Director’s Message
Valley Fever Center for Excellence
May 2026
Welcome to the Valley Fever Center for Excellence. At the Center, we try to provide reliable and timely information about coccidioidomycosis, the medical name for Valley fever.
Valley fever is truly a “One Health Disease.” Because it has been designated by the CDC as a reportable disease for humans, we know how many people are diagnosed in the 28 states that participate in reporting. Notably, Texas does not, even though its western border is known to be intensely endemic (1, 2). In 2023, there were 21,171 reported cases, of which 20,050 (94.7%) were reported from Arizona and California (https://www.cdc.gov/valley-fever/php/statistics/index.html). It is well recognized that there is a many-fold under reporting of the actual number of persons who become ill with Valley fever (3), but at least these counts give us some idea of the scope of the problem. Not so for veterinary medicine. There is no reporting practice for Valley fever in dogs, cats, or any other species, even though veterinarians in the regions where people get Valley fever know that it is a very real problem for their patients as well (4).
For many years the Valley Fever Center for Excellence (VFCE) has provided leadership in defining how important Valley fever is in veterinary practices. While many species are susceptible (5), it’s most notably a disease of dogs. The VFCE conducted a prospective study in Tucson which showed that the infection rate for young dogs was approximately 11% annually (6). More recently, its investigators found that the one-year cost of diagnosis and treatment for uncomplicated valley fever in dogs across 6 endemic southwestern U.S. states ranged from $60,117,875 to $74,858,713 before adjusting for inflation (7). Arizona’s portion of those costs was 94%. None of this information is available from other public sources.
A team of CDC investigators have authored several reports which further characterize the impact of Valley fever on people. For their work, they used a large health insurance database of reimbursement claims (MerativeTM MarketScan® Commercial/Medicare Database). In 2021, direct medical costs for Valley fever once diagnosed were conservatively over $609 million (8). The disease was often protracted: shortness of breath frequently persisted for 3–6 months, and other symptoms such as fatigue, headache, joint pain, and weakness were evident for 9–12 months (p<0.05) (9). This is in keeping with findings from an Arizona Department of Health Services questionnaire survey of patients (10). For the five-year period from 2016 through 2021, there were 54,985 Valley fever-associated hospitalizations, each with an average duration of 8.3 days (11). These studies give us a much better idea of how significant is the cost and overall impact that Valley fever imposes.
An especially important study that the same CDC team did was to estimate how long and at what cost were delays in diagnosis of patients seeking care for Valley fever infections (12). From the same health insurance database, they identified the date that Valley fever was diagnosed and then examined earlier records for clinical codes for compatible symptoms that were consistent with the eventual Valley fever diagnosis to determine the number of days of diagnostic delay. For a sample of 1,920 patients, the average overall cost for each patient’s care was $18,484, calculated in 2024 dollars. As part of this, there was an average delay of 30 days at a cost of $5,250, 28.4% of the total for each patient. Arizona contributed 1,344 of the 1,920 patients. Thus, the estimated overall cost of delay to Arizona insurance payers was $7,056,000 (1,344 patients at $5,250 each) which is $1.24 million per year for the 5.67 years of study. From CDC statistics, the numbers of Arizona Valley fever cases in 2023 were 10,990. From this information, we can estimate that the overall cost to all payors for delays in diagnosing Valley fever in Arizona is $10.1 million per year. These findings are very much in keeping with those that the VFCE has found in more targeted studies of Arizona’s Banner Health (13-15).
Realizing the high cost of diagnostic delays for Valley fever should be of direct interest to the insurance companies themselves because reductions in these delays shouldresult in cost savings in the care that they provide. The challenge is to devise effective strategies to do that. As I discussed in my last Director’s Message, it all starts with awareness, both for clinicians to remember to test for Valley fever and for patients to remember to ask for Valley fever tests when they are sick. This was also a topic we included in the annual meeting for VFCE members that was held last month. The VFCE has successfully employed a systems approach in its affiliation with Banner Health to raise awareness and appropriate testing in the urgent care clinics (16). This and other VFCE contributions were recognized with a resolution passed by the Arizona State Senate in February of this year. However, Banner’s urgent care clinics are only a small part of the total health care in Arizona, accounting for less than 3% of all Valley fever cases in the state (17). If the health insurance companies in Arizona would partner with the VFCE, perhaps we could greatly expand to the entire state the success we have had with Banner Health. In the coming months, I hope to pursue that possibility.
Cited References
1. Ibarra-Mejia G, Khanjani N, Dastoorpour M, Herrera-Molina E, Ardon-Dryer K, Jeon S, et al. The ascending trend of valley fever in El Paso, Texas and its association with regional meteorological and dust factors. International Journal of Biometeorology. 2026;70(4):101.
2. Khanjani N, Thotakura S, Gill TE. Coccidioidomycosis in Texas: Valley fever must be reportable, recognized, and taught. The Southwest Journal of Medicine. 2025;13(57):6.
3. Williams SL, Benedict K, Jackson BR, Rajeev M, Cooksey G, Ruberto I, et al. Estimated Burden of Coccidioidomycosis. JAMA Network Open. 2025;8(6):e2513572–e.
4. Sykes JE, Camponuri SK, Weaver AK, Thompson GR, 3rd, Remais JV. Use of dog serologic data for improved understanding of coccidioidomycosis: A One Health approach. J Infect Dis. 2025.
5. Shubitz LF. Comparative aspects of coccidioidomycosis in animals and humans. Ann N Y Acad Sci. 2007;1111:395–403.
6. Shubitz LE, Butkiewicz CD, Dial SM, Lindan CP. Incidence of coccidioides infection among dogs residing in a region in which the organism is endemic. J.Am.Vet.Med Assoc. 2005;226(11):1846–50.
7. Butkiewicz CD, Sykes JE, Camponuri SK, Weaver AK, Shubitz LF. The costs of the diagnosis and treatment of canine coccidioidomycosis in endemic regions, USA, 2022. Prev Vet Med. 2025;245:106660.
8. Benedict K, Gold JAW, Chiller T, Lyman M. Economic burden of fungal diseases in the United States. Medical Mycology. 2025;63(6).
9. Hennessee I, Williams S, Benedict K, Smith D, Thompson G, Toda M. Persistence of Symptoms among Commercially Insured Patients with Coccidioidomycosis, United States, 2017–2023. Emerging Infectious Disease journal. 2025;31(14).
10. Tsang CA, Anderson SM, Imholte SB, Erhart LM, Chen S, Park BJ, et al. Enhanced surveillance of coccidioidomycosis, Arizona, USA, 2007-2008. Emerg Infect Dis. 2010;16(11):1738–44.
11. Williams SL, Benedict K, Hennessee I, Toda M. Coccidioidomycosis-Associated Hospitalizations, United States, 2016–2021. Open Forum Infectious Diseases. 2025;12(11).
12. Benedict K, Massey J, Fearon Scales M, Hennessee I, Williams SL, Toda M. Impact of Delays in Diagnosis on Healthcare Costs Associated With Blastomycosis, Coccidioidomycosis, and Histoplasmosis in a Commercially Insured Population. Open Forum Infectious Diseases. 2025;12(8).
13. Donovan FM, Wightman P, Zong Y, Gabe L, Majeed A, Ynosencio T, et al. Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA. Emerg Infect Dis. 2019;25(9):1745–7.
14. Ginn R, Mohty R, Bollmann K, Goodsell J, Mendez G, Bradley B, et al. Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Phoenix, Arizona, USA(1). Emerg Infect Dis. 2019;25(9):1742–4.
15. Pu J, Donovan FM, Ellingson K, Leroy G, Stone J, Bedrick E, et al. Clinician Practice Patterns that Result in the Diagnosis of Coccidioidomycosis Before or During Hospitalization. Clin Infect Dis. 2021;73(7):e1587–e93.
16. Galgiani JN, Lang A, Howard BJ, Pu J, Ruberto I, Koski L, et al. Access to Urgent Care Practices Improves Understanding and Management of Endemic Coccidioidomycosis: Maricopa County, Arizona, 2018-2023. The American Journal of Medicine. 2024;137(10):951–7.
17. Pu J, Miranda V, Minior D, Reynolds S, Rayhorn B, Ellingson KD, et al. Improving Early Recognition of Coccidioidomycosis in Urgent Care Clinics: Analysis of an Implemented Education Program. Open Forum Infectious Diseases. 2023;10(1):ofac654