Project Details

EnviroCocci: Mapping Childhood Valley Fever Through Environmental Surveillance and Clinical Outcomes

Alessandro Zulli, PhD

Summary

BACKGROUND: Coccidioidomycosis, or "Valley Fever," is a leading cause of fungal disease in the United States that particularly affects children, causing severe pneumonia and potentially life-threatening disseminated disease affecting bones, joints, and the central nervous system. Clinical surveillance for this disease is limited, often delaying diagnosis and complicating treatment, especially in the vulnerable pediatric population. GAP: There is currently little research on Coccidioides in environmental samples or its shedding patterns in human populations, and no research connecting environmental signals of Coccidioides to clinical outcomes and age-specific indicators. The lack of understanding about whether shedding of Coccidioides by different age groups, particularly children, is reflected in wastewater represents a significant surveillance gap. HYPOTHESIS: We hypothesize that wastewater detections and concentrations of Coccidioides will track and precede clinical indicators of infection during outbreaks, providing an early warning system with approximately one month lead time over clinical cases. We expect this environmental surveillance method will be particularly valuable for monitoring disease patterns in pediatric populations. METHODS: This study will analyze extracted nucleic acids from 936 wastewater samples collected three times weekly from wastewater treatment plants in San Luis Obispo, Merced, and Santa Clara counties from January 2023 to December 2024. We will use digital droplet polymerase chain reaction (ddPCR) to quantify Coccidioides DNA and correlate findings with anonymized clinical case data from the California Department of Public Health, with specific focus on pediatric age groups. RESULTS: We’ve had preliminary detections of Coccidioidomycosis in wastewater. Pending further expansion. IMPACT: This research will develop the first environmental surveillance system for coccidioidomycosis, potentially protecting the approximately 600+ pediatric Valley Fever cases reported annually in California. The early warning system could enable more timely clinical testing, targeted public health interventions, and reduced exposure during high-risk periods, ultimately saving lives and reducing healthcare burden in rural communities where this disease is endemic and spreading due to climate change.