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Beginning in October 2017, the Arizona Department of Health Services (ADHS) noted an increase in the number of reported cases of coccidioidomycosis (Figure). According to provisional data (not finalized), the incidence in December 2017 (17.2 per 100,000 population) represented the highest monthly rate in the last 5 years, surpassing the previous peak of 14.2 cases per 100,000 population in September 2015. In total, 4,827 cases of coccidioidomycosis were reported to ADHS during October 2017–March 2018. Whereas case counts typically increase during these months, this particular period represented a 58.3% increase over the 3,050 cases reported during the same months the previous year and a 50.3% increase over the 6-month average of 3,211 cases reported during October–March for the years 2013–2017. Coccidioidomycosis (Valley fever) is an infectious disease caused by inhalation of Coccidioides spores; approximately 40% of infected persons experience signs and symptoms including fever, cough, fatigue, chest pain, shortness of breath, and rash. Coccidioides is endemic in soil in the southwestern United States (1). The majority of reported U.S. coccidioidomycosis cases occur in Arizona (2), and incidence is seasonal: the highest number of reported cases in Arizona typically occurs during the fall and winter months.* Because of the high number of cases in Arizona and the high predictive value of a positive laboratory result, Arizona’s coccidioidomycosis case definition requires only laboratory evidence to confirm a case (3). Laboratory evidence can include detection of anticoccidioidal immunoglobulin M (IgM) or immunoglobulin G (IgG) antibodies; culture, histopathologic, or molecular evidence of Coccidioides spp.; or coccidioidal skin test conversion after illness onset. During October 2017–March 2018, the median age of persons with reported coccidioidomycosis was 56 years (interquartile range [IQR] = 39–69 years); approximately half (50.5%) of patients were male. Age and sex distributions were similar to those observed during October 2016–March 2017, with a median age of 57 years, (IQR = 40–69); 51.2% of patients were male. Approximately 90% of persons with reported coccidioidomycosis in Arizona reside in the three most populous counties (Maricopa, Pima, and Pinal). During

Notes from the Field: Increase in Coccidioidomycosis — Arizona, October 2017–March 2018