Many questions about valley fever remained unanswered Tuesday afternoon as public health officials, physicians and politicians finished a two-day symposium on the disease, but officials and doctors alike were hopeful that the summit will be a turning point in the fight against valley fever.
Two of the country's top public health officials said they were leaving Bakersfield with a greater understanding of the disease's burden and a renewed commitment to solving its mysteries.
"You all here in Bakersfield and in Arizona have been laboring for (all of) these years to try to come up with answers and we are proud to be here, to be your partners in a new era here, which I think this symposium really serves as a marker for about how we might go forward," Dr. Francis Collins, director for the National Institutes of Health, told the audience during a morning session.
"My real big impression from the two days has been what a heavy burden (valley fever) is for individuals," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, noting that some patients require lifelong treatment. "It really brought home to me just how serious the problem is."
Tuesday's symposium was packed with quick presentations by more than two dozen speakers on everything from valley fever in pets to research detecting what patches of earth harbor valley fever. The disease is caused by inhaling the spores of a fungus that dwells in soil. Valley fever is common in parts of the southwest and has also been found in Central and South America. Most people who have valley fever -- also known as coccidioidomycosis -- will never know they have it, but some develop a flu-like illness and a smaller number of patients become seriously ill. A CDC study found that valley fever was an underlying or contributing cause of more than 3,000 deaths from 1990-2008, about 170 a year.
Presenters talked about a drug -- Nikkomycin Z -- that could potentially cure valley fever in humans, instead of just stabilize the fungus like current medications.
"We think this (drug) just for valley fever, can have sales of $250 million a year,"said David Larwood, CEO of the company Valley Fever Solutions, a drug company spun off by University of Arizona researchers.
An official from the Arizona Department of Health Services spoke about how that state, which has about two-thirds of the reported U.S. cases of valley fever, works to raise awareness among patients and doctors, and hosts an annual awareness week. U.S. Rep. David Schweikert, a Republican representing the Phoenix-Scottsdale area, said he and fellow Congressman Kevin McCarthy, R-Bakersfield, have been plotting on how to get all the different parties concerned about valley fever to communicate and collaborate across state lines.
Another physician suggested that California require that health workers, including doctors and nurse practitioners, complete medical education on valley fever in order to be licensed.
A physician from California Correctional Health Care Services said a skin test would greatly help the agency better identify inmates at risk of becoming infected with valley fever. McCarthy, who organized the symposium, said he and others are will continue pressing the U.S. Food and Drug Administration to waive the fee for a skin test -- developed by a San Diego company -- in order to get it into the market.
Whether or not all of the promising prospects raised during the symposium come to fruition, valley fever advocates said attendees were energized to keep pushing for answers.
"I am more excited. I think (the symposium) surpassed all expectations," said McCarthy, who hosted and organized the symposium.
A major success, McCarthy said, was Monday's announcement that the NIH and CDC will collaborate on a randomized controlled trial focusing on community-acquired pneumonia, the most common presentation of valley fever, and the best treatment for valley fever. The NIH will fund the study, which hopes to enroll about 1,000 people and will require millions of dollars and multiple years to complete, Collins said Monday.
"To accomplish that now has been tremendous," McCarthy said. "It just shows the awareness of valley fever and the need for (the study) has won on its merit."
He said a combination of private and public funding will be needed to achieve the goals around valley fever.
"We have to watch how we fund government but we need to prioritize the money that we have. I mean there's nothing better than putting (those) resources into science," McCarthy said, pointing out that the disease has major costs to individual patients and the prison system.
"With a skin test, how much more would we save? With a vaccine how much more would we save?" he asked.
Dr. Paul Krogstad, a professor of pediatrics and pharmacology at the David Geffen School of Medicine at UCLA, said physicians are less interested in pursuing careers in academic medicine because funding is scarce, but Krogstad hoped the attention from the symposium may attract more bright minds to study valley fever.
"If only a few people with interest in fungal infections, mycology, drug development took an interest in valley fever, things could change," Krogstad said.
Dr. Tom Chiller, deputy chief of the CDC's Mycotic Diseases Branch, said the disease is even more under-diagnosed in South and Central America, where testing is limited. Understanding more about who to treat for valley fever and when to treat them will help people in those areas as well, he said.
"I think that this (push) is really the chance for a new beginning ... toward a more aggressive strategy," Chiller said. "We need to go on the offensive against this disease so that we can actually try to prevent people from being sick, severely sick."
Chiller said the first step is an awareness campaign with solid materials and a strategy for working with public health departments at the county and state level so they are equipped to spread education about the disease. The best offense against valley fever is awareness, Chiller said, pointing to an Arizona study that showed that people were more likely to ask to be tested for valley fever if they knew about the disease.
"Have forums like this, you know, maybe a valley fever awareness week in Bakersfield every year," he said. "Something that reoccurs. Let's get a strategy, let's get something on the calendar, let's get something that continues to happen.
"The people that are passionate about (valley fever) are not going to let (the momentum) die. They're going to continue to make noise and I think we need to harness that noise and put it into a more strategic plan about how we get the message out."