Recent and Forecasted Increases in Coccidioidomycosis Incidence Linked to Hydroclimatic Swings, California, USA

Incidence of coccidioidomycosis, an emerging infectious disease caused by Coccidioides spp. fungi, has increased dramatically since 2000. In 2023, California, USA, reported a near-record 9,054 coccidioidomycosis cases (only surpassed by 9,093 cases in 2019). During April 2023–March 2024, a period capturing the full seasonal rise and fall in incidence, California reported 10,519 cases, 39% higher than the same period the previous year.

The 2023 spike in incidence might be attributable, in part, to a swing from extreme drought to heavy precipitation during winter 2022–2023. Transitions from dry to wet years have been linked to increased coccidioidomycosis incidence. Soil moisture during wet winters is hypothesized to support fungal growth, contributing to an abundance of spores available for airborne dispersal during hot, dry conditions characteristic of summer and early fall. Drought preceding rainy seasons might enhance fungal growth by eliminating microbial competitors from soils or by affecting rodent populations, a putative reservoir host and nutrient source for the fungus. During 2020–2022, California experienced severe drought. An unusually wet winter followed in 2022–2023; statewide precipitation exceeded 150% of average, among the top 10 wettest seasons in the past century. Statewide precipitation during the 2023–2024 wet season was 115% of the long-term average, marking the second consecutive wetter-than-average season after a severe drought. That pattern suggested high coccidioidomycosis incidence might continue throughout the 2024 transmission year. We developed a disease forecast to guide public health alerts and messages by pinpointing when and where disease risk is expected to be highest. Such targeted messaging can raise awareness about disease risk, leading to earlier diagnosis and more effective disease management.