Surveillance of Invasive Bacterial Disease in Alaska, 2005 

Arctic Investigations Program 

National Center for Infectious Diseases 

Centers for Disease Control and Prevention 

4055 Tudor Centre Dr. 

Anchorage, AK 99508 

(907) 729-3400 

ncidaip@cdc.gov
Surveillance of Invasive Bacterial Disease in Alaska, 2005 2 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 3 

Alaska Statewide Invasive Bacterial Disease 

Table of Contents 

 Page

Summary 4 

Introduction 5 

Invasive Pneumococcal Disease 6 

Invasive Haemophilus influenzae 16 

 

Invasive Neisseria meningitidis 21 

Invasive Group A Streptococcus 23 

Invasive Group B Streptococcus 27 

References 31 

Appendix 32 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 4 

Summary

The Centers for Disease Control and Prevention's Arctic Investigations Program (AIP) in Anchorage, 

Alaska, maintains a statewide surveillance system for invasive diseases caused by Streptococcus 

pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and groups A and B streptococci. 

Laboratories throughout the state are requested to send to AIP any isolates of these organisms recovered 

from a blood culture, CSF, or other normally sterile site. Isolate identification is confirmed and, when 

appropriate, serotyped and tested for antimicrobial susceptibility. The objectives of this system are to 

provide information on disease rates within the state, monitor the emergence of antimicrobial resistance, 

and to monitor the effectiveness of implemented vaccine programs, such as the 23-valent pneumococcal 

polysaccharide vaccine, the 7-valent pneumococcal conjugate vaccine and Haemophilus influenzae type 

b vaccines. 

Figure 1: Invasive Bacterial Disease Surveillance Regions – Alaska, 2005 

In 2005, the total numbers of cases of invasive disease caused by these organisms reported to AIP were 

122 S. pneumoniae, 9 H. influenzae, 3 N. meningitidis, 36 group A Strep and 24 group B Strep. Alaska 

Native people had higher rates of disease than non-Native people for all surveillance organisms. Rates 

of invasive pneumococcal disease, H. influenzae and group A Strep were highest in the YK Delta. Rates 

for each organism by region are presented in the following table. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 5 

Table 1: Surveillance Organisms Reported by Region – Alaska, 2005 

Region 

S. pneumoniae 

n (rate*) 

H. influenzae 

n (rate*) 

N. meningitidis 

n (rate*) 

Group A Strep

n (rate*) 

Group B Strep

n (rate*) 

Anchorage 70 (16) 5 (1.1) 0 (0) 17 (3.9) 17 (3.9) 

Arctic Slope 1 (17) 0 (0) 0 (0) 0 (0) 0 (0) 

Bristol Bay 2 (28.1) 0 (0) 0 (0) 0 (0) 0 (0) 

Interior 14 (13.9) 0 (0) 1 (1) 7 (6.9) 3 (3) 

Kotzebue 3 (37.4) 0 (0) 1 (12.5) 0 (0) 1 (12.5) 

Norton Sound 3 (31.7) 1 (10.6) 0 (0) 1 (10.6) 0 (0) 

Southeast 8 (11.3) 0 (0) 0 (0) 6 (8.5) 2 (2.8) 

YK Delta 21 (84.2) 3 (12) 1 (4) 5 (20.1) 1 (4) 

Total 122 (18.4) 9 (1.4) 3 (0.5) 36 (5.4) 24 (3.6) 

*Cases per 100,000 population 

Introduction

AIP conducts statewide surveillance of invasive Streptococcus pneumoniae, Haemophilus influenzae, 

Neisseria meningitidis, and groups A and B Streptococcus. This program is part of a passive, 

laboratory-based surveillance system in which laboratories from all hospitals throughout the state are 

encouraged to participate. The population included in the AIP surveillance is the State of Alaska, which 

totaled 663,661 persons in 2005 [1]. Case detection occurs year-round as participating laboratories send 

isolates recovered from sterile sites to the AIP lab in Anchorage, accompanied by basic demographic 

and clinical information on the cases. Materials and forms for isolate shipment and data collection are 

provided to each lab by AIP. At year-end, AIP asks that each laboratory review their records and 

provide information on any cases that may have been overlooked. In 2005, 23 labs in Alaska 

participated in the invasive disease surveillance system, either by sending isolates to the AIP lab 

throughout the year, conducting year-end record reviews, or both. 

AIP defines a case of invasive Streptococcus pneumoniae, Haemophilus influenzae, Neisseria 

meningitidis, or groups A and B Streptococcus as an isolate of the bacteria from a normally sterile site, 

including blood, cerebrospinal fluid, pleural fluid, peritoneal fluid or joint fluid that has been taken from 

a resident of Alaska. In addition, for group A streptococcus, isolates are requested from deep tissue 

infections such as might be collected from surgical debridement of cases of necrotizing fasciitis.
Surveillance of Invasive Bacterial Disease in Alaska, 2005 6 

Invasive Pneumococcal Disease 

Overall Incidence

A total of 114 pneumococcal isolates were received at AIP in 2005. An additional 8 cases were detected 

through year-end follow up with participating labs throughout the state for a total of 122 cases of 

invasive pneumococcal disease. The overall rate for invasive pneumococcal disease in 2005 was 18.4 

per 100,000 persons per year. Alaska rates for 2005 were higher than the Active Bacterial Core 

Surveillance (ABCs) 2005 national projected rate of 14/100,000 [2]. ABCs is a surveillance system 

operated in 10 states which covers a population of over 39 million persons. 

Seasonality

Invasive Streptococcus pneumoniae cases were identified in each month of 2005. The largest number of 

cases was reported in February. 

Figure 2: Invasive Pneumococcal Disease, by 

Month of Culture - Alaska, 2005

0

2

4

6

8

10

12

14

16

18

January

February

March

April

May

June

July

August

September

October

November

December

Number of Cases

Race

In 2005, the state population was comprised of 19% Alaska Native people (Alaska Natives 129,594, 

non-Natives 534,067) [1]. The percentage of all reported S. pneumoniae cases that occurred in 2005 

among Alaska Native people was 50%; for a total of 61 cases resulting in an age-adjusted rate of 

47.2/100,000 persons per year. Sixty-one cases occurred among the non-Native population for an ageadjusted rate of 10.9/100,000 persons per year. The rate ratio of age-adjusted rates of S. pneumoniae

disease for the Alaska Native population compared with the non-Native population in 2005 is 4.3. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 7 

Table 2: Invasive Streptococcus pneumoniae Cases by Race – Alaska, 2005 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 61 (50) 47.2 57.4 6 (10.7)‡ 

Non-Native† 61 (50) 10.9 55.7 6 (10.2)‡ 

Total 122 56.6 12 (10.4) 

*Cases per 100,000 per percent distribution of Alaska 2000 population 

†Includes 1 case for which race was unknown 

‡Outcome unknown for 5 AK Native cases, 2 non-Native cases

Region

The highest percentage (57%) of invasive pneumococcal disease cases occurred in the Anchorage area 

in 2005. Rates of disease, however, were highest in the YK Delta, 84.2/100,000 persons per year. 

Figure 3: Invasive Pneumococcal Disease, Cases 

& Rates by Region - Alaska, 2005

0

20

40

60

80

Anchorage

Arctic Slope

Bristol Bay

Interior

Kotzebue

Norton Sound

Southeast

YK Delta

Number of Cases

0

20

40

60

80

100

Rate per 100,000

Cases

Rate

Age

Cases occurred in all age groups in 2005 ranging from 0.2 years to 89.9 years with a median age of 41.7 

years. Overall, the highest rates of disease occurred in children less than 2 years old. 

 

When stratified by age and race, the highest rates of disease in 2005 occurred in Alaska Native children 

less than 2 years old (233.6/100,000 persons per year). 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 8 

Figure 4: Invasive Pneumococcal Disease, Cases 

& Rates by Age Group & Race - Alaska, 2005

0

5

10

15

20

25

30

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Number of Cases

0

50

100

150

200

250

Rate per 100,000

AK Native

(# cases)

Non-Native

(# cases)

AK Native

(rate)

Non-Native

(rate)

Since the initiation of a pneumococcal conjugate vaccine program in 2001, overall rates of invasive 

disease have declined dramatically in children less than 2 years of age [3]. In 2000, overall yearly rates 

of pneumococcal disease in children less than 2 years were 191.2/100,000, dropping to a low of 

67.9/100,000 in 2002 and then increasing to 84.2/100,000 in 2005. 

Figure 5: Invasive Pneumococcal Disease by Age 

Group - Alaska, 2001-2005

0

10

20

30

40

50

60

70

80

90

100

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Rate per 100,000

2001

2002

2003

2004

2005

Although pneumococcal disease rates dropped initially in AK Native and non-Native children less than 

2 years after 2000, the rates of disease in AK Native children less than 2 years have been trending 

upward from a low of 93.6/100,000 in 2001 to 233.6/100,000 in 2005. Rates of invasive disease in nonNative children less than 2 years have continued to decline during the same time period reaching a low 

of 26.8 in 2005. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 9 

Figure 6: Invasive Pneumococcal Disease in 

Alaska Natives, by Age Group - Alaska, 2001-2005

0

50

100

150

200

250

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Rate per 100,000

2001

2002

2003

2004

2005

Figure 7: Invasive Pneumococcal Disease in NonNatives, by Age Group - Alaska, 2001-2005

0

50

100

150

200

250

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Rate per 100,000

2001

2002

2003

2004

2005

Clinical Presentation

The primary clinical presentation was determined by a review of the discharge diagnoses in each 

patient’s individual medical record associated with the invasive bacterial illness. In cases with multiple 

discharge diagnoses, the most serious diagnosis related to the pneumococcal infection was recorded as 

the primary clinical presentation. Pneumonia with bacteremia was the most common primary clinical 

presentation in 2005 (57%) followed by bacteremia (25%). Fifteen cases had a secondary 

pneumococcal-related diagnosis in 2005; 14 pneumonia and 1 cellulitis with bacteremia. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 10 

Figure 8: Primary Clinical Presentations of 

Invasive Pneumococcal Disease - Alaska, 2005

70

31

12 6 2 1

0

10

20

30

40

50

60

70

80

Pneumonia*

Bacteremia

Empyema

Meningitis

Septic arthritis

Pericarditis

Number of Cases

*w ith bacteremia

In 2005, blood was the most common source of a positive culture which was used to identify 116 (95%) 

of 122 cases. Cerebrospinal fluid was the positive site for 3% of cases and 1 case each was identified 

through joint fluid and an unspecified other sterile site.

Mortality

In 2005, the overall case fatality ratio for S. pneumoniae in Alaska was 10.4% (12 deaths out of 115 

cases for which outcome was known). The case fatality ratio for non-Natives was similar to Natives; 

10.2% (6 deaths) and 10.7% (6 deaths), respectively. The majority of deaths and the highest case 

fatality ratio occurred in the 65+ age category; 23.8% (5 deaths). 

Figure 9: Invasive Pneumococcal Deaths & Case 

Fatality Ratios by Age Group - Alaska, 2005

0

1

2

3

4

5

6

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Number of Deaths

0

5

10

15

20

25

Case Fatality 

Ratio (%)

Deaths

CFR
Surveillance of Invasive Bacterial Disease in Alaska, 2005 11 

Serotype

Serotyping of invasive pneumococcal isolates is performed at AIP using internationally standardized 

methods. Serotype identification is based on the organism’s polysaccharide capsule which is a principal 

virulence factor for pneumococci. This information provides a way to categorize organisms and to 

determine if the infection was due to a type that could be prevented by use of one of the two available 

pneumococcal vaccines. Serotyping was performed on all of the S. pneumoniae cases for which an 

isolate was available. 

Table 3: Invasive Pneumococcal Serotype Distribution by Race and Age Group – Alaska, 2005 

 Alaska Native Non-Native Unknown 

Serotype Total n (%) <2 2-18 19-64 65+ <2 2-18 19-64 65+ All Ages 

01 3 (2.7) - - - - - 1 2 - - 

03 10 (8.9) 3 - 2 2 - - 2 1 - 

04 3 (2.7) - - 1 - - - 2 - - 

06A 2 (1.8) - - - - - - 1 1 - 

06B 1 (0.9) - - - - - - - 1 - 

07C 1 (0.9) - - - - - - 1 - - 

07F 16 (14.2) 2 4 4 - - 1 4 1 - 

08 11 (9.7) - - 6 - - - 5 - - 

09N 1 (0.9) 1 - - - - - - - - 

09V 2 (1.8) 1 - - - - - - 1 - 

10A 5 (4.4) 2 1 2 - - - - - - 

11A 3 (2.7) - - 1 - - 1 1 - - 

12F 10 (8.9) - - 6 2 - - 2 - - 

14 2 (1.8) - - - - - - - 2 - 

15A 2 (1.8) - 1 - - - - - 1 - 

15B 2 (1.8) - - - - - 1 - 1 - 

15C 2 (1.8) - 1 - - - 1 - - - 

16F 1 (0.9) - - 1 - - - - - - 

17F 2 (1.8) - - 2 - - - - - - 

18C 2 (1.8) - - - - - - - 1 1 

19A 17 (15) 1 - 3 - 3 2 5 3 - 

19F 1 (0.9) - - 1 - - - - - - 

22F 6 (5.3) 1 - 4 - - - 1 - - 

23A 1 (0.9) - - 1 - - - - - - 

23F 1 (0.9) 1 - - - - - - - - 

33F 2 (1.8) 1 - - 1 - - - - - 

34 2 (1.8) - - 1 - - 1 - - - 

35B 1 (0.9) - - - - 1 - - - - 

38 1 (0.9) - - - - - - - 1 - 

Total 113 13 7 35 5 4 8 26 14 1 

In 2005, the most common pneumococcal serotype was 19A (17 isolates, 15%). From 1986 through 

2001, serotype 14 was the most common invasive pneumococcal serotype ranging from 7.4% to 23.5% 

of isolates. Following introduction in 2001 of the pneumococcal conjugate vaccine which includes 

serotype 14, the proportion of serotype 14 isolates has dropped to a low of 1.2% in 2004 and was 1.8% 

of serotyped isolates in 2005. However, disease caused by serotype 19A, which is not included in the 

conjugate vaccine, increased. Prior to 2003, yearly numbers of cases of serotype 19A disease and the 

proportion of total isolates have ranged from 2 to 7 and 1.6% to 6.1%, respectively. Although the 

majority of serotype 19A disease occurred in AK Natives during 2003 and were equally distributed 

between AK Natives and non-Natives in 2004, the majority (76%) of serotype 19A cases occurred in 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 12 

non-Natives in 2005. In 2004, the majority (80%) of serotype 19A cases occurred in the Anchorage 

area; forty-seven percent of cases in 2005 occurred in the Anchorage area and 35% occurred in the 

Interior. Serotype 7F increased to 14.2% (16 cases) of serotyped isolates in 2005; this is the highest 

proportion of isolates attributed to serotype 7F since the initiation of invasive pneumococcal disease 

surveillance in 1986. The highest proportion of isolates previously serotyped as 7F was 9.3% (10 cases) 

in 2000. 

Table 4: Invasive Pneumococcal Serotype Distribution by Region – Alaska, 2005 

Serotype 

Anchorage 

Arctic Slope 

Bristol Bay 

Interior 

Kotzebue 

Norton Sound 

Southeast 

YK Delta 

01 3 - - - - - - - 

03 3 1 - 2 1 - - 3 

04 3 - - - - - - - 

06A 2 - - - - - - - 

06B 1 - - - - - - - 

07C 1 - - - - - - - 

07F 6 - - - - - - 10 

08 8 - - 1 1 - - - 

09N 1 - - - - - - - 

09V 1 - 1 - - - - - 

10A 2 - - - - - - - 

11A 2 - - 1 - - - - 

12F 3 - - 1 - 3 3 - 

14 1 - - 1 - - - - 

15A 1 - - - - - - 1 

15B 2 - - - - - - - 

15C - - - 1 - - 1 - 

16F - - - - - - 1 - 

17F 1 - - - - - - 1 

18C 2 - - - - - - - 

19A 8 - 1 6 - - 1 1 

19F 1 - - - - - - - 

22F 5 - - - 1 - - - 

23A 1 - - - - - - - 

23F 1 - - - - - - - 

33F - - - 1 - - - 1 

34 2 - - - - - - - 

35B 1 - - - - - - - 

38 1 - - - - - - - 

Total 64 1 2 14 3 3 6 20 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 13 

Vaccine Serotypes

Two vaccine types are licensed for prevention of pneumococcal disease. In 2001, the pneumococcal 

conjugate vaccine (PCV7) was included in the Alaska childhood vaccination schedule. This vaccine 

provides protection against the 7 most common pneumococcal serotypes causing invasive disease 

among children (types 4, 6B, 9V, 14, 18C, 19F, 23F). The table below shows the proportion of invasive 

infections from 2005 that were due to serotypes found in the PCV7 vaccine. 

Table 5: Proportion of Invasive Isolates Contained in the PCV7 Vaccine by Age Group and Race 

– Alaska, 2005 

Age (yrs) Alaska Native (%) Non-Native (%) Total (%) 

<2 2 (15%) of 13 0 (0%) of 4 2 (12%) of 17 

2-4 0 (0%) of 3 0 (0%) of 6 0 (0%) of 9 

5+ 2 (5%) of 44 7 (17%) of 42 9 (11%) of 86 

Total 4 (7%) of 60 7 (16%) of 52 11 (10%) of 112 

The 23-valent polysaccharide vaccine (Ps23V) is recommended in Alaska for all persons 55 years and 

older, and for persons over age 2 who are at higher risk for pneumococcal disease. Revaccination is 

recommended after 6 years [4]. In 2005, for persons 55 years and older, 12 (92%) of cases serotyped 

were potentially vaccine preventable invasive pneumococcal illnesses. 

Vaccine Failures

A PCV7 vaccine failure is defined as invasive pneumococcal disease caused by a serotype contained in 

the PCV7 vaccine in a child less than five years old who has had at least two doses of vaccine. There 

were two vaccine failures in 2005; one was in a 14-month old and one in a 19-month old child. The 14-

month old had received three doses of vaccine and the 19-month old had received four doses. The 14-

month old had a history of upper respiratory infections and presented with empyema; the isolate from 

the case was serotype 9V. The 19-month old also had a history of upper respiratory infections and 

presented with pneumonia; the isolate from the case was serotype 23F. 

Potentially Preventable Deaths

In 2005, pneumococcal vaccine status was known for 77 (63%) of the 122 cases; 53 cases (43%) did 

receive a pneumococcal vaccine prior to illness and 24 cases (20%) had no record of a pneumococcal 

vaccine. 

Table 6: Potentially Vaccine Preventable Invasive Pneumococcal Deaths – Alaska, 2005 

Serotypes < 2 years 2-4 5-18 19-54 55-64 65+ Total 

PCV7 0 0 0 0 1 (33%) 0 1 (8%) 

Ps23V 0 0 0 3 (75%) 1 (33%) 3 (60%) 7 (58%) 

Non-Vaccine 0 0 0 1 (25%) 0 2 (40%) 3 (25%) 

Unknown 0 0 0 0 1 (33%) 0 1 (8%) 

Total 0 0 0 4 3 5 12 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 14 

Overall, 58% of all pneumococcal-related mortality in 2005 was potentially preventable with the use of 

the 23-valent polysaccharide vaccine in persons over 2 years old; 25% of deaths were due to disease 

caused by serotypes not contained in either the 7 or 23-valent vaccines. 

Eight of the 12 deaths in 2005 from invasive S. pneumoniae occurred from serotypes contained within 

the Ps23V vaccine. Of the eight deaths, two occurred in vaccinated individuals; time since vaccination 

for each was 3 years and 9 years. 

Table 7: Invasive Pneumococcal Disease, Serotypes of Fatal Cases – Alaska, 2005 

Serotype 

Deaths 

n (%) 

Serotype 

Frequency (n) 

03† 2 (20) 10 

10A† 1 (20) 5 

11A† 1 (33) 3 

12F† 1 (10) 10 

15A 1 (50) 2 

19A† 2 (12) 17 

19F*† 1 (100) 1 

23A 1 (100) 1 

38 1 (100) 1 

*Serotypes contained in the PCV7 vaccine 

†Serotypes contained in the 23-valent polysaccharide vaccine

Associated Medical Conditions

The presence of one or more associated medical conditions was reported in 84% of invasive 

pneumococcal cases in 2005. Cigarette smoking was the most prevalent risk factor observed in adults 

followed closely by alcohol abuse. 

Table 8: Associated Medical Conditions Identified in Invasive Pneumococcal Cases – Alaska, 

2005* 

Medical Condition 

Adult Cases (≥ 18 years) 

n=88, Cases (%) 

Cigarette smoking 41 (47) 

Alcohol abuse 36 (41) 

Chronic lung disease 18 (20) 

Diabetes 13 (15) 

Immunosuppressive treatment 5 (6) 

Injection drug use 3 (3) 

Asplenia 0 (0) 

*More than one risk factor was identified in several cases 

Antibiotic Resistance

Susceptibility testing was performed on all isolates received in 2005. Results of the testing are 

presented in the following table. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 15 

Table 9: Antibiotic Resistance in Invasive Streptococcus pneumoniae Isolates – Alaska, 2005 

Antibiotic Susceptible Intermediate Resistant I + R Total Tested 

Penicillin 96 (85%) 14 (12%) 3 (3%) 17 (15%) 113 

TMP-sulfa 91 (81%) 11 (10%) 11 (10%) 22 (20%) 113 

Erythromycin 103 (91%) 0 (0%) 10 (9%) 10 (9%) 113 

Ceftriaxone 113 (100%) 0 (0%) 0 (0%) 0 (0%) 113 

Tetracycline 109 (97%) 1 (1%) 2 (2%) 3 (3%) 112 

Chloramphenicol 111 (99%) 0 (0%) 1 (1%) 1 (1%) 112 

Rifampin 111 (99%) 0 (0%) 1 (1%) 1 (1%) 112 

Vancomycin 113 (100%) 0 (0%) 0 (0%) 0 (0%) 113 

Levofloxacin 113 (100%) 0 (0%) 0 (0%) 0 (0%) 113 

Clindamycin 107 (100%) 0 (0%) 0 (0%) 0 (0%) 107 

Cut points from the Minimum Inhibitory Concentration (MIC) Interpretive Standards were used to 

determine if an isolate was ‘susceptible’, ‘intermediate’, or ‘resistant’ to the antibiotic being tested [5]. 

The MIC Interpretive Standards definitions of ‘susceptible’, ‘intermediate’, and ‘resistant’ can be found 

in the Appendix. 

Serotypes found in the PCV7 vaccine are more likely to be non-susceptible to penicillin and 

erythromycin than non-vaccine serotypes. One potential benefit of the use of this vaccine was an 

anticipated decline in antibiotic resistance among circulating pneumococci. The data in the following 

graph supports this assumption; since the initiation of the PCV7 vaccine in 2001, antibiotic resistance 

among invasive pneumococci has dropped. During 2003, TMP-sulfa and penicillin resistance increased, 

however, both decreased in 2004 to similar levels of resistance seen in 2002 and have remained at those 

levels in 2005. After steadily declining since 2000 to a low of 4% in 2004, erythromycin resistance has 

increased to 9% of tested isolates in 2005. 

Figure 10: Trends in Antibiotic Resistance Among 

Invasive Pneumococcal Isolates - Alaska, 1988 - 2005

0

5

10

15

20

25

30

35

1988

1990

1992

1994

1996

1998

2000

2002

2004

Year

Percent Resistant

Pen-FR*

Pen-NS*

Erythro

TMP-Sulfa

Tet

 *Pen-FR = fully resistant, Pen-NS = non-susceptible 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 16 

Invasive Haemophilus influenzae

Overall Incidence

In 2005, there were 9 cases of invasive Haemophilus influenzae in Alaska, for a statewide rate of 

1.4/100,000 persons per year. This rate is the same as the national projected rate of 1.4/100,000 persons 

per year [6]. There was one death caused by Haemophilus influenzae in 2005 for a case fatality ratio of 

12.5% (outcome was unknown in one case). 

Seasonality

Figure 11: Haemophilus influenzae Disease by 

Month of Culture - Alaska, 2005

0

1

2

3

4

January

February

March

April

May

June

July

August

September

October

November

December

Month of Culture

Number of Cases

Due to the small number of cases, trends in seasonality cannot be determined, however, five (56%) of 

the nine cases occurred during the summer (May-July). 

Region

The Anchorage area had the highest proportion of invasive Haemophilus influenzae cases in 2005 (5 

cases, 56%). The Yukon-Kuskokwim Delta area, however, had the highest disease rate of 12/100,000 

persons per year. One case was reported in Norton Sound for a regional rate of 10.6/100,000 persons 

per year. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 17 

Figure 12: Invasive Haemophilus influenzae , 

Cases & Rates by Region - Alaska, 2005

0

1

2

3

4

5

6

Anchorage

Arctic Slope

Bristol Bay

Interior

Kotzebue

Norton Sound

Southeast

YK Delta

Number of Cases

0

2

4

6

8

10

12

14

Rate per 100,000

Cases

Rate

Race

Table 10: Invasive Haemophilus influenzae Cases by Race – Alaska, 2005 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 3 (33) 1.5 67 0 (0)† 

Non-Native 6 (67) 1 83 1 (17) 

Total 9 78 1 (12.5) 

*Cases per 100,000 per percent distribution of Alaska 2000 population 

†Outcome unknown in one AK Native case. 

In 2005, 67% of the cases occurred in non-Natives. Age-adjusted rates were calculated for Alaska 

Natives and non-Natives. The age-adjusted rate ratio of H. influenzae disease for the Alaska Native 

population compared with the non-Native population in 2005 was 1.5. 

Age

Haemophilus influenzae cases ranged in age from less than 6 months to 73 years of age in 2005 (median 

3.6 years). Overall, the highest rates of disease occurred in children less than 2 years old and 2-4 years 

old. 

Rates of disease in Alaska Native versus non-Native populations by age group were variable; overall 

numbers of cases and rates by race and age group are presented in Figure 14. The highest rates of 

disease occurred in Alaska Native children less than two years of age (32.5/100,000 persons per year) 

and 2-4 years old (11.7/100,000 persons per year). There were no cases of Haemophilus influenzae in 

AK Native people 5 years old and older. In non-Natives, cases occurred in all age categories except 5-

18 years; the highest rates of disease were in children less than 2 years old (6.7/100,000 persons per 

year). 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 18 

Figure 13: Invasive Haemophilus influenzae by 

Age Group - Alaska, 2005

0

5

10

15

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Rate per 100,000

Figure 14: Invasive Haemophilus influenzae, Cases & 

Rates by Age Group & Race - Alaska, 2005

0

1

2

3

4

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Number of Cases

0

5

10

15

20

25

30

35

Rate per 100,000

AK Native

(# cases)

Non-Native

(# cases)

AK Native

(rate)

Non-Native

(rate)

Clinical Presentation

The primary clinical presentation was determined by a review of the discharge diagnoses in each 

patient’s individual medical record associated with the invasive bacterial illness. For cases with more 

than one diagnosis, the most serious Haemophilus influenzae-related diagnosis was recorded as the 

primary clinical presentation. In 2005, pneumonia was the most common presentation (67% of cases). 

Haemophilus influenzae was isolated from 7 (78%) blood samples and 2 (22%) cerebrospinal fluid 

samples. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 19 

Table 11: Primary Clinical Presentation of Invasive Haemophilus influenzae - Alaska, 2005 

Primary Presentation n (%) 

Pneumonia* 6 (67) 

Meningitis 3 (33) 

Total 9 

*with bacteremia 

Serotypes

All isolates received at AIP are serotyped. The bacterial capsule is the basis for serotyping and is the 

primary virulence factor. Serotype b has been the most common serotype in the past, but its prevalence 

has decreased with use of the childhood Hib vaccine. Surveillance of serotypes is important for 

monitoring vaccine effectiveness and emergence of non-vaccine serotypes. 

Table 12: Serotypes of Invasive Haemophilus influenzae Cases by Race – Alaska, 2005 

 Alaska Native Non-Native 

Serotype Total n (%) <2 2-18 19-64 65+ <2 2-18 19-64 65+ 

a 1 (11) 1 0 0 0 0 0 0 0 

b 4 (44) 1 1 0 0 0 1 0 1 

f 2 (22) 0 0 0 0 1 0 1 0 

NT* 2 (22) 0 0 0 0 0 0 2 0 

Total 9 2 1 0 0 1 1 3 1 

*Non-typable 

Hib

In recent years, the prevalence of Haemophilus influenzae type b has declined due to increased use of a 

childhood vaccine against this serotype. Four cases of Hib occurred in 2005; two in AK Native 

children, 6 months old and 3.5 years old, one in a non-Native child 2.4 years old and one in a non-Native 

adult 73 years old. Vaccine status was known for the three children; the 6 month old was not vaccinated; 

the 2.4 and 3.5 year old were fully vaccinated (3 doses). The 6 month old presented with meningitis and 

the remaining cases presented with pneumonia. The overall Hib rate for 2005 was 0.6/100,000 persons 

per year; for children less than 2 years, the rate was 4.7/100,000.

Antibiotic Resistance

The 8 Haemophilus influenzae isolates received at AIP were tested for susceptibility to ampicillin, 

chloramphenicol, and ceftriaxone; six isolates were tested for susceptibility to TMP/sulfa. All 8 isolates 

were susceptible to chloramphenicol and ceftriaxone; 2 isolates were fully resistant to ampicillin and the 

remaining 6 were susceptible. One isolate was fully resistance to TMP/sulfa, 3 had intermediate 

resistance and 2 were susceptible. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 20 

Table 13: Summary of Invasive Haemophilus influenzae Case Characteristics, Alaska, 2005 

Sex 

Age 

(Yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) Serotype* 

Associated Medical 

Conditions Survived 

F 0.5 AK Native Other CSF Meningitis B None Yes 

M 0.6 AK Native Other Blood Pneumonia A Chronic lung disease Yes 

M 0.6 Non-Native Anchorage Blood Pneumonia F Chronic lung disease No 

M 2.4 Non-Native Anchorage Blood Pneumonia B None Yes 

M 3.6 AK Native Other Blood Pneumonia B Chronic lung disease Unknown 

F 35.6 Non-Native Anchorage Blood Pneumonia NT Chronic lung disease Yes 

M 62.2 Non-Native Anchorage CSF Meningitis F None Yes 

M 64 Non-Native Anchorage Blood Meningitis NT Cigarette smoking, 

alcohol abuse Yes 

M 73 Non-Native Other Blood Pneumonia B 

Cigarette smoking, 

chronic lung disease, 

immune suppressive 

treatment, diabetes 

Yes 

*NT = non-typeable 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 21 

Invasive Neisseria meningitidis

Overall Incidence

A total of 3 cases of invasive Neisseria meningitidis were reported to AIP in 2005 for an overall 

rate of 0.5/100,000. The Alaska rates are similar to the ABCs 2005 national projected rate of 

0.35/100,000 [7]. There was one invasive N. meningitidis-related death in Alaska in 2005 which 

resulted in a case fatality ratio of 50%; outcome was unknown in one case. 

Seasonality

N. meningitidis cases occurred one each in September, October and November; no clusters of 

related cases were reported. 

Race

In 2005, all cases of invasive N. meningitidis cases in Alaska occurred in the AK Native 

population for an age-adjusted rate of 2.1/100,000 persons per year. 

Table 14: Invasive Neisseria meningitidis Cases by Race – Alaska, 2005 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 3 (100) 2.1 33 1 (50)† 

Non-Native 0 0 0 0 (0) 

Total 3 33 1 (50) 

*Cases per 100,000 per percent distribution of Alaska 2000 population 

†Outcome unknown in one case. 

Region

One case of invasive N. meningitidis occurred in each of the following regions: the Interior, 

Kotzebue and the YK Delta. 

Age

Invasive N. meningitidis cases reported in 2005 ranged in age from 3.1 to 39.8 years old; the 

median age was 5.2 years. 

Clinical Presentation

The primary clinical presentation was determined by a review of the discharge diagnoses in each 

patient’s individual medical record associated with the invasive bacterial illness. In cases with 

multiple discharge diagnoses, the most serious diagnosis related to the N. meningitidis infection 

was recorded as the primary clinical presentation. Two cases presented with meningitis and one 

with septic arthritis; one case had a secondary diagnosis of pneumonia. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 22 

N. meningitidis was isolated from blood samples in two of three (67%) cases in 2005. The 

remaining case was isolated from cerebrospinal fluid. 

Mortality

There was one N. meningitidis-related death reported in Alaska in 2005. The death occurred in a 

39.8 year old AK Native female who presented with meningitis and had no risk factors. 

Serogroup

All three invasive N. meningitidis cases in 2005 were serogrouped; all three were serogroup B.

Table 15: Summary of Invasive Neisseria Meningitidis Cases Characteristics, Alaska, 2005 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) Serogroup 

Associated 

Medical 

Conditions Survived 

F 3.1 AK Native Other Blood Meningitis, 

pneumonia B None Unknown 

M 5.2 AK Native Other Blood Septic arthritis B None Yes 

F 39.8 AK Native Other CSF Meningitis B None No 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 23 

Invasive group A Streptococcus

Overall Incidence

A total of 36 cases of invasive group A Streptococcus (GAS) were reported to AIP in 2005. The 

overall rate of invasive GAS disease in the state of Alaska was 5.4/100,000 persons per year. 

The Alaska rate is higher than the ABCs 2005 national projected rate of 3.6/100,000 [8]. In 

2005, there were 2 GAS-related deaths (emm types 3 and 12) for a case fatality ratio of 5.6%; 

outcome was unknown in two cases. 

Seasonality

Cases of group A Streptococcus occurred throughout the year in 2005 with no apparent trends in 

seasonality. 

Figure 15: Invasive group A Streptococcus , by 

Month of Culture - Alaska, 2005

0

2

4

6

8

January

February

March

April

May

June

July

August

September

October

November

December

Month of Culture

Number of Cases

Race

In 2005, 51% of invasive GAS cases in Alaska occurred in the Alaska Native population for an 

age-adjusted rate of 15.5/100,000 persons per year which was over four and a half times higher 

the non-Native age-adjusted rate of 3.2/100,000 persons per year and over three times the 2003 

age-adjusted rate for Alaska Natives (5/100,000 persons). 

Table 16: Invasive group A Streptococcus Cases by Race – Alaska, 2005 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 19 (53) 15.5 26 2 (11)† 

Non-Native 17 (47) 3.2 53 0 (0)† 

Total 36 39 2 (5.6) 

*Cases per 100,000 per percent distribution of Alaska 2000 population 

†Outcome unknown in one each AK Native and non-Native case 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 24 

Region

Seventeen (47.2%) of the 36 invasive group A Streptococcus cases in 2005 were reported in the 

Anchorage area, 7 cases in the Interior, 6 cases in Southeast, 5 cases in the YK Delta and one 

case in Norton Sound. 

A temporal cluster of GAS infections occurred in the Interior during 2005. Six cases of invasive 

GAS were reported in this area between the dates of 11/8/2005 – 12/12/2005. Since surveillance 

for GAS began in 1999, the number of cases reported from the Interior each year has ranged 

from 1 to 7; in 2001, 7 cases were reported but they occurred throughout the year. During 2003-

2004, one case of GAS had been reported from the Interior each year. The cases in 2005 were 

not a cluster of necrotizing fasciitis cases. There were no known epidemiologic links between 

the patients and none died. PFGE analysis of the isolates from the cases revealed three different 

patterns; emm typing resulted in three different types: 58 (1 case), 2 (1 case) and 87 (4 cases). 

Age

Invasive group A Streptococcus cases reported in 2005 ranged in age from 1.2 to 76.8 years old; 

the median age was 42.6 years. Highest rates of disease occurred in children less than 2 years 

old (9.6/100,000). 

Figure 16: Invasive group A Streptococcus by 

Age Group - Alaska, 2005

0

2

4

6

8

10

12

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Rate per 100,000

When stratified by race, the highest rates of invasive group A streptococcal disease occurred in 

Alaska Native persons 55-64 years old (37.3/100,000 persons per year) and Alaska Native 

children less than 2 years of age (16.7/100,000 persons per year). The highest GAS disease rate 

in the non-Native population occurred in children less than 2 years old (6.7/100,000 persons per 

year). No cases were reported in the non-Native population in the 2-4 or 65 and older age 

categories. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 25 

Figure 17: Invasive group A Streptococcus , Cases 

& Rates by Age Group & Race - Alaska, 2005

0

2

4

6

8

10

12

14

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Number of Cases

0

5

10

15

20

25

30

35

40

45

Rate per 100,000

AK Native

(# cases)

Non-Native

(# cases)

AK Native

(rate)

Non-Native

(rate)

Clinical Presentation

The primary clinical presentation was determined by a review of the discharge diagnoses in each 

patient’s individual medical record associated with the invasive bacterial illness. In cases with 

multiple discharge diagnoses, the most serious diagnosis related to the GAS infection was 

recorded as the primary clinical presentation. Table 17 shows the primary clinical presentations 

of invasive group A Streptococcus in Alaska for 2005. Fourteen cases also presented with 

secondary diagnoses including five cellulitis, three pneumonia and one each osteomyelitis, 

necrotizing fasciitis, endometritis and streptococcal toxic shock syndrome. 

Group A Streptococcus was isolated from blood samples in 31 (86%) of 36 cases, two from joint 

fluid, two from synovial fluid and one from tissue. 

 

Table 17: Primary Clinical Presentations of Invasive group A Streptococcus – Alaska, 2005 

Primary Presentation n (%) 

Bacteremia 9 (25) 

Pneumonia* 7 (20) 

Cellulitis* 5 (14) 

Septic arthritis 4 (11) 

Empyema 3 (9) 

Necrotizing fasciitis 2 (6) 

Endometritis 1 (3) 

Peritonitis 1 (3) 

Amnionitis 1 (3) 

Other 3 (9) 

Total 36 

*with bacteremia
Surveillance of Invasive Bacterial Disease in Alaska, 2005 26 

Table 18: Summary of Invasive group A Streptococcus Case Characteristics, Alaska, 2005 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation Clinical Presentation(s) 

emm

Type 

Associated Medical 

Conditions Survived 

M 1.2 Non-Native Anchorage Blood Septicemia 3 None Yes 

F 1.2 AK Native Other Blood Pneumonia 87 None Yes 

F 4.4 AK Native Other Blood Pneumonia 92 None Yes 

M 8 AK Native Other Joint 

fluid 

Septic arthritis, 

osteomyelitis 1 None Yes 

F 10.5 AK Native Other Blood Septicemia 5 None Yes 

M 11.4 Non-Native Anchorage Blood Other 5 None Yes 

F 20.9 Non-Native Anchorage Blood Amnionitis, endometritis 73 Cigarette smoking, chronic 

lung disease Yes 

F 21.2 Non-Native Other Blood Endometritis 73 Cigarette smoking, chronic 

lung disease Yes 

F 27.8 Non-Native Other Tissue Necrotizing fasciitis, strep 

toxic shock 58 None Yes 

F 29.3 Non-Native Anchorage Blood Pneumonia 5 None Unknown 

F 32.7 AK Native Other Blood Bacteremia 87 Unknown Yes 

M 34.1 Non-Native Anchorage Blood Pneumonia Chronic lung disease, 

alcohol abuse Yes 

F 34.9 AK Native Anchorage Blood Cellulitis, necrotizing 

fasciitis 

Cigarette smoking, alcohol 

abuse Yes 

M 35.7 AK Native Anchorage Blood Septicemia 87 Cigarette smoking, diabetes Yes 

M 38.4 Non-Native Anchorage Blood Empyema, pneumonia, 

strep toxic shock 3 None Yes 

M 40 Non-Native Other Blood Other 1 Cigarette smoking Yes 

M 41 AK Native Anchorage Blood Septicemia 3 Diabetes Yes 

M 42.1 Non-Native Anchorage Blood Empyema, pneumonia 5 Cigarette smoking, alcohol 

abuse, injection drugs Yes 

M 43.1 Non-Native Anchorage Blood Cellulitis 12 None Yes 

F 46 AK Native Other Blood Cellulitis 2 None Yes 

M 46.6 AK Native Other Blood Peritonitis 1 Alcohol abuse Yes 

F 47.1 AK Native Other Blood Cellulitis 87 Alcohol abuse Yes 

F 48.6 AK Native Anchorage Blood Pneumonia 92 Cigarette smoking, chronic 

lung disease, alcohol abuse Unknown 

M 49.8 Non-Native Other Joint 

fluid Septic arthritis, cellulitis 1 Diabetes Yes 

M 50.4 Non-Native Anchorage Blood Empyema, pneumonia 5 Cigarette smoking, alcohol 

abuse Yes 

F 51.2 Non-Native Other Blood Septicemia 28 None Yes 

F 53.5 Non-Native Anchorage Blood Bacteremia 102 None Yes 

M 54.3 AK Native Anchorage Synovial 

fluid Septic arthritis, cellulitis Cigarette smoking, alcohol 

abuse Yes 

F 56.2 Non-Native Other Blood Cellulitis 12 None Yes 

F 59.5 AK Native Other Blood Other 5 Cigarette smoking Yes 

F 61.2 AK Native Anchorage Blood Septicemia 3 Diabetes No 

F 63.1 Non-Native Other Blood Pneumonia, cellulitis 87 Diabetes Yes 

F 63.2 AK Native Other Blood Septicemia 12 Immune suppressive 

treatment No 

F 75.6 AK Native Anchorage Blood Necrotizing fasciitis None Yes 

F 76.4 AK Native Other Synovial 

fluid 

Septic arthritis, cellulitis, 

osteomyelitis 92 Cigarette smoking, chronic 

lung disease Yes 

F 76.8 AK Native Other Blood Pneumonia, cellulitis 87 Alcohol abuse Yes 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 27 

Invasive group B Streptococcus

Overall Incidence

A total of 24 cases of invasive group B Streptococcus (GBS) were reported to AIP in 2005. 

Overall rates of invasive GBS disease in the state of Alaska were 3.6/100,000 persons per year. 

The Alaska rate is lower than the ABCs 2005 national projected rate of 7.3/100,000 [9]. In 2004, 

there were four GBS-related deaths for a case fatality ratio of 19% (outcome was unknown in 3 

cases). 

Seasonality

Cases of group B Streptococcus occurred throughout the year with no apparent trends in 

seasonality. 

Figure 18: Invasive group B Streptococcus , by 

Month of Culture - Alaska, 2005

0

1

2

3

4

5

January

February

March

April

May

June

July

August

September

October

November

December

Month of Culture

Numbuer of Cases

Race

In 2004, 32% of invasive group B Streptococcus cases in Alaska occurred in the Alaska Native 

population for an age-adjusted rate of 7.4/100,000 persons per year which is three times the nonNative rate of 2.4/100,000 persons per year. 

Table 19: Invasive group B Streptococcus Cases by Race – Alaska, 2005 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 10 (42) 7.4 50 1 (11)† 

Non-Native 14 (58)‡ 2.4 43 3 (25)† 

Total 24 46 4 (19) 

*Cases per 100,000 per percent distribution of Alaska 2000 population 

†Outcome unknown in 1AK Native, 2 non-Native cases 

‡Includes one case for which race was unknown 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 28 

Region

In 2005, 17 of the 24 reported GBS cases occurred in Anchorage; three cases were reported in 

the Interior, two cases in Southeast Alaska, and one each in Kotzebue and the YK Delta. 

Age

Invasive group B Streptococcus cases reported in 2005 ranged in age from newborn to 89.7 years 

old; the median age was 53.3 years. Highest rates of disease occurred in children less than two 

years old (28.4/100,000 persons per year). 

Figure 19: Invasive group B Streptococcus by 

Age Group - Alaska, 2005

0

5

10

15

20

25

30

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Rate per 100,000

Figure 20: Invasive group B Streptococcus, Cases & 

Rates by Age Group & Race - Alaska, 2005

0

1

2

3

4

5

6

<2 2-4 5-18 19-54 55-64 65+

Age (yrs)

Number of Cases

0

10

20

30

40

50

60

Rate per 100,000

AK Native

(# cases)

Non-Native

(# cases)

AK Native

(rate)

Non-Native

(rate)

The highest rates of disease occurred in AK Native children less than 2 years of age 

(48.7/100,000 persons per year). Two of three cases that occurred in this age category were 

early-onset disease (cases less than 7 days old); and comprised a rate of 0.6/1,000 births. Of the 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 29 

three cases that occurred in children less than 2 years old in non-Natives, two were early-onset 

disease for a rate of 0.3/1,000 births. 

Clinical Presentation

The primary clinical presentation was determined by a review of the discharge diagnoses in each 

patient’s individual medical record associated with the invasive bacterial illness. In cases with 

multiple discharge diagnoses, the most serious diagnosis related to the GBS infection was 

recorded as the primary clinical presentation. In 2005, the most common clinical presentation 

was bacteremia which occurred in 12 cases (50%). 

Group B Streptococcus was isolated from blood in 23 (96%) of 24 cases in 2005; one case was 

isolated from cerebrospinal fluid. 

Table 20: Primary Clinical Presentations of Invasive group B Streptococcus – Alaska, 2005 

*with bacteremia

Antibiotic Resistance

Susceptibility testing was performed on 19 GBS isolates received in 2005. Results of the testing 

are presented in the following table. 

Table 21: Antibiotic Resistance in Invasive group B Streptococcus Isolates – Alaska, 2005 

Antibiotic Susceptible Intermediate Resistant I + R Total Tested 

Penicillin 19 (100%) 0 (0%) 0 (0%) 0 (0%) 19 

Cefotaxime 19 (100%) 0 (0%) 0 (0%) 0 (0%) 19 

Erythromycin 10 (53%) 0 (0%) 9 (47%) 9 (47%) 19 

Tetracycline 1 (5%) 0 (0%) 18 (85%) 18 (95%) 19 

Levoflox 18 (95%) 1 (5%) 0 (0%) 1 (5%) 19 

Clindamycin 14 (74%) 0 (0%) 5 (26%) 5 (26%) 19 

All isolates tested were susceptible to penicillin and cefotaxime. Resistance to erythromycin and 

clindamycin, either intermediate or full, was seen in 65% and 43%, respectively, of isolates 

tested. Isolates from three of the four early onset cases were tested; all were resistant to 

tetracycline and one isolate was additionally resistant to erythromycin and clindamycin.

Primary Presentation n (%) 

Bacteremia 12 (50) 

Osteomyelitis 4 (17) 

Cellulitis* 3 (12.5) 

Pneumonia* 3 (12.5) 

Meningitis 1 (4) 

Amnionitis 1 (4) 

Total 24 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 30 

Table 21: Summary of Invasive group B Streptococcus Case Characteristics, Alaska, 2005 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s)

Associated Medical 

Conditions Survived 

M < 1 day AK Native Anchorage Blood Septicemia None Yes 

M < 1 day AK Native Other Bood Septicemia None Yes 

F < 1 day Non-Native Anchorage Blood Pneumonia None Yes 

F < 1 week Non-Native Anchorage Blood Septicemia None Yes 

M 0.1 AK Native Other CSF Meningitis None Unknown 

M 0.2 Non-Native Anchorage Blood Septicemia Chronic lung disease No 

F 35.4 AK Native Anchorage Blood Amnionitis 

Cigarette smoking, 

chronic lung disease, 

diabetes 

Yes 

F 39.4 AK Native Other Blood Septicemia Immune suppressive 

treatment No 

F 48.3 AK Native Other Blood Osteomyelitis None Yes 

M 51.1 Non-Native Anchorage Blood Osteomyelitis Diabetes Yes 

F 51.9 Non-Native Anchorage Blood Cellulitis 

Cigarette smoking, 

immune suppressive 

treatment 

Unknown 

M 52.6 Non-Native Other Blood Osteomyelitis Diabetes Yes 

F 54 Non-Native Anchorage Blood Cellulitis None Yes 

F 63.4 AK Native Other Blood Septicemia None Yes 

M 63.5 AK Native Other Blood Cellulitis 

Chronic lung 

disease, alcohol 

abuse 

Yes 

F 64.4 Non-Native Anchorage Blood Septicemia Cigarette smoking, 

alcohol abuse No 

F 64.6 Non-Native Anchorage Blood Septicemia None Yes 

M 66.9 Non-Native Anchorage Blood Septicemia None Yes 

M 68.3 AK Native Anchorage Blood Osteomyelitis None Yes 

M 69.3 Non-Native Anchorage Blood Septicemia None Yes 

M 71.3 Non-Native Anchorage Blood Pneumonia Chronic lung disease No 

F 72 Non-Native Anchorage Blood Pneumonia 

Chronic lung 

disease, immune 

suppressive 

treatment, diabetes 

Yes 

Unk 88.6 Unknown Anchorage Blood Bacteremia Unknown Unknown 

F 89.7 AK Native Anchorage Blood Bacteremia None Yes 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 31 

References 

[1] State of Alaska, Department of Labor & Workforce Development. Retrieved 7/27/2006 from 

http://almis.labor.state.ak.us 

[2] Centers for Disease Control and Prevention. 2006. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2005.

[3] HennessyTW, Singleton RJ, Bulkow LR, Bruden DL, Hurlburt DA, Parks, D, Moore M, 

Parkinson AJ, Schuchat A, Butler JC. Impact of heptavalent pneumococcal conjugate 

vaccine on invasive disease; antimicrobial resistance and colonization in Alaska Natives: 

progress towards elimination of a health disparity. Vaccine 2005;23:5464-5473. 

[4] State of Alaska, Department of Health & Human Services. Retrieved 7/30/2007 from 

http://www.epi.hss.state.ak.us/id/iz/vaxpacket/vis/vis-PneumoPoly.pdf

[5] National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards 

for Antimicrobial Susceptibility Testing; Fourteenth Informational Supplement. 2004; 24(1): 

M100-S14. 

[6] Centers for Disease Control and Prevention. 2006. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Haemophilus influenzae, 2005. 

[7] Centers for Disease Control and Prevention. 2006. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Neisseria meningitidis, 2005. 

[8] Centers for Disease Control and Prevention. 2006. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Group A Streptococcus, 2005. 

[9] Centers for Disease Control and Prevention. 2006. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Group B Streptococcus, 2005. 
Surveillance of Invasive Bacterial Disease in Alaska, 2005 32 

Appendix 

MIC Interpretive Standards Definitions: 

 NCCLS [5] provides recommended interpretive categories for various Minimum Inhibitory 

Concentration values (cut points) for each organism which are defined as follows: 

1. Susceptible (S): 

The “susceptible” category implies that an infection due to the strain may be appropriately treated 

with the dosage of antimicrobial agent recommended for that type of infection and infecting 

species, unless otherwise contraindicated. 

2. Intermediate (I): 

The “intermediate” category includes isolates with antimicrobial agent MICs that approach 

usually attainable blood and tissue levels and for which response rates may be lower than for 

susceptible isolates. The “intermediate” category implies clinical applicability in body sites 

where the drugs are physiologically concentrated (e.g., quinolones and -lactams in urine) or 

when a high dosage of a drug can be used (e.g., -lactams). The “intermediate” category also 

includes a buffer zone which should prevent small, uncontrolled technical factors from causing 

major discrepancies in interpretations, especially for drugs with a narrow pharmacotoxicity 

margins. 

3. Resistant (R): 

Resistant strains are not inhibited by the usually achievable systemic concentrations of the agent 

with normal dosage schedules and/or fall in the range where specific microbial resistance 

mechanisms are likely (e.g., -lactamases) and clinical efficacy has not been reliable in treatment 

studies.