Completing Invasive Streptococcus pneumoniae Case Investigations

Kristin Ryker, MPH
ISDH Vaccine-Preventable Disease Epidemiologist

According to the Indiana Communicable Disease Rule (410 IAC 1-2.3-99), local health department (LHD) staff are responsible for the investigation of invasive Streptococcus pneumoniae cases in individuals aged 6 years and older. (Indiana State Department of Health [ISDH] Field Epidemiologists investigate invasive S. pneumoniae cases in those under age 6.)  Investigations must be initiated within 72 hours of notification of the case and must include:

  • Complete pneumococcal vaccine immunization history.  Please avoid submitting an “unknown” pneumococcal vaccine history, as previous pneumococcal vaccination in a S. pneumoniae case can indicate vaccine failure.
  • History of chronic underlying disease, asplenia, or immunosuppression.
  • Drug-resistance patterns.  Please do not leave the drug-resistance pattern blank. If sensitivity testing was not done, attempt to indicate why. Completing this section can aid in detecting increases or decreases in drug-resistance rates.
  • If available, please attach any supporting documents to the completed case investigation form. Supporting documents may include the lab report demonstrating culture of S. pneumoniae, history and progress notes, discharge summary, and/or death summary.

LHDs may be notified of invasive S. pneumoniae cases through several sources, including health care providers, infection control practitioners, laboratories, or the ISDH. Case investigations are not completed when S. pneumoniae is isolated from a non-sterile site (eye, wound, sputum, urine). Case investigations should be completed when S. pneumoniae is isolated from a typically sterile site, including blood, cerebral spinal fluid, peritoneal fluid, pericardial fluid, joint fluid, or fluid collected through tympanocentesis.

The Streptococcus Pneumoniae Case Investigation Form is available at

Local health departments should fax completed investigation forms to the ISDH Epidemiology Resource Center at 317.234.2812 within 30 days of case notification.