Increasing incidence of serotype 38 invasive pneumococcal disease driven by the ST393 clone among children, Denmark 2022-2024

Non-vaccine-serotypes (non-VT) pose a challenge to reducing invasive pneumococcal disease (IPD). Since 2023, serotype 38 IPD has increased in Denmark promoting investigation of this serotype's characteristics. We included all non-VT IPD cases from 2014 to 2024 to calculate annual incidences per 100,000 individuals with 95% confidence intervals (CI). Clinical characteristics and outcomes of serotype 38 IPD were compared with other non-VT IPD in 2022 to 2024. Incidence of serotype 38 IPD increased mainly in children < 2 years, from 0.87 (95% CI 0.02-4.84) to 5.99 (95% CI 2.41-12.34) cases per 100,000 population, whereas the incidence for other non-VT remained stable. SNP analysis, conducted for serotype 38 isolates, revealed that the rise was driven by the ST393 clone with isolates not linked to a region or outbreak. Baseline characteristics and outcomes were similar between the 42 cases of serotype 38 IPD and the 412 other non-VT IPD cases, except for age distribution (p < 0.001) with serotype 38 IPD more frequent in children aged < 2 years (21.4% vs. 3.4%). In conclusion, serotype 38 IPD, driven by the ST393 clone, was the dominant serotype causing non-VT IPD in children < 2 years the last two years, however disease severity was similar to other non-VT IPD.