INVASIVE BACTERIAL DISEASE
SURVEILLANCE REPORT, 2011
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).
• 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 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 42
million.
Page 5
Incidence of Invasive Group A Streptococcal
Disease, Minnesota, 2002-2011
7
Cases per 100,000 Persons
6
5
4.3
4
3.6
3.6
3.3
3
2.9
3.3
3.3
3
2.9
2.4
2
1
0
2002
2003
2004
2005
2006
2007
Year of Diagnosis
2008
2009
2010
2011
Page 6
Incidence of Invasive Group A Streptococcal Disease by
Gender and Age Group, Minnesota, 2011
Characteristic
Cases
(n=231)
Incidence per
100,000 persons
Gender
Male
Female
121
110
4.6
4.1
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.
1
7
12
15
11
20
30
33
49
53
1.5
2.5
3.4
2.1
1.5
3.0
4.0
4.3
9.6
10.8
Page 7
Invasive Group A Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2011
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
1
7
12
15
11
20
30
33
49
53
0
0
0
0
0
1
2
2
3
9
0%
0%
0%
0%
0%
5%
7%
6%
6%
17%
231
17
7%
Page 8
Invasive Group A Streptococcal Disease by Type of
Infection/Syndrome, Minnesota, 2011
Osteomyelitis
Empyema
2%
4%
Septic arthritis (joint)
6%
Cellulitis (skin)
25%
Septic shock
7%
Necrotizing fasciitis
(deep tissue)
7%
Abscess
8%
Pneumonia (lung)
11%
Other
16%
Bacteremia without
another infection
(blood)
14%
This chart represents 297 infections among 231 cases. (Some cases had >1 infection.)
Page 9
Outcome of Invasive Group A Streptococcal Disease by
Type of Infection/Syndrome, Minnesota, 2011
Died
Survived
100
90
80
Percentage
70
60
50
40
30
20
10
0
Bacteremia Pneumonia Cellulitis
without
another
focus
Abscess
Septic
shock
Necrotizing
fasciitis
Septic
arthritis
Empyema
Other
Page 10
Cases of Invasive Group A Streptococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2011
Died
Survived
40
Number of Cases
35
30
25
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, 2010-2011
Died
Survived
40
Number of Cases
35
30
25
20
15
10
5
0
2010
Month of Diagnosis
2011
Page 12
Incidence of Invasive Group B Streptococcal
Disease, Minnesota, 2002-2011
12
Cases per 100,000 Persons
10.1
10
8.7
8.5
2009
2010
8
8
6.2
7
6.5
6.7
6.5
2003
2004
2005
6.4
6
4
2
0
2002
2006
2007
Year of Diagnosis
2008
2011
Page 13
Incidence of Invasive Group B Streptococcal Disease by
Gender and Age Group, Minnesota, 2011
Characteristic
Cases
(n=535)
Incidence per
100,000 persons
Gender
Male
Female
321
214
12.2
8.0
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.
36
4
0
3
15
15
61
108
104
189
52.2
1.4
0
0.4
2.1
2.2
8.0
14.4
21.6
39.3
Page 14
Invasive Group B Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2011
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
36
4
0
3
15
15
61
108
104
189
2
1
0
0
0
0
0
4
5
13
6%
25%
0%
0%
0%
0%
0%
4%
5%
7%
535
25
5%
Page 15
Invasive Group B Streptococcal Disease by Type
of Infection/Syndrome, Minnesota 2011
Abscess
5%
Meningitis (brain/spinal
cord)
1%
Pregnancy Associated
Infection*
Bacteremia without
1%
another infection
(blood)
25%
Joint Infection
7%
Osteomyelitis (bone)
13%
Pneumonia (lung)
7%
Cellulitis (skin)
22%
Other
19%
This chart represents 621 infections among 535 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, 2011
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, 2010-2011
Died
Survived
60
Number of Cases
50
40
30
20
10
0
2010
Month of Diagnosis
2011
Page 18
Incidence of Invasive Early and Late-Onset Group
B Streptococcal Disease, Minnesota, 2002-2011
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
0.36
0.38
0.4
0.31
0.3
0.29
0.26
0.24
0.26
0.31
0.25
0.22
0.31
0.22
0.22
0.18
0.2
0.31
0.29
0.2
0.16
0.1
0
2002
2003
2004
2005
2006
2007
Year of Diagnosis
2008
2009
2010
2011
Page 19
Early-Onset* Group B Streptococcal Disease by Race,
Gestational Age and Outcome, Minnesota, 2011
Characteristic
Cases
(n=21)
Percent
Race
White
Black
Other
13
4
4
62%
19%
19%
Gestational Age
Under 32 weeks
32-37 weeks
Full-term
5
6
10
24%
29%
47%
Outcome
Died
Survived
2
19
10%
90%
* onset 0-6 days of life
Page 20
Invasive Neonatal Sepsis Disease in First 6 Days of
Life by Pathogen, Minnesota, 2011*
Other Strep. Species
9%
Other
13%
Group B Strep.
38%
S. aureus
5%
S. viridians
5%
* This chart represents 58 cases.
E. coli
30%
Page 21
Incidence of Invasive Haemophilus influenzae
Disease, Minnesota, 2000-2011
4
Cases per 100,000 Persons
3.5
3
2.5
1.9
2
1.6
1.4
1.5
1
1.1
1.1
2003
2004
1.5
1.5
1.3
1
1
0.5
0
2002
2005
2006
2007
Year of Diagnosis
2008
2009
2010
2011
Page 22
Incidence of Invasive Haemophilus influenzae Disease by
Gender and Age Group, Minnesota, 2011
Characteristic
Cases
(n=71)
Incidence per
100,000 persons
Gender
Male
Female
25
46
0.95
1.72
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.
3
1
1
1
3
1
6
7
14
34
4.35
0.35
0.28
0.14
0.41
0.15
0.79
0.93
2.90
7.08
Page 23
Invasive Haemophilus influenzae Disease Cases
and Deaths by Age Group, Minnesota, 2011
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.
3
1
1
1
3
1
6
7
14
34
0
0
0
0
0
0
0
0
1
5
0%
0%
0%
0%
0%
0%
0%
0%
7%
15%
Total
71
6
8%
Page 24
Invasive Haemophilus influenzae Disease by Type
of Infection/Syndrome, Minnesota, 2011*
Abscess
4%
Epiglotitis
3%
Other
6%
Otitis
4%
Septic Shock
6%
Pneumonia
49%
Meningitis
9%
Bacteremia without
another infection
(blood)
21%
*This chart represents 79 infections among 71 cases
Page 25
Invasive Haemophilus influenzae Disease by
Serotype, Minnesota 2011 (n=62*)
Serotype f
11%
Serotype e
5%
Serotype b
5%
Serotype a
3%
Non-typeable
76%
* 9 case isolates not available for serotyping
Page 26
Cases of Invasive Haemophilus influenzae Disease by
Month of Diagnosis and Serotype, Minnesota, 2011
Type b
Non type b
12
Number of Cases
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, 2010-2011
Type b
Non type b
12
Number of Cases
10
8
6
4
2
0
2010
Month of Diagnosis
2011
Page 28
Incidence of Invasive Neisseria meningitidis
Disease, Minnesota, 2002-2011
4
Cases per 100,000 Persons
3.5
3
2.5
2
1.5
1
0.72
0.57
0.47
0.5
0.57
0.31
0.29
0.31
2005
2006
2007
0.31
0.17
0.28
0
2002
2003
2004
Year of Diagnosis
2008
2009
2010
2011
Page 29
Incidence of Invasive Neisseria meningitidis Disease by
Gender and Age Group, Minnesota, 2011
Characteristic
Cases
(n=15)
Incidence per
100,000 persons
Gender
Male
Female
6
9
0.23
0.34
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.
4
2
0
0
1
0
1
3
1
3
5.80
0.70
0
0
0.14
0
0.13
0.40
0.21
0.62
Page 30
Invasive Neisseria meningitidis Disease Cases and
Deaths by Age Group, Minnesota, 2011
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.
4
2
0
0
1
0
1
3
1
3
0
0
0
0
0
0
0
0
0
0
0%
0%
--0%
-0%
0%
0%
0%
Total
15
0
0%
Page 31
Invasive Neisseria meningitidis by Type of
Infection/Syndrome, Minnesota 2011
Septic arthritis
13%
Pneumonia (lung)
7%
Meningitis (brain/spinal
cord)
53%
Bacteremia without
another infection
(blood)
27%
Page 32
Cases of Invasive Neisseria meningitidis Disease by
Month of Diagnosis and Serotype, Minnesota, 2011
Serogroup B
Serogroup C
Serogroup Y
Not groupable
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, 2010-2011
Serogroup B
Serogroup C
Serogroup Y
Not groupable
5
Number of Cases
4
3
2
1
0
Month of Diagnosis
Serogroup W135
Page 34
Incidence of Invasive Pneumococcal Disease,
Minnesota, 2002-2011
Cases per 100,000 Persons
25
20
15
11.9
12
10.6
11.6
12.3
12.8
13.6
13
12.3
11
10
5
0
2002
2003
2004
2005
2006
2007
Year of Diagnosis
2008
2009
2010
2011
Page 35
Incidence of Invasive Pneumococcal Disease by
Gender and Age Group, Minnesota, 2011
Characteristic
Cases
(n=582)
Incidence per
100,000 persons
Gender
Male
Female
285
297
10.8
11.1
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.
23
27
11
15
36
47
151
149
123
33.3
9.4
1.0
2.1
5.4
6.2
14.6
31.3
59.5
Page 36
Invasive Pneumococcal Disease Cases and
Deaths by Age Group, Minnesota, 2011
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.
23
27
11
15
36
47
151
149
123
2
0
1
1
2
2
13
26
24
9%
0%
9%
7%
6%
4%
9%
17%
20%
Total
582
71
12%
Page 37
Invasive Pneumococcal Disease by Type of
Infection/Syndrome, Minnesota 2011*
Bacteremia without
another infection
(blood)
21%
Otitis Media
1%
Empyema
2%
Other
8%
Pneumonia (lung)
63%
Meningitis (brain/spinal
cord)
5%
*This figure represents 622 infections among 582 cases
Page 38
Invasive Pneumococcal Isolates by Serotype Included in
13-Valent Conjugate Vaccine* by Age Group,
Minnesota, 2011
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.
23
25
11
15
36
44
148
143
119
6
7
6
8
17
21
44
52
29
26%
28%
55%
53%
47%
47%
30%
36%
24%
Total
564
190
34%
*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, 2011 (n=560)
Total
Resistant
Isolates
% Resistant
Isolates
Penicillin resistance (R)*
Meningitis breakpoints
Non-meningitis breakpoints
133
8
24%
1%
Resistance to drug classes**
No resistance
R to 1 drug class
R to 2-3 drug classes
R to 4-5 drug classes
325
100
60
75
58%
18%
11%
13%
* 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, 2011
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, 2010-2011
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, 2005-2011
25
Cases per 100,000 Persons
20.9
20
19.8
20.3
19.4
18.2
17.1
13.8
15
10
5
0
2005
2006
2007
2008
2009
Year of Diagnosis
* Data from years 2005-2007 includes Ramsey County only.
2010
2011
Page 45
Incidence of Invasive MRSA Disease by Gender and Age
Group, Ramsey and Hennepin Counties, Minnesota, 2011
Characteristic
Cases
(n=302)
Incidence per
100,000 persons
Gender
Male
Female
185
117
22.5
13.8
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.
6
6
0
7
11
22
32
57
53
108
26.0
6.4
0
3.5
4.2
9.2
13.6
25.2
39.5
76.3
Page 46
Invasive MRSA Disease Cases and Deaths by Age Group,
Ramsey and Hennepin Counties, Minnesota, 2011
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
6
6
0
7
11
22
32
57
53
108
0
0
0
0
0
1
3
4
5
29
0%
0%
-0%
0%
5%
9%
7%
9%
27%
302
42
14%
Page 47
Incidence of Invasive MRSA Disease by Case Type,
Ramsey and Hennepin Counties, Minnesota, 2011
Case Type
Cases
Incidence per 100,000
persons
Healthcare-associated
264
15.9
Community-associated
37
2.2
* 1 case had unknown case type
• 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, 2011
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
202
85
117
36
26
25
5
163
193
* 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
Confirmed Legionnaires’ Disease Cases
Minnesota, 2001-2011
60
Number of Cases
50
40
36
34
30
30
20
26
15
17
25
28
27
17
9
10
0
2001
2002
2003
2004
2005
2006
2007
Year of Diagnosis
2008
2009
2010
2011
Page 50
Confirmed Legionnaires’ Disease by Month of
Diagnosis, Minnesota, 2011
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 51
Confirmed Legionnaires’ Disease Cases by Age
Group and Gender, Minnesota, 2011
Age Group
18-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
Total
Male
Female
Total
0
0
2
4
6
4
0
1
1
2
4
4
0
1
3
6
10
8
16 (57%)
12 (43%)
28
Page 52
Possible Exposures Among Confirmed
Legionnaires’ Disease Cases, Minnesota, 2011
Unknown
4%
Travel setting
14%
Community setting
43%
Healthcare setting
39%