Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level.
Date: 2018-09-13
Institutions: European Centre for Disease Prevention and Control
Subjects: disease prevention, harmonisation of standards, health control, health policy, infectious disease, public health, research body, research method, research report, respiratory disease

TECHNICAL REPORT

Generic protocol on 
enhanced surveillance for 
invasive pneumococcal 
disease at the EU/EEA level

www.ecdc.europa.eu

ECDC TECHNICAL REPORT 

Generic protocol on enhanced surveillance 
for invasive pneumococcal disease at the 
EU/EEA level 

 
 
This report was commissioned by the European Centre for Disease Prevention and Control (ECDC), coordinated by 
Edoardo Colzani, and produced by the SpIDnet project team. 

This generic protocol was developed as part of the European Centre for Disease Prevention and Control-funded 
project ‘Assessing the impact of vaccination with the conjugate vaccines on the epidemiology of the invasive 
pneumococcal disease in Europe’, ECDC/2012/038, and updated under the ECDC/2015/031 project. 

The protocol was also updated to take into account the recommendations following the technical meetings of I-
MOVE+ project for the age group 65+ years (work package 3: pneumococcal vaccines, http://www.i-moveplus.eu) 
held in Paris (2016) and Utrecht (2017). I-MOVE+ has received funding from the European Union's Horizon 2020 
research and innovation programme under grant agreement No 634446. 

Suggested citation: European Centre for Disease Prevention and Control. Generic protocol on enhanced 
surveillance for invasive pneumococcal disease at the EU/EEA level. Stockholm: ECDC; 2018. 

Stockholm, September 2018 

ISBN 978-92-9498-189-9 
DOI 10.2900/21108 
Catalogue number TQ-03-18-270-EN-N 

© European Centre for Disease Prevention and Control, 2018  

Cover picture: © SciencePhoto 

Reproduction is authorised, provided the source is acknowledged.  

For any use or reproduction of photos or other material that is not under the EU copyright, permission must be 
sought directly from the copyright holders. 

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TECHNICAL REPORT 

Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Contents 

Abbreviations and glossary ............................................................................................................................ iv 
Executive summary ........................................................................................................................................ 1 
1 Background ................................................................................................................................................ 1 
1.1 Country-specific background ................................................................................................................ 2 
1.2 Rationale for active IPD surveillance at the EU/EEA level and in EU Member States ................................... 2 
1.3 Objectives .......................................................................................................................................... 2 
1.4 Methods ............................................................................................................................................. 3 
1.4.1 Population under surveillance ........................................................................................................ 3 
1.4.2 Type of surveillance system........................................................................................................... 3 
1.4.3 Selection of surveillance units ........................................................................................................ 3 
1.4.4 Outcomes .................................................................................................................................... 3 
1.4.5 Data ............................................................................................................................................ 5 
1.4.6 Surveillance responsibilities, reporting and information flow ............................................................. 7 
1.4.7 Monitoring and evaluation (depends on type of system)................................................................... 7 
1.4.8 Feedback and supervision ............................................................................................................. 8 
1.5 Ethical considerations .......................................................................................................................... 8 
1.6 Studies on vaccination impact and vaccine effectiveness ......................................................................... 8 
Selected bibliography ................................................................................................................................... 14 
Publications ............................................................................................................................................ 14 
Presentations and posters........................................................................................................................ 14 
References .................................................................................................................................................. 17 

Tables 

Table 1. S. pneumoniae serotypes included in different vaccines ........................................................................ 2 
Table 2. List of variables, coding, definitions and data sources ........................................................................... 8 
Table 3. Risk conditions for pneumococcal diseases and corresponding ICD-9 and 10-codes ............................... 13 

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TECHNICAL REPORT 

Abbreviations and glossary 

Ag 

Antimicrobial susceptibility 

Completeness of data 
CSF 
DD 
ECDC 
EU/EEA 
EUCAST 
ICD 

IPD 

ICU 
Lab 
MIC 

NA 
PCR 
PCV 
PCV7 
PCV10 
PCV13 
PPSV23 
Sentinel surveillance system 

Sensitivity (of surveillance system) 

Surveillance site 

Surveillance unit 

TESSy 
Vaccination coverage 

VE 

Antigen, in the context of this paper referring to laboratory method to 
detect S. pneumoniae antigen 
In this context, used as the ability of a microorganism to resist the action of 
an antimicrobial agent, according to clinical breakpoints of the standards 
used 
Proportion of all cases with no missing variable or information 
Cerebrospinal fluid 
Disk diffusion, a method for antimicrobial susceptibility testing 
European Centre for Disease Prevention and Control 
European Union/European Economic Area 
European Committee on Antimicrobial Susceptibility Testing 
International Classification of Diseases, used as discharge diagnostic codes 
or for coding causes of death. The ninth or tenth revisions are currently 
used in most countries. 
Invasive pneumococcal disease, defined as isolation of Streptococcus 
pneumoniae or detection of Streptococcus pneumoniae nucleic acid or 
antigen from normally sterile fluid 
Intensive care unit 
Hospital laboratory 
Minimum inhibitory concentration, the lowest concentration of an 
antimicrobial that inhibits the visible growth of a microorganism after 
overnight incubation 
Not applicable (in context of IPD ECDC case definition) 
Polymerase chain reaction 
Pneumococcal conjugate vaccine 
7-valent pneumococcal conjugate vaccine 
10-valent pneumococcal conjugate vaccine 
13-valent pneumococcal conjugate vaccine 
23-valent pneumococcal polysaccharide vaccine  
Surveillance system that involves collecting data from sample of reporting 
sites 
Proportion of cases reported by surveillance system out of total number of 
cases meeting same case definition in entire population. Also called degree 
of ascertainment or exhaustiveness of surveillance system 
In the context of this paper, surveillance system (in country or region) that 
collaborates with EU/EEA project 
Hospital/laboratory reporting cases to surveillance site included in EU/EEA 
project 
The European Surveillance System 
Proportion of the eligible population which is effectively vaccinated. 
Vaccination coverage should be defined by schedule (number of doses or 
complete schedule) 
Vaccine effectiveness, defined as measure of direct effect of vaccination 
against target disease when used under field conditions 

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TECHNICAL REPORT 

Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Executive summary 

The first pneumococcal conjugate vaccine (PCV) was licensed in 2001. European Union/European Economic Area 
(EU/EEA) Member States have progressively introduced PCVs in their national immunisation plans. Monitoring the 
performance of these vaccines in field conditions represents a high priority. Many Member States have set up or 
reinforced surveillance systems to collect data to assess the health benefits of PCVs in reducing the burden of 
invasive pneumococcal disease (IPD) in all age groups. 

Between 2012 and 2014, the European Centre for Disease Prevention and Control (ECDC) funded SpIDnet, a pilot 
project on ’assessing the impact of vaccination with the conjugate vaccines on the epidemiology of the invasive 
pneumococcal disease in Europe’ It aimed to set up active IPD surveillance in children under five years of age to 
monitor the impact of PCV programmes and improve the comparability of IPD data across Europe. In 2014, ECDC 
funded the ’SpIDnet complementary activities’ project to collect additional surveillance data in all age groups. 

The current SpIDnet generic protocol takes into account the lessons learned during the pilot project and proposes 
a uniform approach for active IPD surveillance in children and enhanced surveillance in other age groups. Public 
health authorities can adapt the generic protocol to meet their specific needs. The document covers the description 
of the public health importance of IPD and rationale for surveillance, surveillance objectives, case identification, 
data collection, monitoring indicators and feedback and supervision. 

This protocol covers neither the specific studies to measure the impact of vaccination programmes and PCV 
effectiveness nor the evaluation of surveillance systems. Specific protocols are developed for these aspects under 
the SpIDnet project and are available upon request. 

According to local needs and surveillance capacity, surveillance sites are invited to use these documents by 
developing specific surveillance protocols with the ultimate goal of strengthening IPD surveillance systems and 
improving comparability of indicators in the EU/EEA. 

1 Background 

Streptococcus pneumoniae is a Gram-positive diplococcus bacterium causing a wide spectrum of illnesses from 
otitis media to meningitis and represents a major public health problem worldwide. IPD is defined as the isolation 
of S. pneumoniae or detection of S. pneumoniae nucleic acid or antigen from a normally sterile fluid [1] and may 
present as meningitis, bacteraemic pneumonia, bacteraemia without focus, septic shock and, less frequently, 
arthritis, pericarditis or peritonitis. S. pneumoniae is commonly found in nasopharyngeal carriage, particularly 
among young children, who represent the main reservoir of pneumococci and source of transmission to new hosts. 
Carriage plays an important role in the epidemiology of pneumococcus, as recent acquisition of S. pneumoniae is 
thought to precede episodes of pneumococcal disease. More than 90 serotypes of S. pneumoniae have been 
identified according to their polysaccharide capsular type showing different virulence and extent of drug resistance. 
Some of them share many serological properties (i.e. cross-reactive antibodies) and are thus included in the same 
serogroup (e.g. serotypes 9N and 9V). 

Two major groups of vaccines are currently available to protect against S. pneumoniae: polysaccharide vaccine (23-
valent vaccine - PPSV23) and PCVs. PPSV23 was licensed in 1983 and is generally recommended for use in the 
elderly, adults and children ≥2 years with underlying medical conditions (risk groups) following national 
recommendations. PCVs (PCV7, PCV10 and PCV13) cover the 7, 10 and 13 serotypes most frequently causing IPD 
in developed countries during the pre-vaccine era (Table 1). PCVs were licensed in the EU in 2001 (PCV7) and 2009 
(PCV10 and PCV13) for use in children under five years of age, with PCV10 and PCV13 progressively replacing 
PCV7 [2,3]. PCV13 was approved to prevent IPD in adults in 2011, and children up to 17 years in 2012 and for 
adults to prevent pneumonia in 2015. Currently, PCV13 is licensed for the prevention of invasive disease, 
pneumonia and acute otitis media caused by S. pneumoniae in infants, children and adolescents from 6 weeks to 
17 years of age, as well as invasive disease and pneumonia caused by S. pneumoniae in adults ≥18 years of age. 

PCV10 and PCV13 were approved on the basis of immunogenicity data. Currently, 25 of 31 EU/EEA Member States 
have PCV included in their infant immunisation schedule, but vaccination policies vary widely across Member States in 
terms of vaccine (PCV 10/13), dose schedule (2+1 or 3+1 doses) and target groups (risk groups only or universal 
vaccination in children). PCV13 vaccination in the elderly has been introduced in certain EU/EEA countries, alone or in 
combination with PPSV23 [4]. 

Medical practices, detection of IPD cases and IPD surveillance also differ widely across countries. Published data on 
surveillance systems show variations in reporting methods, case definitions, laboratory methods and disparities in 
blood-culturing practices to detect cases [5]. 

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Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

TECHNICAL REPORT 

Table 1. S. pneumoniae serotypes included in different vaccines 

Vaccine 

PCV7 

PCV10 

PCV13 

PPSV23 

Serotypes 

4, 6B, 9V, 14, 18C, 19F, 23F 

PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F) and 1, 5, 7F 

PCV10 serotypes (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, 23F) and 3, 6A, 19A 

1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F 

1.1 Country-specific background 

Each surveillance site provides a brief description of: 

 

 

the public health importance of IPD for the country/region (number of cases, incidence, mortality, case-
fatality); and 
vaccination programmes (vaccines available, history of vaccination introduction by vaccine, 
recommendations for vaccination (current and changes over time), schedules, vaccination coverage, any 
published evaluation of impact or effectiveness). 

1.2 Rationale for active IPD surveillance at the EU/EEA level 
and in EU Member States 

IPD is a severe and frequent disease. Since PCVs have been introduced in most EU countries, post-licensure 
surveillance is crucial to assess the impact of these vaccines on the epidemiology of pneumococcal disease in 
Member States, compare the effectiveness of different vaccination schedules, identify risk factors for vaccine failure 
and collect evidence of serotype replacement following the introduction of vaccines. 

According to Decisions 1082/2013/EU and 2000/96/EC, IPD is included in the priority list of diseases under 
surveillance at the EU level [1]. EU surveillance of IPD is important to provide comparable data on IPD at the EU level, 
measure the effectiveness and impact of PCVs at a supra-national level, including its indirect effect, monitor circulating 
strains and detect emerging serotypes representing new health threats and changing targets in the EU. In addition, 
IPD surveillance at the EU level is a unique opportunity to assess the serotype-specific effectiveness of PCV on 
additional serotypes (for which clinical protection is uncertain) and compare the effectiveness and impact of different 
vaccine policies (schedules/vaccines) as individual country studies may lack the statistical power for responding to 
these research questions [6]. This allows ECDC to produce scientific guidance to inform policymaking related to PCVs 
in the EU. 

Trends in diagnostic procedures (e.g. blood culturing), under-reporting (suboptimal sensitivity of the surveillance 
systems) and missing data (mainly on clinical data and vaccination status) represent the main challenges of many 
IPD surveillance systems and may influence the results of impact and effectiveness studies based on surveillance 
data. 

In particular, an active surveillance system collecting a minimum set of variables in a similar way in different EU 
countries may achieve and improve surveillance objectives by: 

 
 
 
 

improving reporting and completeness of data collected 
taking into account trends in diagnostic procedures 
improving the comparability of the data at the EU level; and 
allowing pooling of certain data for meaningful results at the EU level. 

Each surveillance site provides additional rationale for active surveillance in the specific context. 

1.3 Objectives 

The aim is to enhance the existing IPD surveillance system in all age groups in order to: 

 
 

 
 
 

estimate the incidence rate and mortality due to IPD in children and adults 
provide systematic monitoring of circulating S. pneumoniae serotypes to detect emerging strains and 
serotype replacement 
measure the vaccine effectiveness of the pneumococcal vaccines 
evaluate the impact of PCVs in terms of the disease burden of vaccine and non‐vaccine strains; and 
monitor antimicrobial non‐susceptibility in pneumococcal isolates. 

Each surveillance site adapts the above objectives to IPD active surveillance in the country/region. 

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TECHNICAL REPORT 

Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

1.4 Methods 

1.4.1 Population under surveillance 

The study population consists of persons living in the catchment area of the data source used to identify cases (i.e. 
hospital and laboratory catchment areas). All age groups are included to allow the assessment of the indirect effect 
of PCV vaccines in the age groups not targeted for vaccination. 

Each site precisely estimates the population of the catchment area. Special attention is given to match both the 
denominator and numerator data of the surveillance population to enable the correct calculation of incidence rates. 

Each site assesses and describes where the population under surveillance seeks healthcare services to ensure that 
all laboratories and hospitals notifying the cases are contacted to detect any missing cases. 

Each surveillance site states the population under surveillance and how this was estimated (data sources, method 
and time of population estimation, potential limitations). The population under surveillance includes all ages. 

1.4.2 Type of surveillance system 

The proposed surveillance system is an active system for children under five years of age and enhanced in the 
surveillance of other age groups. 

Each surveillance site states the type of surveillance by age groups included. This should be reflected in the 
description of case finding and timelines for active data collection. 

The surveillance system should be built on the existing surveillance systems that may be: 

 
 
 

sentinel or comprehensive 
mandatory or voluntary; or 
laboratory-based or hospital-based. 

Each surveillance site briefly describes the existing surveillance system and the necessary changes to improve the 
capture of cases in the catchment areas (if not already in place). These changes should also be reflected in the 
surveillance methods below. 

If the current IPD surveillance system was ever evaluated, surveillance sites would provide the estimated sensitivity 
of the current surveillance system and its coverage. 

1.4.3 Selection of surveillance units 

The minimum criteria for surveillance unit (hospital/laboratory) selection include: 

 
 
 
 
 
 

known denominators in the catchment area 
individual data collection for the minimum set of variables included by age groups 
surveillance of (services provided for) all IPD clinical manifestations 
diagnostic (X-ray) and laboratory (isolation/PCR/Ag detection) facilities 
access to care for patients with IPD; and 
willingness to participate in the surveillance system. 

A description of the surveillance units is included in the surveillance system. 

Each surveillance site briefly describes how they can ensure this minimum criteria for surveillance unit selection. 

1.4.4 Outcomes 

IPD definition 

The EC 2012 case definition should be used to report IPD cases (1): 

Pneumococcal invasive disease(s) (S. pneumoniae) 

Clinical criteria 

Clinical criteria are not relevant for surveillance purposes. 

Laboratory criteria 

At least one of the following three criteria must be met: 

 
 
 

isolation of S. pneumoniae from a normally sterile site 
detection of S. pneumoniae nucleic acid from a normally sterile site; and 
detection of S. pneumoniae antigen from a normally sterile site. 

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Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

TECHNICAL REPORT 

Epidemiological criteria 

NA 

Case classification 

A. Possible case 

NA 

B. Probable case 

NA 

C. Confirmed case 

A confirmed case is any person meeting the laboratory criteria. 

Each surveillance site states the case definition currently used and compliance with the 2012 EC case definition 
above. For PCR tests, each surveillance site describes criteria to consider a true positive result (e.g. detection of 
two specific pneumococcal genes: ply and an additional capsular gene or lyt and an additional capsular gene 
should be used). 

Case identification 

Depending on the surveillance settings (laboratory- or hospital-based), the starting point for IPD case identification 
includes: 

 

 

 

laboratory results: regular checks of laboratory results logs and retrieval of individual data from medical 
history of the patient and vaccination data from the available sources (i.e. link with the vaccination 
registries or medical records) 
admission for specific clinical syndromes compatible with an IPD (see page 12, outcome classification): 
regular checks of admission/emergency departments logs and follow up of the patient for clinical/laboratory 
diagnosis; and 
regular reminders are sent to laboratories and hospitals to report all diagnosed cases. 

Each surveillance site states how case identification is done and the frequency of contact with data sources. In any 
case, individual data collection requires a link between clinical, laboratory and vaccination data. 

Laboratory confirmation, serotyping and antimicrobial susceptibility testing 

To comply with the IPD case definition, laboratory confirmation through culture, PCR or Ag detection could be used 
for diagnosis. The specific objectives of the surveillance system also require serotyping and antimicrobial 
susceptibility testing. 

 
 

 

Isolation and identification/ PCR or Ag detection can be done at the hospital or reference laboratory. 
Serotyping of isolates is usually done at the reference laboratory using capsular reaction testing (Quellung 
test), gel diffusion with type-specific antisera or PCR. 
Antimicrobial susceptibility testing should be done for all isolates: 
 

Antibiotics to be included: penicillin, macrolide, cephalosporin (other classes of antimicrobials if 
tested) 
Methods to be used: MIC, DD, Etest 
Clinical breakpoints to be used - standards: preferentially European Committee on Antimicrobial 
Susceptibility Testing (EUCAST). 

 
 

Each surveillance site specifies at what level antimicrobial susceptibility testing is performed, the antimicrobials 
tested and methods used (and their sensitivity and specificity if available). At the European level, minimum 
inhibitory concentration (MIC) by antimicrobial are reported (Table 2). If other methods are used in the country, 
the surveillance site should state the specific method, clinical breakpoints for each antimicrobial tested and 
reference/standard used. 

Outcome classification 

The main outcome of this surveillance is IPD, as defined according to the above case definition. This outcome is 
further classified by serotypes, clinical manifestations, antimicrobial susceptibility and severity. 

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Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Classification of IPD by serotype 

According to the serotyping results and the vaccine used in the surveillance site, cases are classified by serotype 
categories: 

 
 

 

 
 

 

all types 
vaccine serotypes: according to the vaccine used, the 7, 10 and 13 serotypes targeted by the respective 
conjugate vaccines 
vaccine related serotypes: the serotypes from the same serogroups as the vaccine serotypes for which 
cross-protection was demonstrated or assumed. (The serotypes included in this category should be clearly 
stated. This category does not include serotypes for which cross-protection was not demonstrated, e.g. 19A 
and 6C are not included in the evaluation of PCV7) 
PPSV serotypes: the 23 serotypes included in the PPSV vaccine 
non-vaccine serotypes: all the other serotypes according to the vaccine used (i.e. non vaccine and non 
vaccine-related); and 
serotype-specific. 

Classification of IPD by clinical manifestations 

The following clinical manifestations of IPD are included in the surveillance and should be specified for each IPD 
case: 

 
 
 
 
 
 

meningitis 
bacteraemic pneumonia 
empyema 
bacteraemia without known focus of infection 
septic shock; and 
others (arthritis, peritonitis, pericarditis). 

Classification of IPD by antimicrobial susceptibility 

MIC by antimicrobial is reported at the European level from each surveillance site. Classification according to 
EUCAST is used for comparisons among surveillance sites. 

Classification of IPD by severity 

Severity is defined as intra-hospital death or death after 30 days of an IPD episode. Other indicators of IPD severity 
such as clinical manifestation as meningitis, length of hospital stay of more than 14 days and intensive care unit 
(ICU) admission are measured. 

Each surveillance site to describe the outcomes used for IPD surveillance, taking into account classification by 
serotyping, clinical manifestation, antimicrobial susceptibility testing and severity. 

1.4.5 Data 

Data sources 

The following data sources should be considered according to the settings: 

 
 
 
 

laboratory databases/results logs 
hospital admission logs/discharge databases 
vaccination data: vaccination cards/vaccine registries/well-baby clinics/medical records; and 
population data source. 

Each surveillance site describes the sources for data collection or the possibility of linking the available databases. 

Denominators 

 
 

Census data by age groups 
Hospital catchment area population data by age group 

Each surveillance site provides population data. In case the population from the hospital/laboratory catchment area 
is used as the denominator, the methods of determining the population covered by the participating surveillance 
unit (hospital, laboratory) should also be described as well as its potential limitations. 

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Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

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Data collection 

Individual data collection should be ensured for all IPD cases included in the surveillance system. The minimum set 
of data that is collected for each IPD case in the age groups <5 years and ≥65 years includes: 

 

 

 

 

 
 

demographic data: age in months/years (ideally date of birth if not considered personal information), 
gender, residence in the hospital/laboratory catchment area, reporting site 
hospitalisation data: admission and discharge dates, clinical manifestation, need for ICU care, outcome 
(alive, intra-hospital death or death within 30 days after the disease onset/diagnosis) 
laboratory data: sterile site that tested positive, method of isolation or detection (tests used), date of 
isolation, result of serotyping and tests used, MIC of antimicrobial susceptibility testing for penicillin, 
macrolide, cephalosporin 
vaccination data: type of vaccine (PCV7/10/13 and/or PPSV23), number of doses, dates of administration 
(each dose for PCV, the last dose for PPSV23) 
underlying conditions (according to the country recommendations for vaccination of risk groups); and 
current season influenza vaccination status. 

The minimum set of data that is collected for each IPD case in the age group 5–64 years includes: 

 
 

 

 

 
 

demographic data: age, gender, residence in hospital/laboratory catchment area, reporting site 
hospitalisation data: clinical manifestation, outcome (alive, intra-hospital death or death within 30 days after 
disease onset/diagnosis) 
laboratory data: site, date of isolation, method of isolation or detection, result of serotyping and tests used, 
MIC of antimicrobial susceptibility testing for penicillin, macrolide, cephalosporin 
vaccination data (if available): type of vaccine (PCV7/10/13 and/or PPSV23), number of doses, dates of 
administration (each dose for PCV, the last dose for PPSV23) 
underlying conditions (according to country recommendations for vaccination of risk groups) 
current seasonal influenza vaccination status. 

Each surveillance site states if the minimum set of data for individual data collection can be collected and fills in 
Table 2. 

Additional data collection is desirable but not compulsory: 

 
 
 
 

member of vulnerable group (to be specified) 
day (group) care attendance 
influenza positive test within 10 days before admission; and 
other risk factors for IPD ( to be specified). 

Each surveillance site specifies the additional variables collected (if any) and includes them in Table 2. 

Additional information at the hospital/laboratory level or population level that could be used for interpretation of 
data comprises: 

 
 
 
 
 

 

number of hospitalisations of any cause (for the age groups under surveillance) 
number of deaths of any cause (for the age groups under surveillance) 
number of cultures performed in the age groups included (blood and cerebrospinal fluid (CSF) cultures) 
changes in clinical practices over time that may affect diagnosis and characterisation of pneumococcus 
changes in laboratory methods over time related to the diagnosis and characterisation of pneumococcus; 
and 
changes in reporting/surveillance system over time (e.g. age groups and clinical syndromes covered) 

Each surveillance site lists additional information to be collected. 

Data checking and transmission 

Data are checked to identify outliers and implausible or missing information at the country/regional level. Data 
should be completed (if missing) or validated (at request) against the data source as much as possible. 

The transfer of data from surveillance units to central level within the country is done according to site-specific 
legislation regarding medical data protection. Secured data transmission from site level to SpIDnet coordination is 
organised using EpiFiles (a platform for secure data transfer developed by coordination hub). 

Each surveillance site describes data checking and management. 

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Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Analysis plan 

Data descriptions and the calculation of the surveillance indicators should be included in an analysis plan. This 
should include a brief description of surveillance data, data checking, description of each variable and calculation of 
specific indicators. Examples of these indicators include: 

 

 
 
 
 
 
 

incidence rate of confirmed hospitalised IPD overall, serotype-specific IPD (all, vaccine, vaccine-related and 
non-vaccine types, serotype-specific), IPD clinical presentations and IPD susceptibility to a specific 
antibiotic/antimicrobial. These incidences are subsequently presented by age, sex, and underlying 
conditions. 
distribution of serotypes by clinical presentation 
number of IPD deaths/total number of IPD overall and by clinical presentation, serotypes 
distribution of isolates by antimicrobial susceptibility (according to EUCAST) 
number of severe cases (see definition page 12) and their description in case reports 
number of clusters of severe cases and specific serotypes; and 
indicators based on vaccine status: number/description of vaccine failures 

Each surveillance site develops an analysis plan presenting the descriptive analysis and analysis by indicators. 

1.4.6 Surveillance responsibilities, reporting and information flow 

Levels of responsibilities 

 
 
 
 

Hospital/laboratory level (surveillance unit) 
Intermediate level (regional level) 
National level: national institute/national reference laboratory 
EU level 

Reporting 

 

 

 

Level 
 
 

In the country: contact of surveillance site personnel with surveillance units 
At the EU level: data transfer according to established mechanisms 

Frequency of reporting 
 
monthly, quarterly, annually 
Forms: case-based/laboratory (lab) forms 
 

Web-based forms for data transmission. 

Each surveillance site describes the responsibilities by level and frequency of reporting. Whenever possible, a 
TESSy-compatible format should be used. 

1.4.7 Monitoring and evaluation (depends on type of system) 

The system is monitored through process indicators (examples): 

 
 
 
 

number of reminders sent to data sources 
number and proportion of notified IPD cases fully documented 
number and proportion of IPD cases reported with complete information collected for each variable; and 
percentage of cases with isolates collected and sent to the reference laboratory for serotyping, antimicrobial 
susceptibility testing. 

Each surveillance site establishes a minimum set of indicators that is used for ongoing monitoring the performance 
of enhanced surveillance. 

Evaluation of surveillance system performance should be done regularly according to a specific evaluation protocol 
developed in accordance with published general guidelines. The following attributes are assessed with priority: 

 

 

Sensitivity of the system. Possible methods are: 
 

comparison with other data sources (e.g. comparison of hospital logs with lab logs in the 
participating sites) 
capture-recapture analysis; and 
other methods (e.g. regression methods). 

 
 

Completeness 
 
 

Percentage of missing data by each variable 
Percentage of missing priority variables (age, clinical manifestations, vaccination variables). 

Each surveillance site evaluates its system using a protocol for active IPD surveillance system evaluation prepared 
in advance. 

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1.4.8 Feedback and supervision 

Each surveillance site establishes a mechanism for regular feedback to surveillance units. An annual report is 
prepared and presented during annual meetings at the EU level to exchange results and lessons learned. 

The coordination team organises periodic teleconferences and/or technical workshops to facilitate decision-making 
and exchanges among partners. 

Each surveillance site briefly describes feedback to the surveillance units and dissemination of site-specific results. 

1.5 Ethical considerations 

This enhanced surveillance system is included among surveillance activities in the countries/regions where it is 
implemented. Ensuring confidentiality in the data flow and ethical approval of this activity is done according to 
current legislation in the country/region. 

In line with local legislation, paper forms are stored in secure locked cabinets at the surveillance unit, regional and 
central levels and access to these cabinets is restricted to essential surveillance personnel and surveillance 
coordinators. Electronic databases will be transferred using secure channels at the superior levels. 

Each surveillance site obtains ethical approval and ensure confidentiality according to specific legislation. 

1.6 Studies on vaccination impact and vaccine effectiveness 

Surveillance data will be used for measuring vaccination programme impact and PCV/PPSV vaccine effectiveness. 
These studies will be conducted according to specific protocols. 

Generic protocols for vaccination programme impact and PCV/PPSV vaccine effectiveness will be updated. 

Table 2. List of variables, coding, definitions and data sources 

Variable name 

Site-specific 
variables 

Variable label 

Type 

Values and coding 

Definition 

Comments 

id 

siteid 

Case unique identifier 

Site identification 

Unique ID 

AA 

datenotif 

Date of notification 

Date 

dd/mm/yyyy 

residence 

ageyears  

agemonths 

sex 

dateadm 

datedis 

outcome 

Residence in the 
catchment area 

Numeric 

0: No 
1: Yes 
9: Unknown 

Age of the case in 
years 

Numeric 

### 

Age of the case in 
months 

Numeric 

## 

Gender 

Code 

Date of the admission 
in the hospital 
Date of the discharge 
from the hospital 

Date 

Date 

Outcome 

Code 

0: Female 
1: Male 
9: Unknown 

dd/mm/yyyy 

dd/mm/yyyy 

0: Alive 
1: Deceased 
9: Unknown 

datedeath 

Date of death 

Date 

dd/mm/yyyy 

Case unique identifier 
Surveillance site 
identification 
Date when case was 
notified for the first time 
to site level 
Residence in catchment 
area of surveillance unit 
reporting to system 
Age of patient in years 
as reported at site level 
in years at time of 
hospital admission 
Age of patient in months 
as reported at site level 
in years at time of 
hospital admission for 
children <2 years 

Gender of reported case 

Date when case was 
admitted to hospital 
Date when case was 
discharged from hospital 
Information on survival: 
alive, deceased, 
unknown 
Date of death of 
admitted patient (if 
outcome=1) 

8 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TECHNICAL REPORT 

Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Variable name 

Site-specific 
variables 

Variable label 

Type 

Values and coding 

Definition 

Comments 

clinic 

Clinical entity 

Multiple 
choice 

meningitis 

pneumonia 

empyema  

bacteraemia 

septicsk 

arthritis 

Pneumococcal 
meningitis 

Bacteraemic 
pneumococcal 
pneumonia 

Pneumococcal 
empyema 

Bacteraemia without 
known focus of 
infection 

Pneumococcal septic 
shock  

Pneumococcal 
arthritis 

Code 

Code 

Code 

Code 

Code 

Code 

0: Unknown 
1: Meningitis 
2: Bacteraemic 
pneumonia 
3: Empyema 
4: Bacteraemia 
5: Septic shock 
8: Other, specify 
9: Unknown 

0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

otherclin 

Other clinical entities  

Text 

string20 

icuadm 

Admission in the ICU 

Code 

0: No 
1: Yes 
9: Unknown 

datediag 

Date of diagnosis 

Date 

dd/mm/yyyy 

fluid 

lcr 

blood 

pleural 

Type of fluid tested 
positive 

Multiple 
choice 

Cerebrospinal fluid 

Code 

Blood culture 

Code 

Pleural fluid 

Code 

0: None 
1: CSF 
2: Blood 
3: Pleural 
4: Articular 
8: Other 
9: Unknown 

0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

Clinical manifestation of 
IPD case 

Case presenting with lab-
confirmed pneumococcal 
meningitis 
Case presenting with lab-
confirmed pneumococcal 
pneumonia 
Case presenting with lab-
confirmed pneumococcal 
empyema 
Case presenting with lab-
confirmed bacteraemia 
(blood stream infection) 
without known focus of 
infection 
Case presenting with 
clinician-diagnosed septic 
shock regardless of focus 
of infection 
Case presenting with lab-
confirmed pneumococcal 
arthritis 

Other clinical entities of 
IPD case 

Lab-confirmed case that 
needed admission  to ICU 
during pneumococcal 
episode 
Date when diagnosis 
was made, should be 
same as identification/ 
confirmation of case 

Fluid tested for IPD case 

Positive testing of CSF in 
case of meningitis 

Positive testing of blood in 
any of invasive cases 

Positive testing of pleural 
fluid in case of pneumonia 

This multiple 
choice variable 
can be collected 
as such or each 
clinical entity can 
be entered 
separately using 
variables below. 
If clinic=8, 
variable 
‘otherclin’ 
specifies other 
clinical entities of 
IPD not listed 

Please specify 
other clinical 
entity for IPD 
cases 

This multiple 
choice variable 
can be collected 
as such or each 
fluid can be 
entered 
separately using 
variables below. 
If fluid=8, 
variable (other 
fluid) specifies 
other positive 
sterile site fluids 
not listed 

9 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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TECHNICAL REPORT 

Variable name 

Site-specific 
variables 

Variable label 

Type 

Values and coding 

Definition 

Comments 

otherfluid 

Other positive fluids 

Text 

String20 

identif 

culture 

pcridentif 

agidentif 

Identification test 
performed 

Multiple 
choice 

Culture performed 

Code 

PCR performed 

Code 

Antigen detection 

Code 

serotype 

Serotype-identified 

Text 

serometh 

Test performed for 
serotyping 

Multiple 
choice 

seroque 

seropcr 

serogel 

seroother 

micpeni 

Serotyping using 
Quellung method 

Code 

Serotyping using PCR 

Code 

Serotyping using gel 
diffusion with specific 
antisera 
Other methods used 
for serotyping  

Code 

Text 

Other fluids that tested 
positive 

Test performed for 
identification of IPD case 

Culture performed on 
sterile site fluids 

PCR performed on sterile 
site fluids 

Ag detection performed on 
sterile site fluids 

Serotype-identified 

Test performed for 
serotyping of S. 
pneumoniae 

Serotyping using 
Quellung method 

Serotyping using PCR 

Serotype using gel 
diffusion with specific 
antisera 

0: Not done 
1: Culture 
2: PCR 
3: Antigen 
9: Unknown 

0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
string3 
PEN: Pending 
NTP: Non-typeable 
UKN: Unknown 

0: Not done 
1: Quellung 
2: PCR 
3: Gel diffusion 
8: Other 
9: Unknown 

0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

string20 

MIC to penicillin  

Numeric 

##.### 

MIC to penicillin in µg/ml 

mic[macrolide] 

MIC to macrolide 

Numeric 

##.## 

mic[cepha] 

MIC to cephalosporin 

Numeric 

##.## 

mic[antimicrobial] 

MIC to antimicrobial 

Numeric 

##.## 

Dose 1 PCV 

Code 

0: No 
1: Yes 
9: Unknown 

Date of vaccination 
with first dose PCV 

Date 

dd/mm/yyyy 

dosepcv1 

datepcv1 

10 

MIC to macrolide in 
µg/ml [please specify 
macrolide used: 
erythromycin, 
azithromycin, 
clarithromycin, etc.] 
MIC to cephalosporin in 
µg/ml (please specify 
cephalosporin used: 
cefotaxime, ceftriaxone, 
etc.) 

MIC to different other 
antimicrobial tested 

First dose of vaccination 
with a PCV 

Date of first dose of 
PCV 

This multiple 
choice variable 
can be collected 
as such or 
separately as 
variables 30–32  

This multiple 
choice variable 
can be collected 
as such or 
separately as 
variables below. 
When 
serometh=8, 
variable 
‘seroother’ 
specifies other 
methods used 
for serotyping 

If not tested, 
variable will be 
left blank 

If not tested, 
variable will be 
left blank 

If not tested, 
variable will be 
left blank 

Please specify 
antimicrobial 
using specific 
variables 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TECHNICAL REPORT 

Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Variable name 

Site-specific 
variables 

Variable label 

Type 

Values and coding 

Definition 

Comments 

brandpcv1 

dosepcv2 

datepcv2 

brandpcv2 

dosepcv3 

datepcv3 

brandpcv3 

dosepcv4 

datepcv4 

brandpcv4 

nbdoses 

doseppv 

dateppv 

nbdosesppv 

Dose 1 vaccine type 
of PCV 

Code 

Dose 2 PCV 

Code 

0: No vaccine 
1: PCV13 
2: PCV10 
3: PCV7 
8: Other 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

Date vaccination with 
second dose PCV 

Date 

dd/mm/yyyy 

Dose 2 vaccine type 
of PCV 

Code 

Dose 3 PCV 

Code 

0: No vaccine 
1: PCV13 
2: PCV10 
3: PCV7 
8: Other 
9: Unknown 
0: No 
1. Yes 
9: Unknown 

Date vaccination with 
third dose PCV 

Date 

dd/mm/yyyy 

Dose 3 vaccine type 
of PCV 

Code 

Dose 4 PCV 

Code 

0: No vaccine 
1:  PCV13 
2: PCV10 
3:  PCV7 
8: Other 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

Date vaccination with 
fourth dose PCV 

Date 

dd/mm/yyyy 

Dose 4 vaccine type 
of PCV 

Code 

Number of doses 

# 

PPSV23 vaccination 

Code 

0: No vaccine 
1: PCV13 
2: PCV10 
3: PCV7 
8: Other 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

Date vaccination with 
PPSV23 
Number of doses with 
PPSV23 

Date 

dd/mm/yyyy 

Numeric 

# 

underdis 

Underlying diseases 

Code 

underdistype 

Underlying diseases 
by immune status 

Code 

cardiovasc 

Cardiovascular 
diseases 

Code 

respdis 

Respiratory diseases 

Code 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Immunocompetent 
2: Immunocompromised 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

Type of PCV at first 
dose 

Second dose of 
vaccination with a PCV 

Date of second dose of 
PCV 

Type of PCV at second 
dose  

Third dose of 
vaccination with a PCV 

Date of third dose of 
PCV 

Type of PCV at third 
dose 

Fourth dose of 
vaccination with a PCV 

Date of fourth dose of 
PCV 

Type of PCV at fourth 
dose 

Number of doses of 
PCV provided 

Vaccination with 
PPSV23 

Date of vaccination with 
PPSV23 
Number of doses of 
PPSV23 provided 

Presence of at least one 
underlying disease which 
represents high risk 
groups for getting IPD 

Underlying diseases by 
immune status 

Patient was diagnosed 
with chronic cardiac 
disease: see table 3 for 
International 
Classification of Diseases 
(ICD) codes 
Patient was diagnosed 
with a chronic respiratory 
disease or asthma: see 
table 3 for ICD codes 

This variable can 
be collected as 
such or by 
specifying 
conditions below 

For definitions, 
please refer to 
table 3 

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TECHNICAL REPORT 

Variable name 

Site-specific 
variables 

Variable label 

Type 

Values and coding 

Definition 

Comments 

rendis 

Renal diseases 

Code 

immunodef 

Immunodeficiency  

Code 

hiv 

leukemia 

lymphoma 

Human 
immunodeficiency 
virus (HIV) disease 
Lymphoid and 
myeloid leukaemia; 
multiple myeloma 
Hodgkin lymphoma, 
Follicular lymphoma, 
Non-follicular 
lymphoma, 
MatureT/NK-cell 
lymphoma, 
Other and unspecified 
types of non-Hodgkin 
lymphoma 

Code 

Code 

Code 

transplant 

Solid organ transplant 

Code 

malignancy 

immunomed 

Generalised 
malignancy 

Immunosuppressing 
medication 

Code 

Code 

diabetes 

Diabetes mellitus 

Code 

asplenia 

Asplenia or 
splenectomised 

Code 

sicklemia 

Sickle cell disease 

Code 

csfleak 

cochlear 

Cerebrospinal fluid 
(CSF) leak 

Code 

Cochlear implant 

Code 

alcoholism 

Alcoholism 

Code 

liverdis 

Liver chronic disease, 
including cirrhosis 

Code 

smoking  

Cigarette smoking 

Code 

Institutionalised 
persons for the elderly 
and disabled 

Day care attendance 
in children < 5 years 

Code 

Code 

institutionalised 

daycare 

otherdis 

12 

Patient was diagnosed 
with a chronic renal 
disease: see table 3 for 
ICD codes 
Patient was diagnosed 
with an acquired or 
congenital 
immunodeficiency: see 
table 3 for ICD codes 

See table 3 

See table 3 

See table 3 

See table 3 

See table 3 

See table 3 

Patient diagnosed with 
diabetes mellitus type 1 
or 2: see table 3 for ICD 
codes 
Patient with asplenia or 
splenectomy in the 
clinical history: see table 
3 for ICD codes 
Patient with sickle cell 
disease in the clinical 
history: see table 3 for 
ICD codes 

See table 3 

See table 3 

See table 3 

See table 3 

See table 3 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 

0:No 
1: Yes 
9: Unknown 

0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 
0: No 
1: Yes 
9: Unknown 

Other underlying 
disease 

Text 

string20 

Specify other underlying 
conditions included in 
the recommendation for 
PCV/PPV vaccination 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TECHNICAL REPORT 

Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Variable name 

Site-specific 
variables 

Variable label 

Type 

Values and coding 

Definition 

Comments 

fluvac 

Influenza vaccination  

Code 

0: No 
1: Yes 
9: Unknown 

Influenza vaccination in 
the previous season 

Other variables  

#: Numerical value. 

Please include 
all other 
variables 
collected in the 
site specific 
surveillance 
system 

Each surveillance site will include the name of the variables used at the site and add specific variables collected in 
addition to those from Table 2. 

Table 3. Risk conditions for pneumococcal diseases and corresponding ICD-9 and 10-codes 

Risk conditions 

Description 

Immunocompromised persons 

Congenital/acquired 
immunodeficiency 

Human immunodeficiency virus (HIV) 
disease 

Chronic kidney disease 

Nephrotic syndrome 

Leukemia 

Lymphoma 

Lymphoid and myeloid leukemia; multiple myeloma 

Hodgkin lymphoma, follicular lymphoma, non-follicular lymphoma, 
matureT/NK-cell lymphoma, other and unspecified types of non-
Hodgkin lymphoma 

ICD-9 
Code 

ICD-10 Code 

135, 279 

D80-D89 

042 

585 

581 

B20-B24 

N18 

N04 

203 – 206 
202.9 

C91-C92, C93, 
C96.9 
C90 

200 - 202 

C81, C82, C83, 
C84, C85 

Generalised malignancy (Metastatic 
solid tumors) 

Malignant neoplasms of ill-defined, other secondary and 
unspecified sites  

195-199 

C76-C80 

Immunosuppressing medication 

No specific ICD-
10 codes 

Solid organ transplant 

Transplanted organ and tissue status 

V42 

Z94 

Functional or anatomical asplenia 

Thalassemia, sickle cell disorders, 
other haemoglobinopathies, diseases 
of the spleen (including anatomical 
asplenia) 

Immunocompetent persons 

Cerebrospinal fluid (CSF) leak 

Cochlear implant 

Chronic heart disease  

Chronic ischemic heart disease, cardiomyopathy, heart failure 

Chronic lung disease 

Diabetes mellitus 

Alcoholism 

Emphysema, other chronic obstructive pulmonary disease (COPD), 
asthma 

Type 1 diabetes, type 2 diabetes, malnutrition-related diabetes, 
other specified diabetes, unspecified diabetes 

250 

E10, E11, E12, 
E13, E14 

Mental and behavioural disorders due to alcohol use, degeneration 
of nervous system due to alcohol, alcoholic polyneuropathy, 
alcoholic myopathy, alcoholic cardiomyopathy, alcoholic gastritis, 
alcoholic liver disease, alcohol-induced acute pancreatitis, alcohol-
induced chronic pancreatitis, maternal care for suspected damage 
to fetus from alcohol 

Chronic liver disease, cirrhosis 

Hepatic failure, not elsewhere specified (NES), chronic hepatitis, 
NES, fibrosis and cirrhosis, other liver diseases, liver malignancy 

Cigarette smoking 

Tobacco use, mental disorders due to tobacco 

Institutionalised persons 

Nursing homes and long-term facilities 

Other ICD codes 

Site-specific conditions included in high-risk groups for 
pneumococcal infection 

282, 289.4-5 

D56, D57, 
D58.2, D73 

349.81, 
388.61 

431 

412 – 414, 
425, 428 

G96.0 

Z96.2 

I25, I42, I50 

492, 493 

J43, J44, J45 

305, 281, 
357.5, 
425.5, 
535.30-31, 
571, 655 

F10, G31.2*, 
G62.1, G72.1*, 
I42.6, K29.2, 
K70, K85.2*, 
K86.0*, O35.4 

155, 470 – 
474  
572.4, 573.9 

K72, K73, K74, 
K76.7, K76.9, 
C22 

300.51 
292.89 

Z72.0*, F17.2, 
F17.3* 

No specific ICD-
10 codes 

13 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

TECHNICAL REPORT 

Selected bibliography 

Publications 

Savulescu C, Krizova P, Lepoutre A, Mereckiene J, Vestrheim DF, Ciruela P, et al. Effect of high-valency 
pneumococcal conjugate vaccines on invasive pneumococcal disease in children in SpIDnet countries: an 
observational multicentre study. Lancet Respir Med. 2017 Aug;5(8):648-656. 

Hanquet G, Krizova P, Valentiner-Branth P, Ladhani S., Nuorti P., Lepoutre A., et. al. Indirect effect of 
childhood pneumococcal conjugate vaccine programmes on invasive pneumococcal disease in older adults 
of ten European countries. Implications for adult vaccination. Thorax. In press. 

Presentations and posters 

Savulescu C, Valentiner-Branth P, Georges S, Mereckiene J, Knol M, Winje B, et al. Effect of vaccination 
programmes using 13-valent pneumococcal conjugate vaccine on the incidence of pneumococcal meningitis 
in children under five years-old: results of SpIDnet multicentre study. Poster presented at: 36th Annual 
Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2018); 30 May 2018; Malmö, 
Sweden. Available from: https://www.morressier.com/article/5ad774e1d462b80296ca6e95. 

Savulescu C, Krizova P, Slotved HC, Levy C, Mereckiene J, Winje B, et al. Effectiveness of 13-valent 
pneumococcal conjugate vaccine on invasive pneumococcal disease in Europe: results of SpIDnet 
multicentre study. Poster presented at: ESPID 2018; 28 May to 2 June 2018; Malmö, Sweden. Available 
from: https://www.morressier.com/article/5ad774e0d462b80296ca6c55. 

Savulescu C, Colzani E, Pastore Celentano L, Hanquet G, SpIDnet group. Impact of higher-valency 
pneumococcal conjugate vaccines on invasive pneumococcal disease in children under 5 years (2011-2016): 
SpIDnet – a European multicentre study. Oral presentation at: 11th International Symposium on 
Pneumococci and Pneumococcal Diseases (ISPPD 2018); 16 April 2018; Melbourne, Australia. Available 
from: https://cmoffice.kenes.com/isppd18/CM.NET.WebUI/CM.NET.WEBUI.scpr/SCPRfunctiondetail.aspx? 
confID=05000000-0000-0000-0000-000000000246&sesID=05000000-0000-0000-0000-
000000050844&absID=07000000-0000-0000-0000-000000610117. 

Hanquet G, Rinta Kokko H, Nuorti P, Colzani E, Pastore Celentano L, Savulescu C, et al. Indirect effect of six 
years of childhood PCV10/13 vaccination on invasive pneumococcal disease in the elderly of 10 European 
countries: implications for elderly vaccination. Poster presented at: ISPPD 2018; 16 to 17 April 2018; 
Melbourne, Australia. Available from: https://simul-europe.com/2018/isppd/HtmlPage1.html?prodId= 
(ISPPD-0647)Elderly_poster_ISPPD2018_electr.pdf.jpg. 

Savulescu, C., Valentiner-Branth, P., Mereckiene, J., Winje, B., Ciruela, P., Latasa, P, et al. Effectiveness of 
the 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in European 
adults aged ≥65 years and above: results of SpIDnet/I-MOVE+ multicentre study (2012-2016). Poster 
presented at: ISPPD 2018; 17 April 2018; Melbourne, Australia. Available from: https://cmoffice.kenes.com/ 
isppd18/CM.NET.WebUI/CM.NET.WEBUI.scpr/SCPRfunctiondetail.aspx?confID=05000000-0000-0000-0000-
000000000246&sesID=05000000-0000-0000-0000-000000049706&absID=%2007000000-0000-0000-0000-
000000609160. 

Savulescu, C., Colzani E, Pastore Celentano L, Hanquet G, SpIDnet group. Impact and effectiveness of 13-
valent pneumococcal conjugate vaccine against invasive pneumococcal disease caused by serotype 19a 
pneumococcus in European children: results of SpIDnet multicentre study. Poster presented at: ISPPD 2018; 
17 April 2018; Melbourne, Australia. Available from: https://cmoffice.kenes.com/isppd18/CM.NET.WebUI/ 
CM.NET.WEBUI.scpr/SCPRfunctiondetail.aspx?confID=05000000-0000-0000-0000-000000000246&sesID= 
05000000-0000-0000-0000-000000049707&absID=07000000-0000-0000-0000-000000624175. 

Savulescu C, Casadevante VF, Belchior E, Mereckiene J, Vestrheim DF, Ciruela P, et al. Impact of 
pneumococcal conjugate vaccines on invasive disease caused by pneumococci non-susceptible to 
antimicrobials in European children under five years old: SpIDnet multicentre study (2011-2015). Oral 
presentation at: European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE 
2017); 7 November 2017; Stockholm, Sweden. Available from: https://www.escaide.eu/sites/escaide/files/ 
documents/ESCAIDE_2017%20abstract%20book_final_03.pdf. 

14 

 
 
TECHNICAL REPORT 

Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

Savulescu C, Krizova P, Slotved HC, Levy C, Mereckiene J, Knol M. Direct and overall effect of 13-valent 
pneumococcal conjugate vaccine against invasive pneumococcal disease caused by serotype 3 
pneumococcus in European children: results of SpIDnet multicentre study. Poster presented at: ESCAIDE 
2017; 8 November 2017; Stockholm, Sweden. Available from: https://www.escaide.eu/sites/escaide/files/ 
documents/ESCAIDE_2017%20abstract%20book_final_03.pdf. 

Savulescu C, Krizova P, Valentiner-Branth P, Belchior E, Mereckiene J, Winje BA, et al. Effectiveness of 13-
valent pneumococcal conjugate vaccine on invasive pneumococcal disease and antimicrobial non-
susceptibility in European children: results of SpIDnet multicentre study. Poster presented at: 35th Annual 
Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2017); 25 May 2017; Madrid, 
Spain. Available from: https://espid2017.kenes.com/Documents/ESPID17%20abstracts.pdf. 

Savulescu C, Valentiner-Branth P, Belchior E, Mereckiene J, Vestrheim DF, Ciruela P, et al. Impact of 
pneumococcal conjugate vaccines on antimicrobial non-susceptible pneumococcal isolates causing invasive 
disease in children: results from SpIDnet multicentre study. Poster presented at: ESPID 2017; 25 May 2017; 
Madrid, Spain. Available from: https://espid2017.kenes.com/Documents/ESPID17%20abstracts.pdf. 

Hanquet G, Savulescu C, Krizova P, Valentiner-Branth P, Ladhani S, Nuorti P, et al. Indirect effect of infant 
PCV10/13 vaccination on IPD in the elderly: pooled analysis from 13 EU sites in 10 EU countries. Oral 
presentation at: 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2017); 
23 April 2017; Vienna, Austria. Available from: https://www.escmid.org/escmid_publications/escmid_ 
elibrary/material/?mid=52495. 

Savulescu C, Krizova P, Espenhain L, Lepoutre A, Mereckiene J, Knol M, et al. PCV13 effectiveness and 
overall effect of PCV10/13 vaccination programmes in children under five years of age. Oral presentation at: 
European Scientific Conference on Applied Infectious Disease Epidemiology 2016 (ESCAIDE 2016); 29 
November 2016; Stockholm, Sweden. Available from: https://www.slideshare.net/ECDC_EU/camelia-
savulescu-pcv13-effectiveness-and-overall-effect-of-pcv1013-vaccination-programmes-in-children-under-five-
years-of-age-spidnet-multicentre-studies. 

Hanquet G, Krizova P, Espenhain L, Nuorti P, Lepoutre A, Mereckiene J, et al. Indirect effect of infant 
PCV10/13 vaccination on IPD in the elderly: pooled analysis from 13 EU sites. Oral presentation at: 
ESCAIDE 2016; 29 November 2016; Stockholm, Sweden. Available from: https://www.slideshare.net/ECDC_ 
EU/germaine-hanquet-indirect-effect-of-infant-pcv1013-vaccination-on-ipd-in-the-elderly-pooled-analysis-
from-13-eu-sites. 

Effectiveness of 13 valent pneumococcal conjugate vaccine against invasive pneumococcal disease: results 
of SpIDnet – a European multicentre study (2012-2014). Presented at: 10th International Symposium on 
Pneumococci and Pneumococcal Diseases (ISPPD 2016); 26 to 30 June 2016; Glasgow, Scotland. 

Savulescu C, Pastore Celentano L, Hanquet, SpIDnet group. Impact of higher-valency conjugate vaccines on 
Invasive Pneumococcal Disease incidence (2010-2014): Results of a European multi-centre study. Poster 
presented at: ISPPD 2016; 30 June 2016; Glasgow, Scotland. Available from: http://s3-eu-west-
1.amazonaws.com/poster-isppd2016/original/ISPPD-0557.pdf. 

Savulescu C, Pastore Celentano L, Hanquet G, SpIDnet2 group. Overall effectiveness of higher-valency 
pneumococcal conjugate vaccines on invasive pneumococcal disease in children under 5 years (2010-2014): 
results of SpIDnet2 - a European multicentre study. Presented at: 34th Annual Meeting of the European 
Society for Paediatric Infectious Diseases (ESPID 2016); 12 May 2016; Brighton, UK. Available from: 
https://espid2016.kenes.com/Documents/ESPID16_Abstracts.pdf. 

Hanquet G, Lepoutre A, Ciruela P, Vestrheim DF, Smith-Palmer A, Krizova P, et al. Indirect effect of childhood 
PCV10/13 vaccination on invasive pneumococcal disease among seniors 65 years old and over in six 
European countries (SpIDnet network): Implications for PCV13 vaccination of the elderly. Oral presentation 
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Savulescu C, Pastore Celentano L, Hanquet G, SpIDnet group. Effectiveness of 13-valent pneumococcal 
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Generic protocol on enhanced surveillance for invasive pneumococcal disease at the EU/EEA level 

TECHNICAL REPORT 

Savulescu C, Krizova P, Lepoutre A, Cotter S, Vestrheim DF, Sirbu A, et al. High vaccine effectiveness and 
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17 

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