The South Asian Pneumococcal Surveillance network uses standard recruitment and laboratory procedures for surveillance of invasive pneumococcal disease in India, Nepal, and Sri Lanka. Children aged 2 months to 5 years who were admitted to the sentinel surveillance site, Lady Ridgeway Hospital for Children, in Colombo, Sri Lanka, and who presented with signs and symptoms of meningitis, pneumonia, or very severe disease were studied. Blood culture and CSF culture specimens were analyzed at the microbiology laboratory at Lady Ridgeway Hospital for Children. Specimens were processed by routine conventional methods. Antigen testing was performed on CSF specimens with use of commercially available latex agglutination test kits. From January 2005 to March 2007, we observed 23 isolates of Streptococcus pneumoniae, and the most common serotypes were 19F, 14, 23F, and 6B. Of the serotypes found, 60% are covered by the currently available 7-valent conjugate pneumococcal vaccine. More than 90% of the isolates were penicillin resistant, and the rate of resistance to third-generation cephalosporins was also high.