001624

  Abstract

  Downscaled climate projections provide valuable information needed to better understand the impacts of climate change on health outcomes and to inform adaptation and mitigation strategies at local to regional scales. Because downscaled climate products vary in their representations of fine-scale spatiotemporal patterns, due to of multiple interacting factors, epidemiologic analyses need to consider how differences across downscaling approaches impact projections of health impacts into the future. We evaluate the projected seasonality of coccidioidomycosis in response to projected temperature and precipitation estimated using global climate models from CMIP6 included in California's Fifth Climate Change Assessment, downscaled using two approaches: (a) dynamical downscaling using the Weather Research and Forecasting model; and (b) hybrid statistical downscaling using the Localized Constructed Analogs approach. Our results indicate that by end of century, coccidioidomycosis transmission is projected to start earlier, end later, and last longer across the California endemic region; however, the magnitude of these changes varies by downscaling method. Specifically, LOCA2-hybrid projected a season onset that is 4.2 weeks earlier and an end that is 4.1 weeks later than historical conditions, while the dynamical approach projected a 4 week earlier onset and a 3.8 week later end compared to the historical period. Overall, the LOCA2-hybrid product estimates that the transmission season will last about 0.3 weeks longer than what is projected using dynamical downscaling by end of century. This analysis highlights the sensitivity of coccidioidomycosis seasonality projections to choice of downscaling product, underscoring the need to account for these differences in mitigation and adaptation planning.

  View details for DOI 10.1029/2025GH001624

  View details for PubMedID 41480418

  View details for PubMedCentralID PMC12754269

• The costs of the diagnosis and treatment of canine coccidioidomycosis in endemic regions, USA, 2022. Preventive veterinary medicine Butkiewicz, C. D., Sykes, J. E., Camponuri, S. K., Weaver, A. K., Shubitz, L. F. 2025; 245: 106660

  Abstract

  Coccidioidomycosis ("Valley fever") is a fungal disease that causes a wide range of illness severity in animals and people. Here, we use U.S. Census data, surveys of pet ownership demographics, and results of a nation-wide dog serologic study to estimate the financial burden of the disease to dog owners. We estimate that the one-year cost of diagnosis and treatment for uncomplicated pulmonary coccidioidomycosis in dogs across 6 endemic southwestern U.S. states ranged from $60,117,875 to $74,858,713 before adjusting for inflation. The financial burden to dog owners for uncomplicated illness was 9-11 % of discretionary income during the first year of diagnosis and treatment. Adjusting for inflation from 2019 to 2022, the year of our coccidioidomycosis incidence data, the costs increase to $73,944,986 to $92,076,217 annually. In 2025 this increases further to $90,176,812 to $112,288,070. Though there is a lack of specific case numbers of disseminated or complicated coccidioidomycosis, the cost of care for dogs that require emergency care, advanced diagnostics, surgery, and second and third line drugs is higher, putting greater financial strain on dog owners.

  View details for DOI 10.1016/j.prevetmed.2025.106660

  View details for PubMedID 40845432

• Valley Fever Is an Occupational Illness: Let's Get the Data to Prevent It. American journal of industrial medicine Bartels, J. G., Head, J. R., Camponuri, S. K., Eisen, E. A. 2025; 68 (11): 929-932

  Abstract

  Valley fever is a fungal disease acquired through inhalation of spores of the fungus Coccidioides. Spores become airborne when soil is disturbed, making outdoor workers, such as agricultural or construction workers, at higher risk of exposure and disease. Valley fever is endemic and increasing in the American Southwest, with numerous documented outbreaks among construction crews, archeologists, prison employees, wildland firefighters, and military personnel. Valley fever is recognized as a work-related disease in California, but not Arizona or other states with endemic disease. Epidemiologists require surveillance data with patient industry and occupation to make the case to clinicians, legislators, and employers that Valley fever is an occupational disease that can be prevented through tailored interventions. Valley fever is a reportable disease in 28 states, including California and Arizona, and Washington, D.C.; however, most case reports are sent through automated lab reports or manual case reporting, which seldom include information about industry or occupation. Electronic case reporting (eCR), in which automated disease reports are sent to public health agencies from health care facilities via electronic medical records, provides a new pathway to streamline case reporting and is more conducive to inclusion of industry and occupation data in case reports. Occupational reporting through eCR would help build the epidemiological base to identify worker populations with excess cases of Valley fever, to identify occupational clusters, facilitate early outbreak detection, provide evidence for worker compensation claims of work-related infections, and support the development of more protective legislation to train and educate workers on prevention methods.

  View details for DOI 10.1002/ajim.70017

  View details for PubMedID 40954976

  View details for PubMedCentralID PMC12512082

• Updating the Epidemiology of Blastomycosis and Histoplasmosis in the United States, Using National Electronic Health Record Data, 2013-2023 JOURNAL OF INFECTIOUS DISEASES Bartels, J. G. E., Camponuri, S. K., Snow, T. T., Bustamante, B., Kane, N. J., Reynolds, R. M., Lee, A., Hoffman, M. A., White, T. C., Remais, J., Head, J. R. 2025; 232 (6): e1048-e1059

  Abstract

  Where surveillance data are limited, nationally representative electronic health records allow for geographic, temporal, and demographic characterization of the fungal diseases blastomycosis and histoplasmosis.We identified incident blastomycosis and histoplasmosis cases from 2013 to 2023 within Oracle EHR Real-World Data, which comprises 1.6 billion healthcare encounters nationally. To characterize spatiotemporal incidence trends, we used generalized estimating equations weighted for nonrepresentativeness of electronic health record-reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates between regions, race/ethnicity, gender, and age subgroups and the national population.National incidence rates in 2023 were 2.4 (95% confidence interval [CI]: 1.6-3.5) and 1.9 times (95% CI: 1.6-2.2) rates in 2013, for blastomycosis and histoplasmosis, respectively. Blastomycosis incidence rates among Hispanic or Latino and non-Hispanic Black individuals were 60% (sIRR: 1.6 [95% CI: 1.0-2.4]) and 30% (sIRR: 1.3 [95% CI: 1.0-1.6]) higher than the standardized national incidence rate. Histoplasmosis incidence rates were elevated among non-Hispanic White patients (sIRR: 1.05 [95% CI: 1.02-1.08]). Standardized incidence rates of both diseases were higher among older and male patients, were consistently elevated in the Upper Midwest and Ohio Valley regions, and increased greatly in the Northern Rockies and Plains from 2013 to 2023. We estimated high incidence in states (blastomycosis: Illinois, Kentucky, and West Virginia; histoplasmosis: Missouri, Iowa, and Oklahoma) that do not report to surveillance.This analysis revealed increasing incidence rates of blastomycosis and histoplasmosis, with increasing diagnoses outside of historically endemic regions, and notable differences in incidence by race/ethnicity, gender, and age.

  View details for DOI 10.1093/infdis/jiaf472

  View details for Web of Science ID 001582854400001

  View details for PubMedID 40928323

  View details for PubMedCentralID PMC12718065

• Use of Dog Serologic Data for Improved Understanding of Coccidioidomycosis: A One Health Approach. The Journal of infectious diseases Sykes, J. E., Camponuri, S. K., Weaver, A. K., Thompson, G. R., Remais, J. V. 2025; 231 (5): e986-e995

  Abstract

  Coccidioidomycosis (Valley fever) occurs when animals and humans inhale spores of Coccidioides spp, soil-dwelling fungi of the southwestern United States (US). The spatial epidemiology of coccidioidomycosis is poorly understood due to irregular detection of Coccidioides in soil, disease underdiagnosis, and lack of nationwide mandatory reporting. Data on seroreactivity to Coccidioides among dogs-which are highly susceptible to coccidioidomycosis, widespread across the US, and have limited travel-may strengthen our understanding human disease risk.We analyzed serologic test results for 834 899 dogs between 2012 and 2022 from all known diagnostic laboratories conducting serologic testing for anti-Coccidioides antibodies in dogs in the US. We used testing date and county-level location data to estimate spatial and temporal trends in incidence and test positivity for dogs and compared them to human surveillance data.The overall seropositivity rate among tested dogs was 37.6% (313 829/834 899). Average test positivity rates in states with ≥0.5 tests per annum per 10 000 households were 35.4% (Texas) to 74.1% (Montana). For these states, average annual incidence per 10 000 households was as follows: Arizona (86.8), New Mexico (0.89), Nevada (0.78), California (0.75), Montana (0.63), Colorado (0.41), Oregon (0.41), Texas (0.38), Idaho (0.37), Wyoming (0.34), Utah (0.32), and Washington (0.26). Human incidence in California and Arizona between 2012 and 2022 was significantly correlated with dog incidence (ρ = 0.75 and ρ = 0.65, respectively). The distribution of seropositive dogs expanded from 76 of 3144 counties (2.4%) in 2012 to 390 in 2022 (12.4%).Further investment in human diagnostic infrastructure and provider knowledge may ameliorate significant underrecognition of this emerging fungal disease.

  View details for DOI 10.1093/infdis/jiaf184

  View details for PubMedID 40200130

  View details for PubMedCentralID PMC12128064

• Recent and Forecasted Increases in Coccidioidomycosis Incidence Linked to Hydroclimatic Swings, California, USA. Emerging infectious diseases Camponuri, S. K., Heaney, A. K., Cooksey, G. S., Vugia, D. J., Jain, S., Swain, D. L., Balmes, J., Remais, J. V., Head, J. R. 2025; 31 (5): 1028-1032

  Abstract

  In 2023, California reported near-record high coccidioidomycosis cases after a dramatic transition from drought to heavy precipitation. Using an ensemble model, we forecasted 12,244 cases statewide during April 1, 2024-March 31, 2025, a 62% increase over cases reported 2 years before and on par with case counts for 2023.

  View details for DOI 10.3201/eid3105.241338

  View details for PubMedID 40102178

  View details for PubMedCentralID PMC12044236

• Characterizing the Soil Microbial Community Associated with the Fungal Pathogen Coccidioides immitis. Journal of fungi (Basel, Switzerland) Radosevich, M., Head, J., Couper, L., Weaver, A., Camponuri, S., Montoya, L., Taylor, J. W., Remais, J. 2025; 11 (4)

  Abstract

  Coccidioidomycosis is a fungal disease affecting humans and other mammals caused by environmental pathogens of the genus Coccidioides. Human exposure to the pathogen occurs via inhalation of spores aerosolized from soil. Thus, understanding the ecological factors that shape the distribution of Coccidioides in soils is important for minimizing the risk of human exposure, though this task remains challenging due to the pathogen's highly variable spatial distribution. Here, we examined the associations between the soil microbial community and Coccidioides immitis' presence within the Carrizo Plain National Monument, a minimally disturbed grassland ecosystem, and the site of a longitudinal study examining the effects of rodents and their burrows on C. immitis' presence in soils. Using internal transcribed spacer 2 (ITS2) and 16S amplicon sequencing to characterize the soil fungal and bacterial communities, we found over 30 fungal species, including several other members of the Onygenales order, that co-occurred with C. immitis more frequently than would be expected by chance. Coccidioides-positive samples were significantly higher in fungal and bacterial diversity than negative samples, an association partly driven by higher Coccidioides presence within rodent burrows compared to surface soils. Soil source (i.e., rodent burrow versus surface soil) explained the largest amount of variation in bacterial and fungal community diversity and composition, with soils collected from rodent burrows having higher fungal and bacterial diversity than those collected from adjacent surface soils. While prior evidence is mixed regarding the relationship between the presence of Coccidioides and microbial diversity, we find that favorable microhabitats, such as rodent burrows, lead to a positive association between soil microbial diversity and Coccidioides presence, particularly in otherwise resource-limited natural environments.

  View details for DOI 10.3390/jof11040309

  View details for PubMedID 40278129

  View details for PubMedCentralID PMC12028473

• Prolonged coccidioidomycosis transmission seasons in a warming California: a Markov state transition model of shifting disease dynamics. Journal of the Royal Society, Interface Camponuri, S. K., Head, J. R., Collender, P. A., Weaver, A. K., Heaney, A. K., Colvin, K. A., Bhattachan, A., Sondermeyer-Cooksey, G., Vugia, D. J., Jain, S., Remais, J. V. 2025; 22 (223): 20240821

  Abstract

  Coccidioidomycosis, an emerging fungal disease in the southwestern United States, exhibits pronounced seasonal transmission, yet the influence of current and future climate on the timing and duration of transmission seasons remains poorly understood. We developed a distributed-lag Markov state transition model to estimate the effects of temperature and precipitation on the timing of transmission season onset and end, analysing reported coccidioidomycosis cases (n = 72 125) in California from 2000 to 2023. Using G-computation substitution estimators, we examined how hypothetical changes in seasonal meteorology impact transmission season timing. Transitions from cooler, wetter conditions to hotter, drier conditions were found to significantly accelerate season onset. Dry conditions (10th percentile of precipitation) in the spring shifted season onset an average of 2.8 weeks (95% CI: 0.43-3.58) earlier compared with wet conditions (90th percentile of precipitation). Conversely, transitions back to cooler, wetter conditions hastened season end, with dry autumn conditions extending the season by an average of 0.69 weeks (95% CI: 0.37-1.41) compared with wet conditions. When dry conditions occurred in the spring and autumn, the transmission season extended by 3.70 weeks (95% CI: 1.23-4.22). With prolonged dry seasons expected in California with climate change, our findings suggest this shift will extend the period of elevated coccidioidomycosis risk.

  View details for DOI 10.1098/rsif.2024.0821

  View details for PubMedID 39999883

  View details for PubMedCentralID PMC11858782

• Estimating the Exposure-Response Relationship between Fine Mineral Dust Concentration and Coccidioidomycosis Incidence Using Speciated Particulate Matter Data: A Longitudinal Surveillance Study. Environmental health perspectives Weaver, A. K., Keeney, N., Head, J. R., Heaney, A. K., Camponuri, S. K., Collender, P., Bhattachan, A., Okin, G. S., Eisen, E. A., Sondermeyer-Cooksey, G., Yu, A., Vugia, D. J., Jain, S., Balmes, J., Taylor, J., Remais, J. V., Strickland, M. J. 2025; 133 (1): 17003

  Abstract

  Coccidioidomycosis, caused by inhalation of Coccidioides spp. spores, is an emerging infectious disease that is increasing in incidence throughout the southwestern US. The pathogen is soil-dwelling, and spore dispersal and human exposure are thought to co-occur with airborne mineral dust exposures, yet fundamental exposure-response relationships have not been conclusively estimated.We estimated associations between fine mineral dust concentration and coccidioidomycosis incidence in California from 2000 to 2017 at the census tract level, spatiotemporal heterogeneity in exposure-response, and effect modification by antecedent climate conditions.We acquired monthly census tract-level coccidioidomycosis incidence data and modeled fine mineral dust concentrations from 2000 to 2017. We fitted zero-inflated distributed-lag nonlinear models to estimate overall exposure-lag-response relationships and identified factors contributing to heterogeneity in exposure-responses. Using a random-effects meta-analysis approach, we estimated county-specific and pooled exposure-responses for cumulative exposures.We found a positive exposure-response relationship between cumulative fine mineral dust exposure in the 1-3 months before estimated disease onset and coccidioidomycosis incidence across the study region [incidence rate ratio (IRR) for an increase from 0.1 to 1.1 μg/m3=1.60; 95% CI: 1.46, 1.74]. Positive, supralinear associations were observed between incidence and modeled fine mineral dust exposures 1 [IRR=1.13 (95% CI: 1.10, 1.17)], 2 [IRR=1.15 (95% CI: 1.09, 1.20)] and 3 [IRR=1.08 (95% CI: 1.04, 1.12)] months before estimated disease onset, with the highest exposures being particularly associated. The cumulative exposure-response relationship varied significantly by county [lowest IRR, western Tulare: 1.05 (95% CI: 0.54, 2.07); highest IRR, San Luis Obispo: 3.01 (95% CI: 2.05, 4.42)]. Season of exposure and prior wet winter were modest effect modifiers.Lagged exposures to fine mineral dust were strongly associated with coccidioidomycosis incidence in the endemic regions of California from 2000 to 2017. https://doi.org/10.1289/EHP13875.

  View details for DOI 10.1289/EHP13875

  View details for PubMedID 39804964

  View details for PubMedCentralID PMC11729455

• Coccidioidomycosis seasonality in California: a longitudinal surveillance study of the climate determinants and of seasonal 2000-2021 - 2021 LANCET REGIONAL HEALTH-AMERICAS Heaney, A. K., Camponuri, S. K., Head, J. R., Collender, P., Weaver, A., Cooksey, G., Yu, A., Vugia, D., Jain, S., Bhattachan, A., Taylor, J., Remais, J. 2024; 38: 100864

  Abstract

  Coccidioidomycosis, an emerging fungal disease in the western USA, exhibits seasonal patterns that are poorly understood, including periods of strong cyclicity, aseasonal intervals, and variation in seasonal timing that have been minimally characterized, and unexplained as to their causal factors. Coccidioidomycosis incidence has increased markedly in recent years, and our limited understanding of intra- and inter-annual seasonality has hindered the identification of important drivers of disease transmission, including climate conditions. In this study, we aim to characterize coccidioidomycosis seasonality in endemic regions of California and to estimate the relationship between drought conditions and coccidioidomycosis seasonal periodicity and timing.We analysed data on all reported incident cases of coccidioidomycosis in California from 2000 to 2021 to characterize seasonal patterns in incidence, and conducted wavelet analyses to assess the dominant periodicity, power, and timing of incidence for 17 counties with consistently high incidence rates. We assessed associations between seasonality parameters and measures of drought in California using a distributed lag nonlinear modelling framework.All counties exhibited annual cyclicity in incidence (i.e., a dominant wavelet periodicity of 12 months), but there was considerable heterogeneity in seasonal strength and timing across regions and years. On average, 12-month periodicity was most pronounced in the Southern San Joaquin Valley and Central Coast. Further, the annual seasonal cycles in the Southern San Joaquin Valley and the Southern Inland regions occurred earlier than those in coastal and northern counties, yet the timing of annual cycles became more aligned among counties by the end of the study period. Drought conditions were associated with a strong attenuation of the annual seasonal cycle, and seasonal peaks became more pronounced in the 1-2 years after a drought ended.We conclude that drought conditions do not increase the risk of coccidioidomycosis onset uniformly across the year, but instead promote increased risk concentrated within a specific calendar period (September to December). The findings have important implications for public health preparedness, and for how future shifts in seasonal climate patterns and extreme events may impact spatial and temporal coccidioidomycosis risk.National Institutes of Health.

  View details for DOI 10.1016/j.lana.2024.100864

  View details for Web of Science ID 001298771200001

  View details for PubMedID 39253708

  View details for PubMedCentralID PMC11382213

• COVID-19 Vaccination and Incidence of Pediatric SARS-CoV-2 Infection and Hospitalization. JAMA network open Head, J. R., Collender, P. A., León, T. M., White, L. A., Sud, S. R., Camponuri, S. K., Lee, V., Lewnard, J. A., Remais, J. V. 2024; 7 (4): e247822

  Abstract

  A SARS-CoV-2 vaccine was approved for adolescents aged 12 to 15 years on May 10, 2021, with approval for younger age groups following thereafter. The population level impact of the pediatric COVID-19 vaccination program has not yet been established.To identify whether California's pediatric COVID-19 immunization program was associated with changes in pediatric COVID-19 incidence and hospitalizations.A case series on COVID-19 vaccination including children aged 6 months to 15 years was conducted in California. Data were obtained on COVID-19 cases in California between April 1, 2020, and February 27, 2023.Postvaccination evaluation periods spanned 141 days (June 10 to October 29, 2021) for adolescents aged 12 to 15 years, 199 days (November 29, 2021, to June 17, 2022) for children aged 5 to 11 years, and 225 days (July 17, 2022, to February 27, 2023) for those aged 6 to 59 months. During these periods, statewide vaccine coverage reached 53.5% among adolescents aged 12 to 15 years, 34.8% among children aged 5 to 11 years, and 7.9% among those aged 6 to 59 months.Age-stepped implementation of COVID-19 vaccination was used to compare observed county-level incidence and hospitalization rates during periods when each age group became vaccine eligible to counterfactual rates predicted from observations among other age groups. COVID-19 case and hospitalization data were obtained from the California reportable disease surveillance system.Between April 1, 2020, and February 27, 2023, a total of 3 913 063 pediatric COVID-19 cases and 12 740 hospitalizations were reported in California. Reductions of 146 210 cases (95% prediction interval [PI], 136 056-158 948) were estimated among adolescents aged 12 to 15 years, corresponding to a 37.1% (35.5%-39.1%) reduction from counterfactual predictions. Reductions of 230 134 (200 170-265 149) cases were estimated among children aged 5 to 11 years, corresponding to a 23.7% (20.6%-27.3%) reduction from counterfactual predictions. No evidence of reductions in COVID-19 cases statewide were found among children aged 6 to 59 months (estimated averted cases, -259; 95% PI, -1938 to 1019), although low transmission during the evaluation period may have limited the ability to do so. An estimated 168 hospitalizations (95% PI, 42-324) were averted among children aged 6 to 59 months, corresponding to a 24.4% (95% PI, 6.1%-47.1%) reduction. In meta-analyses, county-level vaccination coverage was associated with averted cases for all age groups. Despite low vaccination coverage, pediatric COVID-19 immunization in California averted 376 085 (95% PI, 348 355-417 328) reported cases and 273 (95% PI, 77-605) hospitalizations among children aged 6 months to 15 years over approximately 4 to 7 months following vaccination availability.The findings of this case series analysis of 3 913 063 cases suggest reduced pediatric SARS-CoV-2 transmission following immunization. These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations.

  View details for DOI 10.1001/jamanetworkopen.2024.7822

  View details for PubMedID 38652476

  View details for PubMedCentralID PMC11040406

• Association between wildfires and coccidioidomycosis incidence in California, 2000-2018: a synthetic control analysis. Environmental epidemiology (Philadelphia, Pa.) Phillips, S., Jones, I., Sondermyer-Cooksey, G., Yu, A. T., Heaney, A. K., Zhou, B., Bhattachan, A., Weaver, A. K., Campo, S. K., Mgbara, W., Wagner, R., Taylor, J., Lettenmaier, D., Okin, G. S., Jain, S., Vugia, D., Remais, J. V., Head, J. R. 2023; 7 (4): e254

  Abstract

  The frequency and severity of wildfires in the Western United States have increased over recent decades, motivating hypotheses that wildfires contribute to the incidence of coccidioidomycosis, an emerging fungal disease in the Western United States with sharp increases in incidence observed since 2000. While coccidioidomycosis outbreaks have occurred among wildland firefighters clearing brush, it remains unknown whether fires are associated with an increased incidence among the general population.We identified 19 wildfires occurring within California's highly endemic San Joaquin Valley between 2003 and 2015. Using geolocated surveillance records, we applied a synthetic control approach to estimate the effect of each wildfire on the incidence of coccidioidomycosis among residents that lived within a hexagonal buffer of 20 km radii surrounding the fire.We did not detect excess cases due to wildfires in the 12 months (pooled estimated percent change in cases: 2.8%; 95% confidence interval [CI] = -29.0, 85.2), 13-24 months (7.9%; 95% CI = -27.3, 113.9), or 25-36 months (17.4%; 95% CI = -25.1, 157.1) following a wildfire. When examined individually, we detected significant increases in incidence following three of the 19 wildfires, all of which had relatively large adjacent populations, high transmission before the fire, and a burn area exceeding 5,000 acres.We find limited evidence that wildfires drive increases in coccidioidomycosis incidence among the general population. Nevertheless, our results raise concerns that large fires in regions with ongoing local transmission of Coccidioides may be associated with increases in incidence, underscoring the need for field studies examining Coccidioides spp. in soils and air pre- and post-wildfires.

  View details for DOI 10.1097/EE9.0000000000000254

  View details for PubMedID 37545805

  View details for PubMedCentralID PMC10402968

• Coccidioides undetected in soils from agricultural land and uncorrelated with time or the greater soil fungal community on undeveloped land. PLoS pathogens Wagner, R., Montoya, L., Head, J. R., Campo, S., Remais, J., Taylor, J. W. 2023; 19 (5): e1011391

  Abstract

  Coccidioidomycosis is a typically respiratory fungal disease that, in the United States, occurs primarily in Arizona and California. In California, most coccidioidomycosis cases occur in the San Joaquin Valley, a primarily agricultural region where the disease poses a risk for outdoor workers. We collected 710 soil samples and 265 settled dust samples from nine sites in the San Joaquin Valley and examined how Coccidioides detection varied by month, site, and the presence and abundance of other fungal species. We detected Coccidioides in 89 of 238 (37.4%) rodent burrow soil samples at five undeveloped sites and were unable to detect Coccidioides in any of 472 surface and subsurface soil samples at four agricultural sites. In what is the largest sampling effort undertaken on agricultural land, our results provide no evidence that agricultural soils in the San Joaquin Valley harbor Coccidioides. We found no clear association between Coccidioides and the greater soil fungal community, but we identified 19 fungal indicator species that were significantly associated with Coccidioides detection in burrows. We also did not find a seasonal pattern in Coccidioides detection in the rodent burrow soils we sampled. These findings suggest both the presence of a spore bank and that coccidioidomycosis incidence may be more strongly associated with Coccidioides dispersal than Coccidioides growth. Finally, we were able to detect Coccidioides in only five of our 265 near-surface settled dust samples, one from agricultural land, where Coccidioides was undetected in soils, and four from undeveloped land, where Coccidioides was common in the rodent burrow soils we sampled. Our ability to detect Coccidioides in few settled dust samples indicates that improved methods are likely needed moving forward, though raises questions regarding aerial dispersal in Coccidioides, whose key transmission event likely occurs over short distances in rodent burrows from soil to naïve rodent lungs.

  View details for DOI 10.1371/journal.ppat.1011391

  View details for PubMedID 37228157

  View details for PubMedCentralID PMC10246812

• Effects of precipitation, heat, and drought on incidence and expansion of coccidioidomycosis in western USA: a longitudinal surveillance study. The Lancet. Planetary health Head, J. R., Sondermeyer-Cooksey, G., Heaney, A. K., Yu, A. T., Jones, I., Bhattachan, A., Campo, S. K., Wagner, R., Mgbara, W., Phillips, S., Keeney, N., Taylor, J., Eisen, E., Lettenmaier, D. P., Hubbard, A., Okin, G. S., Vugia, D. J., Jain, S., Remais, J. V. 2022; 6 (10): e793-e803

  Abstract

  Drought is an understudied driver of infectious disease dynamics. Amidst the ongoing southwestern North American megadrought, California (USA) is having the driest multi-decadal period since 800 CE, exacerbated by anthropogenic warming. In this study, we aimed to examine the influence of drought on coccidioidomycosis, an emerging infectious disease in southwestern USA.We analysed California census tract-level surveillance data from 2000 to 2020 using generalised additive models and distributed monthly lags on precipitation and temperature. We then developed an ensemble prediction algorithm of incident cases of coccidioidomycosis per census tract to estimate the counterfactual incidence that would have occurred in the absence of drought.Between April 1, 2000, and March 31, 2020, there were 81 448 reported cases of coccidioidomycosis throughout California. An estimated 1467 excess cases of coccidioidomycosis were observed in California in the 2 years following the drought that occurred between 2007 and 2009, and an excess 2649 drought-attributable cases of coccidioidomycosis were observed in the 2 years following the drought that occurred between 2012 and 2015. These increased numbers of cases more than offset the declines in cases that occurred during drought. An IQR increase in summer temperatures was associated with 2·02 (95% CI 1·84-2·22) times higher incidence in the following autumn (September to November), and an IQR increase in precipitation in the winter was associated with 1·45 (1·36-1·55) times higher incidence in the autumn. The effect of winter precipitation was 36% (25-48) stronger when preceded by two dry, rather than average, winters. Incidence in arid counties was most sensitive to precipitation fluctuations, while incidence in wetter counties was most sensitive to temperature.In California, multi-year cycles of dry conditions followed by a wet winter increases transmission of coccidioidomycosis, especially in historically wetter areas. With anticipated increasing frequency of drought in southwestern USA, continued expansion of coccidioidomycosis, along with more intense seasons, is expected. Our results motivate the need for heightened precautions against coccidioidomycosis in seasons that follow major droughts.National Institutes of Health.

  View details for DOI 10.1016/S2542-5196(22)00202-9

  View details for PubMedID 36208642

  View details for PubMedCentralID PMC10189771