Laboratory confirmation requires at least one of the following:

• isolation of S. pneumoniae from blood, CSF or another normally sterile site (for example, joint fluid, pleural fluid)
• detection of S. pneumoniae nucleic acid from blood, CSF or another normally sterile site
• a positive newer generation S. pneumoniae antigen test on CSF or pleural fluid

Note: in the absence of invasive disease, isolation of S. pneumoniae from a non-sterile site (such as sputum, nasal aspirates and ear discharge) is not notifiable. A positive urine antigen test is also not notifiable.