THE COHEN GROUP
  Environmental Health & Safety Consulting Services

The Cohen Group Newsletter - Volume 7  Issue 2, Article 1.  April, 2005

Many people living along the California coast have never heard of Valley Fever, but it is a fungus infection that is actually quite common in certain parts of the southwestern U.S. and Mexico that meet certain soil and climatic conditions. In California, it is found in many areas of the great Central Valley, particularly in the southern portion.

Valley fever is another name for the infection coccidioidomycosis, which is caused by Coccidioides immitis, a fungus that lives in soil. The fungus produces spores that can be inhaled when the soil is disturbed and the spores become airborne. Spores are hardy forms of the fungus that can live for a long time in harsh environmental conditions such as heat, cold, and drought. The fungus spores get into the air when construction activities, natural disasters, or wind disturbs soil contaminated with the Valley Fever fungus. The disease is not as common during the winter months in California because the rains keep the soil wet, thereby preventing the spores from becoming airborne.

Valley Fever usually affects the lungs. In many cases, there are no symptoms. In some cases, symptoms are similar to a common cold or can be as severe as pneumonia. In rare instances, Valley Fever can affect other parts of the body. When it does so, it is called "disseminated Valley Fever."

An estimated 50,000 to 100,000 persons develop symptoms of Valley Fever each year in the U.S., with an estimated 35,000 new infections per year in California alone. Valley fever is on the rise because of the growing number of people who are moving to areas where the fungus is common (such as Arizona) and because of an increase in the number of persons with weakened immune systems (i.e., an aging population). Recent natural disasters have also triggered a rise in Valley Fever cases. The Central Valley of Southern California had a four-year epidemic of Valley Fever in the early 1990s after a severe drought. Cases of Valley Fever also increased in persons exposed to fungus-contaminated dust released by the January 1994 earthquake in Northridge, California.

About 60 percent of infected persons have absolutely no symptoms from infection by this fungus. The infection may be so mild that it may not be noticeable. About 40% of those infected typically develop cold or flu-like symptoms that can last up to a month. Hence the name "Valley Fever." Most persons, however, develop what seems to be a slight cold, that quickly subsides, and they will never know that the "cold" was really a mild case of Valley Fever unless a test for Valley Fever is performed and shows a positive result.

Symptoms typically begin within two weeks after inhaling the spores and may include: headache, fever, chills, sweats, cough, joint aches, and fatigue -- all of which are commonly associated with the "flu." Skin rashes may also occur. The severity of the symptoms is related to the susceptibility of the person inhaling the spores.

In the very worst cases involving a very small percentage of infected persons (<1%), Valley Fever develops into a more serious disease that can spread outside the lungs to the brain, bone, and skin. Without proper treatment in these rare cases, Valley Fever can lead to severe pneumonia, meningitis, and even death. This is why cases of Valley Fever need to be properly diagnosed and carefully monitored by medical professionals.

Valley Fever is generally diagnosed by a simple skin test, but a physician may confirm the diagnosis with an antibody blood test or culture. If the skin test is negative initially, it is often repeated until a positive reaction is recorded. A positive skin test reassures the doctor that his patient has developed immunity to the fungus. Thus, once an individual has developed a positive skin test for Valley Fever, that person is immune from further infection and will not get the disease again if he or she inhales the spores. The more accurate blood test provides information regarding the severity of the disease and assists doctors in deciding when to prescribe medication. There is no vaccine yet against Valley Fever, but it is treatable with a variety of oral and intravenous anti-fungal agents.

Anyone can get Valley Fever, but people who engage in activities that disturb the soil in the Central Valley where the Valley Fever fungus is common are at increased risk. They include:

· farmers,
· construction workers,
· military personnel, and
· archaeologists.

People with weakened immune systems are at increased risk for disseminated disease and can become seriously ill when infected. Others at increased risk include the elderly, African-Americans, Filipinos, and women in the third trimester of pregnancy. Valley Fever is NOT spread from person to person. It can only be contracted by inhaling fungal spores from the air.

Persons at risk for Valley Fever should try to avoid exposure to dust and dry soil in areas where Valley Fever is common. Workers at construction sites where work activities are disturbing the soil should try to stay upwind of any airborne dust as much as possible. When that can’t be done, or when winds in the area are strong and general dust levels are high, wearing a disposable respirator will help reduce exposure. A simple dust mask (N95 designation) - worn properly - will filter out 95% of all but the very finest dust particles, including most fungus spores, and will provide good protection against inhaling the Valley Fever spores.

Valley Fever: A Training Topic?

On June 11, 2002, the Division of Occupational Safety and Health ("Division") issued a citation to a contractor alleging a "general" violation of Title 8, California Code of Regulations ("CCR") § 1510(c) for failing to train employees regarding "the well known hazard of coccidiomycosis (Valley Fever) in the jobsite area." The citation also stated "employees were not instructed in the recognition of the signs and symptoms of Valley Fever or advised to consult a physician in the event of experiencing symptoms of Valley Fever."

The employer filed an appeal of the citation with the California Occupational Safety and Health Appeals Board and a hearing commenced on March 16, 2005. The hearing was not completed and was continued to a future date.

The primary grounds of appeal are whether § 1510(c) requires an employer to train about diseases and whether exposure to the disease (in this case, Valley Fever) is due to an occupational exposure or as a result of living in an area where the disease may occur.

Another issue of importance is the precedential affect of the citation; that is, does § 1510(c) require an employer to train about diseases and if so, which ones?

Note: Section 1510 titled, "Safety Instruction for Employees," can be found in the Construction Safety Orders of Title 8. Section 1510(c) which is the subject of the citation reads as follows:

"Where employees are subject to known job site hazards, such as, flammable liquids and gases, poisons, caustics, harmful plants and animals, toxic materials, confined spaces, etc., they shall be instructed in the recognition of the hazard, in the procedures for protecting themselves from injury, and in the first aid procedure in the event of injury."