INVASIVE BACTERIAL DISEASE
SURVEILLANCE REPORT, 2014
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, 2004-2014
Cases per 100,000 Persons
7
6
5
4
3
4.6
4.4
2.9
3.3
3.3
3.3
2006
2007
2008
3.9
3.6
3.2
3
2.4
2
1
0
2004
2005
2009
2010
Year of Diagnosis
2011
2012
2013
2014
Page 6
Incidence of Invasive Group A Streptococcal Disease by
Gender and Age Group, Minnesota, 2014
Characteristic
Cases
(n=259)
Incidence per
100,000 persons
Gender
Male
Female
139
120
5.0
4.3
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
10
8
7
23
22
24
37
53
71
5.1
3.2
2.1
1.0
2.9
2.8
3.3
4.7
9.6
13.9
Page 7
Invasive Group A Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2014
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
4
10
8
7
23
22
24
37
53
71
0
0
0
0
0
0
2
3
7
16
0%
0%
0%
0%
0%
0%
8%
8%
13%
23%
259
28
11%
Page 8
Invasive Group A Streptococcal Disease by Type of
Infection/Syndrome, Minnesota, 2014
Abscess
6%
Peritonitis
STSS
1%
2%
Osteomyelitis
3%
Otitus media
1%
Bacteremia without
another infection
(blood)
16%
Septic arthritis (joint)
10%
Other
10%
Empyema
1%
Necrotizing fasciitis
(deep tissue)
4%
Pneumonia (lung)
7%
Septic shock
9%
This chart represents 354 infections among 259 cases (some cases had >1 infection).
Cellulitis (skin)
28%
Page 9
Outcome of Invasive Group A Streptococcal Disease by
Type of Infection/Syndrome, Minnesota, 2014
Died
Survived
100%
90%
80%
Percentage
70%
60%
50%
40%
30%
20%
10%
0%
Bacteremia Pneumonia
without
another
focus
Cellulitis
Abscess
STSS
Necrotizing Septic shock
fasciitis
Other
Page 10
Cases of Invasive Group A Streptococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2014
Died
Survived
35
Number of Cases
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, 2013-2014
Died
Survived
40
Number of Cases
35
30
25
20
15
10
5
0
2013
Month of Diagnosis
2014
Page 12
Incidence of Invasive Group B Streptococcal
Disease, Minnesota, 2005-2014
Cases per 100,000 Persons
12
10
10
8
8
6.5
7
8.7
8.5
2009
2010
10.6
11.1
10.1
6.4
6
4
2
0
2005
2006
2007
2008
Year of Diagnosis
2011
2012
2013
2014
Page 13
Incidence of Invasive Group B Streptococcal Disease by
Gender and Age Group, Minnesota, 2014
Characteristic
Cases
(n=548)
Incidence per
100,000 persons
Gender
Male
Female
309
239
11.5
8.8
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.
36
1
2
3
25
28
45
105
112
191
52.4
0.4
0.6
0.4
3.4
4.0
6.4
13.3
20.2
36.9
Page 14
Invasive Group B Streptococcal Disease Cases
and Deaths by Age Group, Minnesota, 2014
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
1
2
3
25
28
45
105
112
191
4
0
0
0
1
0
0
4
0
7
11%
0%
0%
0%
4%
0%
0%
4%
0%
4%
548
16
3%
Page 15
Invasive Group B Streptococcal Disease by Type
of Infection/Syndrome, Minnesota 2014
Pregnancy Associated
Infection*
2%
Abscess
8%
Meningitis (brain/spinal
cord)
3%
Bacteremia without
another infection
(blood)
26%
Joint Infection
11%
Osteomyelitis (bone)
9%
Pneumonia (lung)
5%
Cellulitis (skin)
17%
This chart represents 630 infections among 548 cases. (Some cases had >1 infection.)
Other
19%
* 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, 2014
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, 2013-2014
Died
Survived
80
Number of Cases
70
60
50
40
30
20
10
0
2013
Month of Diagnosis
2014
Page 18
Incidence of Invasive Early and Late-Onset Group
B Streptococcal Disease, Minnesota, 2005-2014
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
0.44
0.4
0.36
0.31
0.3
0.31
0.25
0.22
0.31
0.22
0.29
0.25
0.22
0.2
0.18
0.2
0.31
0.2
0.16
0.17
0.1
0.1
0
0.25
0.23
2005
2006
2007
2008
2009
2010
Year of Diagnosis
2011
2012
2013
2014
Page 19
Early-Onset* Group B Streptococcal Disease by Race,
Gestational Age and Outcome, Minnesota, 2014
Characteristic
Cases
(n=16)
Percent
Race
White
Black
Asian
Other
11
1
1
3
69%
6%
6%
19%
Gestational Age
Under 32 weeks
32-37 weeks
Full-term
3
2
11
19%
13%
69%
Outcome
Died
Survived
3
13
19%
81%
* onset 0-6 days of life
Page 20
Invasive Neonatal Sepsis Disease in First 6 Days of
Life by Pathogen, Minnesota, 2014*
Enterococcus
L. monocytogenes
3%
3%
Other
12%
Group B Strep.
27%
H. influenzae
7%
S. pneumoniae
3%
S. viridians
13%
* This chart represents 60 cases.
E. coli
33%
Page 21
Incidence of Invasive Haemophilus influenzae
Disease, Minnesota, 2004-2014
4
Cases per 100,000 Persons
3.5
3
2.5
2.3
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
2014
Page 22
Incidence of Invasive Haemophilus influenzae Disease by
Gender and Age Group, Minnesota, 2014
Characteristic
Cases
(n=123)
Incidence per
100,000 persons
Gender
Male
Female
54
69
2.00
2.53
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.
11
7
5
2
4
7
2
5
21
59
16.02
2.51
1.38
0.28
0.55
0.99
0.28
0.63
3.78
11.39
Page 23
Invasive Haemophilus influenzae Disease by Type
of Infection/Syndrome, Minnesota 2014
Epiglottitis (throat)
2%
Arthritis
2%
Cellulitis
3%
Other
7%
Meningitis
(brain/spinal cord)
7%
Septic Shock
7%
Bacteremia without
another infection
(blood)
33%
This graph represents 135 infections in 123 cases (some cases had > 1 infection).
Pneumonia (lung)
50%
Page 24
Invasive Haemophilus influenzae Disease by
Serotype, Minnesota 2014 (n=123*)
Serotype f
13%
Serotype e
5%
Serotype b
1%
Serotype a
14%
Non-typeable
68%
* 6 case isolates not available for serotyping
Page 25
Cases of Invasive Haemophilus influenzae Disease by Month
of Diagnosis, Serotype and Outcome, Minnesota, 2014
Type b
Non type b
Number of Cases
20
15
10
5
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Month of Diagnosis
Sep
Oct
Nov
Dec
Page 26
Cases of Invasive Haemophilus influenzae Disease by
Month of Diagnosis and Serotype, Minnesota, 2013-2014
Type b
Non type b
Number of Cases
20
15
10
5
0
2013
Month of Diagnosis
2014
Page 27
Incidence of Invasive Neisseria meningitidis
Disease, Minnesota, 2003-2014
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
0.17
2010
Year of Diagnosis
0.28
0.22
0.22
2011
2012
2013
0.11
2014
Page 28
Incidence of Invasive Neisseria meningitidis Disease by
Gender and Age Group, Minnesota, 2014
Characteristic
Cases
(n=6)
Incidence per
100,000 persons
Gender
Male
Female
4
2
0.15
0.07
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
0
0
1
1
0
3
0
0
0
1.46
0
0
0.14
0.14
0
0.43
0
0
0
Page 29
Invasive Neisseria meningitidis Disease Cases and
Deaths by Age Group, Minnesota, 2014
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.
1
0
0
1
1
0
3
0
0
0
0
0
0
0
0
0
1
0
0
0
------33.3%
----
Total
6
1
16.6%
Page 30
Invasive Neisseria meningitidis by Type of
Infection/Syndrome, Minnesota 2014*
Septic Shock
33%
Meningitis (brain/spinal
cord)
33%
Pneumonia
17%
*This chart represents 8 infections among 6 cases (two cases had > 1 infection).
Bacteremia without
another infection
(blood)
50%
Page 31
Cases of Invasive Neisseria meningitidis Disease by
Month of Diagnosis and Serotype, Minnesota, 2014
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 32
Cases of Invasive Neisseria meningitidis Disease by Month
of Diagnosis and Serotype, Minnesota, 2013-2014
Serogroup B
Serogroup C
Serogroup Y
Not groupable
Serogroup W135
5
Number of Cases
4
3
2
1
0
2013
Month of Diagnosis
2014
Page 33
Incidence of Invasive Pneumococcal Disease,
Minnesota, 2005-2014
Cases per 100,000 Persons
25
20
15
11.6
12.3
12.8
13.6
13
12.3
10.9
10
9.4
10.1
8.8
5
0
2005
2006
2007
2008
2009
2010
Year of Diagnosis
2011
2012
2013
2014
Page 34
Incidence of Invasive Pneumococcal Disease by
Gender and Age Group, Minnesota, 2014
Characteristic
Cases
(n=476)
Incidence per
100,000 persons
Gender
Male
Female
241
235
8.9
8.6
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.
19
22
19
25
26
30
124
122
89
27.7
7.9
1.8
3.4
3.7
4.3
11.2
22.6
41.3
Page 35
Invasive Pneumococcal Disease Cases and
Deaths by Age Group, Minnesota, 2014
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.
19
22
19
25
26
30
124
122
89
1
0
0
2
1
3
12
8
10
5%
0%
0%
8%
4%
10%
10%
7%
11%
Total
476
37
8%
Page 36
Invasive Pneumococcal Disease by Type of
Infection/Syndrome, Minnesota 2014*
Bacteremia without
another infection
(blood)
29%
Pneumonia (lung)
53%
Otitis Media
1%
Empyema
1%
Other
11%
Meningitis (brain/spinal
cord)
5% cases (some cases had > 1 infection).
*This chart represents 512 infections among 476
Page 37
Invasive Pneumococcal Isolates by Serotype Included in
13-Valent Conjugate Vaccine* by Age Group,
Minnesota, 2014
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.
18
21
19
23
25
28
119
115
85
4
4
3
3
1
5
32
20
16
22%
19%
16%
13%
4%
18%
27%
17%
19%
Total
453
88
19%
*Serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F
Page 38
Invasive Pneumococcal Isolates by Resistance to
Antimicrobial Agents, Minnesota, 2014
(n=453 viable isolates)
Total
Resistant
Isolates
% Resistant
Isolates
Penicillin resistance (R)*
Meningitis breakpoints
Non-meningitis breakpoints
90
20
20%
4%
Resistance to drug classes**
No resistance
R to 1 drug class
R to 2-3 drug classes
R to 4-5 drug classes
260
113
37
43
52%
25%
8%
9%
* 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 39
Cases of Invasive Pneumococcal Disease by
Month of Diagnosis and Outcome, Minnesota, 2014
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 40
Cases of Invasive Pneumococcal Disease by Month of
Diagnosis and Outcome, Minnesota, 2013-2014
Died
Survived
100
90
Number of Cases
80
70
60
50
40
30
20
10
0
Month of Diagnosis
Page 41
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 42
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 43
Incidence of Invasive MRSA Disease, Ramsey and
Hennepin Counties, 2004-2014
Cases per 100,000 Persons
25
20
19.8
19.4
20.9
20.3
18.2
17.1
14.0
13.8
15
15.1
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
2014
Page 44
Incidence of Invasive MRSA Disease by Gender and Age
Group, Ramsey and Hennepin Counties, Minnesota, 2014
Characteristic
Cases
(n=261)
Incidence per
100,000 persons
Gender
Male
Female
158
103
18.0
12.2
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
2
2
4
13
13
37
43
61
85
4.1
2.2
1.8
1.9
4.8
5.2
16.9
18.0
36.6
58.9
Page 45
Invasive MRSA Disease Cases and Deaths by Age Group,
Ramsey and Hennepin Counties, Minnesota, 2014
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
2
2
4
13
13
37
43
61
85
0
0
0
0
0
1
3
3
3
16
0%
0%
0%
0%
0%
3.8%
11.5%
11.5%
11.5%
61.5%
261
26
10.0%
Page 46
Incidence of Invasive MRSA Disease by Case Type,
Ramsey and Hennepin Counties, Minnesota, 2014
Case Type
Cases
Incidence per 100,000
persons
Healthcare-associated
182
10.5
Community-associated
76
4.4
• 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.
• 3 cases could not be classified
Page 47
Invasive MRSA Disease by Type of Infection,
Ramsey and Hennepin Counties, Minnesota, 2014
Type of Infection*
Bacteremia (blood)
Without another source of infection
With another source of infection
Septic arthritis (joint)
Pneumonia (lung)
Osteomyelitis (bone)
Cellulitis/skin abscess (skin)
Endocarditis (heart)
More than one infection type
Other infection**
Cases
190
97
93
48
31
39
32
8
134
78
* Cases may have had more than 1 type of infections
** Other infections included bursitis, catheter site infection, chronic and/or
pressure ulcers, empyema (pus), internal organ abscess, meningitis
(brain/spinal cord), peritonitis, surgical incision or surgical site infections,
septic emboli, septic shock, and urinary tract infections
Page 48
Confirmed Legionellosis Cases
Minnesota, 2004-2014
58
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
2010
Year of Diagnosis
2011
2012
2013
2014
Page 49
Confirmed Legionellosis Cases
Minnesota, 2004-2014
58
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
2010
Year of Diagnosis
2011
2012
2013
2014
Page 50
Number of Cases
Confirmed Legionellosis Cases
by Month of Diagnosis, Minnesota, 2014
15
14
13
12
11
10
9
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 Legionellosis Cases by Age Group and
Gender, Minnesota, 2014
Age Group
18-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60-69 yrs.
70+ yrs.
Total
Male
Male
Female
Female
Total
Total
11
11
10
10
99
10
10
88
11
11
55
44
44
44
22
22
15
15
13
13
14
14
12
12
39
39(67%)
(67%)
19
19(33%)
(33%)
58
58
Page 52
Possible Exposures Among Confirmed
Legionnaires’ Disease Cases, Minnesota 2014
Unknown
19%
Community setting
36%
Travel setting
28%
Healthcare setting
24%