INVASIVE BACTERIAL DISEASE
SURVEILLANCE REPORT, 2010
Emerging Infections Program
Active Bacterial Core Surveillance (ABCs)
Minnesota Department of Health
Diseases included
• Group A Streptococcus
page 5
• Group B Streptococcus
page 12
• Haemophilus influenzae
page 21
• Neisseria meningitidis
page 28
• Streptococcus pneumoniae
page 34
• Methicillin-resistant Staphylococcus aureus (MRSA)
page 42
• Legionellosis
page 49
Page 3
Surveillance Methods
• Cases include Minnesota residents with invasive
infections due to Group A Streptococcus, Group B
Streptococcus, Haemophilus influenzae, Neisseria
meningitidis, Streptococcus pneumoniae, and MethicillinResistant Staphylococcus aureus (MRSA). Haemophilus
influenzae.
• Invasive infections are from normally sterile body sites
such as blood, cerebrospinal fluid and others. These
usually cause serious illnesses (disease).
• Legionellosis is also included in this report and has
separate confirmatory testing criteria including urine
antigen, culture, paired serology, and PCR or DFA
combined with culture or urine antigen.
Page 4
Surveillance Methods (cont.)
• All hospitals and reference laboratories serving
Minnesotans are contacted routinely to identify cases.
• Species confirmation, antibiotic resistance and other
testing is performed by the MDH Public Health Laboratory.
• Disease rates are based on census population data.
• The Centers for Disease Control and Prevention (CDC)
includes these results from Minnesota and other states
and regions in a network called Active Bacterial Core
Surveillance (ABCs) which covers a population base of 41
million.
Page 5
Incidence of Invasive Group A Streptococcal
Disease, Minnesota, 2001-2010
10
Cases per 100,000 Persons
9
8
7
6
5
4
3.6
4
2.9
3
2.9
3.3
3.3
3.3
2006
2007
2008
3.6
3
2.4
2
1
0
2001
2002
2003
2004
2005
Year of Diagnosis
2009
2010
Page 6
Incidence of Invasive Group A Streptococcal Disease by
Gender and Age Group, Minnesota, 2010
Characteristic
Cases
Incidence per
100,000 persons
Gender
Male
Female
84
74
3.2
2.8
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
2
10
9
4
8
17
19
23
20
46
2.7
3.4
2.6
0.6
1.1
2.6
2.5
3.1
4.3
9.7
Page 7
Invasive Group A Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2010
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
Total
Cases
Deaths
% Died
2
10
9
4
8
17
19
23
20
46
0
0
0
1
0
0
1
3
2
6
0%
0%
0%
25%
0%
0%
5%
13%
10%
13%
158
13
8%
Page 8
Invasive Group A Streptococcal Disease by Type of
Infection/Syndrome, Minnesota, 2010
STSS
3%
Abscess
12%
Bacteremia without
another infection
(blood)
21%
Osteomyelitis
4%
Septic arthritis (joint)
4%
Necrotizing fasciitis
(deep tissue)
4%
Other
12%
Pneumonia (lung)
8%
Cellulitis (skin)
32%
Page 9
Outcome of Invasive Group A Streptococcal Disease by
Type of Infection/Syndrome, Minnesota, 2010
Died
Survived
100
90
80
Percentage
70
60
50
40
30
20
10
0
Bacteremia
without
another focus
Pneumonia
Cellulitis
Abscess
STSS
Necrotizing
fasciitis
Other
Page 10
Cases of Invasive Group A Streptococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2010
Died
Survived
25
Number of Cases
20
15
10
5
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Month of Diagnosis
Sep
Oct
Nov
Dec
Page 11
Cases of Invasive Group A Streptococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2009-2010
Died
Survived
35
Number of Cases
30
25
20
15
10
5
0
2009
Month of Diagnosis
2010
Page 12
Incidence of Invasive Group B Streptococcal
Disease, Minnesota, 2001-2010
10
Cases per 100,000 Persons
9
8.7
8.5
2009
2010
8
8
7
6
6.2
7
6.5
6.7
6.5
2003
2004
2005
6.4
5.5
5
4
3
2
1
0
2001
2002
2006
Year of Diagnosis
2007
2008
Page 13
Incidence of Invasive Group B Streptococcal Disease by
Gender and Age Group, Minnesota, 2010
Characteristic
Cases
(n=448)
Incidence per
100,000 persons
Gender
Male
Female
242
206
9.2
7.8
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
47
0
0
2
16
31
33
94
81
144
64.4
0
0
0.3
2.1
4.7
4.3
12.8
17.6
30.4
Page 14
Invasive Group B Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2010
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
Total
Cases
Deaths
% Died
47
0
0
2
16
31
33
94
81
144
2
0
0
0
0
1
1
3
4
13
4%
--0%
0%
3%
3%
3%
5%
9%
448
24
5%
Page 15
Invasive Group B Streptococcal Disease by Type
of Infection/Syndrome, Minnesota 2010
Meningitis (brain/spinal
cord)
2%
Pregnancy Associated
Infection** 3%
2%
STSS
3%
Joint Infection
8%
Bacteremia without
another infection
(blood)
35%
Osteomyelitis (bone)
12%
Pneumonia (lung)
8%
Other*
13%
Cellulitis (skin)
17%
This chart represents 470 infections among 448 cases. (Some cases had >1 infection.)
** Mother had one of the following infections: Endometriosis, Septic Abortion, Choriamnionitis, or Placental Infection with fetal demise.
Page 16
Cases of Invasive Group B Streptococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2010
Died
Survived
60
Number of Cases
50
40
30
20
10
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Month of Diagnosis
Sep
Oct
Nov
Dec
Page 17
Cases of Invasive Group B Streptococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2009-2010
Died
Survived
60
Number of Cases
50
40
30
20
10
0
2009
Month of Diagnosis
2010
Page 18
Invasive Neonatal Sepsis Disease in First Six Days
of Life by Pathogen, Minnesota, 2010*
Other Strep. Species
12%
Other
7%
H. influenzae
7%
Group B Strep.
54%
S. viridians
10%
E. coli
10%
* This chart represents 58 cases.
Page 19
Incidence of Invasive Early and Late-Onset Group
B Streptococcal Disease, Minnesota, 2001-2010
EO (infection at 0-6 days of life)
LO (infection at 7-89 days of life)
Cases per 100,000 Persons
0.7
0.6
0.5
0.44
0.4
0.38
0.4
0.36
0.33
0.3
0.31
0.29
0.26
0.26
0.24
0.26
0.31
0.25
0.22
0.31
0.29
0.22
0.22
2008
2009
0.18
0.2
0.2
0.1
0
2001
2002
2003
2004
2005
2006
Year of Diagnosis
2007
2010
Page 20
Early-Onset* Group B Streptococcal Disease by Race,
Gestational Age and Outcome, Minnesota, 2010
Characteristic
Cases
(n=31)
Percent
Race
White
Black
Other
22
4
5
71%
13%
16%
Gestational Age
Under 32 weeks
32-37 weeks
Full-term
Unknown
4
4
22
1
13%
13%
71%
3%
Outcome
Died
Survived
1
30
3%
97%
* onset 0-6 days of life
Page 21
Incidence of Invasive Haemophilus influenzae
Disease, Minnesota, 2000-2010
4
Cases per 100,000 Persons
3.5
3
2.5
1.9
2
1.6
1.4
1.5
1.1
1.1
2000
2001
1
1.1
1.1
2003
2004
1.5
1.5
2009
2010
1
1
0.5
0
2002
2005
2006
Year of Diagnosis
2007
2008
Page 22
Incidence of Invasive Haemophilus influenzae Disease by
Gender and Age Group, Minnesota, 2010
Characteristic
Cases
Incidence per
100,000 persons
Gender
Male
Female
34
47
1.30
1.78
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
5
4
0
5
1
2
6
3
11
44
6.85
1.37
-0.71
0.13
0.30
0.77
0.41
2.39
9.28
Page 23
Invasive Haemophilus influenzae Disease Cases
and Deaths by Age Group, Minnesota, 2010
Age Group
Cases
Deaths
% Died
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
5
4
0
5
1
2
6
3
11
44
0
0
0
0
1
0
0
0
1
9
0%
0%
0%
0%
100%
0%
0%
0%
9%
21%
Total
81
11
14%
Page 24
Invasive Haemophilus influenzae Disease by Type
of Infection/Syndrome, Minnesota 2010
Epiglotitis (throat)
1%
Cellulitis
1%
Pyelonephritis
1%
Meningitis (brain/spinal
cord)
6%
Pneumonia (lung)
51%
Bacteremia without
another infection
(blood)
40%
Page 25
Invasive Haemophilus influenzae Disease by
Serotype, Minnesota 2010 (n=78*)
Serotype f
10%
Serotype e
8%
Serotype b
1%
Serotype a
8%
Non-typeable
73%
* 3 case isolates not available for serotyping
Page 26
Cases of Invasive Haemophilus influenzae Disease by Month
of Diagnosis, Serotype and Outcome, Minnesota, 2010
Type b
Non type b
16
Number of Cases
14
12
10
8
6
4
2
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Month of Diagnosis
Sep
Oct
Nov
Dec
Page 27
Cases of Invasive Haemophilus influenzae Disease by
Month of Diagnosis and Serotype, Minnesota, 2009-2010
Type b
Non type b
16
Number of Cases
14
12
10
8
6
4
2
0
2009
Month of Diagnosis
2010
Page 28
Incidence of Invasive Neisseria meningitidis
Disease, Minnesota, 2000-2010
4
Cases per 100,000 Persons
3.5
3
2.5
2
1.5
1
0.5
0.72
0.45
0.54
0.57
0.47
0.57
0.31
0.29
0.31
2005
2006
2007
0.31
0.17
0
2000
2001
2002
2003
2004
Year of Diagnosis
2008
2009
2010
Page 29
Incidence of Invasive Neisseria meningitidis Disease by
Gender and Age Group, Minnesota, 2010
Characteristic
Cases
(n=9)
Incidence per
100,000 persons
Gender
Male
Female
1
8
0.04
0.30
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
2
1
0
0
1
0
2
0
1
2
2.74
0.34
0
0
0.13
0
0.26
0
0.22
0.42
Page 30
Invasive Neisseria meningitidis Disease Cases and
Deaths by Age Group, Minnesota, 2010
Age Group
Cases
Deaths
% Died
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
2
1
0
0
1
0
2
0
1
2
1
0
0
0
0
0
0
0
0
0
50%
0%
--0%
-0%
-0%
0%
Total
9
1
11%
Page 31
Invasive Neisseria meningitidis by Type of
Infection/Syndrome, Minnesota 2010
Tracheobronchitis
11%
Pneumonia (lung)
11%
Meningitis (brain/spinal
cord)
45%
Bacteremia without
another infection
(blood)
33%
Page 32
Cases of Invasive Neisseria meningitidis Disease by
Month of Diagnosis and Serotype, Minnesota, 2010
Serogroup B
Serogroup C
Serogroup Y
Serogroup Z
Serogroup W135
5
Number of Cases
4
3
2
1
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Month of Diagnosis
Sep
Oct
Nov
Dec
Page 33
Cases of Invasive Neisseria meningitidis Disease by Month
of Diagnosis and Serotype, Minnesota, 2009-2010
Serogroup B
Serogroup C
Serogroup Y
Serogroup Z
5
Number of Cases
4
3
2
1
0
Month of Diagnosis
Serogroup W135
Page 34
Incidence of Invasive Pneumococcal Disease,
Minneapolis-St. Paul Metropolitan Area, 2000-2001 and
Minnesota, 2002-2010
Cases per 100,000 Persons
25
20
16.6
15
12.7
11.9
12
10.6
11.6
12.3
12.8
2007
2008
13.6
13
10
5
0
2001
2002
2003
2004
2005
2006
Year of Diagnosis
2009
2010
12.3
Page 35
Incidence of Invasive Pneumococcal Disease by
Gender and Age Group, Minnesota, 2010
Characteristic
Cases
Incidence per
100,000 persons
Gender
Male
Female
350
299
13.4
11.3
Age Group
Under 1 yr.
1-4 yrs.
5-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-64 yrs.
65-79 yrs.
80+ yrs.
31
56
24
26
34
116
125
122
115
42.5
19.2
2.3
3.5
5.1
14.9
12.5
26.2
56.2
Page 36
Invasive Pneumococcal Disease Cases and
Deaths by Age Group, Minnesota, 2010
Age Group
Cases
Deaths
% Died
Under 1 yr.
1-4 yrs.
5-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-64 yrs.
65-79 yrs.
80+ yrs.
31
56
24
26
34
116
125
122
115
1
0
0
1
1
7
15
14
24
3%
0%
0%
4%
3%
6%
12%
12%
21%
Total
649
63
10%
Page 37
Invasive Pneumococcal Disease by Type of
Infection/Syndrome, Minnesota 2010*
Bacteremia without
another infection
(blood)
25%
Otitis Media
2%
Empyema
2%
Other
7%
Meningitis (brain/spinal
cord)
5%
*This chart represents 684 infections among 649 cases
Pneumonia (lung)
59%
Page 38
Invasive Pneumococcal Isolates by Serotype Included in
13-Valent Conjugate Vaccine* by Age Group,
Minnesota, 2010
Age Group
Isolates
# included in
PCV-13
% included in
PCV-13
Under 1 yr.
1-4 yrs.
5-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-64 yrs.
65-79 yrs.
80+ yrs.
29
54
24
25
34
112
123
116
108
19
35
17
17
15
32
86
54
42
66%
65%
71%
68%
44%
29%
70%
47%
39%
Total
625
317
51%
*Serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F
Page 39
Invasive Pneumococcal Isolates by Resistance to
Antimicrobial Agents, Minnesota, 2010
Total
Resistant
Isolates
% Resistant
Isolates
Penicillin resistance (R)*
Meningitis breakpoints
Non-meningitis breakpoints
146
4
23%
1%
Resistance to drug classes**
R to 1 drug class
R to 2-3 drug classes
R to 4-5 drug classes
91
49
76
15%
8%
12%
Total
625
35%
* Isolates with MIC > 0.12 μg/ml are Penicillin-R for meningitis, > 8 μg/ml for non-meningitis.
** Twelve drug classes assessed; R to beta-lactams was assessed by penicillin MIC > 0.12 μg/ml.
Page 40
Cases of Invasive Pneumococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2010
Died
Survived
100
90
Number of Cases
80
70
60
50
40
30
20
10
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Month of Diagnosis
Sep
Oct
Nov
Dec
Page 41
Cases of Invasive Pneumococcal Disease by Month of
Diagnosis and Outcome, Minnesota, 2009-2010
Died
Survived
100
90
Number of Cases
80
70
60
50
40
30
20
10
0
Month of Diagnosis
Page 42
Invasive MRSA Surveillance Methods
• Cases include Hennepin and Ramsey County, Minnesota
residents with invasive infections due to methicillinresistant Staphylococcus aureus (MRSA).
• Invasive infections are from normally sterile body sites
such as blood, cerebrospinal fluid and others. These
usually cause serious illnesses (disease).
• All metro area hospitals and reference laboratories
serving Minnesotans are contacted routinely to identify
cases.
Page 43
Invasive MRSA Surveillance Methods
(cont.)
• Species confirmation, antibiotic resistance and other
testing is performed by the MDH Public Health.
• Disease rates are based on census population data.
• The Centers for Disease Control and Prevention (CDC)
includes these results from Minnesota and other states
and regions in a network called Active Bacterial Core
Surveillance (ABCs) which covers a population base of 41
million.
Page 44
Incidence of Invasive MRSA Disease, Ramsey and
Hennepin Counties*, 2004-2010
25
Cases per 100,000 Persons
20.9
19.8
20
20.3
19.4
17.1
13.8
15
11.9
10
5
0
2004
2005
2006
2007
2008
Year of Diagnosis
* Data from years 2004-2007 includes Ramsey County only.
2009
2010
Page 45
Incidence of Invasive MRSA Disease by Gender and Age
Group, Ramsey and Hennepin Counties, Minnesota, 2010
Characteristic
Cases
Incidence per
100,000 persons
Gender
Male
Female
121
108
14.8
12.8
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
2
2
0
3
8
18
29
41
36
90
8.7
2.1
0
1.5
3.0
7.5
12.3
18.1
26.8
63.6
Page 46
Invasive MRSA Disease Cases and Deaths by Age Group,
Ramsey and Hennepin Counties, Minnesota, 2010
Age Group
Under 1 yr.
1-4 yrs.
5-9 yrs.
10-19 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
Total
Cases
Deaths
% Died
2
2
0
3
8
18
29
41
36
90
0
0
0
1
0
0
1
3
3
21
0%
0%
-33%
0%
0%
3%
7%
8%
23%
229
29
13%
Page 47
Incidence of Invasive MRSA Disease by Case Type,
Ramsey and Hennepin Counties, Minnesota, 2010
Case Type
Cases
Incidence per 100,000
persons
Healthcare-associated
203
12.2
Community-associated
25
1.5
• Healthcare-associated if case had one or more of the following: MRSA
infection was identified more than 3 days after hospital admission; history of
hospitalization, surgery, dialysis or residence in a long-term care facility in the
previous year; or, presence of an indwelling catheter.
• Community-associated: none of the previously mentioned criteria were met.
Page 48
Invasive MRSA Disease by Type of Infection,
Ramsey and Hennepin Counties, Minnesota, 2010
Type of Infection*
Bacteremia (blood)
Without another source of infection
With another source of infection
Pneumonia (lung)
Osteomyelitis (bone)
Cellulitis (skin)
Endocarditis (heart)
More than one infection type
Other infection**
Cases
131
61
70
23
30
13
6
89
55
* Cases may have had more than 1 type of infections
** Other infections included urinary tract, internal organ abscess, empyema
(pus), septic arthritis (joint), meningitis (brain/spinal cord)
Page 49
Cases of Legionellosis by Month of Diagnosis,
Minnesota, 2010
10
9
Number of Cases
8
7
6
5
4
3
2
1
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Month of Diagnosis
Sep
Oct
Nov
Dec
Page 50
Confirmed Legionellosis Cases by Age Group and
Sex, Minnesota, 2010
Age Group
18-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
Total
Male
Female
Total
1
2
4
9
7
6
0
0
1
0
4
2
1
2
5
9
11
8
29 (81%)
7 (19%)
36
Page 51
Confirmed Legionellosis Cases
Minnesota, 2001-2010
40
36
34
35
30
Number of Cases
30
27
26
25
25
20
17
17
15
15
9
10
5
0
2001
2002
2003
2004
2005
2006
Year of Diagnosis
2007
2008
2009
2010
Page 52
Laboratory Tests Used to Diagnose Confirmed
Cases of Legionellosis, Minnesota 2010
Culture
3%
Paired Serology
3%
Urine Antigen and
Culture
14%
Urine Antigen and PCR
6%
Urine Antigen
74%
Additional unconfirmed cases
• 3 cases were tested by single serology alone (not confirmatory)
• 4 cases were tested by PCR alone (suspect case)