Saturday, March 25, 2023
| Characteristic | Arizona No. (%) | California No. (%) | Nevada, New Mexico, Utah, and Washington combined† No. (%) | Other states combined§ No. (%) | Total No. (%) |
|---|---|---|---|---|---|
| Sex (n = 20,034) | |||||
| Male | 4,679 (45) | 5,301 (59) | 243 (59) | 169 (59) | 10,392 (52) |
| Female | 5,668 (55) | 3,687 (41) | 168 (41) | 115 (41) | 9,638 (48) |
| Other | 0 (0) | 3 (0) | 1 (<1) | 0 (0) | 4 (0) |
| Age group (yrs) (n = 20,041) | |||||
| <1 | 0 (0) | 9 (0) | 0 (0) | 0 (0) | 9 (0) |
| 1–5 | 33 (<1) | 51 (1) | 1 (<1) | 0 (0) | 85 (<1) |
| 6–20 | 650 (6) | 706 (8) | 25 (6) | 6 (2) | 1,387 (7) |
| 21–40 | 2,111 (20) | 2,596 (29) | 71 (17) | 28 (10) | 4,806 (24) |
| 41–64 | 3,874 (37) | 3,754 (42) | 172 (42) | 111 (39) | 7,911 (40) |
| 65–80 | 2,925 (28) | 1,489 (17) | 126 (31) | 117 (41) | 4,657 (23) |
| >80 | 759 (7) | 386 (4) | 17 (4) | 24 (8) | 1,186 (6) |
| Race and ethnicity (n = 7,846) | |||||
| American Indian or Alaska Native, non-Hispanic | 177 (8) | 47 (1) | 16 (6) | 1 (<1) | 241 (3) |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 72 (3) | 358 (7) | 11 (4) | 9 (5) | 450 (6) |
| Black, non-Hispanic | 161 (7) | 336 (6) | 16 (6) | 15 (8) | 528 (7) |
| Hispanic or Latino (all races) | 511 (23) | 1,972 (38) | 65 (26) | 11 (6) | 2,559 (33) |
| White, non-Hispanic | 1,260 (56) | 1,706 (33) | 140 (55) | 146 (77) | 3,252 (41) |
| Other¶ | 51 (2) | 752 (15) | 5 (2) | 8 (4) | 816 (10) |
| Total | 10,359 (100) | 9,004 (100) | 412 (100) | 286 (100) | 20,061 (100) |
Number and percentage of coccidioidomycosis cases, by area and selected patient characteristics* — 23 states, 2019
*Sex was missing for 27 cases, age was missing for 20 cases, and race and ethnicity was missing for 12,215 cases.
†
Coccidioides is known to be present in Nevada, New Mexico, Utah, and Washington, although these states report fewer cases than Arizona
and California.
§Refers to all other states where coccidioidomycosis is reportable and at least one case was reported in 2019 (Alabama, Arkansas,
Delaware, Indiana, Kansas, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, North Dakota,
Ohio, Oregon, Rhode Island, South Dakota, Wisconsin, and Wyoming).
¶Calculated on basis of two or more race category.
| Characteristic | Arizona | California | Nevada, New Mexico, Utah, and Washington combined§ | Other states combined¶ | Total |
|---|---|---|---|---|---|
| Sex (n = 20,034) | |||||
| Male | 129.4 | 27.0 | 3.0 | 0.2 | 15.8 |
| Female | 154.8 | 18.6 | 2.1 | 0.1 | 14.4 |
| Age group (yrs) (n = 20,041) | |||||
| <1 | 0 | 2.0 | 0 | 0 | 0.6 |
| 1–5 | 7.5 | 2.1 | 0.1 | 0 | 1.0 |
| 6–20 | 45.9 | 9.4 | 0.8 | 0.1 | 5.5 |
| 21–40 | 107.7 | 22.6 | 1.6 | 0.2 | 13.2 |
| 41–64 | 186.8 | 31.9 | 3.7 | 0.5 | 19.9 |
| 65–80 | 280.6 | 32.6 | 6.4 | 1.2 | 27.3 |
| >80 | 285.2 | 30.3 | 3.7 | 1.0 | 26.2 |
| Race and ethnicity (n = 7,846) | |||||
| American Indian or Alaska Native, non-Hispanic | 61.7 | 29.0 | 4.7 | 0.2 | 17.4 |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 27.4 | 6.0 | 1.0 | 0.4 | 4.6 |
| Black, non-Hispanic | 49.4 | 15.1 | 2.4 | 0.2 | 4.0 |
| Hispanic or Latino (all races) | 24.6 | 14.1 | 2.2 | 0.3 | 11.2 |
| White, non-Hispanic | 32.0 | 11.8 | 1.4 | 0.3 | 4.1 |
| Other** | 33.4 | 67.5 | 1.0 | 0.5 | 24.6 |
| Total | 142.3 | 22.8 | 2.6 | 0.4 | 15.1 |
Incidence rate* of coccidioidomycosis, by area and selected patient characteristics† — 23 states, 2019
*Cases per 100,000 population. State-specific denominators from estimated 2019 U.S. Census Bureau data were used for Arizona
and California incidence rates. Pooled state-specific denominators from estimated 2019 U.S. Census Bureau data were used for
the respective incidence rates of the Nevada, New Mexico, Utah, and Washington combined grouping; other states combined grouping;
and the total grouping. U.S. Census Bureau data were not available to calculate incidence rate for sex category "other" (three
cases in California and one case in Nevada, New Mexico, Utah, and Washington combined).
†Sex was missing for 27 cases, age was missing for 20 cases, and race and ethnicity was missing for 12,215 cases.
§
Coccidioides is known to be present in Nevada, New Mexico, Utah, and Washington, although these states report fewer cases than Arizona
and California.
¶Refers to all other states where coccidioidomycosis is reportable and at least one case was reported in 2019 (Alabama, Arkansas,
Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oregon, Rhode Island,
South Dakota, Wisconsin, and Wyoming).
**Calculated on basis of two or more races category.
| Characteristic | Arkansas No. (%) | Delaware No. (%) | Illinois No. (%) | Indiana No. (%) | Kansas No. (%) | Kentucky No. (%) | Louisiana No. (%) | Michigan No. (%) | Minnesota No. (%) | Nebraska No. (%) | Pennsylvania No. (%) | Wisconsin No. (%) | Total No. (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sex (n = 1,119) | |||||||||||||
| Male | 45 (48) | 0 (0) | 160 (55) | 61 (57) | 7 (50) | 30 (65) | 12 (60) | 133 (59) | 133 (62) | 29 (43) | 7 (44) | 14 (58) | 631 (56) |
| Female | 49 (52) | 0 (0) | 131 (45) | 46 (43) | 7 (50) | 16 (35) | 8 (40) | 92 (41) | 81 (38) | 39 (57) | 9 (56) | 10 (42) | 488 (44) |
| Age group (yrs) (n = 1,124) | |||||||||||||
| <1 | 0 (0) | 0 (0) | 0 (0) | 2 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (<1) |
| 1–5 | 2 (2) | 0 (0) | 1 (<1) | 2 (2) | 0 (0) | 0 (0) | 1 (5) | 1 (<1) | 2 (1) | 0 (0) | 0 (0) | 0 (0) | 9 (1) |
| 6–20 | 15 (16) | 0 (0) | 34 (12) | 23 (21) | 0 (0) | 7 (15) | 2 (10) | 17 (8) | 22 (10) | 8 (12) | 0 (0) | 4 (17) | 132 (12) |
| 21–40 | 32 (34) | 1 (100) | 79 (27) | 36 (33) | 1 (7) | 11 (24) | 9 (43) | 60 (27) | 51 (24) | 18 (27) | 2 (13) | 3 (13) | 303 (27) |
| 41–64 | 25 (26) | 0 (0) | 119 (41) | 28 (26) | 9 (64) | 22 (48) | 7 (33) | 101 (45) | 83 (39) | 29 (43) | 8 (50) | 9 (38) | 440 (39) |
| 65–80 | 20 (21) | 0 (0) | 49 (17) | 14 (13) | 3 (21) | 5 (11) | 2 (10) | 41 (18) | 50 (23) | 12 (18) | 5 (31) | 8 (33) | 209 (19) |
| >80 | 1 (1) | 0 (0) | 10 (3) | 3 (3) | 1 (7) | 1 (2) | 0 (0) | 5 (2) | 6 (3) | 1 (2) | 1 (6) | 0 (0) | 29 (3) |
| Race and ethnicity (n = 859) | |||||||||||||
| American Indian or Alaska Native, non-Hispanic | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (<1) | 1 (<1) | 2 (3) | 0 (0) | 0 (0) | 4 (<1) |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 1 (2) | 0 (0) | 7 (3) | 2 (2) | 1 (8) | 0 (0) | 9 (47) | 0 (0) | 5 (3) | 0 (0) | 0 (0) | 0 (0) | 25 (3) |
| Black, non-Hispanic | 12 (21) | 0 (0) | 34 (17) | 15 (16) | 0 (0) | 0 (0) | 1 (5) | 8 (5) | 5 (3) | 3 (5) | 1 (14) | 0 (0) | 79 (9) |
| Hispanic or Latino (all races) | 5 (9) | 0 (0) | 27 (13) | 5 (5) | 0 (0) | 2 (8) | 7 (37) | 7 (4) | 3 (2) | 4 (6) | 1 (14) | 2 (9) | 63 (7) |
| White, non-Hispanic | 38 (68) | 0 (0) | 133 (66) | 70 (73) | 12 (92) | 22 (88) | 2 (11) | 137 (77) | 159 (92) | 58 (87) | 5 (71) | 20 (91) | 656 (76) |
| Other§ | 0 (0) | 0 (0) | 2 (4) | 4 (7) | 0 (0) | 1 (2) | 0 (0) | 25 (45) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 32 (4) |
| Hospitalization (n = 460) | |||||||||||||
| Yes | 36 (69) | —¶ | — | 62 (63) | 10 (71) | — | — | — | 101 (49) | 27 (42) | — | 13 (54) | 249 (54) |
| No | 16 (31) | — | — | 36 (37) | 4 (29) | — | — | — | 107 (51) | 37 (58) | — | 11 (46) | 211 (46) |
| Death (n = 415) | |||||||||||||
| Yes | 2 (8) | — | — | 5 (5) | 2 (14) | — | — | — | 10 (5) | 1 (2) | — | 0 (0) | 20 (5) |
| No | 23 (92) | — | — | 93 (95) | 12 (86) | — | — | — | 196 (95) | 47 (98) | — | 24 (100) | 395 (95) |
| Total | 95 (100) | 1 (100) | 292 (100) | 108 (100) | 14 (100) | 46 (100) | 21 (100) | 225 (100) | 214 (100) | 68 (100) | 16 (100) | 24 (100) | 1,124 (100) |
Number and percentage of histoplasmosis cases, by state, selected patient characteristics, and clinical outcomes* — 12 states,† 2019
*Sex was missing for five cases, race and ethnicity was missing for 265 cases, hospitalization status was missing for 664
cases, and death status was missing for 709 cases.
†Rhode Island reported zero cases in 2019.
§Calculated on basis of two or more race category.
¶Not available.
| Characteristic | Arkansas | Delaware | Illinois | Indiana | Kansas | Kentucky | Louisiana | Michigan | Minnesota | Nebraska | Pennsylvania | Wisconsin | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sex (n = 1,119) | |||||||||||||
| Male | 3.0 | 0 | 2.6 | 1.8 | 0.5 | 1.4 | 0.5 | 2.7 | 4.7 | 3.0 | 0.1 | 0.5 | 1.8 |
| Female | 3.2 | 0 | 2.0 | 1.4 | 0.5 | 0.7 | 0.3 | 1.8 | 2.9 | 4.0 | 0.1 | 0.3 | 1.3 |
| Age group (yrs) (n = 1,124) | |||||||||||||
| <1 | 0 | 0 | 0 | 2.5 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0.2 |
| 1–5 | 1.1 | 0 | 0.1 | 0.5 | 0 | 0 | 0.3 | 0.2 | 0.6 | 0 | 0 | 0 | 0.2 |
| 6–20 | 2.5 | 0 | 1.4 | 1.7 | 0 | 0.8 | 0.2 | 0.9 | 2.0 | 2.0 | 0 | 0.4 | 1.0 |
| 21–40 | 4.1 | 0.4 | 2.3 | 2.0 | 0.1 | 1.0 | 0.7 | 2.3 | 3.4 | 3.5 | 0.1 | 0.2 | 1.6 |
| 41–64 | 2.8 | 0 | 3.1 | 1.4 | 1.1 | 1.6 | 0.5 | 3.3 | 4.9 | 5.3 | 0.2 | 0.5 | 2.0 |
| 65–80 | 4.8 | 0 | 3.1 | 1.6 | 0.8 | 0.8 | 0.3 | 2.9 | 7.0 | 5.0 | 0.3 | 1.0 | 2.2 |
| >80 | 0.9 | 0 | 2.2 | 1.3 | 0.9 | 0.7 | 0 | 1.4 | 2.9 | 1.4 | 0.2 | 0 | 1.1 |
| Race and ethnicity (n = 859) | |||||||||||||
| American Indian or Alaska Native, non-Hispanic | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1.8 | 1.7 | 12.3 | 0 | 0 | 1.2 |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 1.7 | 0 | 1.0 | 1.2 | 1.1 | 0 | 10.8 | 0 | 1.7 | 0 | 0 | 0 | 1.0 |
| Black, non-Hispanic | 2.6 | 0 | 1.9 | 2.3 | 0 | 0 | 0.1 | 0.6 | 1.3 | 3.2 | 0.1 | 0 | 0.9 |
| Hispanic or Latino (all races) | 2.4 | 0 | 1.3 | 1.2 | 0 | 1.3 | 3.4 | 1.6 | 1.1 | 2.1 | 0.1 | 0.6 | 1.2 |
| White, non-Hispanic | 1.8 | 0 | 1.7 | 1.3 | 0.6 | 0.6 | 0.1 | 1.8 | 3.6 | 3.8 | 0.1 | 0.4 | 1.3 |
| Other¶ | 0 | 0 | 1.0 | 3.1 | 0 | 1.2 | 0 | 11.0 | 0 | 0 | 0 | 0 | 2.3 |
| Total | 3.2 | 0.1 | 2.3 | 1.6 | 0.5 | 1.0 | 0.5 | 2.3 | 3.8 | 3.5 | 0.1 | 0.3 | 1.6 |
Incidence rate* of histoplasmosis, by state and selected patient characteristics† — 12 states,§ 2019
*Cases per 100,000 population. State-specific denominators from estimated 2019 U.S. Census Bureau data were used for Arkansas,
Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Nebraska, Pennsylvania, and Wisconsin incidence
rates. Pooled state-specific denominators from estimated 2019 U.S. Census Bureau data were used to calculate the incidence
rate for the total grouping.
†Sex was missing for five cases, and race and ethnicity was missing for 265 cases.
§Rhode Island reported zero cases in 2019.
¶Calculated on basis of two or more race category.
| Characteristic | Arkansas No. (%) | Louisiana No. (%) | Michigan No. (%) | Minnesota No. (%) | Wisconsin No. (%) | Total No. (%) |
|---|---|---|---|---|---|---|
| Sex (n = 239) | ||||||
| Male | 18 (64) | 7 (100) | 17 (65) | 56 (71) | 70 (71) | 168 (70) |
| Female | 10 (36) | 0 (0) | 9 (35) | 23 (29) | 29 (29) | 71 (30) |
| Age group (yrs) (n = 240) | ||||||
| <1 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| 1–5 | 1 (4) | 0 (0) | 0 (0) | 1 (1) | 0 (0) | 2 (1) |
| 6–20 | 8 (29) | 0 (0) | 0 (0) | 6 (8) | 10 (10) | 24 (10) |
| 21–40 | 6 (21) | 2 (29) | 4 (15) | 37 (47) | 30 (30) | 79 (33) |
| 41–64 | 11 (39) | 2 (29) | 13 (50) | 22 (28) | 42 (42) | 90 (38) |
| 65–80 | 2 (7) | 3 (43) | 8 (31) | 13 (16) | 15 (15) | 41 (17) |
| >80 | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 3 (3) | 4 (2) |
| Race and ethnicity (n = 208) | ||||||
| American Indian or Alaska Native, non-Hispanic | 0 (0) | 0 (0) | 1 (5) | 5 (7) | 4 (5) | 10 (5) |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 1 (5) | 0 (0) | 0 (0) | 8 (11) | 6 (7) | 15 (7) |
| Black, non-Hispanic | 3 (15) | 2 (100) | 1 (5) | 7 (9) | 11 (13) | 24 (12) |
| Hispanic or Latino (all races) | 3 (15) | 0 (0) | 1 (5) | 4 (5) | 6 (7) | 14 (7) |
| White, non-Hispanic | 13 (65) | 0 (0) | 19 (86) | 52 (68) | 60 (68) | 144 (69) |
| Other† | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (1) | 1 (1) |
| Hospitalization (n = 228) | ||||||
| Yes | 14 (82) | 5 (83) | 16 (62) | 51 (65) | 61 (61) | 147 (65) |
| No | 3 (18) | 1 (17) | 10 (38) | 28 (35) | 39 (39) | 81 (36) |
| Death (n = 224) | ||||||
| Yes | 1 (8) | 2 (29) | 3 (12) | 5 (6) | 9 (9) | 20 (9) |
| No | 11 (92) | 5 (71) | 23 (88) | 74 (94) | 91 (91) | 204 (91) |
| Total | 28 (100) | 7 (100) | 26 (100) | 79 (100) | 100 (100) | 240 (100) |
Number and percentage of blastomycosis cases, by state, selected patient characteristics, and clinical outcomes* — five states, 2019
*Sex was missing for one case, race and ethnicity was missing for 32 cases, hospitalization status was missing for 12 cases,
and death status was missing for 16 cases.
†Calculated on basis of two or more race category.
| Characteristic | Arkansas | Louisiana | Michigan | Minnesota | Wisconsin | Total |
|---|---|---|---|---|---|---|
| Sex (n = 239) | ||||||
| Male | 1.2 | 0.3 | 0.4 | 1.9 | 2.4 | 1.2 |
| Female | 0.7 | 0 | 0.2 | 0.8 | 1.0 | 0.5 |
| Age group (yrs) (n = 240) | ||||||
| <1 | 0 | 0 | 0 | 0 | 0 | 0 |
| 1–5 | 0.5 | 0 | 0 | 0.3 | 0 | 0.1 |
| 6–20 | 1.4 | 0 | 0 | 0.6 | 0.9 | 0.5 |
| 21–40 | 0.8 | 0.2 | 0.3 | 2.5 | 2.0 | 1.3 |
| 41–64 | 1.2 | 0.2 | 0.8 | 1.3 | 2.3 | 1.2 |
| 65–80 | 0.5 | 0.5 | 1.1 | 1.8 | 1.9 | 1.3 |
| >80 | 0 | 0 | 0.4 | 0 | 1.4 | 0.2 |
| Race and ethnicity (n = 208) | ||||||
| American Indian or Alaska Native, non-Hispanic | 0 | 0 | 1.8 | 8.3 | 7.6 | 4.5 |
| Asian and Native Hawaiian or other Pacific Islander, non-Hispanic | 2.1 | 0 | 0 | 2.7 | 3.4 | 1.6 |
| Black, non-Hispanic | 0.7 | 0.1 | 0.1 | 1.8 | 3.0 | 0.6 |
| Hispanic or Latino (all races) | 1.4 | 0 | 0.2 | 1.5 | 1.7 | 0.9 |
| White, non-Hispanic | 0.6 | 0 | 0.3 | 1.2 | 1.3 | 0.7 |
| Other§ | 0 | 0 | 0 | 0 | 1.0 | 0.2 |
| Total | 0.9 | 0.2 | 0.3 | 1.4 | 1.7 | 0.8 |
Incidence rate* of blastomycosis, by state and selected patient characteristics† — five states, 2019
*Cases per 100,000 population. State-specific denominators from estimated 2019 U.S. Census Bureau data were used for Arkansas,
Louisiana, Michigan, Minnesota, and Wisconsin incidence rates. Pooled state-specific denominators from estimated 2019 U.S.
Census Bureau data were used to calculate the incidence rate for the total grouping.
†Sex was missing for one case, race and ethnicity was missing for 32 cases, hospitalization status was missing for 12 cases,
and death status was missing for 16 cases.
§Calculated on basis of two or more race category.
Physicians - maximum of 0.75 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.75 ABIM MOC points
Nurses - 0.75 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.75 Knowledge-based ACPE (0.075 CEUs)
This activity is intended for public health officials, infectious disease clinicians, internists, pulmonologists, nurses, pharmacists, and other clinicians caring for patients with or at risk for coccidioidomycosis, histoplasmosis, or blastomycosis.
The goal of this activity is for learners to be better able to describe geographic distribution, populations at risk, and seasonality of coccidioidomycosis, histoplasmosis, and blastomycosis, according to 2019 US surveillance data.
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This report summarizes national surveillance data for coccidioidomycosis, histoplasmosis, and blastomycosis in 2019. States with the highest case numbers were Arizona and California for coccidioidomycosis; Illinois, Michigan, and Minnesota for histoplasmosis; and Minnesota and Wisconsin for blastomycosis. Compared with coccidioidomycosis, which is a nationally notifiable condition, histoplasmosis and blastomycosis are reportable in limited states. High mortality and hospitalization rates for histoplasmosis and blastomycosis suggest underreporting of mild and severe disease while highlighting their severe clinical outcomes. Health care professionals should consider these three mycoses when evaluating patients with community-acquired pneumonia or other acute lower respiratory illness who were involved in high-risk activities and live in, work in, or have traveled to areas where these fungi are known to be endemic and which might be expanding due to climate change. Improved and expanded surveillance would allow a more robust public health response to these diseases.
