ADVANCEMENT OF THE SCIENCE
then reduce the burden of poor air quality days by pairing masking recommendations with increased availability of free, quality masks or respirators (e.g., via free mask vend- ing machines). The most salient health-related conse- quence of drought in the CRB is coccidi- oidomycosis. Valley fever poses a health risk to all CRB residents, and those who are infected can experience severe, chronic symptoms. Alarmingly, Valley fever cases in the CRB doubled over the study period (Figure 8), and no large-scale mitigation efforts exist. Furthermore, the geographic spread of coccidioidomycosis could fur- ther increase the burden of Valley fever in the CRB. Thus, public health practitioners and policymakers should enact solutions to curtail the transmission and spread of Val- ley fever. Control of coccidioidomycosis transmis- sion, however, presents a unique challenge for policymakers and is hindered by the absence of a consistent, unified reporting system in the CRB. While there are national mandates for reporting Valley fever, not every state is required to report it, and some health departments do not notify the CDC of Valley fever cases. Thus, Valley fever data are avail- able for most of the CRB; however, no data are available for Colorado and granular data (i.e., county-level) are available only for Ari- zona and California. In this way, Valley fever is not unlike other emerging or zoonotic public health challenges such as toxoplasmosis. This lack of consistent reporting creates knowl- edge gaps in Valley fever transmission and geographic distribution. To improve understanding of Valley fever distribution and transmission in the CRB, the states of Colorado, Nevada, New Mexico, Utah, and Wyoming should report county-level Valley fever data to CDC. Even with a unified, consistent report- ing system, many coccidioidomycosis cases, especially asymptomatic ones, will remain unreported; however, a joint, One Health reporting system could facilitate robust sur- veillance. Dogs are more susceptible to coc- cidioidomycosis than humans and, therefore, can serve as sentinels for human disease. Thus, an integrated human–animal report- ing system will more accurately detect Valley fever transmission. Creating an integrated,
FIGURE 7
Average Valley Fever Incidence per 100,000 Residents in the Colorado River Basin From 2013–2022
FIGURE 8
Total Valley Fever Cases and Median Valley Fever Incidence in the Colorado River Basin From 2013–2022
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Volume 87 • Number 10
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