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Occupational Coccidioidomycosis in California: Outbreak Investigation, Respirator Recommendations, and Surveillance Findings

Das, Rupali MD, MPH; McNary, Jennifer MPH, CIH; Fitzsimmons, Kathleen MPH; Dobraca, Dina MPH; Cummings, Kate MPH; Mohle-Boetani, Janet MD, MPH; Wheeler, Charlotte MD, MPH; McDowell, Ann MPH; Iossifova, Yulia MD, PhD; Bailey, Rachel DO, MPH; Kreiss, Kathleen MD; Materna, Barbara PhD, CIH

Journal of Occupational and Environmental Medicine: May 2012 - Volume 54 - Issue 5 - p 564–571
doi: 10.1097/JOM.0b013e3182480556
Original Articles

Objective: To describe the investigation of a 2007 occupational coccidioidomycosis outbreak in California, recommend prevention measures, and assess statewide disease burden.

Methods: We evaluated the worksite, observed work practices, interviewed the workers and employer, reviewed medical records, provided prevention recommendations including risk-based respirator selection, and analyzed statewide workers' compensation claims.

Results: Ten of 12 workers developed acute pulmonary coccidioidomycosis; none used respiratory protection. We recommended engineering, work practice, and administrative controls, powered air-purifying respirator use, and medical care. Occupational coccidioidomycosis incidence nearly quadrupled in California from 2000 to 2006, with the highest rates in construction and agricultural workers.

Conclusions: Construction workers are at risk for occupational coccidioidomycosis. The high attack rate in this outbreak was due to lack of awareness, rainfall patterns, soil disruption, and failure to use appropriate controls. Multiple risk-based measures are needed to control occupational coccidioidomycosis in endemic areas.

From the Occupational Health Branch (Drs Das and Materna, and Ms McNary, Ms Fitzsimmons, and Ms Dobraca) and Infectious Diseases Branch (Ms Cummings, and Drs Mohle-Boetani and Wheeler), California Department of Public Health; San Luis Obispo County Health Department (Ms McDowell), Calif; and National Institute for Occupational Safety and Health (Drs Iossifova, Bailey, and Kreiss), Atlanta, Ga.

Address correspondence to: Dr Rupali Das, MD, MPH, Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, P-3, Richmond, CA 94804 (

Disclosure: The authors declare no conflict of interest.

Copyright © 2012 by the American College of Occupational and Environmental Medicine