In addition to the challenges associated with outbreak detection, defining whether a cluster of coccidioidomycosis cases or a period of elevated incidence truly represents an outbreak can be difficult, particularly when a specific exposure source is not apparent. Coccidioidomycosis incidence fluctuates with season and weather (16), and increased reports resulting from seasonal sporadic infection could be interpreted as an outbreak. For this review, we excluded several reports noting increased incidence over a prolonged period, despite specific identification with the terms “outbreak” or “epidemic” (16 18), to focus on outbreaks with more clearly defined sources.
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