The fight against disease can be a long, hard road. To be sure, the hardest part is often to understand what is causing someone to be ill. In the Central Valley, perhaps no disease is a better example of this than cocciodiomycosis or valley fever.
The arid land in the Central Valley and the American southwest has historically presented health challenges that were long assumed to be associated with a summer cold. Even though valley fever was first described during the last century, recognition of the disease’s occurrence must be improved. The number of diagnosed cases has risen in recent years from 719 in 1998 to more than 5,600 in 2011. That begs the question: within the fastest-growing region in California, just how prevalent is valley fever, and what can we do to fight it at the earliest opportunity?
In 2013, we worked to find answers to those questions during the Valley Fever Symposium in Kern County. For those of us based at the National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC), what we learned there from patients and their family members strengthened our resolve to get to the bottom of this public health problem. By the end of the symposium, NIH announced plans to design and launch a clinical trial to study early treatment of valley fever. CDC pledged to help NIH find the best sites to conduct the trial, including in California and Arizona.
Since that time, CDC estimates that between 20 and 30 percent of community-acquired pneumonia cases are actually valley fever. In addition, CDC recently began collaborating with partners in California and other states to increase healthcare provider and public awareness about valley fever, and is developing new tools that allow for better detection of the fungus in the environment.
In June, with continued support from Congress, NIH awarded Duke University an initial $5 million to conduct the clinical trial to study the impact of early treatment with the antifungal drug fluconazole. The trial will draw from patients who are seeing their doctors to treat community-acquired pneumonia. Study volunteers will be given fluconazole or a placebo, in addition to being treated for community-acquired pneumonia.
We anticipate that this trial will benefit public health and will allow for a scientifically rigorous evaluation of whether or not fluconazole — when administered in the early stages of valley fever — can at least reduce the severity of symptoms and length of illness, if not eliminate the disease entirely. Additionally, we hope the trial will increase awareness of valley fever, which may also improve the ability to diagnose it in its earliest stages.
The ultimate success of the valley fever trial or any clinical trial depends on you. The engagement of local community experts and medical professionals who have been on the front lines for years will be sure to bolster the trial, but public awareness and willingness to enroll in the trial is the only way we will be able to gain the knowledge to advance our fight against valley fever. The upcoming launch of this trial is a key step forward for the community. While there is still much work do, our goal is to begin enrolling volunteers later this fall. Stay tuned.
At the symposium, our message was clear: the fight against disease, especially rare ones, is arduous. But we are undeterred and resolved to ultimately eradicate valley fever. The launch of this clinical trial will only strengthen our ability to do so.
Congressman Kevin McCarthy is the House Majority Leader and Chairman of the Congressional Valley Fever Task Force. He wrote this with Francis S. Collins, M.D., Ph.D., the Director of the National Institutes of Health; and Thomas R. Frieden, M.D., M.P.H., the Director of the Centers for Disease Control and Prevention. Both Drs. Collins and Frieden participated in Congressman McCarthy’s Valley Fever Symposium held at CSUB in 2013.