Table 1.

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.

Table 2.

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.

Table 3.

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.

Table 4.

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.

Table 5.

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.

Table 6.

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.

Faculty

Dallas J. Smith, PharmD

Epidemic Intelligence Service
Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Dallas J. Smith, PharmD, has no relevant financial relationships.

Samantha L. Williams, MPH

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Samantha L. Williams, MPH, has no relevant financial relationships.

Kaitlin M. Benedict, MPH

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Kaitlin M. Benedict, MPH, has no relevant financial relationships.

Brendan R. Jackson, MD

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Brendan R. Jackson, MD, has no relevant financial relationships.

Mitsuru Toda, PhD

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Mitsuru Toda, PhD, has no relevant financial relationships.

CME Author

Laurie Barclay, MD

Freelance writer and reviewer
Medscape, LLC

Disclosures

Laurie Barclay, MD, has the following relevant financial relationships:
Formerly owned stocks in: AbbVie Inc.

Compliance Reviewer/Nurse Planner

Leigh Schmidt, MSN, RN, CNE, CHCP

Associate Director, Accreditation and Compliance, Medscape, LLC

Disclosures

Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

CME / ABIM MOC / CE

Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019

Authors: Dallas J. Smith, PharmD; Samantha L. Williams, MPH; Kaitlin M. Benedict, MPH; Brendan R. Jackson, MD; Mitsuru Toda, PhD
CME / ABIM MOC / CE Released: 12/19/2022
Valid for credit through: 12/19/2023

Start Activity

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Target Audience and Goal Statement

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.

Upon completion of this activity, participants will:

Describe epidemiological features of coccidioidomycosis, histoplasmosis, and blastomycosis, according to 2019 U.S. surveillance data
Determine incidence of coccidioidomycosis, histoplasmosis, and blastomycosis among racial and ethnic groups, and overall outcomes, according to 2019 U.S. surveillance data
Identify clinical and public health implications of geographic distribution, populations at risk, and seasonality of coccidioidomycosis, histoplasmosis, and blastomycosis, according to 2019 U.S. surveillance data

Faculty

Dallas J. Smith, PharmD

Epidemic Intelligence Service
Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Dallas J. Smith, PharmD, has no relevant financial relationships.

Samantha L. Williams, MPH

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Samantha L. Williams, MPH, has no relevant financial relationships.

Kaitlin M. Benedict, MPH

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Kaitlin M. Benedict, MPH, has no relevant financial relationships.

Brendan R. Jackson, MD

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Brendan R. Jackson, MD, has no relevant financial relationships.

Mitsuru Toda, PhD

Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
CDC

Disclosures

Mitsuru Toda, PhD, has no relevant financial relationships.

CME Author

Laurie Barclay, MD

Freelance writer and reviewer
Medscape, LLC

Disclosures

Laurie Barclay, MD, has the following relevant financial relationships:
Formerly owned stocks in: AbbVie Inc.

Compliance Reviewer/Nurse Planner

Leigh Schmidt, MSN, RN, CNE, CHCP

Associate Director, Accreditation and Compliance, Medscape, LLC

Disclosures

Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

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From Morbidity & Mortality Weekly Report

CME / ABIM MOC / CE

Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019

Authors: Dallas J. Smith, PharmD; Samantha L. Williams, MPH; Kaitlin M. Benedict, MPH; Brendan R. Jackson, MD; Mitsuru Toda, PhDFaculty and Disclosures

CME / ABIM MOC / CE Released: 12/19/2022

Valid for credit through: 12/19/2023

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References

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Dallas J. Smith, PharmD

Samantha L. Williams, MPH

Kaitlin M. Benedict, MPH

Brendan R. Jackson, MD

Mitsuru Toda, PhD

CME Author

Laurie Barclay, MD

Compliance Reviewer/Nurse Planner

Leigh Schmidt, MSN, RN, CNE, CHCP

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Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019

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Dallas J. Smith, PharmD

Samantha L. Williams, MPH

Kaitlin M. Benedict, MPH

Brendan R. Jackson, MD

Mitsuru Toda, PhD

CME Author

Laurie Barclay, MD

Compliance Reviewer/Nurse Planner

Leigh Schmidt, MSN, RN, CNE, CHCP

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Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019

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