Surveillance of Invasive Bacterial Disease in Alaska, 2004 

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, 2004 2 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 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 32 

Appendix 33 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 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, 2004 

In 2004, the total numbers of cases of invasive disease caused by these organisms reported to AIP were 

100 S. pneumoniae, 12 H. influenzae, 5 N. meningitidis, 26 group A Strep and 34 group B Strep. Alaska 

Native populations had higher rates of disease than non-Native populations in all invasive disease except 

those caused by N. meningitidis. 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. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 5 

Table 1: Surveillance Organisms Reported by Region – Alaska, 2004 

Region 

S. pneumoniae 

n (rate*) 

H. influenzae 

n (rate*) 

N. meningitidis 

n (rate*) 

Group A Strep

n (rate*) 

Group B Strep

n (rate*) 

Anchorage 69 (16.0) 8 (1.9) 5 (1.2) 17 (3.9) 21 (4.9) 

Arctic Slope 1 (16.5) 0 (0) 0 (0) 1 (16.5) 2 (32.9) 

Bristol Bay 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 

Interior 9 (9.2) 0 (0) 0 (0) 1 (1.0) 5 (5.1) 

Kotzebue 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 

Norton Sound 2 (21.3) 0 (0) 0 (0) 2 (21.3) 0 (0) 

Southeast 7 (9.9) 0 (0) 0 (0) 1 (1.4) 6 (8.5) 

YK Delta 12 (48.7) 4 (16.2) 0 (0) 4 (16.2) 0 (0) 

Total 100 (15.3) 12 (1.8) 5 (0.8) 26 (4.0) 34 (5.2) 

*Cases per 100,000 

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 655,435 persons in 2004 [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 2004, 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, 2004 6 

Invasive Pneumococcal Disease 

Overall Incidence

A total of 84 pneumococcal isolates were received at AIP in 2004. An additional 16 cases were detected 

through year-end follow up with participating labs throughout the state for a total of 100 cases of 

invasive pneumococcal disease. The overall invasive pneumococcal case rate for 2004 was 15.3 per 

100,000 persons per year. Alaska rates for 2004 were higher than the Active Bacterial Core 

Surveillance (ABCs) 2004 national projected rate of 13.8/100,000 [2]. ABCs is a surveillance system 

operated in 9 states which covers a population of over 38 million persons. 

Seasonality

Invasive Streptococcus pneumoniae cases were identified in each month of 2004. The largest number of 

cases was reported in March. 

Figure 2: Invasive Pneumococcal Disease, by 

Month of Culture - Alaska, 2004

0

2

4

6

8

10

12

14

16

January

February

March

April

May

June

July

August

September

October

November

December

Number of Cases

Race

In 2004, the state population was comprised of 19% Alaska Natives (Alaska Natives 127,008, nonNatives 528,427) [1]. The percentage of all reported S. pneumoniae cases that occurred in 2004 among 

Alaska Natives was 46%; for a total of 46 cases resulting in an age-adjusted rate of 35.1/100,000 

persons per year. Fifty-four cases occurred among the non-Native population for an age-adjusted rate of 

9.5/100,000 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 2004 is 3.7. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 7 

Table 2: Invasive Streptococcus pneumoniae Cases by Race – Alaska, 2004 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 46 (46) 35.1 43.5 4 (8.9)‡ 

Non-Native† 54 (54) 9.5 51.9 12 (23)‡ 

Total 100 48 16 (16.5) 

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

†Includes 2 cases for which race was unknown 

‡Outcome unknown for 1 AK Native case, 2 Non-Native cases

Region

The highest percentage (69%) of invasive pneumococcal disease cases occurred in the Anchorage area 

in 2004. Rates of disease, however, were highest in the YK Delta, 48.7/100,000 persons per year. 

Figure 3: Invasive Pneumococcal Disease, Cases 

& Rates by Region - Alaska, 2004

0

10

20

30

40

50

60

70

80

Anchorage

Arctic Slope

Bristol Bay

Interior

Kotzebue

Norton Sound

Southeast

YK Delta

Number of Cases

0

10

20

30

40

50

60

Rate per 100,000

Cases

Rate

Age

Cases occurred in all age groups in 2004 ranging from 0.2 years to 98.1 years with a median of 46.6 

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 2004 occurred in Alaska Native children 

less than 2 years old (200.2/100,000 persons per year). 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 8 

Figure 4: Invasive Pneumococcal Disease, Cases 

& Rates by Age Group & Race - Alaska, 2004

0

5

10

15

20

25

<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 81.3/100,000 in 2004. 

Figure 5: Invasive Pneumococcal Disease by Age 

Group - Alaska, 2000-2004

0

20

40

60

80

100

120

140

160

180

200

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

Age (yrs)

Rate per 100,000

2000

2001

2002

2003

2004

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 200.2/100,000 in 2004. Rates of invasive disease in nonNative children less than 2 years have continued to decline during the same time period, however, there 

has been a slight increase from a low of 26.9/100,000 in 2003 to 33.5/100,000 in 2004. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 9 

Figure 6: Invasive Pneumococcal Disease in 

Alaska Natives, by Age Group - Alaska, 2000-2004

0

100

200

300

400

500

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

Age (yrs)

Rate per 100,000

2000

2001

2002

2003

2004

Figure 7: Invasive Pneumococcal Disease in NonNatives, by Age Group - Alaska, 2000-2004

0

100

200

300

400

500

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

Age (yrs)

Rate per 100,000

2000

2001

2002

2003

2004

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 2004 (62%) followed by septicemia (21%). Seven cases had a secondary pneumococcalrelated diagnosis in 2004; 5 pneumonia and 1 each cellulitis with bacteremia and hemolytic uremic 

syndrome. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 10 

Figure 8: Primary Clinical Presentations of 

Invasive Pneumococcal Disease - Alaska, 2004

62

21

8 3 2 1111

0

10

20

30

40

50

60

70

Pneumonia*

Septicemia

Meningitis

Empyema

Peritonitis

Cellulits*

Septic arthritis

Osteomyelitis

Bacteremia

Number of Cases

*w ith bacteremia

In 2004, blood was the most common source of a positive culture which was used to identify 90 (90%) 

of 100 cases. Cerebrospinal fluid was the positive site for 7% of cases and 1 case each was identified 

through pleural fluid, peritoneal fluid and an autopsy cerebrospinal fluid sample.

Mortality

In 2004, the overall case fatality ratio for S. pneumoniae in Alaska was 16.5% (16 deaths out of 97 cases 

for which outcome was known). The case fatality ratio for non-Natives was higher than Natives; 23% 

(12 deaths) and 8.9% (4 deaths), respectively. Although the majority of deaths occurred in the 19-54 

year old age category (8 deaths), 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, 2004

0

2

4

6

8

10

<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, 2004 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 subtype 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 vaccine types. 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, 2004 

 Alaska Native Non-Native Unknown 

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

03 6 (7.1) - - 1 1 - - 2 1 1 

04 6 (7.1) - - 3 - - 1 1 1 - 

06A 1 (1.2) 1 - - - - - - - - 

06B 1 (1.2) - - - - 1 - - - - 

07C 2 (2.4) - - - - - - 1 1 - 

07F 6 (7.1) 1 2 3 - - - - - - 

08 4 (4.8) - - 2 - - - 2 - - 

09N 4 (4.8) - - 1 - - - 1 1 - 

09V 1 (1.2) - - - - - - 1 - - 

10A 2 (2.4) - 1 - - - - - 1 - 

11A 4 (4.8) - - 2 - - - 2 - - 

12F 6 (7.1) 1 - 4 - - - 1 - - 

14 1 (1.2) - - - - - - 1 - - 

15B 3 (3.6) 1 - - - - - 2 - - 

15B/15C 1 (1.2) 1 - - - - - - - - 

15C 1 (1.2) - - - - - - 1 - - 

16F 1 (1.2) - - - - - - - 1 - 

17F 2 (2.4) 1 - - 1 - - - - - 

19A 15 (17.9) 3 1 2 1 2 1 3 2 1 

20 1 (1.2) - - 1 - - - - - - 

22A 1 (1.2) 1 - - - - - - - - 

22F 6 (7.1) 1 - - 1 - 1 1 2 - 

23A 2 (2.4) - - - - - - 2 - - 

23B 1 (1.2) - - - - - - - - - 

23F 1 (1.2) - - - - - - 1 - - 

33F 2 (2.4) 1 - - - - - 1 - - 

34 1 (1.2) - - 1 - - - - - - 

35B 1 (1.2) - - - - - - - 1 - 

37 1 (1.2) - - - - - 1 - - - 

Total 84 12 4 20 4 3 4 23 12 2 

In 2004, the most common pneumococcal serotype was 19A (15 isolates, 17.9%). 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 1.2% in 2004. 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, in 2004 cases were equally distributed between AK Natives and non-Natives. The 

majority (80%) of serotype 19A cases occurred in the Anchorage area. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 12 

Table 4: Invasive Pneumococcal Serotype Distribution by Region – Alaska, 2004 

Serotype 

Anchorage 

Arctic Slope 

Interior 

Norton Sound 

Southeast 

YK Delta 

03 3 - 1 - 2 - 

04 4 - 2 - - - 

06A - - - - - 1 

06B 1 - - - - - 

07C 1 - 1 - - - 

07F 3 - - - - 3 

08 3 - - - - 1 

09N 3 - - - 1 - 

09V 1 - - - - - 

10A - - 1 - - 1 

11A 2 - 1 - 1 - 

12F 4 - - 2 - - 

14 1 - - - - - 

15B - 1 - - - - 

15B/15C 1 - - - - - 

15C 1 - - - - - 

16F 1 - - - - - 

17F 1 - - - - 1 

19A 12 - - - 1 2 

20 - - - - - 1 

22A - - - - - 1 

22F 3 - 2 - 1 - 

23A 1 - 1 - - - 

23B 1 - - - - - 

23F 1 - - - - - 

33F 1 - - - 1 - 

34 - - - - - 1 

35B 1 - - - - - 

37 1 - - - - - 

Total 53 1 9 2 7 12 

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 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 13 

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

infections from 2004 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, 2004 

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

<2 0 (0%) of 12 1 (25%) of 4 1 (6%) of 16 

2-4 0 (0%) of 3 0 (0%) of 1 0 (0%) of 4 

5+ 3 (12%) of 25 6 (15%) of 39 9 (14%) of 64 

Total 3 (8%) of 40 7 (16%) of 44 10 (12%) of 84 

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 2004, for persons 55 years and older, 24 (80%) of 30 cases serotyped 

were potentially vaccine preventable invasive pneumococcal illnesses. 

Potentially Preventable Deaths

In 2004, pneumococcal vaccine status was known for 65 (65%) of the 100 cases; 42 cases (42%) did 

receive a pneumococcal vaccine prior to illness and 23 cases (23%) had no record of a pneumococcal 

vaccine. 

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 2004. 

Two of the 16 deaths in 2004 from invasive S. pneumoniae occurred from serotypes contained within 

the Ps23V vaccine (03 and 04) in vaccinated individuals. Time since vaccination was 2 years and 8 

years, respectively. 

Table 6: Invasive Pneumococcal Disease, Serotypes of Fatal Cases – Alaska, 2004 

Serotype Deaths (%) Frequency (n) 

03† 2 (33) 6 

04*† 1 (17) 6 

07C 1 (50) 2 

09N† 2 (50) 4 

10A† 1 (50) 2 

11A† 1 (25) 4 

12F† 1 (17) 6 

15B† 1 (33) 3 

22F† 2 (33) 6 

23A 1 (50) 2 

23F*† 1 (100) 1 

*Serotypes contained in the PCV7 vaccine 

†Serotypes contained in the 23-valent polysaccharide vaccine
Surveillance of Invasive Bacterial Disease in Alaska, 2004 14 

Overall, 75% of all pneumococcal-related mortality in 2004 was potentially preventable with the use of 

the 23-valent polysaccharide vaccine in persons over 2 years old. 

Table 7: Potentially Vaccine Preventable Invasive Pneumococcal Deaths – Alaska, 2004 

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

PCV7 0 0 0 1 (13%) 1 (50%) 0 2 (13%) 

Ps23V 0 0 0 7 (88%) 1 (50%) 4 (80%) 12 (75%) 

Total 1 0 0 8 2 5 16 

Associated Medical Conditions

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

pneumococcal cases in 2004. 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, 

2004* 

Medical Condition 

Adult Cases (≥ 18 years) 

n=74, Cases (%) 

Cigarette smoking 32 (43) 

Alcohol abuse 29 (39) 

Chronic lung disease 18 (24) 

Diabetes 12 (16) 

Immunosuppressive treatment 5 (7) 

Injection drug use 4 (5) 

Asplenia 3 (4) 

*More than one risk factor was identified in several cases 

Antibiotic Resistance

Susceptibility testing was performed on all isolates received in 2004. Results of the testing are 

presented in the following table. 

Table 9: Antibiotic Resistance in Invasive Streptococcus pneumoniae Isolates – Alaska, 2004 

Antibiotic Susceptible Intermediate Resistant I + R Total Tested 

Penicillin 71 (85%) 13 (15%) 0 (0%) 13 (15%) 84 

TMP-sulfa 68 (81%) 9 (11%) 7 (8%) 16 (19%) 84 

Erythromycin 81 (96%) 0 (0%) 3 (4%) 3 (4%) 84 

Ceftriaxone 84 (100%) 0 (0%) 0 (0%) 0 (0%) 84 

Tetracycline 82 (99%) 1 (1%) 0 (0%) 1 (1%) 83 

Chloramphenicol 84 (100%) 0 (0%) 0 (0%) 0 (0%) 84 

Rifampin 84 (100%) 0 (0%) 0 (0%) 0 (0%) 84 

Vancomycin 84 (100%) 0 (0%) 0 (0%) 0 (0%) 84 

Levoflox 84 (100%) 0 (0%) 0 (0%) 0 (0%) 84 

Clindamycin 84 (100%) 0 (0%) 0 (0%) 0 (0%) 84 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 15 

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. 

Figure 10: Trends in Antibiotic Resistance Among 

Invasive Pneumococcal Isolates - Alaska, 1988 - 2004

0

5

10

15

20

25

30

35

198819901992199419961998200020022004

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, 2004 16 

Invasive Haemophilus influenzae

Overall Incidence

In 2004, there were 12 cases of invasive Haemophilus influenzae in Alaska, for a statewide rate of 

1.8/100,000 persons per year. This rate is similar to the national projected rate of 1.4/100,000 persons 

per year [6]. There were no deaths caused by Haemophilus influenzae in 2004. 

Seasonality

Figure 11: Haemophilus influenzae Disease by 

Month of Culture - Alaska, 2004

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, cases occurred 

in all seasons. 

Region

The Anchorage area had the highest proportion of invasive Haemophilus influenzae cases in 2004 (8 

cases, 67%). The Yukon-Kuskokwim Delta area, however, had the highest disease rate of 16.2/100,000 

persons per year. No cases were reported in any other region of Alaska in 2004. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 17 

Figure 12: Invasive Haemophilus influenzae , 

Cases & Rates by Region - Alaska, 2004

0

1

2

3

4

5

6

7

8

9

Anchorage

Arctic Slope

Bristol Bay

Interior

Kotzebue

Norton Sound

Southeast

YK Delta

Number of Cases

0

2

4

6

8

10

12

14

16

18

Rate per 100,000

Cases

Rate

Race

Table 10: Invasive Haemophilus influenzae Cases by Race – Alaska, 2004 

Race 

Cases 

n (%) 

Age Adjusted 

Rate * % Male 

Deaths 

n (%) 

Alaska Native 4 (33) 2.9 75 0 (0) 

Non-Native 8 (67) 1.4 50 0 (0) 

Total 12 58 0 (0) 

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

In 2004, 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 2004 was 2.1. 

Age

Haemophilus influenzae cases ranged in age from less than 6 months to 91 years of age in 2004 (median 

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

greater than 65 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 (16.7/100,000 persons per year) 

and adults greater than 65 years old (14/100,000 persons per year). There were no cases of 

Haemophilus influenzae in non-Native or AK Native children 2 to 4 years old. In adult age categories, 

there were no H. influenzae cases reported in AK Natives 55-64 years old. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 18 

Figure 13: Invasive Haemophilus influenzae by 

Age Group - Alaska, 2004

0

2

4

6

8

10

12

<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, 2004

0

1

2

3

4

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

Age (yrs)

Number of Cases

0

2

4

6

8

10

12

14

16

18

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 2004, three cases had a secondary Haemophilus influenzae-related 

diagnosis; 2 cases with pneumonia and one case with an unspecified other diagnosis. 

Haemophilus influenzae was isolated from 8 (67%) blood samples, 3 (25%) cerebrospinal fluid samples 

and 1 (8%) tracheal aspirate. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 19 

Table 11: Primary Clinical Presentation of Invasive Haemophilus influenzae - Alaska, 2004 

Primary Presentation n (%) 

Pneumonia* 5 (42) 

Meningitis 3 (25) 

Septicemia 2 (17) 

Peritonitis 1 (8) 

Empyema 1 (8) 

Total 12 

*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, 2004 

 Alaska Native Non-Native 

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

b 2 (18) 1 0 0 0 0 0 1 0 

f 4 (36) 0 1 0 0 0 1 1 1 

NT* 5 (45) 0 0 1 0 1 0 1 2 

Total 11† 1 1 1 0 1 1 3 3 

*Non-typable 

†One case not serotyped 

Hib

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

childhood vaccine against this serotype. Two cases of Hib occurred in 2004; one in a 4 month old male 

AK Native and one in a 60 year old non-Native male. The 4 month old male had received two doses of 

PedVaxHib vaccine (2 and 4 months) and presented with meningitis 11 days after the second vaccine 

dose. The overall Hib rate for 2004 was 0.3/100,000 persons per year; for children less than 2 years, the 

rate was 4.9/100,000.

Antibiotic Resistance

The 11 Haemophilus influenzae isolates received at AIP were tested for susceptibility to ampicillin, 

chloramphenicol, ceftriaxone and TMP/sulfa. All 11 isolates were susceptible to chloramphenicol and 

ceftriaxone; 2 isolates were fully resistant to ampicillin and the remaining 9 were susceptible;1 isolate 

was fully resistance to TMP/sulfa and the remaining 10 were susceptible. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 20 

Table 13: Summary of Invasive Haemophilus influenzae Case Characteristics, Alaska, 2004 

Sex 

Age 

(Yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) Serotype* 

Associated Medical 

Conditions Survived 

M 0.4 AK Native Other CSF Meningitis B Chronic lung disease Yes 

F 0.4 Non-Native Anchorage Aspirate Pneumonia NT None Yes 

M 9.5 Non-Native Anchorage Blood Peritonitis F None Yes 

M 11.6 AK Native Anchorage Blood Pneumonia F Chronic lung disease Yes 

M 20.9 AK Native Other Blood Septicemia NT Cigarette smoking Yes 

M 48.4 Non-Native Other Blood Pneumonia NT 

Cigarette smoking, 

chronic lung disease, 

alcohol abuse 

Yes 

M 60.3 Non-Native Other Blood Pneumonia B Chronic lung disease Yes 

M 60.8 Non-Native Anchorage Blood Empyema, 

pneumonia F None Yes 

F 69.5 Non-Native Anchorage CSF Meningitis NT None Yes 

F 71.3 Non-Native Anchorage CSF Meningitis, 

pneumonia F Diabetes Yes 

F 72.2 Non-Native Anchorage Blood Septicemia NT 

Chronic lung disease, 

immune suppressive 

treatement 

Yes 

F 91.4 AK Native Anchorage Blood Pneumonia † Chronic lung disease Yes 

*NT = non-typeable 

†Isolate not received for serotyping
Surveillance of Invasive Bacterial Disease in Alaska, 2004 21 

Invasive Neisseria meningitidis

Overall Incidence

A total of 5 cases of invasive Neisseria meningitidis were reported to AIP in 2004 for an overall 

rate of 0.8/100,000. The Alaska rates are similar to the ABCs 2004 national projected rate of 

0.3/100,000 [7]. There were two invasive N. meningitidis-related deaths in Alaska in 2004 

which resulted in a case fatality ratio of 40%. 

Seasonality

N. meningitidis cases occurred in January (1 case), February (2 cases), August (1 case), and 

September (1 case); no clusters of related cases were reported. 

Race

In 2004, 80% of invasive N. meningitidis cases in Alaska occurred in the non-Native population 

for an age-adjusted rate of 0.8/100,000 persons per year compared to the Alaska Native rate of 

0.6/100,000 persons per year. 

Table 14: Invasive Neisseria meningitidis Cases by Race – Alaska, 2004 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 1 (20) 0.6 100 0 (0) 

Non-Native 4 (80) 0.8 75 2 (50) 

Total 5 80 2 (40) 

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

Region

All five invasive N. meningitidis cases in 2004 occurred in Southcentral Alaska. 

Age

Invasive N. meningitidis cases reported in 2004 ranged in age from 0.8 to 60.9 years old; the 

median age was 17.3 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 septicemia and 

three cases presented with meningitis. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 22 

N. meningitidis was isolated from cerebrospinal fluid samples in 3 of 5 (60%) cases in 2004. 

The remaining two cases were isolated from blood. 

Mortality

There were two N. meningitidis-related deaths reported in Alaska in 2004. One death occurred 

in a 20.2 year old non-Native male who presented with meningitis and had a history of alcohol 

abuse. The second death occurred in a 60.9 year old non-Native male who presented with 

septicemia and was a cigarette smoker. 

Serogroup

All five invasive N. meningitidis cases in 2004 were serogrouped; all five were serogroup B.

Table 15: Summary of Invasive Neisseria Meningitidis Cases Characteristics, Alaska, 2004 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) 

Associated 

Medical 

Conditions Survived 

M 0.8 AK Native Anchorage CSF Meningitis None Yes 

M 4.5 Non-Native Anchorage Blood Septicemia None Yes 

F 17.3 Non-Native Anchorage CSF Meningitis Cigarette 

smoking Yes 

M 20.2 Non-Native Anchorage CSF Meningitis Alcohol 

abuse No 

M 60.9 Non-Native Anchorage Blood Septicemia Cigarette 

smoking No 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 23 

Invasive group A Streptococcus

Overall Incidence

A total of 26 cases of invasive group A Streptococcus (GAS) were reported to AIP in 2004. The 

overall rate of invasive GAS disease in the state of Alaska was 4/100,000 persons per year. The 

Alaska rate is slightly higher than the ABCs 2004 national projected rate of 3.3/100,000 [8]. In 

2004, there were 2 GAS-related deaths for a case fatality ratio of 8%. 

Seasonality

Cases of group A Streptococcus occurred throughout the year in 2004 with no apparent trends in 

seasonality. 

Figure 15: Invasive group A Streptococcus , by 

Month of Culture - Alaska, 2004

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 2004, 54% of invasive GAS cases in Alaska occurred in the Alaska Native population for an 

age-adjusted rate of 11/100,000 persons per year which was over four times higher the nonNative age-adjusted rate of 2.3/100,000 persons per year and over twice the 2003 age-adjusted 

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

Table 16: Invasive group A Streptococcus Cases by Race – Alaska, 2004 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%) 

Alaska Native 14 (54) 11 29 1 (7) 

Non-Native 12 (46) 2.3 58 1 (8) 

Total 26 42 2 (8) 

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

Region
Surveillance of Invasive Bacterial Disease in Alaska, 2004 24 

Seventeen (65.4%) of the 26 invasive group A Streptococcus cases in 2004 were reported in the 

Anchorage area, 4 cases in the YK Delta, 2 cases in Norton Sound and one case each in 

Southeast, the Interior and the Arctic Slope regions. 

Age

Invasive group A Streptococcus cases reported in 2004 ranged in age from 0.4 to 93.4 years old; 

the median age was 42.7 years. Highest rates of disease occurred persons 65 years and older 

(21.6/100,000). 

Figure 16: Invasive group A Streptococcus by 

Age Group - Alaska, 2004

0

5

10

15

20

25

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

Age (yrs)

Rate per 100,000

Figure 17: Invasive group A Streptococcus , Cases 

& Rates by Age Group & Race - Alaska, 2004

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)

In 2004, the highest rates of invasive group A streptococcal disease occurred in Alaska Natives 

less than 2 years old (33.4/100,000 persons per year) and Alaska Native adults 65 years of age 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 25 

and older (56.1/100,000 persons per year). The highest GAS disease rate in the non-Native 

population occurred in the 65+ years age category (14.5/100,000 persons per year). No cases 

were reported in the AK Native or non-Native population in the 2-4 age category and no cases 

were reported in the non-Native population in the less than 2 age category. 

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 2004. 

Group A Streptococcus was isolated from blood samples in 20 (77%) of 26 cases and one each 

from pleural fluid, joint fluid and an unidentified other sterile site. 

 

Table 17: Primary Clinical Presentations of Invasive group A Streptococcus – Alaska, 2004 

Primary Presentation n (%) 

Cellulitis* 10 (38.5) 

Septicemia 4 (15.4) 

Pneumonia* 4 (15.4) 

Septic arthritis 3 (11.5) 

Empyema 1 (3.9) 

Osteomyelitis 1 (3.9) 

Endometritis 1 (3.9) 

Bursitis 1 (3.9) 

Other 1 (3.9) 

Total 26 

*with bacteremia
Surveillance of Invasive Bacterial Disease in Alaska, 2004 26 

Table 18: Summary of Invasive group A Streptococcus Case Characteristics, Alaska, 2004 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s) Associated Medical Conditions Survived 

F 0.4 AK Native Anchorage Joint 

fluid Osteomyelitis None Yes 

M 0.8 AK Native Other Blood Pneumonia, cellulitis, 

necrotizing fasciitis None Yes 

M 11.3 Non-Native Anchorage Blood Pneumonia None No 

F 13.8 AK Native Other Joint 

fluid Other None Yes 

M 16.2 AK Native Other Blood Cellulitis None Yes 

F 18.3 AK Native Other Blood Endometritis None Yes 

M 24.4 Non-Native Anchorage Blood 

Septic arthritis, 

cellulitis, toxic shock 

syndrome 

Cigarette smoking Yes 

F 33.7 Non-Native Other Blood Cellulitis None Yes 

M 35.7 Non-Native Anchorage Joint 

fluid 

Septic arthritis, 

cellulitis None Yes 

F 37.2 AK Native Other Blood Cellulitis Cigarette smoking Yes 

M 37.4 AK Native Anchorage Other Bursitis Cigarette smoking, alcohol 

abuse Yes 

M 39.4 Non-Native Anchorage Blood Cellulitis Cigarette smoking Yes 

M 40.1 Non-Native Anchorage Joint 

fluid 

Septic arthritis, 

cellulitis None Yes 

F 45.4 AK Native Anchorage Pleural 

fluid 

Empyema, 

pneumonia 

Cigarette smoking, alcohol 

abuse Yes 

F 50.0 AK Native Anchorage Blood Septicemia None Yes 

F 59.1 AK Native Other Blood Septicemia Cigarette smoking, diabetes Yes 

F 63.8 Non-Native Anchorage Blood Cellulitis Diabetes Yes 

F 68.7 AK Native Anchorage Blood Cellulitis Chronic lung disease, diabetes Yes 

F 69.1 Non-Native Other Blood Septicemia None Yes 

M 69.6 AK Native Anchorage Blood Septicemia Cigarette smoking, alcohol 

abuse Yes 

F 75.6 AK Native Other Blood Pneumonia Cigarette smoking No 

F 82.7 Non-Native Anchorage Blood Cellulitis None Yes 

M 82.8 Non-Native Anchorage Blood Cellulitis Cigarette smoking, immune 

suppressive treatment Yes 

F 88.5 AK Native Other Blood Cellulitis None Yes 

F 88.8 Non-Native Anchorage Blood Cellulitis None Yes 

M 93.4 Non-Native Anchorage Blood Pneumonia None Yes 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 27 

Invasive group B Streptococcus

Overall Incidence

A total of 34 cases of invasive group B Streptococcus (GBS) were reported to AIP in 2004. 

Overall rates of invasive GBS disease in the state of Alaska were 5.2/100,000 persons per year. 

The Alaska rate is lower than the ABCs 2004 national projected rate of 7.2/100,000 [9]. In 2004, 

there were three GBS-related deaths for a case fatality ratio of 9% (outcome was unknown in 1 

case). 

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, 2004

0

1

2

3

4

5

6

7

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 7.2/100,000 persons per year compared with the nonNative rate of 4/100,000 persons per year. 

Table 19: Invasive group B Streptococcus Cases by Race – Alaska, 2004 

Race 

Cases 

n (%) 

Age Adjusted 

Rate* % Male 

Deaths 

n (%)†

Alaska Native 11 (32) 7.2 55 2 (18) 

Non-Native 23 (68)‡ 4 61 1 (5) 

Total 34 59 3 (9) 

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

†Outcome unknown in 1 non-Native case 

‡Includes one case for which race was unknown 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 28 

Region

In 2004, 21 of the 34 reported GBS cases occurred in Anchorage; six cases were reported in 

Southeast Alaska, five in the Interior and two in the Arctic Slope. 

Age

Invasive group B Streptococcus cases reported in 2004 ranged in age from newborn to 80.1 years 

old; the median age was 53.9 years. Highest rates of disease occurred in children less than two 

years old (57.4/100,000 persons per year) and in the 65 and older age category (26.5/100,000 

person per year). 

Figure 19: Invasive group B Streptococcus by 

Age Group - Alaska, 2004

0

10

20

30

40

50

60

70

<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, 2004

0

1

2

3

4

5

6

7

8

9

<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)

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

(100.1/100,000 persons per year). One of six cases that occurred in this age category was early-
Surveillance of Invasive Bacterial Disease in Alaska, 2004 29 

onset disease (cases less than 7 days old); and comprised a rate of 0.33/1,000 births. Of the six 

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

for a rate of 0.27/1,000 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 2004, the most common clinical presentation 

was septicemia which occurred in 15 cases (44%). One case of endocarditis had additional 

presentations of osteomyelitis and cellulitis. 

Group B Streptococcus was isolated from blood in 31 (91%) of 34 cases in 2004; two cases were 

isolated from cerebrospinal fluid and one from joint fluid. 

Table 20: Primary Clinical Presentations of Invasive group B Streptococcus – Alaska, 2004 

*with bacteremia

Antibiotic Resistance

Susceptibility testing was performed on 28 of 29 GBS isolates received in 2004. Results of the 

testing are presented in the following table. 

Table 21: Antibiotic Resistance in Invasive group B Streptococcus Isolates – Alaska, 2004 

Antibiotic Susceptible Intermediate Resistant I + R Total Tested 

Penicillin 27 (100%) 0 (0%) 0 (0%) 0 (0%) 27 

Cefotaxime 28 (100%) 0 (0%) 0 (0%) 0 (0%) 28 

Erythromycin 10 (36%) 3 (11%) 15 (54%) 18 (65%) 28 

Tetracycline 2 (7%) 0 (0%) 26 (93%) 26 (93%) 28 

Levoflox 27 (96%) 0 (0%) 1 (4%) 1 (4%) 28 

Clindamycin 16 (57%) 2 (7%) 10 (36%) 12 (43%) 28 

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 

Primary Presentation n (%) 

Septicemia 15 (44) 

Cellulitis* 5 (15) 

Endocarditis 4 (12) 

Pneumonia* 3 (9) 

Meningitis 3 (9) 

Bacteremia 2 (6) 

Septic arthritis 1 (3) 

Other 1 (3) 

Total 34 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 30 

tested. Isolates from two of the three early onset cases were tested; both showed resistance to 

erythromycin and tetracycline and one isolate was additionally resistant to clindamycin.
Surveillance of Invasive Bacterial Disease in Alaska, 2004 31 

Table 21: Summary of Invasive group B Streptococcus Case Characteristics, Alaska, 2004 

Sex 

Age 

(yrs) Race Residence 

Site of 

Isolation 

Clinical 

Presentation(s)

Associated Medical 

Conditions Survived 

M < 1 day Non-Native Anchorage Blood Septicemia None Unknown 

F < 1 day AK Native Other Blood Septicemia None Yes 

M < 1 day Non-Native Anchorage Blood Septicemia None Yes 

F 0.1 Non-Native Anchorage CSF Meningitis None Yes 

M 0.1 AK Native Anchorage Blood Septicemia None Yes 

F 0.1 AK Native Other Blood Meningitis Chronic lung disease Yes 

M 0.1 Non-Native Other Blood Septicemia None Yes 

M 0.1 AK Native Anchorage Blood Septicemia None Yes 

M 0.2 Non-Native Other CSF Meningitis None Yes 

F 0.3 AK Native Anchorage Blood Septicemia None Yes 

M 0.3 Non-Native Other Blood Septicemia None Yes 

M 0.5 AK Native Anchorage Blood Pneumonia None Yes 

F 38 Non-Native Anchorage Blood Bacteremia Cigarette smoking, 

diabetes Yes 

F 47.8 Non-Native Anchorage Blood Cellulitis Diabetes Yes 

M 48.8 Non-Native Anchorage Blood 

Endocarditis, 

cellulitis, 

osteomyelitis 

Diabetes No 

F 50 Non-Native Anchorage Blood Septicemia None Yes 

M 52.7 Non-Native Other Blood Endocarditis Cigarette smoking, 

diabetes Yes 

M 54.9 AK Native Other Blood Septicemia None Yes 

F 56.6 Non-Native Anchorage Blood Cellulitis Immune suppressive 

treatment, diabetes Yes 

M 58.9 AK Native Anchorage Blood Septicemia Alcohol abuse No 

F 59.9 Non-Native Other Blood Endocarditis Diabetes Yes 

M 61.1 Non-Native Anchorage Blood Septicemia Alcohol abuse, 

diabetes Yes 

M 63.9 Non-Native Anchorage Joint fluid Septic arthritis None Yes 

M 65.9 AK Native Other Blood Cellulitis Diabetes Yes 

F 68.5 Non-Native Anchorage Blood Cellulitis None Yes 

F 69.1 AK Native Anchorage Blood Pneumonia 

Cigarette smoking, 

chronic lung disease, 

alcohol abuse 

No 

M 69.2 Non-Native Anchorage Blood Endocarditis None Yes 

F 71 Unknown Other Blood Septicemia None Yes 

M 71.7 Non-Native Anchorage Blood Cellulitis Alcohol abuse Yes 

M 75 Non-Native Other Blood Other Diabetes Yes 

M 77.5 Non-Native Other Blood Septicemia Diabetes Yes 

F 77.7 AK Native Other Blood Bacteremia None Yes 

M 78.9 Non-Native Anchorage Blood Pneumonia Diabetes Yes 

F 80.1 Non-Native Anchorage Blood Septicemia None Yes 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 32 

References 

[1] State of Alaska, Department of Labor & Workforce Development. Retrieved 5/20/2005 from 

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

[2] Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network 

Streptococcus pneumoniae, 2004 – Provisional. 

[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] Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network 

Haemophilus influenzae, 2004 – Provisional. 

[7] Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network 

Neisseria meningitidis, 2004 – Provisional. 

[8] Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network 

group A Streptococcus, 2004 – Provisional. 

[9] Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network 

group B Streptococcus, 2004 – Provisional. 
Surveillance of Invasive Bacterial Disease in Alaska, 2004 33 

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 β-lactams in urine) or 

when a high 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 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., β-lactamases) and clinical efficacy has not been reliable in treatment 

studies.