Abstract This study assessed the epidemiological and microbiological invasive pneumococcal disease (IPD) changes that occurred before and after the emergence of COVID-19 in Italy . All IPD cases reported through the nationwide surveillance system during 2018–2023 were included. IPD incidence and serotype distributions were analyzed by age group. IPD incidence in 2020–2021 declined in all age groups compared with 2018–2019 , especially in children less than 2 years of age and elderly people aged > 64 years. A resurgence of IPD cases was observed from late 2022 onwards , with values in children exceeding those seen before the pandemic. The post COVID-19 increase in children was mainly driven by some PCV13 serotypes , such as 3, 19A, and 19F , but also non-vaccine serotypes, including 10A, 8, and 24F , while in the elderly population , a predominance of serotypes 3 and 8 was observed . In conclusion, a steep drop in IPD incidence was observed during the peak of the COVID-19 pande...