Prolonged dry seasons lengthen coccidioidomycosis transmission seasons: implications for a changing California

Coccidioidomycosis, a fungal disease caused by soil-borne Coccidioides spp., exhibits pronounced seasonal transmission, with incidence in California typically peaking in the fall. However, the influence of climate on the timing and duration of transmission seasons remains poorly understood. Using weekly data on reported coccidioidomycosis cases in California from 2000-2023, we developed a distributed-lag Markov state-transition model to estimate the effects of temperature and precipitation on the timing of transmission season onset and end. We found that transitions from cooler, wetter conditions to hotter, drier conditions accelerate season onset. Dry conditions (10^th percentile of precipitation) in the spring shifted season onset an average of 2.8 weeks (95% CI: 0.43-3.58) earlier compared to wet conditions (90^th percentile of precipitation). Conversely, transitions back to cooler, wetter conditions hastened season end, with dry fall conditions extending the season by an average of 0.69 weeks (95% CI: 0.37-1.41) compared to wet conditions. When dry conditions occurred in the spring and fall, the transmission season extended by 3.70 weeks (95% CI: 1.23-4.22). As California is expected to experience prolonged dry seasons with climate change, our findings suggest this shift may lengthen the time at which populations are at elevated coccidioidomycosis risk.