MMWR – Morbidity and Mortality Weekly Report

1. Increase in Reported Coccidioidomycosis — United States, 1998–2011

CDC
Division of News & Electronic Media           
404-639-3286

Coccidioidomycosis, also called Valley Fever, is a fungal respiratory illness that is a substantial and increasing public health problem in the Southwest portion of the United States Valley Fever is an infection caused by inhaling fungal spores from the environment. This study shows that nearly 112,000 cases of Valley Fever were reported to CDC during 1998-2011. Valley Fever cases reported from Arizona, California, Nevada, New Mexico, and Utah increased from 2,265 in 1998 (incidence rate of 5.3 cases per 100,000 population) to over 22,000 in 2011 (incidence rate of 42.6 per 100,000). Arizona reported 66 percent of all Valley Fever cases and had an average yearly increase in incidence of 16 percent; California reported 31 percent of all cases and had an average yearly increase of 13 percent. Rates of Valley Fever were highest among people ages 60 and over. Health-care providers should be aware of this infection among people with respiratory illnesses who live in or have traveled to the Southwestern US. Although Valley Fever does not spread between people and is rarely fatal, it can be serious and costly. More research is needed to understand why the number of reported cases of Valley Fever has increased.

2. Two Measles Outbreaks After International Importation — Utah, March–June 2011

Valoree Vernon
Vaccine Preventable Disease Epidemiologist
Utah Department of Health
vvernon@utah.gov
801-538-6191

Utah health departments investigated two measles outbreaks during March–June 2011, comprising 13 confirmed cases with 69 percent being unvaccinated. One outbreak was associated with an unvaccinated U.S. resident who traveled internationally, and for the second outbreak the source was unknown.  Measles should be considered in the differential diagnosis of febrile rash illness, especially in unvaccinated persons with recent international travel. Both serum and respiratory specimens should be collected from suspected patients at first contact, because serological testing coupled with molecular testing provides the best opportunity for laboratory confirmation.  To maintain elimination of measles in the United States, it is imperative that a confirmed or a suspected case of measles be immediately reported to public health authorities to limit the spread of measles. Health-care providers should also remind their patients to be current with MMR vaccine, especially before they travel internationally.

3. Three Cases of Congenital Rubella Syndrome in the Postelimination Era — Maryland, Alabama, and Illinois, 2012

CDC
Division of News & Electronic Media           
404-639-3286

Congenital rubella syndrome (CRS) is a constellation of devastating birth defects that can include cataracts, hearing impairment, and heart defects. It is caused when a pregnant woman is infected with rubella virus, and she passes that infection to her fetus. Because more than 90 percent of persons in the United States have been vaccinated against rubella (German measles) or have natural immunity, CRS is now an extremely rare disease in this country. However, during 2012, three cases of CRS occurred in the United States. In all three cases, the mother, who did not have documentation of vaccination, was born in a foreign country, became pregnant, and was likely infected there. The infants suffered brain malformations, heart defects, cataracts, hearing impairment, pneumonitis, and blood disorders. One of the infants died because of CRS. Although CRS is a rare occurrence in the United States, in this era of elimination, healthcare providers and public health officials should maintain a high level of suspicion among children born with birth defects compatible with CRS to mothers who were in rubella-endemic countries during their pregnancies, This will help ensure that appropriate and timely specimens can be collected and a thorough epidemiologic investigation can be conducted to confirm the disease.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES