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Valley Fever Training

UC ANR Valley Fever Training

Safety Note #202: Valley Fever Awareness

Training for employees shall include the following italicized topics (as specified in AB 203):

(1) What Valley Fever is and how it is contracted.

Valley Fever is an infection caused by the fungus Coccidioides immitis that lives in the top 2 to 12 inches of soil in many parts of the state. When soil containing this fungus is disturbed by activities such as digging, vehicles, or by the wind, the fungal spores can become airborne and potentially be inhaled by workers. People can become infected with Valley Fever by breathing in fungal spores that grow and reproduce in their body. Valley Fever is not contagious, the illness is not spread from one person to another. According to the Centers for Disease Control and Prevention (CDC), most people who breathe in the spores don’t get sick, and it’s difficult to prevent exposure to Coccidioides in areas where it’s common in the environment.

(2) High risk areas and types of work and environmental conditions during which the risk of contracting Valley Fever is highest.

The fungal spores are more likely to be present in the soils of the Central Valley, and may also be present in other areas of California.

AB 203 requires training for employees working at worksites in Counties where Valley Fever is highly endemic, including Fresno, Kern, Kings, Madera, Merced, Monterey, San Joaquin, San Luis Obispo, Santa Barbara, Tulare and Ventura. (Highly endemic means that the annual incidence rate of Valley Fever is greater than 20 cases per 100,000 persons per year.) While the Bill mentions ‘construction’ employers/employees, the specified work activities are equally agriculturally related and operations being performed at various ANR worksites.

When fungal spores are present, any work activity that disturbs the soil, such as digging, grading or other earth moving operations, or vehicle operation on dirt roads, can cause the spores to become airborne, therefore increasing the risk of Valley Fever. All workers on sites where the fungus is present, and who are exposed to dusty conditions and wind-blown dusts are at increased risk of becoming infected. Agricultural work is identified as an activity that can increase your risk of getting Valley Fever, although it’s important to note that cultivated, irrigated soil may be less likely to contain the fungus compared to dry, undisturbed soils.

 (3) Personal risk factors that may create a higher risk for some individuals, including pregnancy, diabetes, having a compromised immune system due to causes including, but not limited to, human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), having received an organ transplant, or taking immunosuppressant drugs such as corticosteroids or tumor necrosis factor inhibitors.

Anyone who lives or travels to areas where Coccidioides is in the environment can get Valley Fever. Valley Fever can affect people of any age, but it’s most common in adults aged 60 and older. Certain groups of people may be at higher risk for developing more severe infection, such as:

  • people who have weakened immune systems, for example, people who:
    • had an organ transplant
    • are taking medications such as corticosteroids or TNF-inhibitors
    • have HIV/AIDS
  • pregnant women
  • people with diabetes
  • people who are Black or Filipino (source: CDC)

(4) Personal and environmental exposure prevention methods that may include, but are not limited to, water-based dust suppression, good hygiene when skin and clothing is soiled by dust, limiting contamination of drinks and food, working upwind from dusty areas when feasible, wet cleaning dusty equipment when feasible, and wearing a respirator when exposure to dust cannot be avoided.

Cal/OSHA provides the following suggestions about preventing Valley Fever:

  • Determine if a worksite is in an area where fungal spores likely are to be present.
  • Adopt site plans and work practices that minimize the disturbance of soil and maximize ground cover.
  • Use water, appropriate soil stabilizers and/or re-vegetation to reduce airborne dust.
  • Limit workers’ exposure to outdoor dust in disease-endemic areas by (1) providing air-conditioned cabs for vehicles that generate dust and making sure workers keep windows and vents closed, (2) suspending work during heavy winds, and (3) providing [eating areas] sleeping quarters, if applicable, away from sources of dust.
  • [Stay upwind of digging, when possible]
  • When exposure to dust is unavoidable, provide approved respiratory protection to filter particles.
  • Train supervisors and workers in how to recognize symptoms of Valley Fever and minimize exposure.

When exposure to dust is unavoidable, provide NIOSH-approved respiratory protection with particulate filters rated as N95, N99, P100 or HEPA. Household materials such as washcloths, bandanas, and handkerchiefs do not protect workers from breathing in dust and spores.

Take measures to reduce transporting spores offsite by cleaning tools, equipment, and vehicles with water to remove soil before leaving the site; have separate work clothes, coveralls or Tyvek suits that can be removed at the end of the workday; remove work boots at the worksite, use water or boot scrapers/brushes.

According to the CDC, it’s very difficult to avoid breathing in the fungus Coccidioides in areas where it’s common in the environment. People who live in these areas can try to avoid spending time in dusty places as much as possible. People who are at risk for severe Valley Fever may be able to lower their chances of developing the infection by following common-sense methods, such as:

  • Stay inside during dust storms and close your windows.
  • Use air filtration measures indoors, [in vehicles, close windows and use recirculating air].
  • Clean skin injuries well with soap and water to reduce the chances of developing a skin infection, especially if the wound was exposed to dirt or dust.
  • Take preventive antifungal medication if your healthcare provider says you need it.
  • Avoid activities that involve close contact to dirt or dust, including yard work, gardening, and digging—[for those at risk of severe disease].

(5) The importance of early detection, diagnosis, and treatment to help prevent the disease from progressing. Early diagnosis and treatment are important because the effectiveness of medication is greatest in early stages of the disease.

Symptoms of Valley Fever can be mistake for other diseases such as the flu (influenza) and TB (tuberculosis), so it is important for workers to obtain medical care for an accurate diagnosis and possible treatment. Early diagnosis and treatment are essential because the effectiveness of medication is greatest in early stages of the disease.

 (6) Recognizing common signs and symptoms of Valley Fever, which include fatigue, cough, fever, shortness of breath, headache, muscle aches or joint pain, rash on upper body or legs, and symptoms similar to influenza that linger longer than usual.

The most common signs and symptoms of Valley Fever include fatigue, cough, fever, shortness of breath, headache, muscle aches or joint pain, rash on upper body or legs, and symptoms similar to flu that linger longer than usual. When infected, symptoms usually occur 7 to 21 days after breathing in spores.

(7) The importance of reporting symptoms to the employer and seeking medical attention from a physician and surgeon for appropriate diagnosis and treatment.

Encourage workers to report Valley Fever symptoms promptly to a supervisor. Not associating these symptoms with workplace exposures can lead to a delay in appropriate diagnosis and treatment.

Follow ANR’s procedures for reporting a workplace injury/illness if infected, see Safety Note #123.

Send the worker to a workers' compensation healthcare provider or occupational medicine clinic whose staff is knowledgeable about Valley Fever. Alert the provider or clinic to the possibility that the employee was exposed to dusts that may contain coccidioides spores.

Report all hospitalized cases and deaths to Cal/OSHA.*

*Note that employers have a legal responsibility to immediately report to Cal/OSHA any serious injury or illness, or death (including any due to Valley Fever) of an employee occurring in a place of employment or in connection with any employment. Employers also have responsibilities to control workers' exposure to hazardous materials.

(8) Common treatment and prognosis for Valley Fever.

Healthcare providers rely on your medical and travel history, symptoms, physical examinations, and laboratory tests to diagnose Valley fever. The most common way that healthcare providers test for Valley fever is by taking a blood sample and sending it to a laboratory to look for Coccidioides antibodies or antigens.

Many people who are exposed to the fungus Coccidioides never have symptoms. Other people may have flu-like symptoms that go usually away on their own after weeks to months. If your symptoms last for more than a week, contact your healthcare provider.

Valley fever isn’t contagious, so you don’t need to stay at home to avoid spreading the infection to other people. However, your healthcare provider may recommend that you rest at home to help your body fight off the infection.

For many people, the symptoms of Valley fever will go away without any treatment. Healthcare providers choose to prescribe antifungal medication for some people to try to reduce the severity of symptoms or prevent the infection from getting worse. Antifungal medication is typically given to people who are at higher risk for developing severe Valley fever. The treatment is usually 3 to 6 months of fluconazole or another type of antifungal medication. There are no over-the-counter medications to treat Valley fever. If you have Valley fever, you should talk to your healthcare provider about whether you need treatment. (source: CDC)

Safety Note, Educational Materials, Fact Sheets, Postings:

Safety Note #202: Valley Fever Awareness

CDC: https://www.cdc.gov/fungal/educational-material.html & https://www.cdc.gov/fungal/diseases/coccidioidomycosis/information.html

CDPH: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/Pages/Cocci.aspx#

CDC Facts about Valley Fever PDF Fact Sheet: https://www.cdc.gov/fungal/diseases/coccidioidomycosis/pdf/Facts-about-valley-fever-H.pdf

CDPH Preventing Work-Related Valley Fever Fact Sheet: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/HESIS/CDPH%20Document%20Library/CocciFact.pdf

Trainings, Power Points, Webinars:

CDPH Valley Fever Tailgate Training Guide: //ucanr.edu/sites/safety/files/333256.pdf or https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/HESIS/CDPH%20Document%20Library/ValleyFeverWorkerTraining.pdf

CDPH Tailgate Training Guide in Español: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/HESIS/CDPH%20Document%20Library/ValleyFeverWorkerTrainingSPAN.pdf

CDPH Power Point Valley Fever Training: //ucanr.edu/sites/safety/files/333257.pptx

CDPH Preventing Valley Fever in Outdoor Workers Webinar: https://vimeo.com/391621871/b6e6346fb2
Webinar Slides: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/HESIS/CDPH%20Document%20Library/ValleyFeverOutdoorWorkersFeb2020.pdf

CDC Power Point Valley Fever Training: //ucanr.edu/sites/safety/files/333258.pptx

Resources:

Department of Industrial Relations, Cal/OSHA: https://www.dir.ca.gov/dosh/valley-fever-home.html

Centers for Disease Control and Prevention, CDC: https://www.cdc.gov/fungal/diseases/coccidioidomycosis/index.html

CDC resources in Español: https://www.cdc.gov/fungal/diseases/coccidioidomycosis/spanish/index.html

National Institute for Occupational Safety and Health (NIOSH) Valley Fever Prevention in a Work Setting: https://www.cdc.gov/niosh/topics/valleyfever/prevention.html

California Department of Public Health, CDPH: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Coccidioidomycosis.aspx

CDPH in Español: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/FiebredelValle.aspx

Assembly Bill 203, Valley Fever Legislation: //ucanr.edu/sites/safety/files/333255.pdf or https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB203

Training Completion Survey:

Please complete the following brief survey to acknowledge that you have received Valley Fever awareness information/training: http://ucanr.edu/survey/survey.cfm?surveynumber=26101