Surveillance of Invasive Bacterial Disease in Alaska, 2006 

Arctic Investigations Program 

National Center for Preparedness, Detection & Control of 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, 2006 2 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 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, 2006 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 in an Alaska resident. 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 pneumococcal 

conjugate vaccine and Haemophilus influenzae type b vaccines. 

Figure 1: Invasive Bacterial Disease Surveillance Regions – Alaska, 2006 

In 2006, the total numbers of cases of invasive disease caused by these organisms reported to AIP were 138 S. 

pneumoniae, 19 H. influenzae, 3 N. meningitidis, 39 group A Streptococci (GAS) and 25 group B Streptococci

(GBS). Alaska Native people had higher rates of disease than non-Native people for all surveillance organisms. 

Rates of invasive pneumococcal disease and H. influenzae were highest in the YK Delta. Rates for each 

organism by region are presented in the following table. 

Arctic Slope

Interior

Kotzebue

Norton Sound

YK Delta

Bristol Bay

Anchorage

Southeast
Surveillance of Invasive Bacterial Disease in Alaska, 2006 5 

Table 1: Surveillance Organisms Reported by Region – Alaska, 2006 

Region 

S. pneumoniae 

n (rate*) 

H. influenzae 

n (rate*) 

N. meningitidis 

n (rate*) 

GAS 

n (rate*) 

GBS 

n (rate*) 

Anchorage 80 (18) 7 (1.6) 1 (0.2) 27 (6.1) 17 (3.8)

Arctic Slope 1 (17.3) 0 (0) 0 (0) 2 (34.7) 1 (17.3)

Bristol Bay 0 (0) 1 (14) 0 (0) 0 (0) 1 (14) 

Interior 15 (14.8) 2 (2) 0 (0) 6 (5.9) 3 (3) 

Kotzebue 5 (62) 0 (0) 1 (12.4) 0 (0) 1 (12.4) 

Norton Sound 5 (52.4) 1 (10.5) 0 (0) 0 (0) 0 (0) 

Southeast 7 (10) 1 (1.4) 0 (0) 1 (1.4) 2 (2.9) 

YK Delta 25 (100.4) 7 (28.1) 1 (4) 3 (12) 0 (0) 

Total 138 (20.6) 19 (2.8) 3 (0.4) 39 (5.8) 25 (3.7)

*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 670,053 persons in 2006 

[1]. Case detection occurs year-round as participating laboratories send isolates recovered from sterile sites to 

the AIP laboratory 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 laboratory by AIP. At yearend, AIP asks that each laboratory review their records and provide information on any cases that may have 

been overlooked. In 2006, 23 laboratories in Alaska participated in the invasive disease surveillance system, 

either by sending isolates to the AIP laboratory throughout the year, conducting year-end record reviews, or 

both. 

AIP defines a case of invasive S. pneumoniae, H. influenzae, N. meningitidis, GAS or GBS 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 GAS, 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, 2006 6 

Invasive Pneumococcal Disease 

Overall Incidence

A total of 135 pneumococcal isolates were received at AIP in 2006. An additional 3 cases were detected 

through year-end follow up with participating laboratories throughout the state for a total of 138 cases of 

invasive pneumococcal disease. The overall rate for invasive pneumococcal disease in 2006 was 20.6 per 

100,000 persons per year. Alaska rates for 2006 were higher than the Active Bacterial Core Surveillance 

(ABCs) 2006 national projected rate of 13.8/100,000 [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 2006. The largest number of cases 

was reported in December. 

Figure 2: Invasive Pneumococcal Disease, by 

Month of Culture - Alaska, 2006

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 2006, the state population was comprised of 19.6% Alaska Native people (Alaska Natives 131,002, nonNatives 539,051) [1]. The percentage of all reported S. pneumoniae cases that occurred in 2006 among Alaska 

Native people was 54%; for a total of 74 cases resulting in an age-adjusted rate of 52.7/100,000 persons per 

year. Sixty-four cases occurred among the non-Native population for an age-adjusted rate of 11.2/100,000 

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 2006 is 4.7. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 7 

Table 2: Invasive Streptococcus pneumoniae Cases by Race – Alaska, 2006 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 74 (54) 52.7 48 4 (5) 

Non-Native† 64 (46) 11.2 64 7 (11)‡ 

Total 138 56 11 (8) 

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

†Includes 1 case for which race was unknown 

‡Outcome unknown for 1 non-Native case

Region 

The highest percentage (58%) of invasive pneumococcal disease cases occurred in the Anchorage area in 2006. 

Rates of disease, however, were highest in the YK Delta (100.4/100,000 persons per year). 

Figure 3: Invasive Pneumococcal Disease, Cases 

& Rates by Region - Alaska, 2006

0

20

40

60

80

100

Anchorage

Arctic Slope

Bristol Bay

Interior

Kotzebue

Norton Sound

Southeast

YK Delta

Number of Cases

0

20

40

60

80

100

120

Rate per 100,000

Cases

Rate

Age

Cases occurred in all age groups in 2006 ranging from 10 days to 101.6 years with a median age of 46 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 2006 occurred in Alaska Native children less 

than 2 years old (335.9/100,000 persons per year). 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 8 

Figure 4: Invasive Pneumococcal Disease, Cases 

& Rates by Age Group & Race - Alaska, 2006

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

300

350

400

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 142.2/100,000 in 2006. 

Although pneumococcal disease rates dropped initially in AK Native and non-Native children less than 2 years 

of age 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 335.9/100,000 in 2006. Rates of invasive disease in non-Native children less 

than 2 years declined during the same time period reaching a low of 26.8 in 2005 and increasing to 

60.6/100,000 in 2006. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 9 

Figure 6: Invasive Pneumococcal Disease in 

Alaska Natives, by Age Group - Alaska, 2001-2006

0

50

100

150

200

250

300

350

400

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

Age (yrs)

Rate per 100,000

2001

2002

2003

2004

2005

2006

Figure 7: Invasive Pneumococcal Disease in NonNatives, by Age Group - Alaska, 2001-2006

0

50

100

150

200

250

300

350

400

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

Age (yrs)

Rate per 100,000

2001

2002

2003

2004

2005

2006

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 2006 (67%) 

followed by bacteremia (17%). Twelve cases had a secondary pneumococcal-related diagnosis in 2006 - 11 

pneumonia and 1 empyema. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 10 

Figure 8: Primary Clinical Presentations of 

Invasive Pneumococcal Disease - Alaska, 2006

93

23 19

7

1 1 1

0

20

40

60

80

100

Pneumonia*

Bacteremia

MeningitisEmpyema

Septic arthritis

Cellulitis*

Other

Number of Cases

*w ith bacteremia

In 2006, blood was the most common source of a positive culture which was used to identify 126 (91%) of 138 

cases. Cerebrospinal fluid was the positive site for 5% of cases, 3 cases were identified from autopsy samples 

and 1 case each was identified through pleural fluid and an unspecified other sterile site.

Mortality 

In 2006, the overall case fatality ratio for S. pneumoniae in Alaska was 8% (11 deaths out of 137 cases for 

which outcome was known). The case fatality ratio for non-Natives was higher than Natives; 11.1% (7 deaths) 

and 5.4% (4 deaths), respectively. The majority of deaths and the highest case fatality ratio occurred in the 65+ 

age category; 20.7% (6 deaths). 

Figure 9: Invasive Pneumococcal Deaths & Case 

Fatality Ratios by Age Group - Alaska, 2006

0

1

2

3

4

5

6

7

<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, 2006 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, 2006 

 Alaska Native Non-Native Unknown 

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

01 1 (<1) - - - - - - - 1 - 

03 7 (5) - - - 1 2 1 1 2 - 

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

06A 6 (4) 2 - - - 1 - 2 - 1 

06B 1 (<1) - - - - - - - 1 - 

07C 1 (<1) - - - - - - 1 - - 

07F 23 (17) 4 1 4 2 2 1 8 1 - 

08 13 (10) - - 7 1 - - 5 - - 

09N 3 (2) - 1 - - - - 2 - - 

09V 1 (<1) - - - - - - - 1 - 

10A 1 (<1) - - - 1 - - - - - 

10F 1 (<1) - - - - - 1 - - - 

11A 1 (<1) - - 1 - - - - - - 

12F 12 (9) 2 3 4 2 - - 1 - - 

14 2 (1.5) - - - - - - 2 - - 

15A 4 (3) 1 - 1 1 - - - 1 - 

15B 1 (<1) - - - - - - - 1 - 

15C 1 (<1) - - - - - - 1 - - 

16F 2 (1.5) 1 - - - - 1 - - - 

17F 4 (3) - 1 1 1 - 1 - - - 

19A 18 (13) 7 1 1 1 2 - 3 3 - 

20 5 (4) - - 4 - - - - 1 - 

22F 4 (3) 1 - 2 - - - - 1 - 

23A 3 (2) - - - 1 - - 1 1 - 

23B 3 (2) - - - - 1 1 - 1 - 

31 1 (<1) - - - - - - 1 - - 

33A 1 (<1) - - - 1 - - - - - 

33F 3 (2) 1 1 1 - - - - - - 

34 2 (1.5) - - 1 - - - - 1 - 

35B 2 (1.5) - - 1 - - - - 1 - 

35F 3 (2) 1 - - - - 1 - 1 - 

NT* 1 (<1) - - 1 - - - - - - 

Total 134 20 8 31 12 8 7 29 18 1 

*Non-typeable 

In 2006, the most common pneumococcal serotype was 7F (23 isolates, 17%). 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 1.5% of serotyped isolates in 

2006. However, disease caused by serotypes 7F and 19A, which are not included in the conjugate vaccine, 

increased. Prior to 2005, yearly numbers of cases of serotype 7F disease and the proportion of total isolates 

have ranged from 1 to 10 and 0.9% to 9.3%, respectively. Although the majority (62.5%) of serotype 7F

disease occurred in AK Natives during 2005, it was more evenly distributed between AK Native people (48%) 

and non-Natives (52%) in 2006. In 2006, the majority (65%) of serotype 7F cases occurred in the Anchorage 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 12 

area; serotype 19A cases were more widely distributed throughout the state although the largest proportion 

(48%) of cases occurred in Anchorage. 

Table 4: Invasive Pneumococcal Serotype Distribution by Region – Alaska, 2006 

Serotype 

Anchorage 

Arctic 

Slope 

Interior 

Kotzebue 

Norton 

Sound 

Southeast 

YK Delta 

01 1 - - - - - - 

03 7 - - - - - - 

04 1 - 1 1 - - - 

06A 4 - - - - - 2 

06B 1 - - - - - - 

07C - - 1 - - - - 

07F 15 - 1 - - - 7 

08 12 - - - - 1 - 

09N 1 - - - - 1 1 

09V - - 1 - - - - 

10A - - - - - - 1 

10F 1 - - - - - - 

11A - - - - - - 1 

12F 5 - - 2 2 - 3 

14 1 - 1 - - - - 

15A - - 1 - 1 1 1 

15B 1 - - - - - - 

15C 1 - - - - - - 

16F - - - - - - 2 

17F 2 - 1 - - - - 

19A 11 1 2 1 - 1 3 

20 2 - 3 - - - - 

22F 2 - - 1 1 - - 

23A 2 - - - - - - 

23B 1 - 1 - - 1 - 

31 1 - - - - - - 

33A - - 1 - - - - 

33F - - - - 1 - 2 

34 1 - - - - - 1 

35B 1 - - - - 1 - 

35F 2 - - - - 1 - 

NT* - - 1 - - - - 

Total 77 1 15 5 5 7 24 

*Non-typeable 

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 2006 that were due to 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 13 

serotypes found in the PCV7 vaccine. There were no cases of pneumococcal disease caused by serotypes 

contained in the PCV7 vaccine in children less than 5 years of age, the age group for which the vaccine is 

recommended. 

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

Alaska, 2006 

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

<2 0 (0%) of 20 0 (0%) of 9 0 (0%) of 29 

2-4 0 (0%) of 4 0 (0%) of 3 0 (0%) of 7 

5+ 2 (4%) of 47 5 (10%) of 51 7 (7%) of 98 

Total 2 (3%) of 71 5 (8%) of 63 7 (5%) of 134 

For the year covered by this report, the 23-valent polysaccharide vaccine (Ps23V) was 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 was recommended after 6 years [4]. In 2006, for persons 55 years and older, 32 (76%) of 42 

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 no 

vaccine failures in 2006. 

Potentially Preventable Deaths

In 2006, pneumococcal vaccine status was known for 95 (69%) of the 138 cases; 64 cases (46%) did receive a 

pneumococcal vaccine prior to illness and 31 cases (22%) had no record of a pneumococcal vaccine. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 14 

Table 6: Potentially Vaccine Preventable Invasive Pneumococcal Deaths – Alaska, 2006 

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

PCV7 0 0 0 0 0 1 (17%) 1 (9%) 

Ps23V 1 (100%)* 0 0 1 (33%) 0 4 (66%) 6 (55%) 

Non-Vaccine 0 1 (100%) 0 1 (33%) 0 1 (17%) 3 (17%) 

Unknown 0 0 0 1 (33%) 0 0 1 (9%) 

Total 1 1 0 3 0 6 11 

*Ps23V not recommended for use in children < 2 

Overall, 45% of all pneumococcal-related mortality in 2006 was potentially preventable with the use of the 23-

valent polysaccharide vaccine in persons over 2 years old; 17% of deaths were due to disease caused by

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

Six of the 11 deaths in 2006 from invasive S. pneumoniae occurred from serotypes contained within the Ps23V

vaccine; 5 of the deaths were in individuals eligible for the vaccine. Of those five deaths, two occurred in 

vaccinated individuals; time since vaccination for each was 3 years and 4 years. 

Table 7: Invasive Pneumococcal Disease, Serotypes of Fatal Cases – Alaska, 2006 

Serotype 

Deaths 

n (%) 

Serotype 

Frequency (n) 

01† 1 (100%) 1 

03† 1 (14%) 7 

06B*† 1 (100%) 1 

15B† 1 (100%) 1 

19A† 2 (11%) 18 

22F† 1 (25%) 4 

34 2 (100%) 2 

35F 1 (33%) 3 

NT 1 (100%) 1 

*Serotypes contained in the PCV7 vaccine 

†Serotypes contained in the 23-valent polysaccharide vaccine 

‡Non-typeable

Associated Medical Conditions

The presence of one or more associated medical conditions was reported in 82% of invasive pneumococcal

cases in 2006. 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, 2006* 

Medical Condition/Risk 

Factor 

Adult Cases (≥ 18 years) 

n=93, Cases (%) 

Cigarette smoking 43 (46) 

Alcohol abuse 36 (39) 

Chronic lung disease 29 (31) 

Diabetes 14 (15) 

Immunosuppressive treatment 5 (5) 

Injection drug use 1 (1) 

Asplenia 0 (0) 

*More than one risk factor was identified in several cases 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 15 

Antibiotic Resistance

Susceptibility testing was performed on all isolates received in 2006. Results of the testing are presented in the 

following table. 

Table 9: Antibiotic Resistance in Invasive Streptococcus pneumoniae Isolates – Alaska, 2006 

Antibiotic Susceptible Intermediate Resistant I + R Total Tested 

Penicillin 104 (78%) 25 (19%) 5 (4%) 29 (22%) 134 

TMP-sulfa 108 (81%) 10 (7%) 16 (12%) 26 (19%) 134 

Erythromycin 125 (93%) 0 (0%) 9 (7%) 9 (7%) 134 

Ceftriaxone 133 (99%) 1 (1%) 0 (0%) 1 (1%) 134 

Tetracycline 131 (98%) 0 (0%) 2 (2%) 2 (2%) 133 

Chloramphenicol 134 (100%) 0 (0%) 0 (0%) 0 (0%) 134 

Rifampin 132 (99%) 2 (1%) 0 (0%) 2 (1%) 134 

Vancomycin 133 (100%) 0 (0%) 0 (0%) 0 (0%) 133 

Levofloxacin 134 (100%) 0 (0%) 0 (0%) 0 (0%) 134 

Clindamycin 132 (99%) 0 (0%) 2 (1%) 2 (1%) 134 

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 2006. After steadily declining since 2000 to a low 

of 4% in 2004, erythromycin resistance increased to 9% of tested isolates in 2005 and decreased slightly to 7% 

in 2006. 

Figure 10: Trends in Antibiotic Resistance Among 

Invasive Pneumococcal Isolates - Alaska, 1989 - 2006

0

5

10

15

20

25

30

35

1989

1991

1993

1995

1997

1999

2001

2003

2005

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, 2006 16 

Invasive Haemophilus influenzae

Overall Incidence 

In 2006, there were 19 cases of invasive Haemophilus influenzae in Alaska, for a statewide rate of 2.8/100,000 

persons per year. This rate is higher than the national projected rate of 1.6/100,000 persons per year [6]. There 

were three deaths caused by H. influenzae in 2006 for a case fatality ratio of 15.8%. 

Seasonality 

Cases of invasive H. influenzae occurred throughout 2006, however, due to the small number of cases, trends in 

seasonality cannot be determined. 

Region 

Although the Anchorage and YK Delta areas had the same number of invasive H. influenzae cases in 2006 (7 

cases each), the rate of disease was significantly higher in the YK Delta (28.1/100,000) than in Anchorage 

(1.6/100,000). Other areas with high rates of disease were Bristol Bay (14.1/100,000) and Norton Sound 

(10.5/100,000) although there was only one case in each region. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 17 

Figure 12: Invasive Haemophilus influenzae , 

Cases & Rates by Region - Alaska, 2006

0

1

2

3

4

5

6

7

8

Anchorage

Arctic Slope

Bristol Bay

Interior

Kotzebue

Norton Sound

Southeast

YK Delta

Number of Cases

0

5

10

15

20

25

30

Rate per 100,000

Cases

Rate

Race 

Table 10: Invasive Haemophilus influenzae Cases by Race – Alaska, 2006 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 13 (68) 8 46 3 (23) 

Non-Native 6 (32) 1 83 0 (0) 

Total 19 58 3 (16) 

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

In 2006, 68% of the cases occurred in Alaska 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 2006 was 8. 

Age 

H. influenzae cases ranged in age from newborn to 73 years of age in 2006 (median 45.7 years). Overall, the 

highest rates of disease occurred in children less than 2 years old and adults 65 and older. 

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 (96/100,000 persons per year) and Alaska Native adults 65 

years and older (26.3/100,000 persons per year). In non-Natives, 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, 2006 18 

Figure 13: Invasive Haemophilus influenzae by 

Age Group - Alaska, 2006

0

5

10

15

20

25

30

35

<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, 2006

0

1

2

3

4

5

6

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

Age (yrs)

Number of Cases

0

20

40

60

80

100

120

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 H. influenzae-related diagnosis was recorded as the primary clinical presentation. In 2006, 

pneumonia was the most common presentation (47% of cases). 

H. influenzae was isolated from 14 (74%) blood samples, 3 (16%) cerebrospinal fluid samples and 2 (10%) 

autopsy samples. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 19 

Table 11: Primary Clinical Presentation of Invasive Haemophilus influenzae - Alaska, 2006 

Primary Presentation n (%) 

Pneumonia* 9 (47) 

Bacteremia 6 (32) 

Meningitis 3 (16) 

Unknown 1 (5) 

Total 19 

*with bacteremia 

Serotypes 

All isolates received at AIP are serotyped; 18 of the 19 cases in 2006 had isolates and were 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, 2006 

 Alaska Native Non-Native 

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

a 2 2 0 0 0 0 0 0 0 

b 3 0 2 0 0 0 0 1 0 

d 1 1 0 0 0 0 0 0 0 

e 1 0 0 0 0 0 0 1 0 

f 4 2 0 0 0 0 0 1 1 

NT* 7 1 0 3 1 1 0 1 0 

Total 18 6 2 3 1 1 0 4 1 

*Non-typable 

Hib

In recent years, the prevalence of H. influenzae type b has declined due to increased use of a childhood vaccine 

against this serotype. Three cases of Hib occurred in 2006; two in AK Native children, 2.7 and 7.4 years old, 

and one in a non-Native adult 54.7 years old. Vaccine status was known for the two children and both were 

fully vaccinated (3 doses). All three cases presented with pneumonia and bacteremia. The overall Hib rate for 

2006 was 0.4/100,000 persons per year; the rate in AK Native people was 1.5/100,000 persons per year.

Antibiotic Resistance 

Eighteen Haemophilus influenzae isolates received at AIP were tested for susceptibility to chloramphenicol, 

ceftriaxone and TMP/sulfa. All 18 isolates were susceptible to chloramphenicol and ceftriaxone; 4 isolates 

were fully resistant to TMP/sulfa, 3 had intermediate resistance and 9 were susceptible. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 20 

Table 13: Summary of Invasive Haemophilus influenzae Case Characteristics, Alaska, 2006 

Sex Age (Yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) Serotype* 

Associated Medical 

Conditions Survived 

F Newborn Non-Native Anchorage Blood Bacteremia NT None Yes 

F 0.2 AK Native Other Autopsy Unknown NT Unknown No

M 0.4 AK Native Other Blood Pneumonia F None Yes 

F 0.5 AK Native Other CSF Meningitis F None Yes 

M 0.6 AK Native Other Autopsy Pneumonia A Chronic lung disease No 

F 1.0 AK Native Other CSF Meningitis A None Yes 

M 1.5 AK Native Other Blood Bacteremia D None Yes 

F 2.7 AK Native Other Blood Pneumonia B None Yes 

M 7.4 AK Native Other Blood Pneumonia B Chronic lung disease Yes 

F 45.7 AK Native Anchorage Blood Bacteremia NT Cigarette smoking, 

alcohol abuse No 

M 52.2 Non-Native Anchorage Blood Pneumonia NT None Yes 

M 54.7 Non-Native Anchorage Blood Pneumonia B Cigarette smoking, 

alcohol abuse Yes 

M 56.2 Non-Native Anchorage CSF Meningitis F Diabetes Yes 

M 57.9 Non-Native Anchorage Blood Pneumonia E Chronic lung disease Yes 

M 62.1 AK Native Anchorage Blood Pneumonia NT 

Cigarette smoking, 

chronic lung disease, 

alcohol abuse 

Yes 

F 62.4 AK Native Other Blood Pneumonia NT 

Cigarette smoking, 

chronic lung disease, 

alcohol abuse 

Yes 

F 65.5 AK Native Other Blood Bacteremia Unknown 

Cigarette smoking, 

immune suppressive 

treatment, diabetes 

Yes 

M 68.4 Non-Native Other Blood Bacteremia F None Yes

M 73.1 AK Native Other Blood Bacteremia NT Chronic lung disease, 

alcohol abuse Yes 

*NT = non-typeable 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 21 

Invasive Neisseria meningitidis

Overall Incidence

A total of 3 cases of invasive Neisseria meningitidis were reported to AIP in 2006 for an overall 

rate of 0.4/100,000. The Alaska rates are similar to the ABCs 2006 national projected rate of 

0.3/100,000 [7]. There were no invasive N. meningitidis-related deaths in Alaska in 2006. 

Seasonality

N. meningitidis cases occurred one each in February, July and November; no clusters of related 

cases were reported. 

Race

In 2006, 67% of the cases occurred in Alaska Natives. Age-adjusted rates were calculated for 

Alaska Natives and non-Natives. The age-adjusted rate ratio of N. meningitidis disease for the 

Alaska Native population compared with the non-Native population in 2006 was 5. 

Table 14: Invasive Neisseria meningitidis Cases by Race – Alaska, 2006 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 2 (67) 1.0 50 0 (0) 

Non-Native 1 (33) 0.2 0 0 (0) 

Total 3 33 0 (0) 

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

Region

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

Kotzebue and the YK Delta. 

Age

Invasive N. meningitidis cases reported in 2006 ranged in age from 1.9 to 25.7 years old; the 

median age was 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 bacteremia. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 22 

N. meningitidis was isolated from cerebrospinal fluid in two of three (67%) cases in 2006. The 

remaining case was isolated from blood. 

Mortality

There were no N. meningitidis-related deaths reported in Alaska in 2006. 

Serogroup 

All three invasive N. meningitidis cases in 2006 were serogrouped; two were serogroup B and 

one was serogroup Y.

Table 15: Summary of Invasive Neisseria Meningitidis Cases Characteristics, Alaska, 2006 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) Serogroup 

Associated 

Medical 

Conditions Survived 

M 1.9 AK Native Other CSF Meningitis B None Yes 

F 2.0 AK Native Other CSF Meningitis B None Yes 

F 25.7 NonNative Anchorage Blood Bacteremia Y None Yes 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 23 

Invasive group A Streptococcus

Overall Incidence

A total of 39 cases of invasive group A Streptococcus (GAS) were reported to AIP in 2006. The 

overall rate of invasive GAS disease in the state of Alaska was 5.8/100,000 persons per year. 

The Alaska rate is higher than the ABCs 2006 national projected rate of 3.8/100,000 [8]. In 

2006, there were 3 GAS-related deaths (emm types 73 and 92, 1 unknown) for a case fatality 

ratio of 7.9%; outcome was unknown in one case. 

Seasonality 

Cases of group A Streptococcus occurred throughout the year in 2006 with no apparent trends in 

seasonality. 

Figure 15: Invasive group A Streptococcus , by 

Month of Culture - Alaska, 2006

0

2

4

6

8

10

January

February

March

April

May

June

July

August

September

October

November

December

Month of Culture

Number of Cases

Race

In 2006, 51% of invasive GAS cases in Alaska occurred in the Alaska Native population for an 

age-adjusted rate of 17/100,000 persons per year which was over five times higher the nonNative age-adjusted rate of 3.4/100,000 persons per year. 

Table 16: Invasive group A Streptococcus Cases by Race – Alaska, 2006 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 20 (51) 17 55 1 (5) 

Non-Native 19 (49) 3.4 53 2 (11)† 

Total 39 54 3 (7.9) 

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

†Outcome unknown in one non-Native case 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 24 

Region

Twenty-seven (69.2%) of the 39 invasive group A Streptococcus cases in 2006 were reported in 

the Anchorage area, 6 cases in the Interior, 3 cases in the YK Delta, 2 cases in the Arctic Slope 

and one case in Southeast. 

Age

Invasive group A Streptococcus cases reported in 2006 ranged in age from 0.8 to 93.4 years old; 

the median age was 39.6 years. Highest rates of disease occurred in children less than 2 years 

old (28.4/100,000). 

Figure 16: Invasive group A Streptococcus by 

Age Group - Alaska, 2006

0

5

10

15

20

25

30

<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 children less than two years old (64/100,000 persons per year) and Alaska Native 

persons 65 and older (52.6/100,000 persons per year). The highest GAS disease rate in the nonNative population occurred in children less than 2 years old (13.5/100,000 persons per year). 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 25 

Figure 17: Invasive group A Streptococcus , Cases 

& Rates by Age Group & Race - Alaska, 2006

0

2

4

6

8

10

12

14

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

Age (yrs)

Number of Cases

0

10

20

30

40

50

60

70

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 2006. Six cases also presented with secondary 

diagnoses including septic arthritis, endocarditis, cellulitis and pneumonia. 

Group A Streptococcus was isolated from blood samples in 28 (72%) of 39 cases, four from joint 

fluid, two from an abscess, one each from peritoneal fluid, pleural fluid and a wound, and two 

from other sterile sites. 

 

Table 17: Primary Clinical Presentations of Invasive group A Streptococcus – Alaska, 2006 

Primary Presentation n (%) 

Cellulitis* 12 (31) 

Bacteremia 10 (26) 

Septic arthritis 4 (10) 

Pneumonia* 4 (10) 

Necrotizing fasciitis 3 (8) 

Empyema 2 (5) 

Bursitis 1 (2.5) 

Peritonitis 1 (2.5) 

Septic abortion 1 (2.5) 

Other 1 (2.5) 

Total 39 

*with bacteremia
Surveillance of Invasive Bacterial Disease in Alaska, 2006 26 

Table 18: Summary of Invasive group A Streptococcus Case Characteristics, Alaska, 2006 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) 

emm

Type 

Associated Medical 

Conditions Survived 

F 0.8 AK Native Anchorage Blood Empyema, pneumonia 73 None Yes 

F 0.9 AK Native Anchorage Abscess Cellulitis None Yes 

F 1.0 Non-Native Anchorage Blood Bacteremia 11 None Yes 

F 1.3 AK Native Anchorage Blood Bacteremia 73 None Yes 

M 1.3 Non-Native Anchorage Blood Bacteremia 44 None Yes 

F 1.9 AK Native Anchorage Blood Septic arthritis 75 None Yes 

M 4.2 Non-Native Other Blood Bacteremia 4 None Yes 

M 8.1 Non-Native Other Blood Bacteremia 89 Unknown Yes 

M 14.1 AK Native Anchorage Joint fluid Septic arthritis, bursitis 87 None Yes 

M 15.3 Non-Native Anchorage Blood Bacteremia 6 None Yes 

F 16.1 Non-Native Other Peritoneal 

fluid Peritonitis 92 None Yes 

M 19.2 AK Native Anchorage Abscess Cellulitis None Yes 

M 26.0 AK Native Anchorage Wound Cellulitis, bursitis Smoking, alcohol abuse Yes 

F 26.3 Non-Native Other Blood Bacteremia 28 None Yes 

M 28.7 AK Native Anchorage Joint fluid Septic arthritis, bursitis 87 Alcohol abuse Yes 

F 29.4 AK Native Other Blood Septic abortion 87 None Yes 

M 29.8 AK Native Other Blood Pneumonia 92 None Yes 

M 31.1 AK Native Anchorage Blood Bacteremia 73 Smoking, alcohol abuse, 

diabetes No 

F 38.7 AK Native Other Joint fluid Septic arthritis, 

necrotizing fasciitis 73 Smoking Yes 

M 39.6 Non-Native Other Blood Bacteremia 73 None Yes 

M 43 Non-Native Other Blood Endocarditis, 

necrotizing fasciitis 1 Alcohol abuse Unknown 

M 45.8 AK Native Anchorage Blood Pneumonia 4 Smoking Yes 

M 46.6 Non-Native Anchorage Blood Pneumonia 92 Smoking, alcohol abuse No 

M 50.5 AK Native Anchorage Blood Cellulitis 49.1 Smoking, alcohol abuse Yes 

M 51.8 Non-Native Anchorage Blood Cellulitis Diabetes No 

M 52.1 AK Native Anchorage Other Cellulitis Smoking, alcohol abuse Yes 

M 52.6 AK Native Anchorage Blood Pneumonia 49.1 Smoking, chronic lung 

disease Yes 

F 53.3 Non-Native Anchorage Blood Cellulitis None Yes 

M 53.4 Non-Native Anchorage Blood 

Septic arthritis, 

necrotizing fasciitis, 

cellulitis 

5.14 Smoking, diabetes Yes 

M 53.4 AK Native Other Joint fluid Bursitis Alcohol abuse Yes 

F 58.5 Non-Native Anchorage Blood Cellulitis Chronic lung disease, 

diabetes Yes 

M 61.2 Non-Native Anchorage Blood Cellulitis 49.1 Diabetes Yes 

F 62.9 AK Native Anchorage Other Other 87 Smoking, chronic lung 

disease, alcohol abuse Yes 

F 70.4 AK Native Other Blood Bacteremia 71 Immune suppressive 

treatment Yes 

F 71.6 Non-Native Anchorage Pleural 

fluid Empyema, pneumonia 3.1 None Yes 

F 72.8 AK Native Other Blood Septic arthritis 11 Diabetes Yes 

F 84.7 Non-Native Anchorage Blood Cellulitis 89 Chronic lung disease Yes 

F 85.1 Non-Native Anchorage Blood Cellulitis None Yes 

F 93.4 Non-Native Anchorage Blood Cellulitis 44 Diabetes Yes 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 27 

Invasive group B Streptococcus

Overall Incidence

A total of 25 cases of invasive group B Streptococcus (GBS) were reported to AIP in 2006. 

Overall rates of invasive GBS disease in the state of Alaska were 3.7/100,000 persons per year. 

The Alaska rate is lower than the ABCs 2006 national projected rate of 7.1/100,000 [9]. In 2006, 

there was one GBS-related death for a case fatality ratio of 4% (outcome was unknown in 1 

case). 

Seasonality

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

seasonality. 

Race

In 2006, 32% of invasive group B Streptococcus cases in Alaska occurred in the Alaska Native 

population for an age-adjusted rate of 5.4/100,000 persons per year which is twice the nonNative rate of 2.8/100,000 persons per year. 

Table 19: Invasive group B Streptococcus Cases by Race – Alaska, 2006 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 8 (32) 5.4 75 0 (0) 

Non-Native 17 (68)‡ 2.8 59 1 (6) 

Total 25 64 1 (4) 

*Cases per 100,000 per percent distribution of Alaska 2000 population 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 28 

‡Includes one case for which race was unknown 

Region 

In 2006, 17 (68%) of the 25 reported GBS cases occurred in Anchorage; three cases were 

reported in the Interior, two cases in Southeast Alaska, and one each in Kotzebue, Bristol Bay 

and the Arctic Slope. 

Age

Invasive group B Streptococcus cases reported in 2006 ranged in age from 4 days to 85.7 years 

old; the median age was 57 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, 2006

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, 2006

0

1

2

3

4

5

6

7

<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)
Surveillance of Invasive Bacterial Disease in Alaska, 2006 29 

The highest rates of disease occurred in AK Native children less than 2 years of age (48/100,000 

persons per year). There was no early-onset disease (cases less than 7 days old). Of the three 

cases that occurred in children less than 2 years old in non-Natives, one was early-onset disease 

for a rate of 0.1/1,000 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 2006, the most common clinical presentation 

was bacteremia which occurred in 14 cases (56%). 

Group B Streptococcus was isolated from blood in 22 (88%) of 25 cases in 2006; one case each 

was isolated from bone, joint fluid and an unspecified sterile site. 

Table 20: Primary Clinical Presentations of Invasive group B Streptococcus – Alaska, 2006 

*with bacteremia

Antibiotic Resistance

Susceptibility testing was performed on 19 GBS isolates received in 2006. Results of the testing 

are presented in the following table. 

Table 21: Antibiotic Resistance in Invasive group B Streptococcus Isolates – Alaska, 2006 

Antibiotic Susceptible Intermediate Resistant I + R Total Tested 

Penicillin 18 (100%) 0 (0%) 0 (0%) 0 (0%) 18 

Cefotaxime 18 (100%) 0 (0%) 0 (0%) 0 (0%) 18 

Erythromycin 16 (84%) 0 (0%) 3 (16%) 3 (16%) 19 

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

Levofloxacin 19 (100%) 0 (0%) 0 (0%) 0 (0%) 19 

Clindamycin 17 (89%) 0 (0%) 2 (11%) 2 (11%) 19 

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

clindamycin was seen in 16% and 11%, respectively, of isolates tested. The one early onset case 

did not have an isolate available for testing.

Primary Presentation n (%) 

Bacteremia 14 (56) 

Osteomyelitis 2 (8) 

Septic arthritis 2 (8) 

Cellulitis* 2 (8) 

Meningitis 2 (8) 

Endometritis 1 (4) 

Endocarditis 1 (4) 

Other 1 (4) 

Total 25 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 30 

Table 21: Summary of Invasive group B Streptococcus Case Characteristics, Alaska, 2006 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s)

Associated Medical 

Conditions Survived 

M 4 days Non-Native Other CSF Meningitis None Yes 

M 15 days AK Native Anchorage Blood Bacteremia None Yes 

M 18 days AK Native Anchorage Blood Bacteremia None Yes 

F 0.2 Non-Native Anchorage Blood Bacteremia None Yes 

M 0.2 AK Native Other CSF Meningitis None Yes 

M 0.2 Unknown Other Blood Bacteremia None Yes 

F 17.1 AK Native Anchorage Blood Bacteremia Chronic lung disease Yes 

F 22.3 Non-Native Anchorage Blood Endometritis None Yes 

M 47.6 Non-Native Other Joint fluid Septic arthritis Unknown Yes 

F 49.5 Non-Native Anchorage Blood Bacteremia Diabetes Yes 

F 52.6 Non-Native Anchorage Blood Cellulitis Smoking Yes 

F 53.4 AK Native Anchorage Bone Osteomyelitis, 

septic arthritis Smoking, diabetes Yes 

M 57.0 Non-Native Anchorage Blood Endocarditis None No 

F 57.1 Non-Native Anchorage Blood Bacteremia Diabetes Yes 

M 57.7 Non-Native Other Blood Cellulitis Diabetes Yes 

M 58.9 Non-Native Other Blood Septic arthritis Diabetes Yes 

M 61.3 AK Native Anchorage Blood Bacteremia Chronic lung 

disease, diabetes Yes 

M 64.3 AK Native Other Blood Bacteremia Smoking, diabetes Yes 

M 64.8 AK Native Other Blood Bacteremia Chronic lung disease Yes 

M 66.9 Non-Native Anchorage Other Other None Yes 

M 73.2 Non-Native Anchorage Blood Osteomyelitis Diabetes Yes 

M 73.7 Non-Native Anchorage Blood Bacteremia None Yes 

F 76.4 Non-Native Anchorage Blood Bacteremia Diabetes Yes 

M 77.0 Non-Native Anchorage Blood Bacteremia None Yes 

F 85.7 Non-Native Anchorage Blood Bacteremia None Yes 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 31 

References 

[1] State of Alaska, Department of Labor & Workforce Development. Retrieved 7/16/2007 from 

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

[2] Centers for Disease Control and Prevention. 2007. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2006.

[3] Hennessy TW, 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] Clinical and Laboratory Standards Institute (CLSI). Performance Standards for 

Antimicrobial Susceptibility Testing; Nineteenth Informational Supplement. 2009; 29(3): 

M100-S19. p.21. 

[6] Centers for Disease Control and Prevention. 2007. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Haemophilus influenzae, 2006. 

[7] Centers for Disease Control and Prevention. 2007. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Neisseria meningitidis, 2006. 

[8] Centers for Disease Control and Prevention. 2007. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Group A Streptococcus, 2006. 

[9] Centers for Disease Control and Prevention. 2007. Active Bacterial Core Surveillance 

Report, Emerging Infections Program Network, Group B Streptococcus, 2006. 
Surveillance of Invasive Bacterial Disease in Alaska, 2006 32 

Appendix 

MIC Interpretive Standards Definitions: 

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

Concentration values (cut points) for each organism/antibiotic combination which are defined as 

follows: 

1. Susceptible (S): 

The “susceptible” category implies that isolates are inhibited by the usually achievable 

concentrations of antimicrobial agent when the recommended dosage is used for the site of 

infection. 

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 efficacy applicability in body 

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

or when a higher dosage of a drug can be used (e.g., β-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 narrow 

pharmacotoxicity margins. 

3. Resistant (R): 

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

normal dosage schedules, and/or that demonstrate MICs or zone diameters that fall in the range 

where specific microbial resistance mechanisms are likely (e.g., β-lactamases) are likely, and 

clinical efficacy of the agent against the isolate has not been reliably shown in treatment studies.