Valley Fever Outbreak Blamed On Coalinga State Hospital

http://www.nytimes.com/2007/12/30/us/30inmates.html?_r=1&hp&oref=slogin

December 30, 2007
Infection Hits a California Prison Hard
By JESSE McKINLEY

COALINGA, Calif. — When any of the 5,300 inmates at Pleasant Valley State Prison begin coughing and running a fever, doctors do not think flu, bronchitis or even the common cold.

They think valley fever; and, more often than they would like, they are right.

In the past three years, more than 900 inmates at the prison have contracted the fever, a fungal infection that has been both widespread and lethal.

At least a dozen inmates here in Central California have died from the disease, which is on the rise in other Western states, including Arizona, where the health department declared an epidemic after more than 5,500 cases were reported in 2006, including 33 deaths.

Endemic to parts of the Southwest, valley fever has been reported in recent years in a widening belt from South Texas to Northern California. The disease has infected archaeologists digging at the Dinosaur National Monument in Utah and dogs that have inhaled the spores while sniffing for illegal drugs along the Mexican border.

In most cases, the infection starts in the lungs and is usually handled by the body without permanent damage. But serious complications can arise, including meningitis; and, at Pleasant Valley, the scope of the outbreak has left some inmates permanently disabled, confined to wheelchairs and interned in expensive long-term hospital stays.

About 80 prison employees have also contracted the fever, Pleasant Valley officials say, including a corrections officer who died of the disease in 2005.

What makes the disease all the more troubling is that its cause is literally underfoot: the spores that cause the infection reside in the region’s soil. When that soil is disturbed, something that happens regularly where houses are being built, crops are being sown and a steady wind churns, those spores are inhaled. The spores can also be kicked up by Mother Nature including earthquakes and dust storms.

“It doesn’t matter whether you’re custody staff, it doesn’t matter if you’re a plumber or an electrician,” said James A. Yates, the warden at Pleasant Valley. “You breathe the same air as you walk around out there.”

The epidemic at the prison has led to a clash of priorities for a correctional system that is dealing with below average medical care and chronic overcrowding.

Last fall, heeding advice from local health officials and a federal receiver charged with improving the state’s prison medical care, the Department of Corrections and Rehabilitation delayed plans to add 600 new beds out of concern that the construction might stir up more spores.

Officials at the prison blame the construction of a state hospital nearby for causing a spike in valley fever. The construction was under way from 2001 to 2005, and valley fever hit its peak here in 2006, when the disease was diagnosed in 514 inmates.

This year, about 300 cases have been diagnosed among inmates at the prison, which sits along a highway lined with almond groves and signs advertising new “semi-custom homes.” Felix Igbinosa, the prison’s medical director, said “the No. 1 reason” was thought to be the soil disturbance from new construction.

The delayed expansion here was part of a $7.9 billion plan signed by Gov. Arnold Schwarzenegger last summer to relieve overcrowding in the state’s prisons. Pleasant Valley was built in 1994 to house 2,000 inmates.

California reported more than 3,000 cases of valley fever in 2006, the most in a decade. Explanations for the spike have included increased residential development and changes in weather patterns that have resulted in increased blooms of the fungus.

Other prisons in the Central Valley of California have had increases in the number of fever cases in recent years, but in none has the rate of infection been higher than at Pleasant Valley, where about one inmate in 10 tested positive in 2006.

Even allowing for the nearby construction, experts say they do not know why the disease is so rampant here.

“Is the soil surrounding Pleasant Valley different?” asked Dr. Demosthenes Pappagianis of the University of California, Davis.

“There’s a lot we still need to know about it,” said Dr. Pappagianis, a professor of medical microbiology and immunology who has been studying valley fever for more than 50 years.

Early symptoms of the disease, which is clinically known as coccidioidomycosis, mimic the flu, with symptoms that include a cough, lethargy and a fever. Most of those who become infected recover with little or no treatment and are subsequently immune.

In about 2 percent to 3 percent of the cases, the disease spreads from the lungs and can attack the bones, liver, spleen and skin.

For the 11,000 non-inmate residents of Coalinga, about 200 miles southeast of San Francisco, the disease has been a fact of life for generations. “We just deal,” said Trish Hill, the city’s mayor. “You don’t do stupid things like go out on windy days or dig in the dirt.”

Inmates appear to be especially susceptible to the disease, in part because they come from areas all over the state and have not developed an immunity to the disease. California corrections officials are preparing new guidelines for prison design, including ventilation and landscaping.

“Prisons tend to have a lot of bare dirt, and that has some security benefit,” said Deborah Hysen, the corrections department’s deputy secretary of facility planning. “But in the case of valley fever, you want to really contain the soil.”

At Pleasant Valley, officials say the outbreak of valley fever places a burden on the institution, requiring guards to escort inmates to local hospitals, where stays can last months and result in medical and security costs of $1 million and more, said Dr. Igbinosa, the medical director.

The disease also affects inmate morale, doctors say.

Gilbert Galaviz was convicted of murder and is serving a sentence of 25 years to life. Mr. Galaviz had been at Pleasant Valley for a week or so when he started to feel sick. “I couldn’t breathe,” he said. “My chest starting hurting, I had pain all over like somebody beat me up, and I would sweat bad at night.”

The cause was valley fever. After six months, Mr. Galaviz is still weak, having lost 30 pounds, and is barely able to complete a lap in the prison yard. Earlier this month, he was attacked and his jaw broken.

“It wouldn’t have been like that if it hadn’t been for valley fever,” Mr. Galaviz said, his jaw still wired shut. “They wouldn’t have got me. It would have been the other way around.”

Dan Barry is off. Beginning Jan. 14, the “This Land” column will appear on Mondays.