Clinical evidence of invasive disease  with laboratory confirmation of infection:
- Isolation of
Streptococcus pneumoniae from a normally sterile site ;
- Demonstration of
S. pneumoniae DNA from a normally sterile site .
 Clinical illness associated with invasive disease manifests itself mainly as pneumonia with bacteremia, bacteremia without a known site of infection and meningitis. Pneumonia without bacteremia is not reportable.
 Normally sterile sites include: blood, CSF, pleural fluid, pericardial fluid, peritoneal fluid, bone or joint (synovial) fluid, deep tissue specimen taken during surgery. Excludes: middle ear and superficial wound aspirates, or specimens taken from infected areas/abscesses in sites following penetrating wounds.