INVASIVE BACTERIAL DISEASE
SURVEILLANCE REPORT, 2013
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, 2004-2013
Cases per 100,000 Persons
7
6
5
4.4
4
3
2.9
3.3
3.3
3.3
2006
2007
2008
3.9
3.6
4.3
3
2.4
2
1
0
2004
2005
2009
Year of Diagnosis
2010
2011
2012
2013
Page 6
Incidence of Invasive Group A Streptococcal Disease by
Gender and Age Group, Minnesota, 2013
Characteristic
Cases
(n=209)
Incidence per
100,000 persons
Gender
Male
Female
124
85
4.6
3.1
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
9
0
7
16
20
33
29
34
52
1.5
3.2
0
1.0
2.2
2.9
4.6
3.7
6.4
10.3
Page 7
Invasive Group A Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2013
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
9
0
7
16
20
33
29
34
52
0
0
0
0
0
1
0
2
1
10
0%
0%
0%
0%
0%
5%
0%
7%
3%
19%
209
14
7%
Page 8
Invasive Group A Streptococcal Disease by Type of
Infection/Syndrome, Minnesota, 2013
Abscess
10%
STSS
2%
Endometritis
Epiglotitis
1%
1%
Bacteremia without
another infection
(blood)
16%
Osteomyelitis
4%
Other
11%
Septic arthritis (joint)
7%
Necrotizing fasciitis
(deep tissue)
8%
Pneumonia (lung)
4%
Septic shock
9%
This chart represents 268 infections among 209 cases (some cases had >1 infection).
Cellulitis (skin)
27%
Page 9
Outcome of Invasive Group A Streptococcal Disease by
Type of Infection/Syndrome, Minnesota, 2013
Died
Survived
100
90
80
Percentage
70
60
50
40
30
20
10
0
Bacteremia
without
another
focus
Pneumonia
Cellulitis
Abscess
STSS
Necrotizing Septic shock
fasciitis
Other
Page 10
Cases of Invasive Group A Streptococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2013
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, 2012-2013
Died
Survived
40
Number of Cases
35
30
25
20
15
10
5
0
2012
Month of Diagnosis
2013
Page 12
Incidence of Invasive Group B Streptococcal
Disease, Minnesota, 2004-2013
Cases per 100,000 Persons
12
10
10
8
8
6.7
6.5
2004
2005
7
8.7
8.5
2009
2010
10.6
11.1
6.4
6
4
2
0
2006
2007
2008
Year of Diagnosis
2011
2012
2013
Page 13
Incidence of Invasive Group B Streptococcal Disease by
Gender and Age Group, Minnesota, 2013
Characteristic
Cases
(n=597)
Incidence per
100,000 persons
Gender
Male
Female
331
266
12.4
9.8
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.
30
0
1
3
21
30
54
131
135
192
44.4
0
0.3
0.4
2.9
4.4
7.4
16.8
25.3
38.2
Page 14
Invasive Group B Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2013
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
30
0
1
3
21
30
54
131
135
192
1
0
0
0
0
1
0
4
5
10
3%
0%
0%
0%
0%
3%
0%
3%
4%
5%
597
21
4%
Page 15
Invasive Group B Streptococcal Disease by Type
of Infection/Syndrome, Minnesota 2013
Meningitis (brain/spinal
cord)
1%
Pregnancy Associated
Infection*
3%
Abscess
6%
Bacteremia without
another infection
(blood)
24%
Joint Infection
10%
Osteomyelitis (bone)
14%
Pneumonia (lung)
4%
Cellulitis (skin)
18%cases had >1 infection.)
This chart represents 752 infections among 597 cases. (Some
Other
20%
** 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, 2013
Died
Survived
80
Number of Cases
70
60
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, 2012-2013
Died
Survived
80
Number of Cases
70
60
50
40
30
20
10
0
2012
Month of Diagnosis
2013
Page 18
Incidence of Invasive Early and Late-Onset Group
B Streptococcal Disease, Minnesota, 2004-2013
EO (infection at 0-6 days of life)
LO (infection at 7-89 days of life)
Cases per 1,000 Live Births
0.7
0.6
0.5
0.4
0.44
0.38
0.36
0.31
0.3
0.26
0.31
0.25
0.22
0.31
0.22
0.22
0.18
0.2
0.31
0.29
0.25
0.2
0.2
0.16
0.1
0.1
0
0.17
2004
2005
2006
2007
2008
2009
Year of Diagnosis
2010
2011
2012
2013
Page 19
Early-Onset* Group B Streptococcal Disease by Race,
Gestational Age and Outcome, Minnesota, 2013
Characteristic
Cases
(n=17)
Percent
Race
White
Black
Other
14
0
3
82%
-18%
Gestational Age
Under 32 weeks
32-37 weeks
Full-term
2
5
10
12%
30%
58%
Outcome
Died
Survived
1
16
94%
6%
* onset 0-6 days of life
Page 20
Invasive Neonatal Sepsis Disease in First 6 Days of
Life by Pathogen, Minnesota, 2013*
H. influenzae
3%
Group A Strep.
3%
Other
6%
S. viridians
14%
Group B Strep.
47%
E. coli
25%
* This chart represents 36 cases.
S. aureus
3%
Page 21
Incidence of Invasive Haemophilus influenzae
Disease, Minnesota, 2004-2013
4
Cases per 100,000 Persons
3.5
3
2.5
1.9
2
1.5
1.6
1.1
1
1.4
1.5
1.5
2009
2010
1.6
1.7
1.3
1
0.5
0
2004
2005
2006
2007
2008
Year of Diagnosis
2011
2012
2013
Page 22
Incidence of Invasive Haemophilus influenzae Disease by
Gender and Age Group, Minnesota, 2013
Characteristic
Cases
(n=91)
Incidence per
100,000 persons
Gender
Male
Female
43
48
1.61
1.77
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
8
0
0
4
2
5
10
19
39
5.92
2.85
--0.55
0.29
0.69
1.28
3.56
7.70
Page 23
Incidence of Invasive Haemophilus influenzae Disease by
Gender and Age Group, Minnesota, 2013
Characteristic
Cases
(n=91)
Incidence per
100,000 persons
Gender
Male
Female
43
48
1.61
1.77
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
8
0
0
4
2
5
10
19
39
5.92
2.85
--0.55
0.29
0.69
1.28
3.56
7.70
Page 24
Invasive Haemophilus influenzae Disease by Type
of Infection/Syndrome, Minnesota 2013
Arthritis
2%
Cellulitis
2%
Other
8%
Epiglotitis (throat)
2%
Meningitis
(brain/spinal cord)
5%
Septic Shock
7%
Bacteremia without
another infection
(blood)
32%
This graph represents 98 infections in 91 cases (some cases had > 1 infection).
Pneumonia (lung)
48%
Page 25
Invasive Haemophilus influenzae Disease by
Serotype, Minnesota 2013 (n=91*)
Serotype f
18%
Serotype e
8%
Serotype b
5%
Serotype a
9%
* 3 case isolates not available for serotyping
Non-typeable
60%
Page 26
Cases of Invasive Haemophilus influenzae Disease by Month
of Diagnosis, Serotype and Outcome, Minnesota, 2013
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, 2012-2013
Type b
Non type b
16
Number of Cases
14
12
10
8
6
4
2
0
2012
Month of Diagnosis
2013
Page 28
Incidence of Invasive Neisseria meningitidis
Disease, Minnesota, 2003-2013
4
Cases per 100,000 Persons
3.5
3
2.5
2
1.5
1
0.57
0.5
0
2003
0.47
2004
0.57
0.31
0.29
0.31
2005
2006
2007
0.31
2008
2009
Year of Diagnosis
0.17
2010
0.28
0.22
0.22
2011
2012
2013
Page 29
Incidence of Invasive Neisseria meningitidis Disease by
Gender and Age Group, Minnesota, 2013
Characteristic
Cases
(n=12)
Incidence per
100,000 persons
Gender
Male
Female
3
9
0.11
0.33
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
2
0
1
2
0
1
4.44
0.36
0.28
0.14
0.28
0
0.14
0.26
0
0.20
Page 30
Invasive Neisseria meningitidis Disease Cases and
Deaths by Age Group, Minnesota, 2013
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
2
0
1
2
1
1
1
0
0
0
0
0
0
0
0
0
33%
0%
0%
0%
0%
-0%
0%
0%
0%
Total
12
1
8%
Page 31
Invasive Neisseria meningitidis by Type of
Infection/Syndrome, Minnesota 2013*
Septic Shock
8%
Pneumonia
8%
Meningitis (brain/spinal
cord)
54%
Bacteremia without
another infection
(blood)
31%
*This chart represents 13 infections among 12 cases (one case had > 1 infection).
Page 32
Cases of Invasive Neisseria meningitidis Disease by
Month of Diagnosis and Serotype, Minnesota, 2013
Serogroup B
Serogroup C
Serogroup Y
Non 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, 2012-2013
Serogroup B
Serogroup C
Serogroup Y
Not groupable
Serogroup W135
5
Number of Cases
4
3
2
1
0
2012
Month of Diagnosis
2013
Page 34
Incidence of Invasive Pneumococcal Disease,
Minnesota, 2004-2013
Cases per 100,000 Persons
25
20
15
10.6
11.6
12.3
12.8
13.6
13
12.3
10.9
10
9.4
10.1
5
0
2004
2005
2006
2007
2008
2009
Year of Diagnosis
2010
2011
2012
2013
Page 35
Incidence of Invasive Pneumococcal Disease by
Gender and Age Group, Minnesota, 2013
Characteristic
Cases
(n=542)
Incidence per
100,000 persons
Gender
Male
Female
267
275
10.0
10.2
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.
13
32
11
13
30
38
150
148
107
19.2
11.4
1.0
1.8
4.4
5.2
13.8
28.6
50.2
Page 36
Invasive Pneumococcal Disease Cases and
Deaths by Age Group, Minnesota, 2013
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.
13
32
11
13
30
38
150
148
107
1
0
0
1
1
2
13
13
26
8%
0%
0%
8%
3%
5%
9%
9%
24%
Total
542
57
11%
Page 37
Invasive Pneumococcal Disease by Type of
Infection/Syndrome, Minnesota 2013*
Bacteremia without
another infection
(blood)
21%
Otitis Media
1%
Empyema
1%
Other
11%
Pneumonia (lung)
62%
Meningitis (brain/spinal
cord)
4%
*This chart represents 569 infections among 542 cases (some cases had > 1 infection).
Page 38
Invasive Pneumococcal Isolates by Serotype Included in
13-Valent Conjugate Vaccine* by Age Group,
Minnesota, 2013
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.
13
29
10
13
29
37
146
139
104
3
2
2
6
6
11
40
32
19
23%
7%
20%
46%
21%
30%
27%
23%
18%
Total
520
121
23%
*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, 2013
(n=518 viable isolates)
Total
Resistant
Isolates
% Resistant
Isolates
Penicillin resistance (R)*
Meningitis breakpoints
Non-meningitis breakpoints
90
16
17%
3%
Resistance to drug classes**
No resistance
R to 1 drug class
R to 2-3 drug classes
R to 4-6 drug classes
294
149
44
31
57%
29%
8%
6%
* 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, 2013
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, 2011-2012
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 42
million.
Page 44
Incidence of Invasive MRSA Disease, Ramsey and
Hennepin Counties, 2004-2013
Cases per 100,000 Persons
25
20
19.8
19.4
20.9
20.3
18.2
17.1
14.0
13.8
15
12.5
10
5
0
2005
2006
2007
2008
2009
Year of Diagnosis
* Data from years 2004-2007 includes Ramsey County only.
2010
2011
2012
2013
Page 45
Incidence of Invasive MRSA Disease by Gender and Age
Group, Ramsey and Hennepin Counties, Minnesota, 2013
Characteristic
Cases
(n=213)
Incidence per
100,000 persons
Gender
Male
Female
126
87
15.1
10.0
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.
3
6
1
4
10
12
26
44
45
62
12.5
6.6
0.9
1.9
3.7
5.0
11.7
18.6
28.2
44.2
Page 46
Invasive MRSA Disease Cases and Deaths by Age Group,
Ramsey and Hennepin Counties, Minnesota, 2013
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
3
6
1
4
11
12
26
44
45
62
0
0
0
0
0
0
1
4
5
8
0%
0%
0%
0%
0%
0%
5.6%
22.2%
27.8%
44.4%
213
18
8.4%
Page 47
Incidence of Invasive MRSA Disease by Case Type,
Ramsey and Hennepin Counties, Minnesota, 2013
Case Type
Cases
Incidence per 100,000
persons
Healthcare-associated
179
10.5
Community-associated
33
1.9
• 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, 2013
Type of Infection*
Bacteremia (blood)
Without another source of infection
With another source of infection
Pneumonia (lung)
Osteomyelitis (bone)
Cellulitis/skin abscess (skin)
Endocarditis (heart)
More than one infection type
Other infection**
Cases
146
50
96
26
31
41
4
82
110
* 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, 2004-2013
60
51
Number of Cases
50
40
20
36
34
30
30
50
26
25
28
27
17
10
0
2004
2005
2006
2007
2008
2009
Year of Diagnosis
2010
2011
2012
2013
Page 50
Confirmed Legionnaires’ Disease by Month of
Diagnosis, Minnesota, 2013
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 by Month of
Diagnosis, Minnesota, 2012-2013
10
9
Died
Survived
Number of Cases
8
7
6
5
4
3
2
1
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month of Diagnosis
Page 52
Confirmed Legionnaires’ Disease Cases by Age
Group and Gender, Minnesota, 2013
Age Group
18-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
Total
Male
Female
Total
0
3
5
7
8
12
2
0
1
2
3
7
2
3
6
9
11
19
35 (70%)
15 (30%)
50
Page 53
Possible Exposures Among Confirmed
Legionnaires’ Disease Cases, Minnesota 2013
Unknown
4%
Travel setting
18%
Healthcare setting
16%
Community setting
36%