PIGG and infection: However, a previous temporal analysis showed that the Dutch surge in iGAS coincided with a significant increase of invasive emm-type 1.0 isolates, where the M1UK variant became dominant among invasive emm-type 1.0 isolates.32,33 A new emm-type 4 lineage, M4NL22, has also been associated with the iGAS surge in the Netherlands.34 In our study, emm-type 4.0 was predominant in nonfocal infections, similar to findings from Nygaard et al8 and Villalón et al.35 We saw a dramatic increase in iGAS caused by emm-type 3.93 at the beginning of 2024.