Researchers from Arizona’s three state universities will get $3.1 million to pinpoint hotspots and infection patterns for Valley fever, providing new tools to combat the fungal disease that sickens more people in Arizona than in any other state.

The three-year grant, awarded to the Valley Fever Collaborative by the Arizona Board of Regents, represents the largest state investment targeting the respiratory disease in recent Arizona history. It comes six months after a series of AZCIR reports highlighted the difficulty of tracking and preventing Valley fever infections, and exposed how a dearth of dedicated state funding has limited public understanding about the ecology and true impact of the dust-borne pathogen. 

“We know Arizona is responsible for two-thirds of all U.S. Valley fever infections, but just looking across the land, we can’t tell which places the fungus grows or are the source of so many infections,” Dr. John Galgiani, director of the University of Arizona College of Medicine’s Valley Fever Center for Excellence in Tucson, said in a statement.

“This study will try to connect the dots between strains that cause people to get sick, where in the land they come from, and what it is about those hotspots that makes the fungus thrive. With this new information, we might prevent infections at work sites or even for everyone who lives here.”

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Valley fever, formally known as coccidioidomycosis, is caused by a fungus endemic to the Southwest that naturally occurs in soil. The fungal spores can easily become airborne when wind or activity from people or machines disturb the ground. Once inhaled, the spores infect the lungs, producing symptoms that can range from fatigue and cough to pneumonia. In rare cases, the disease can spread throughout the body, sometimes infecting the brain and spinal column.

Arizona health officials confirmed more than 23,000 cases of Valley fever from January 2020 through December 2021. Research suggests Arizonans who work outdoors are more likely to contract the disease, with the most serious form of the illness disproportionately affecting people of color.

Insufficient data collection and a lack of state and federal funding have long prevented the public from fully understanding the risks surrounding the disease, according to AZCIR’s previous reporting: Funding for Valley fever surveillance has appeared just once in the past 15 years as a $300,000 line item in the state health department budget, approved by the Arizona Legislature in 2007.

The $3.1 million ABOR award, which relies on Technology and Research Initiative Fund dollars, marks a “sea change in the idea of having state leadership at various levels see that this is an important project,” Galgiani told AZCIR.  

“This is really, really different for the state of Arizona.”

On the environmental front, researchers will pair air and soil samples to identify fungus hotspots, work to determine the types of soil in which spores thrive, examine which conditions encourage the movement of those spores and more thoroughly investigate how airborne transmission works.

Those efforts, in turn, will allow experts to develop risk-assessment models and make targeted infection-prevention recommendations, such as urging operators of construction sites with confirmed Coccidioides spores to use dust-control strategies and require workers to use protective gear. Given that the fungus has only colonized small portions of the Sonoran Desert, universally implementing such strategies would be “overkill,” according to Galgiani.

The clinical portion of the initiative will involve taking cultures from infected patients, sequencing the genomes of the fungus, and attempting to establish common sources of infection. 

Paul Keim, executive director of the Pathogen and Microbiome Institute at Northern Arizona University, pointed to blowing dust along the Interstate 10 corridor between Phoenix and Tucson as an example. 

“People are driving along there, they end up back in Tucson or they end up in the Phoenix area, and we don’t know whether they acquired (Valley fever) along there,” he said. “By working with Galgiani and using the genome analysis, we’re going to be able to compare the patterns of the fungus in the soil with the fungus that ends up causing disease in people. We’ll be able to define … on a geographic scale, where are the really dangerous places.”

Researchers involved in the project acknowledged the award falls far short of what it would take to fully tackle Valley fever—Galgiani has estimated a vaccine would cost $150 to $200 million. But they stressed that the investment is a strategic one, because it’s putting together teams of Arizona researchers that would not be working together on problems like this otherwise.

“Our goal is to address the problem of Valley fever at its source,” Neal Woodbury, vice president for research and chief science and technology officer for ASU’s Knowledge Enterprise, said in a statement. 

“By understanding where the fungal pathogen grows and how it enters the air, we can pinpoint approaches to avoid human exposure to begin with.”

AZCIR reporter Shaena Montanari contributed to this report.

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Maria Polletta is an investigative reporter for AZCIR focused on covering inequities in education.