Date of Award

Summer 2014

Degree Type


Degree Name

Master of Public Health (MPH)


Health and Kinesiology

First Advisor

Gerald C. Hyner

Committee Member 1

Roseann Lyle

Committee Member 2

Vicki Simpson


Introduction. Incidence of Coccidioidomycosis has been increasing nationally, from 2,271 cases in 1998 to 17,802 cases in 2012. Missouri is not endemic to Coccidioidomycosis but the incidence has been increasing since becoming reportable in 2003. To describe epidemiology of Coccidioidomycosis in Missouri we conducted a retrospective review of surveillance data at Missouri Department of Health & Senior Services (DHSS) for the years, 2004-2013.

Methods. Data was obtained from Missouri Health Surveillance Information System (WebSurv), the statewide reporting system for notifiable diseases. All cases that were "Confirmed" were included in the study.

Results. There were a total of 93 confirmed cases eligible for the study, of which 67 (72%) were male and 26 (28%) were female. The incidence rate of Coccidioidomycosis increased from 0.05 per 100,000 population in 2004 to 0.28 per 100,000 in 2013. The age groups, > 70 yrs. (24%) and 60-69 years (23%) were most affected. The predominant race was white accounting for 54 % of cases and the race of 37 % was unknown. Pneumonia (23%) and Flu-like illness (22%) were the most common presentations. Culture (26%) and Complement Fixation (20%) were the most common diagnostic tests. Median time from symptom onset to diagnosis was 25 days (range 3 - 304 days). A total of 43 (46%) patients required hospitalization and 5 of these were admitted to an ICU. Of the 69 patients with known travel history, 45 had history of travel to endemic regions and 24 had no travel history. Mapping of cases with and without history of travel to the endemic areas outside the state revealed that cases were occurring in all regions of Missouri. Those with history of travel were significantly more likely to be diagnosed based on positive culture and/or PCR testing compared to those who did not travel, who were more likely to be diagnosed with serological tests.

Conclusions. Our study demonstrated significant increase in the incidence of Coccidioidomycosis in Missouri during 2004-2013. Majority of cases were related to travel to endemic areas. There was a similar distribution of cases with or without travel to endemic areas across the state. Additional studies will be required to ascertain whether true endemic cases exist in Missouri.

Included in

Epidemiology Commons