Figure 1. Flow diagram of cases included in the analysis of patients with IPD in South Africa, 2012–2018. Asterisk (*) indicates that cases were not typed for 1 of the following reasons: the case was identified by the laboratory information system data audits, n = 651; the sample was positive for pneumococcal antigen detection but nonviable upon culture, n = 14; the isolate was not received and thus serotyping not possible, n = 379; or sample was nonviable and PCR negative, n = 81. Dagger (†) indicates that samples for which Quellung did not yield a valid result were prepared for PCR confirmation and serotyping if PCR positive. If the multiplex PCR was negative for all 38 detectable serotypes, then the sample was excluded from analysis. IPD, invasive pneumococcal disease.