California Prison Beset by Deadly Valley Fever Epidemic

by John E. Dannenberg

In the past three years more than 900 of the 5,300 prisoners at California’s Pleasant Valley State Prison (PVSP) in Fresno County, plus 80 staff members, have contracted coccidioidomycosis, a fungus commonly known as “valley fever.” Over a dozen prisoners and one guard have died from the disease. Valley fever forms in the lungs, where inhaled fungal spores colonize.

The soil-based fungus, which is indigenous from California’s central valley down to South Texas, most often causes symptoms similar to the flu (and in the process confers lifelong immunity); however, in two to three percent of cases it metastasizes. Once it gets into the bloodstream it is often fatal.

Although valley fever has occasionally infected archaeologists digging in Utah’s Dinosaur National Monument and drug-sniffing dogs along the Mexican border, its statistical prevalence in California prisons is troubling. California reported 3,000 cases of valley fever in the general population in 2006, of which 514 were diagnosed at PVSP alone. This 17% morbidity rate among prisoners is astounding. Further, from a mortality standpoint, 12 deaths in 900 prison cases equals a 1.3% fatality rate – double the community rate of 0.6% (based on 33 deaths in 5,500 infections reported in Arizona in 2006). Put another way, if the general population had the same mortality rate as prisoners, there would have been another 38 valley fever-related deaths in the community.

Epidemiologists have puzzled over the high prison morbidity rate. Natives of California’s central valley have long since gained immunity by living there. This comes from exposure to the region’s heavy farming, which causes dust (replete with fungal spores) to rise into the air regularly.
Earthquakes and dust storms are also causative factors. But a spike in valley fever cases at PVSP coincided with the construction of a new mental health hospital nearby.

The high infection rate at PVSP (and to a lesser degree at other central valley prisons) has been correlated with two other factors: 1) importation of non-local prisoners and 2) prisoners with compromised immune systems. This has translated into a high rate of serious valley fever cases among HIV-infected prisoners from Los Angeles, many of whom are susceptible under both factors. As a result, prison officials have been preemptively moving such vulnerable prisoners from PVSP to other areas in the state.

Indeed, when the California DOC scheduled new construction to expand its existing prisons, the 600 beds planned for PVSP were put on hold because the construction would have disturbed the soil and exacerbated the local valley fever epidemic. PVSP, an isolated prison, also suffers from below-average medical care according to former federal healthcare Receiver Robert Sillen. Sillen had proposed simply closing PVSP, thereby truncating both the exposure and medical care problems. Looked at from another perspective, PVSP prisoners and non-local staff have been unwittingly pressed into service as experimental guinea pigs for valley fever epidemiologists to study.

Those who contract severe but non-fatal valley fever infections can suffer for life. Prisoner Gilbert Galaviz, serving 25-years-to-life for murder, developed symptoms just one week after arriving at PVSP. “I couldn’t breathe. My chest started hurting, I had pain all over like somebody beat me up, and I would sweat bad at night.” Six months later, Galaviz was still weak and 30 pounds lighter; he could barely walk one lap in the prison yard.

According to a report by the Fresno County grand jury released on April 9, 2008, despite taking some precautions the DOC has failed to adequately protect both prisoners and staff at PVSP from valley fever. “We are already working to address many of the concerns of the grand jury,” stated DOC spokesman Paul Verke. Meanwhile, prisoners remain at risk of contracting potential lethal fungal infections – not a pleasant outcome for those doing time at the Pleasant Valley facility.

Note: PLN previously reported on valley fever at California prisons in our August 2007 cover story, “Prisons as Incubators and Spreaders of Disease and Illness.”

Sources: New York Times, Sacramento Bee