INVASIVE BACTERIAL DISEASE SURVEILLANCE REPORT, 2010

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1 INVASIVE BACTERIAL DISEASE SURVEILLANCE REPORT, Emerging Infections Program Active Bacterial Core Surveillance (ABCs) Minnesota Department of Health

2 Diseases included Group A Streptococcus page 5 Group B Streptococcus page Haemophilus influenzae page Neisseria meningitidis page 8 Streptococcus pneumoniae page 34 Methicillin-resistant Staphylococcus aureus (MRSA) page 4 Legionellosis page 49

3 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 Methicillin- Resistant 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.

4 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 4 million.

5 9 Page 5 Incidence of Invasive Group A Streptococcal Disease, Minnesota, - Cases per, Persons Year of Diagnosis

6 Page 6 Incidence of Invasive Group A Streptococcal Disease by Gender and Age Group, Minnesota, Characteristic Cases Incidence per, persons Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs

7 Page 7 Invasive Group A Streptococcal Disease Cases and Deaths by Age Group, Minnesota, Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs % % % 5% % % 5% 3% % 3% Total %

8 Page 8 Invasive Group A Streptococcal Disease by Type of Infection/Syndrome, Minnesota, Abscess % STSS 3% Bacteremia without another infection (blood) % Osteomyelitis 4% Septic arthritis (joint) 4% Necrotizing fasciitis (deep tissue) 4% Other % Pneumonia (lung) 8% Cellulitis (skin) 3%

9 Page 9 Outcome of Invasive Group A Streptococcal Disease by Type of Infection/Syndrome, Minnesota, Died Survived Percentage Bacteremia without another focus Pneumonia Cellulitis Abscess STSS Necrotizing fasciitis Other

10 Page Cases of Invasive Group A Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 5 Died Survived Number of Cases 5 5 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis

11 Page Cases of Invasive Group A Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 9-35 Died Survived 3 Number of Cases Month of Diagnosis 9

12 Page Incidence of Invasive Group B Streptococcal Disease, Minnesota, - Cases per, Persons Year of Diagnosis

13 Page 3 Incidence of Invasive Group B Streptococcal Disease by Gender and Age Group, Minnesota, Characteristic Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs. Cases (n=448) Incidence per, persons

14 Page 4 Invasive Group B Streptococcal Disease Cases and Deaths by Age Group, Minnesota, Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs % % % 3% 3% 3% 5% 9% Total %

15 Page 5 Invasive Group B Streptococcal Disease by Type of Infection/Syndrome, Minnesota Meningitis (brain/spinal cord) % Pregnancy Associated Infection** 3% % STSS 3% Joint Infection 8% Osteomyelitis (bone) % Bacteremia without another infection (blood) 35% Pneumonia (lung) 8% Other* 3% Cellulitis (skin) 7% This chart represents 47 infections among 448 cases. (Some cases had > infection.) ** Mother had one of the following infections: Endometriosis, Septic Abortion, Choriamnionitis, or Placental Infection with fetal demise.

16 Page 6 Cases of Invasive Group B Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 6 Died Survived 5 Number of Cases 4 3 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis

17 Page 7 Cases of Invasive Group B Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 9-6 Died Survived 5 Number of Cases 4 3 Month of Diagnosis 9

18 Page 8 Invasive Neonatal Sepsis Disease in First Six Days of Life by Pathogen, Minnesota, * Other Strep. Species % Other 7% H. influenzae 7% Group B Strep. 54% S. viridians % * This chart represents 58 cases. E. coli %

19 Page 9 Incidence of Invasive Early and Late-Onset Group B Streptococcal Disease, Minnesota, -.7 EO (infection at -6 days of life) LO (infection at 7-89 days of life) Cases per, Persons Year of Diagnosis

20 Page Early-Onset* Group B Streptococcal Disease by Race, Gestational Age and Outcome, Minnesota, Characteristic Race White Black Other Gestational Age Under 3 weeks 3-37 weeks Full-term Unknown Outcome Died Survived Cases (n=3) Percent 7% 3% 6% 3% 3% 7% 3% 3% 97% * onset -6 days of life

21 Incidence of Invasive Haemophilus influenzae Disease, Minnesota, - 4 Page 3.5 Cases per, Persons Year of Diagnosis

22 Page Incidence of Invasive Haemophilus influenzae Disease by Gender and Age Group, Minnesota, Characteristic Cases Incidence per, persons Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs

23 Page 3 Invasive Haemophilus influenzae Disease Cases and Deaths by Age Group, Minnesota, Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs % % % % % % % % 9% % Total 8 4%

24 Page 4 Invasive Haemophilus influenzae Disease by Type of Infection/Syndrome, Minnesota Meningitis (brain/spinal cord) 6% Epiglotitis (throat) % Cellulitis % Pyelonephritis % Bacteremia without another infection (blood) 4% Pneumonia (lung) 5%

25 Page 5 Invasive Haemophilus influenzae Disease by Serotype, Minnesota (n=78*) Serotype f % Serotype b % Serotype e 8% Serotype a 8% Non-typeable 73% * 3 case isolates not available for serotyping

26 Page 6 Cases of Invasive Haemophilus influenzae Disease by Month of Diagnosis, Serotype and Outcome, Minnesota, Number of Cases Type b Non type b Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis

27 Page 7 Cases of Invasive Haemophilus influenzae Disease by Month of Diagnosis and Serotype, Minnesota, 9- Number of Cases Type b Non type b 9 Month of Diagnosis

28 4 Page 8 Incidence of Invasive Neisseria meningitidis Disease, Minnesota, Cases per, Persons Year of Diagnosis

29 Page 9 Incidence of Invasive Neisseria meningitidis Disease by Gender and Age Group, Minnesota, Characteristic Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs. Cases (n=9) 8 Incidence per, persons

30 Page 3 Invasive Neisseria meningitidis Disease Cases and Deaths by Age Group, Minnesota, Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs. 5% % % -- % -- % % Total 9 %

31 Page 3 Invasive Neisseria meningitidis by Type of Infection/Syndrome, Minnesota Tracheobronchitis % Pneumonia (lung) % Meningitis (brain/spinal cord) 45% Bacteremia without another infection (blood) 33%

32 Page 3 Cases of Invasive Neisseria meningitidis Disease by Month of Diagnosis and Serotype, Minnesota, 5 Serogroup B Serogroup C Serogroup Y Serogroup Z Serogroup W35 4 Number of Cases 3 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis

33 Page 33 Cases of Invasive Neisseria meningitidis Disease by Month of Diagnosis and Serotype, Minnesota, 9-5 Serogroup B Serogroup C Serogroup Y Serogroup Z Serogroup W35 4 Number of Cases 3 Month of Diagnosis

34 Incidence of Invasive Pneumococcal Disease, Minneapolis-St. Paul Metropolitan Area, - and Minnesota, - 5 Page 34 Cases per, Persons Year of Diagnosis

35 Incidence of Invasive Pneumococcal Disease by Gender and Age Group, Minnesota, Characteristic Cases Incidence per, persons Gender Male Female Page 35 Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs yrs yrs yrs yrs. 8+ yrs

36 Page 36 Invasive Pneumococcal Disease Cases and Deaths by Age Group, Minnesota, Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs yrs yrs yrs yrs. 8+ yrs % % % 4% 3% 6% % % % Total %

37 Page 37 Invasive Pneumococcal Disease by Type of Infection/Syndrome, Minnesota * Bacteremia without another infection (blood) 5% Otitis Media % Empyema % Pneumonia (lung) 59% Other 7% Meningitis (brain/spinal cord) 5% *This chart represents 684 infections among 649 cases

38 Page 38 Invasive Pneumococcal Isolates by Serotype Included in 3-Valent Conjugate Vaccine* by Age Group, Minnesota, Age Group Isolates # included in PCV-3 Under yr. -4 yrs. 5-9 yrs. -9 yrs yrs yrs yrs yrs. 8+ yrs % included in PCV-3 66% 65% 7% 68% 44% 9% 7% 47% 39% Total % *Serotypes, 3, 4, 5, 6A, 6B, 7F, 9V, 4, 8C, 9A, 9F, 3F

39 Page 39 Invasive Pneumococcal Isolates by Resistance to Antimicrobial Agents, Minnesota, Penicillin resistance (R)* Meningitis breakpoints Non-meningitis breakpoints Total Resistant Isolates 46 4 % Resistant Isolates 3% % Resistance to drug classes** R to drug class R to -3 drug classes R to 4-5 drug classes % 8% % Total 65 35% * Isolates with MIC >. 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 >. μg/ml.

40 Page 4 Cases of Invasive Pneumococcal Disease by Month of Diagnosis and Outcome, Minnesota, 9 8 Died Survived Number of Cases Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis

41 Page 4 Cases of Invasive Pneumococcal Disease by Month of Diagnosis and Outcome, Minnesota, Died Survived Number of Cases Month of Diagnosis

42 Page 4 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.

43 Invasive MRSA Surveillance Methods (cont.) Page 43 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 4 million.

44 Incidence of Invasive MRSA Disease, Ramsey and Hennepin Counties*, 4-5 Page 44 Cases per, Persons Year of Diagnosis * Data from years 4-7 includes Ramsey County only.

45 Page 45 Incidence of Invasive MRSA Disease by Gender and Age Group, Ramsey and Hennepin Counties, Minnesota, Characteristic Cases Incidence per, persons Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs

46 Page 46 Invasive MRSA Disease Cases and Deaths by Age Group, Ramsey and Hennepin Counties, Minnesota, Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. -9 yrs yrs yrs yrs yrs. 7+ yrs % % -- 33% % % 3% 7% 8% 3% Total 9 9 3%

47 Page 47 Incidence of Invasive MRSA Disease by Case Type, Ramsey and Hennepin Counties, Minnesota, Case Type Cases Incidence per, persons Healthcare-associated 3. Community-associated 5.5 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.

48 Page 48 Invasive MRSA Disease by Type of Infection, Ramsey and Hennepin Counties, Minnesota, 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 * Cases may have had more than type of infections ** Other infections included urinary tract, internal organ abscess, empyema (pus), septic arthritis (joint), meningitis (brain/spinal cord)

49 9 8 Page 49 Cases of Legionellosis by Month of Diagnosis, Minnesota, Number of Cases Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis

50 Page 5 Confirmed Legionellosis Cases by Age Group and Sex, Minnesota, Age Group Male Female Total 8-9 yrs yrs yrs yrs yrs. 7+ yrs Total 9 (8%) 7 (9%) 36

51 Confirmed Legionellosis Cases Minnesota, - Page Number of Cases Year of Diagnosis

52 Page 5 Laboratory Tests Used to Diagnose Confirmed Cases of Legionellosis, Minnesota Culture 3% Paired Serology 3% Urine Antigen and Culture 4% 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)

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INVASIVE BACTERIAL DISEASE SURVEILLANCE REPORT, 26 Emerging Infections Program Active Bacterial Core Surveillance (ABCs) Minnesota Department of Health Diseases Included Group A Streptococcus page 5 Group