Coccidioidomycosis

is a disease acquired by inhaling spores of Coccidioides immitis, a fungus found in cer-tain arid regions, including the San Joaquin Valley, Cali-fornia, USA, where 8 state prisons are located. During 2011, we reviewed coccidioidomycosis rates at 2 of the prisons that consistently report>80 % of California’s cases among inmates and determined inmate risk factors for primary, severe, and disseminated coccidioidomycosis. Inmates of African American race/ethnicity who were>40 years of age were at significantly higher risk for primary coccidioidomycosis than their white counterparts (odds ratio 2.0, 95 % CI 1.5–2.8). Diabetes was a risk factor for severe pulmonary coccidioidomycosis, and being Afri-can American was a risk factor for disseminated disease. These findings contributed to a court decision mandating exclusion of African American inmates and inmates with diabetes from the 2 California prisons with the highest rates of coccidioidomycosis. Coccidioidomycosis, commonly called “cocci ” or “valley fever, ” is an illness caused by Coccidioides immitis and C. posadasii, soil-dwelling fungi found in certain arid regions of the southwestern United States, northern Mexico, and Central and South America. Infec-tion is acquired by inhaling airborne fungal spores and is not spread person-to-person. Sixty percent of Coccidi-oides infections are asymptomatic, and most symptom-atic infections consist of self-limited, flu-like illnesses. A small proportion of cases result in prolonged illness that may require lifelong treatment and can be life-threaten-ing, particularly the 3%–5 % in which the disease dissemi-nates outside of the lungs. Infection, except in very rare cases, confers lifelong immunity. In 2005, the medical executive team of the Californi