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 B Streptococcus page 2 Haemophilus influenzae page 2 Neisseria meningitidis page 28 Streptococcus pneumoniae page 34 Methicillin-resistant Staphylococcus aureus (MRSA) page 42 Legionnaires Disease 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, 24-26 7 6 Cases per, Persons 5 4 3 2 2.9 2.4 3.3 3.3 3.3 3.6 3 4.4 3.2 3.9 4.6 4.2 4.8 24 25 26 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis
Page 6 Incidence of Invasive Group A Streptococcal Disease by Gender and Age Group, Minnesota, 26 Characteristic Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. Cases (n=277) 49 28 5 6 7 2 22 27 9 48 52 79 Incidence per, persons 5.2 4.5 7. 2..9.7 3. 3.6 2.9 6.2 8.3 4.3
Page 7 Invasive Group A Streptococcal Disease Cases and Deaths by Age Group, Minnesota, 26 Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. 5 6 7 2 22 27 9 48 52 79 5 5 2% % % % 4.5% % 5.3%.4% 9.6% 4% Total 277 24 8.7%
Invasive Group A Streptococcal Disease by Type of Infection/Syndrome, Minnesota, 26 Osteomyelitis 2% Endometritis 2% Septic arthritis (joint) 5% Empyema 2% Necrotizing fasciitis (deep tissue) 5% Abscess 6% STSS 2% Peritonitis % Otitis % Bacteremia without another infection (blood) 8% Other 8% Page 8 Pneumonia (lung) 7% Septic shock 6% Cellulitis (skin) 25% This chart represents 374 infections among 277 cases (some cases had > infection).
Page 9 Outcome of Invasive Group A Streptococcal Disease by Type of Infection/Syndrome, Minnesota, 26 Percentage % 9% 8% 7% 6% 5% 4% 3% 2% % % Died Survived
Page Cases of Invasive Group A Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 26 35 Died Survived 3 Number of Cases 25 2 5 5 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis
Page Cases of Invasive Group A Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 25-26 Number of Cases 4 35 3 25 2 5 5 Died Survived Month of Diagnosis 25 26
Page 2 Incidence of Invasive Group B Streptococcal Disease, Minnesota, 27-26 Cases per, Persons 2 8 6 4 2 6.4 8 8.7 8.5.6.. 9.7 9.9 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis
Page 3 Incidence of Invasive Group B Streptococcal Disease by Gender and Age Group, Minnesota, 26 Characteristic Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. Cases (n=544) 3 244 35 4 6 27 4 87 48 85 Incidence per, persons. 8.8 49.8.4.6 2.2 3.7 6.. 24.6 34.2
Page 4 Invasive Group B Streptococcal Disease Cases and Deaths by Age Group, Minnesota, 26 Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. 35 4 7 28 4 87 5 85 3 2 2 5 2 9% % % % 6% 7% 2% 2% 3% 6% Total 544 27 5%
Page 5 Invasive Group B Streptococcal Disease by Type of Infection/Syndrome, Minnesota 26 Meningitis (brain/spinal cord) % Joint Infection 8% Osteomyelitis (bone) 4% Pregnancy Associated Infection* % Abscess 7% Bacteremia without another infection (blood) 35% Pneumonia (lung) 6% Cellulitis (skin) 22% This chart represents 634 infections among 544 cases. (Some cases had > infection.) * Mother had one of the following infections: Endometriosis, Septic Abortion, Choriamnionitis, or Placental/Amniotic Infection with fetal demise. Other 6%
Page 6 Cases of Invasive Group B Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 26 Number of Cases 8 7 6 5 4 3 2 Died Survived Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis
Page 7 Cases of Invasive Group B Streptococcal Disease by Month of Diagnosis and Outcome, Minnesota, 25-26 Number of Cases 8 7 6 5 4 3 2 Died Survived Month of Diagnosis 25 26
Page 8 Incidence of Invasive Early and Late-Onset Group B Streptococcal Disease, Minnesota, 27-26.7 EO (infection at -6 days of life) LO (infection at 7-89 days of life) Cases per, Live Births.6.5.4.3.2..3.3.8.22.29.22.44.2.3.6.2..25.7.3.25.23.23.3.9 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis
Page 9 Early-Onset* Group B Streptococcal Disease by Race, Gestational Age and Outcome, Minnesota, 26 Characteristic Race White Black Asian Multiple Races Unknown Gestational Age Under 32 weeks 32-37 weeks Full-term Outcome Died Survived Cases (n=2) 9 6 2 3 3 5 3 2 9 Percent 43% 29% 5% % 4% 4% 24% 62% % 9% * onset -6 days of life
Invasive Neonatal Sepsis Disease in First 6 Days of Life by Pathogen, Minnesota, 26* Enterococcus % Page 2 Other Strep. Spp 3% Other 3% H. influenzae 2% S. aureus 5% Group B Strep. 36% S. viridians 2% * This chart represents 6 infections among 59 cases. E. coli 29%
Incidence of Invasive Haemophilus influenzae Disease, Minnesota, 24-26 4 Page 2 3.5 Cases per, Persons 3 2.5 2.5..9.6.4.5.5.3.6.7 2.3.9 2.3.5 24 25 26 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis
Page 22 Incidence of Invasive Haemophilus influenzae Disease by Gender and Age Group, Minnesota, 26 Characteristic Gender Male Female Cases (n=26) 69 57 Incidence per, persons 2.53 2.7 Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. 3 9 2 3 8 5 26 48 8.5 3.2.56.4.4.9.74.4 4.32 8.88
Page 23 Invasive Haemophilus influenzae Disease Cases and Deaths by Age Group, Minnesota, 26 Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. 3 9 2 3 8 5 26 48 2 4 2% -- -- -- -- -- -- -- 3% 8% Total 26 6 3%
Page 24 Invasive Haemophilus influenzae Disease by Type of Infection/Syndrome, Minnesota 26 Epiglottitis (throat) 3% Abscess (not skin) Peritonitis 2% 2% Other 6% Meningitis (brain/spinal cord) % Pneumonia (lung) 49% Septic Shock 2% Bacteremia without another infection (blood) 24% This graph represents 44 infections in 26 cases (some cases had > infection).
Page 25 Invasive Haemophilus influenzae Disease by Serotype, Minnesota 26 (n=8*) Serotype f 4% Serotype b 4% Serotype e 3% Serotype a 3% Non-typeable 69% * 8 case isolates not available for serotyping
Page 26 Cases of Invasive Haemophilus influenzae Disease by Month of Diagnosis and Serotype, Minnesota, 26 Type b Non type b 2 Number of Cases 5 5 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis
Page 27 Cases of Invasive Haemophilus influenzae Disease by Month of Diagnosis and Serotype, Minnesota, 25-26 Type b Non type b 2 Number of Cases 5 5 25 Month of Diagnosis 26
4 Page 28 Incidence of Invasive Neisseria meningitidis Disease, Minnesota, 23-26 3.5 Cases per, Persons 3 2.5 2.5.5.57.47.3.29.3.57.3.7.28.22.22..5.9 23 24 25 26 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis
Page 29 Incidence of Invasive Neisseria meningitidis Disease by Gender and Age Group, Minnesota, 26 Characteristic Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. Cases (n=5) 3 2 2 Incidence per, persons..7.28.4.7.8
Page 3 Invasive Neisseria meningitidis Disease Cases and Deaths by Age Group, Minnesota, 26 Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. 2 Total 5 -- -- -- -- -- -- -- -- -- -- --
Page 3 Invasive Neisseria meningitidis by Type of Infection/Syndrome, Minnesota 26 Pneumonia 2% Meningitis (brain/spinal cord) 4% Bacteremia without another infection (blood) 4%
Page 32 Cases of Invasive Neisseria meningitidis Disease by Month of Diagnosis and Serotype, Minnesota, 26 5 Serogroup B Serogroup C Serogroup Y Non groupable Serogroup W35 Non-viable 4 Number of Cases 3 2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis
Page 33 Cases of Invasive Neisseria meningitidis Disease by Month of Diagnosis and Serotype, Minnesota, 25-26 5 Serogroup B Serogroup C Serogroup Y Not groupable Serogroup W35 Non-viable 4 Number of Cases 3 2 25 Month of Diagnosis 26
Incidence of Invasive Pneumococcal Disease, Minnesota, 27-26 25 Page 34 Cases per, Persons 2 5 5 2.8 3.6 3 2.3.9 9.4. 8.8 9.8 8.8 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis
Page 35 Incidence of Invasive Pneumococcal Disease by Gender and Age Group, Minnesota, 26 Characteristic Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-64 yrs. 65-79 yrs. 8+ yrs. Cases (n=485) 249 236 8 3 3 2 32 37 47 34 79 Incidence per, persons 9. 8.6 25.6 4.6.2.6 4.4 5.5 3. 22.8 36.2
Page 36 Invasive Pneumococcal Disease Cases and Deaths by Age Group, Minnesota, 26 Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-64 yrs. 65-79 yrs. 8+ yrs. 8 3 3 2 32 37 47 34 79 2 4 4 5 % 8% % % 6% % % % 4% Total 485 47 %
Page 37 Invasive Pneumococcal Disease by Type of Infection/Syndrome, Minnesota 26* Other Septic Shock 6% 9% Otitis Media % Meningitis (brain/spinal cord) 6% Pneumonia (lung) 48% Bacteremia without another infection (blood) 3% *This chart represents 52 infections among 485 cases (some cases had > infection).
Page 38 Invasive Pneumococcal Isolates by Serotype Included in 3-Valent Conjugate Vaccine* by Age Group, Minnesota, 26 Age Group Isolates # included in PCV-3 Under yr. -4 yrs. 5-9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-64 yrs. 65-79 yrs. 8+ yrs. 8 2 9 23 25 28 9 5 85 4 4 3 3 5 32 2 6 % included in PCV-3 22% 9% 6% 3% 4% 8% 27% 7% 9% Total 453 88 9% *Serotypes, 3, 4, 5, 6A, 6B, 7F, 9V, 4, 8C, 9A, 9F, 23F
Page 39 Invasive Pneumococcal Isolates by Resistance to Antimicrobial Agents, Minnesota, 26 (n=456 viable isolates) Penicillin resistance (R)* Meningitis breakpoints Non-meningitis breakpoints Resistance to drug classes** No resistance R to drug class R to 2-3 drug classes R to 4-5 drug classes Total Resistant Isolates 84 2 244 36 47 29 % Resistant Isolates 8% <% 54% 3% % 6% * Isolates with MIC >.2 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 >.2 μg/ml.
Page 4 Cases of Invasive Pneumococcal Disease by Month of Diagnosis and Outcome, Minnesota, 26 9 8 Died Survived Number of Cases 7 6 5 4 3 2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis
Page 4 Cases of Invasive Pneumococcal Disease by Month of Diagnosis and Outcome, Minnesota, 25-26 9 8 Died Survived Number of Cases 7 6 5 4 3 2 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, 24-26 25 Cases per, Persons 2 5 5 9.8 9.4 2.9 2.3 7. 3.8 8.2 4. 2.5 5...6 25 26 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis * Data from years 24-27 includes Ramsey County only.
Page 45 Incidence of Invasive MRSA Disease by Gender and Age Group, Ramsey and Hennepin Counties, Minnesota, 26 Characteristic Gender Male Female Age Group Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. Cases (n=26) 3 76 3 9 44 52 63 Incidence per, persons 4.9 8.4 4...9.5 4.8 4. 9. 8.8 27.6 4.
Page 46 Invasive MRSA Disease Cases and Deaths by Age Group, Ramsey and Hennepin Counties, Minnesota, 26 Age Group Cases Deaths % Died Under yr. -4 yrs. 5-9 yrs. -9 yrs. 2-29 yrs. 3-39 yrs. 4-49 yrs. 5-59 yrs. 6-69 yrs. 7+ yrs. 3 9 44 52 63 3 5 2 % % % % % % 5.3% 6.8% 9.6% 9.% Total 26 2.2%
Page 47 Incidence of Invasive MRSA Disease by Case Type, Ramsey and Hennepin Counties, Minnesota, 26 Case Type Cases Incidence per, persons Healthcare-associated 54 8.7 Community-associated 52 2.9 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, 26 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 57 63 94 4 23 27 44 8 84 5 * Cases may have had more than 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
Confirmed Legionnaires Disease Cases By Year, Minnesota, 24-26 4 Page 49 2 5 Number of Cases 8 6 4 2 7 34 26 3 25 3 36 3 5 5 58 5 24 25 26 27 28 29 2 2 22 23 24 25 26 Year of Diagnosis
Page 5 Confirmed Legionnaires Disease Cases by Month of Diagnosis, Minnesota, 26 Number of Cases 37 36 35 34 33 32 3 3 29 28 27 26 25 24 23 22 2 2 9 8 7 6 5 4 3 2 9 8 7 6 5 4 3 2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month of Diagnosis
Page 5 Confirmed Legionnaires Disease Cases by Age Group and Gender, Minnesota, 26 Age Group Male Female Total 8-29 yrs. 3 23 3-39 yrs. 4 3 27 4-49 yrs. 5 56 5 5-59 yrs. 22 9 42 334 6-69 yrs. 2 48 429 7+ yrs. 7 8 44 23 Total 39 72 (67%) (63%) 9 43 (33%) (37%) 58 5