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Valley fever confirmed in cast, crew of outdoor filming event
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An investigation by the California Department of Health identified five laboratory-confirmed cases and five probable cases of coccidioidomycosis, or valley fever, among cast and crew members filming at an outdoor set in Ventura County, Calif., according to an MMWR report.
“Public health professionals, clinicians and the television and film industry should be aware that employees working outdoors in areas where Coccidioides is endemic (eg, central and southern California), even those not engaged in soil-disruptive work, might be at risk for coccidioidomycosis,” the investigators wrote.
The first patient identified was an actor who presented to the ED on Feb. 28, 2012, after a 2-week history of fever and cough. The second patient identified was a camera operator who sought treatment in the ED on Feb. 24, 2012, after a 2-week history of cough, joint aches and muscle pain. Both patients had worked at the same outdoor filming event that took place Jan. 17 to 19 in Ventura County.
A subsequent review of information from the California Department of Industrial Relations found six more workers with the same employer, who had also participated in the filming event and were evaluated for possible work-related valley fever. Two other cases were identified: one by review of social media in which one patient posted about his hospitalization, and one by a relative.
Only two of the patients reported soil-disrupting activities, including digging and moving dirt. However, substantial soil-disruptive work, including grading and digging and filling a mud pit, occurred on the site shortly before filming.
“Working at a site immediately after soil disturbance might expose workers to Coccidioides spores and a complete [Injury and Illness Prevention Program] for these employees should include 1) covering spoils piles and wetting disturbed areas, 2) establishing criteria for suspending work on the basis of wind and dust conditions, and 3) prompt disease recognition and referral to occupational medicine clinics for evaluation, treatment and follow-up,” the investigators wrote.
Disclosure: The investigators report no relevant financial disclosures.
Perspective
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George Thompson, MD
Coccidioides spp. is a soil-dwelling fungus that becomes airborne when the soil is disrupted. Although people who work regularly with soil, such as archaeologists and construction workers, have the highest risk, coccidioidomycosis can affect anybody. This infection is endemic to certain parts of California, Arizona and Texas, as well as portions of New Mexico, Utah, Nevada and Washington. Last year, the CDC published a report about the increasing incidence of valley fever over the last decade, and has done a great job of increasing disease awareness. This report reinforces the suggestion that valley fever be considered in any patient with a consistent illness in an endemic area, even among those with occupations not considered high-risk.
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