Paper Information

Coccidioidomycosis (Valley fever, VF) is a climate-sensitive infectious disease caused by inhaling soil-dwelling fungus Coccidioides, mostly reported in southwestern USA. Although soil moisture (SM) and soil temperature (ST) are known to shape the fungal lifecycle, their effects on coccidioidomycosis remain understudied. Most prior studies have relied on their proxies-precipitation and air temperature-that might not accurately capture soil hydrothermal dynamics. We conducted multivariable negative binomial regressions to estimate seasonal associations between incidence and climate drivers-including SM, ST, and wind speed from the North American Land Data Assimilation Phase 2 (NLDAS-2), and PM10-based dusty-day counts-in Arizona's hyperendemic counties (Maricopa, Pima, and Pinal) from 2000 to 2022. We found higher incidence in areas with hotter, drier soils and more seasonal dusty days. Multi-year soil hydrothermal cycles-alternating wet-dry and cool-hot periods along with concurrent dry, dusty conditions-significantly influenced incidence. Notably, no antecedent dry-cool seasons were linked to increased incidence, indicating moisture and/or heat are prerequisites for fungal growth and dispersal. SM showed more consistent and widespread effects than ST across seasons and lags, with winter and spring soils most influential. Higher incidence followed wetter winters and monsoons, and dry, hot springs and falls. Our models using NLDAS-2 SM and ST data showed robust performance and generalizability across exposure seasons. Our results support adding multi-year soil indicators-with up to 3-year lead times-into early-warning systems to enhance VF forecasting and better prepare endemic regions for the challenges of a warming, drying, and increasingly variable climate.