Director’s Message
Valley Fever Center for Excellence
November 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.
In 2003, The Valley Fever Center for Excellence proposed to then Arizona’s governor, Janet Napolitano, to proclaim the week of November 3rd as Valley Fever Awareness Week. By doing this, we established what is now a 23-year tradition. This year Valley Fever Awareness Week is declared by Governor Hobbs to be November 14th through 22nd, and it is cosponsored by the Arizona Department of Health Services (Figure 1). By doing this, we hope to draw Arizona’s attention to the problem of Valley fever in our state and how important it is to know about Valley fever by those who develop symptoms. Since there is no effective way to eliminate the chance of infection, knowing about this risk is everyone’s best defense.
Valley fever is caused by a fungus that resides in much of Arizona’s Sonoran Desert which surrounds the major population centers in Maricopa, Pinal, and Pima Counties. This includes Phoenix and Tucson. Infections are started by fungal spores when they become airborne and are inhaled. The spores are microscopic and can travel extensive distances. For this reason, nearly all persons living in this region are at risk of infection. Illness due to Valley fever is usually something that is eventually controlled by people’s immune system, and it then produces life-long immunity against a second infection. Also, it is not passed from person to person, so people who are infected pose no risk to anyone around them. For these reasons, there is a lot of good news about this disease. On the other hand, Valley fever often causes symptoms that persist for many weeks if not many months. With protracted illness, people frequently seek medical help, and until the cause of their symptoms is correctly diagnosed as due to Valley fever, persons are often subjected to well-meaning but ineffective medical care, such as repeated prescriptions for antibiotics, CT scans, and even diagnostic procedures like bronchoscopies or lung biopsies. There is a simple blood test that is very specific for Valley fever and can be ordered by any clinician in an urgent care clinic, the emergency department, or at primary care offices. It is even offered by some Arizona clinical laboratories to people directly without an order from a clinician. However, health care professionals often do not know when this test should be ordered. Even if they do know about Valley fever, they still may forget to test for it. As a result, patients suffering from Valley fever, who know about Valley fever, get their illness diagnosed sooner, when they insist that their treating physician order the needed Valley fever blood test.
It is hard to underestimate how important it is to know what sorts of symptoms Valley fever usually causes. Because the infection starts in the lungs, it is not surprising that respiratory symptoms are common. These include coughing, chest pain, and difficulty breathing, often associated with fever, drenching night sweating, or debilitating fatigue. In Arizona, if a physician suspects that these symptoms are due to pneumonia, Valley fever testing is always recommended, and patients requesting that testing are more likely to get it.
Besides pneumonia, Valley fever symptoms commonly also suggest a variety of other diagnoses such as acute upper respiratory infection, bronchitis, or even the flu. These other diagnoses can be due to many things, may get better promptly, and perhaps not all of these should be tested for Valley fever. However, in patients whose symptoms persist a week or more without improvement, especially if associated with unusually profound fatigue, Valley fever becomes increasingly likely the cause. A study published last year by CDC investigators (1) found that patients with Valley fever received medical care for an average of 30 days before it was correctly diagnosed. It is not clear from that study how many of the patients eventually found to have Valley fever were initially diagnosed as pneumonia and how many were diagnosed with other respiratory conditions. Anecdotally from the experience of Tucson’s Banner-University Health Valley Fever Clinic, nonpneumonia diagnoses are common initially. From the CDC study, the cost of each delay in diagnosis averaged $175, and the typical cost of a Valley fever test is only $50. Clearly, it would be cost effective to test more persons who might have Valley fever even if many of those tests are found to be negative.
The Valley Fever Center for Excellence has partnered with Banner Urgent Care Service (BUCS) for the past several years with the goal of improving the rate of testing patients with pneumonia. This has been successful, increasing rate of testing from less than 2% of pneumonia patients in 2020 to consistently over 40% now.(2) From our ongoing surveillance of BUCS clinics, we have found that the percentage of patients whose pneumonia is due to Valley fever ranges sometimes over 45% and at others to less than 5%, but, as shown in Figure 2. year-in and year-out the average is 12%.(3) What has also been learned from this surveillance is that patients who do not have pneumonia but are tested for Valley fever anyway have a positivity rate of 10%, nearly as high as for patients with pneumonia.(2)
Valley fever can also produce other symptoms, sometimes when the respiratory symptoms are not the most prominent. A synonym for Valley fever is “Desert rheumatism” because it frequently causes joint pain, muscle aches, and skin rashes such as erythema nodosum. These symptoms, when they have no obvious cause or if they are unusually persistent, are also very good reasons to ask for a Valley fever test.
Knowing about Valley fever leads to a diagnosis sooner. This was discovered by very detailed surveillance by the Arizona Department of Health Services two decades ago (4) and is still true today. For many patients, having a precise diagnosis of Valley fever eliminates the anxiety from not knowing the cause of their illness, accurate recommendations for how to manage their situation, and in most cases an excellent prognosis, albeit a relatively protracted recovery. For the few who have more complicated infections, early diagnosis leads to therapies that limit the damage and avoids more serious long-term disabilities. For most people, early diagnosis may reduce the cost of their illnesses. Valley Fever Awareness Week is just one way that the Valley Fever Center for Excellence is trying to make “Valley fever” a household phrase in Arizona. We have developed a program to distribute handouts to visitors to remind them of this problem if they become sick when they return home, away from where Valley fever is common. A group of high school students have partnered with the Center to distribute this information, printed on bookmarks of their design, in the public libraries in Tucson (Figure 3). Last month, members of the Center participated in the SaddleBrooke Health Fair to spread information about Valley Fever. We participate in similar activities throughout the year.
The Valley Fever Center for Excellence fosters awareness because we think that community outreach is very important. For those who agree, please consider a philanthropic contribution to the Center to help sustain our efforts. Donations can be made here.
John N Galgiani MD
Cited References
1. 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).
2. 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.
3. Galgiani JN, Abraham RS, Monath TP. Opportunities and challenges for a coccidioidomycosis vaccine. J. Infect. Dis. 2026;in press.
4. 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