Official Statistics

National flu and COVID-19 surveillance report: 10 October (week 41)

Updated 14 November 2024

Applies to England

This report summarises the information from the surveillance systems which are used to monitor COVID-19 (caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), influenza, and diseases caused by seasonal respiratory viruses in England. The report is based on data up to week 40 of 2024 (between 30 September and 6 October 2024).

Main points

The main messages of this report are:

• COVID-19 activity increased across most indicators and is at low to moderate levels

• Influenza activity increased across most indicators but remained at low levels

• respiratory syncytial virus (RSV) activity increased slightly across most indicators but remains at low levels

Flu, COVID-19 and RSV activity

Influenza activity

Influenza activity was at low levels but increased across most indicators compared with the previous reporting week. Emergency department (ED) attendances for influenza-like-illness (ILI) increased overall. The number of influenza-confirmed ARI incidents in week 40 decreased slightly compared with the previous week.

Weekly influenza vaccine uptake for the 2024 to 2025 season is reported for the first time. Compared with the equivalent week last season (2023 to 2024), vaccine uptake is comparable for those aged 2 years, slightly higher for those aged 3 years, and lower for pregnant women. Data is not comparable to previous seasons for those aged 65 years and over, and those aged under 65 years in clinical risk groups. This is because these cohorts were eligible from 3 October, rather than 1 September, in this season.

Indicator	Trend	Level [note 1]	Data
Laboratory surveillance	Increasing slightly	Green	Influenza positivity increased slightly with a weekly mean positivity rate of 1.9% compared with 1.5% in the previous week
Influenza-like illnesses (ILI) General Practice (GP) consultations	Increasing	Green	The weekly ILI consultation rate increased to 3.2 per 100,000 registered population in participating GP practices compared with 2.5 per 100,000 in the previous week
GP swabbing positivity	Decreasing	Green	In week 39, among all tested samples, 0.9% were positive for influenza
Hospital admissions	Not available	Green	The overall weekly hospital admission rate for influenza increased to 0.61 per 100,000. This surveillance formally starts in week 40 so comparisons to the previous week are not possible
ICU/HDU admissions	Not available	Green	The overall ICU or HDU rate for influenza decreased to 0.00 per 100,000. This surveillance formally starts in week 40 so comparisons to the previous week are not possible

COVID-19 activity

COVID-19 activity increased across most indicators compared with the previous reporting week. The number of reported SARS-CoV-2 confirmed ARI incidents in week 40 decreased slightly compared with the previous week. In sequenced samples, the most prevalent lineage was K.3.1.1.

Indicator	Trend	Level [note 1]	Data
Laboratory surveillance	Stable	Green	COVID-19 PCR positivity in hospital settings remained stable at a weekly mean positivity rate of 13.4% compared with 13.3% in the previous week.
GP swabbing positivity	Decreasing	Amber	In week 39, among all tested samples, 10% were positive for SARS-CoV-2
Hospital admissions	Increasing	Green	The overall weekly hospital admission rate for COVID-19 increased to 4.55 per 100,000 compared with 3.72 per 100,000 in the previous week
ICU/HDU admissions	Decreasing	Green	The overall ICU or HDU rate for COVID-19 decreased to 0.12 per 100,000 compared with 0.14 per 100,000 in the previous week

Respiratory syncytial virus (RSV) activity

Respiratory syncytial virus (RSV) activity increased slightly across most indicators. Emergency department (ED) attendances for acute bronchiolitis increased nationally.

Indicator	Trend	Level [note 1]	Data
Laboratory surveillance	Increasing	Green	RSV positivity increased to 1.6% compared with 0.7% in the previous week
GP swabbing positivity	Decreasing	Green	Among all tested samples, 0.5% were positive for RSV
Hospital admissions	Increasing	Green	The overall weekly hospital admission rate for RSV increased to 0.39 per 100,000 compared with 0.28 per 100,000 in the previous week

Other viruses

Indicator	Trend	Level [note 1]	Data
Adenovirus	Decreasing slightly	Amber	Adenovirus positivity (laboratory surveillance) decreased slightly to 2%
Human metapneumovirus (hMPV)	Decreasing	Green	hMPV positivity (laboratory surveillance) decreased to 0.4%
Parainfluenza	Stable	Green	Parainfluenza positivity (laboratory surveillance) remained stable at 1.2%
Rhinovirus	Stable	Amber	Rhinovirus positivity (laboratory surveillance) remained stable at 17.1%

Note 1: for indicators where moving epidemic method (MEM) thresholds exist, these thresholds were used to determine the level of activity (green, amber, red): Baseline and low levels were combined into ‘green’, high and very high levels were combined into ‘red’, and the medium level was kept as ‘amber’. For indicators where MEM thresholds do not exist, the mean and standard deviation of activity over the past year was used as a guide to the level of activity (green, amber, red) alongside expert opinion and triangulation of other data sources. This method is experimental and is still under development.

Laboratory surveillance

Laboratory confirmed cases

The Second Generation Surveillance System (SGSS) captures test result information for notifiable infectious diseases, including COVID-19 and influenza, from laboratories in England. The Unified Sample Dataset (USD), used to calculate the percentage tests positive for SARS-CoV-2 among all SARS-CoV-2 tests, stores all SARS-CoV-2 test results reported to SGSS, Respiratory DataMart, and UKHSA laboratories.

COVID-19 cases

As of 8 October 2024, there were a total of 2,887 COVID-19 cases identified in hospital settings in week 40, increasing slightly from 2,722 cases in the previous week. COVID-19 PCR positivity in hospital settings remained stable in week 40, with a weekly average positivity rate of 13.4% compared with 13.3% in the previous week. Positivity rates were highest in those aged 85 years and over, at a weekly average positivity rate of 21.1%. This remained stable when compared with week 39, when positivity rates were at 20.6% among those aged 85 years and over.

Figure 1. Total daily COVID-19 cases and percentage of tests positive for SARS-CoV-2 among all reported SARS-Cov-2 tests, England

Figure 2. Percentage of tests positive for SARS-CoV-2 among all reported SARS-CoV-2 tests by age group, England

Influenza cases

As of 8 October 2024, influenza positivity in week 40 increased with a weekly average positivity rate of 1.9% compared with 1.5% in the previous week. Influenza positivity rates were highest in those aged between 5 and 14 years at a weekly average positivity rate of 4.9%. This has increased from 2.6% among those aged between 5 and 14 years in week 39.

Figure 3. Percentage of tests positive for influenza among all reported influenza tests, England [note 2]

Note 2: data from previous seasons is aligned by day.

Figure 4. Percentage of tests positive for influenza among all reported influenza tests by age group, England

Respiratory DataMart System

Respiratory DataMart is a sentinel laboratory-based surveillance system where participating laboratories report positive and negative test results for a number of respiratory viruses from samples primarily taken in hospital. A small proportion of primary care samples are also included in this reporting.

In week 40, data is based on reporting from 10 out of the 16 sentinel laboratories.

In week 40, 4,118 respiratory specimens reported through the Respiratory DataMart System were tested for influenza. There were 87 positive samples for influenza: 51 influenza A (not subtyped), 27 influenza A (H3N2), 4 influenza A (H1N1)pdm09, and 6 influenza B. Overall, influenza positivity increased slightly to 2.1% in week 40 compared with 1.9% in the previous week.

In week 40, 4,647 respiratory specimens reported through the Respiratory DataMart System were tested for SARS-CoV-2. There were 506 positive samples for SARS-CoV-2. SARS-CoV-2 positivity remained stable at 10.9% compared with 10.8% in the previous week, with the highest positivity in those aged 80 years and over, at 17.9%.

RSV positivity increased to 1.6%, with the highest positivity in those aged under 5 years at 7.8%.

Adenovirus positivity decreased slightly to 2%, with the highest positivity in those aged under 5 years at 5.1%.

Human metapneumovirus (hMPV) positivity decreased to 0.4%, with the highest positivity in those aged between 5 and 14 years, at 0.6%.

Parainfluenza positivity remained stable at 1.2%, with the highest positivity in those aged under 5 years, at 4.6%.

Rhinovirus positivity remained stable at 17.1%, with the highest positivity in those aged under 5 years, at 43.1%.

DataMart data is provisional and subject to retrospective updates.

Figure 5a. Respiratory DataMart weekly percentage of tests positive for influenza, SARS-CoV-2, RSV and rhinovirus, England

Figure 5b. Respiratory DataMart weekly percentage of tests positive for adenovirus, hMPV and parainfluenza, England [Note 3]

Note 3: shading represents 95% confidence intervals.

Figure 6. Respiratory DataMart weekly cases by influenza subtype, England [note 3]

Note 3: shading represents 95% confidence intervals.

Figure 7. Respiratory DataMart weekly percentage testing positive for RSV by season, England

Figure 8. Respiratory DataMart weekly percentage testing positive for RSV by age, England

SARS-CoV-2 lineages

UKHSA conducts genomic surveillance of SARS-CoV-2 lineages.

This section provides an overview of circulating lineages in England, derived from data on sequenced PCR-positive SARS-CoV-2 samples in SGSS.

The prevalence of UKHSA-designated lineages amongst sequenced cases is presented in Figure 9.

To account for reporting delays, we report the proportion of lineages within COVID-19 cases that have had a sequenced positive sample between 2 September 2024 and 15 September 2024. Of those sequenced in this period, 59.35% were classified as KP.3.1.1, 9.35% were classified as XEC, 7.94% were classified as JN.1, 6.07% were classified as KP.2, 4.67% were classified as JN.1.11.1, 4.67% were classified as KP.3.1 and 4.21% were classified as KP.3.3.

Figure 9. Prevalence of SARS-CoV-2 lineages amongst available sequenced cases for England from 2 October 2023 to 22 September 2024

Community surveillance

Acute respiratory infection incidents (ARI)

Data is presented on viral ARI incidents in different settings that are reported to UKHSA Health Protection Teams (HPTs).

Please note that prior to July 2024, ARI incidents were recorded in HPZone, a previous case and incident management system. From July to September 2024, HPTs transitioned to a new system, the Case and Incident Management System (CIMS). ARI outbreak reporting was paused during the transitional period and will be updated retrospectively. Any interpretation of seasonal and temporal trends since 1 July 2024 should consider the likelihood of differences in reporting of ARI incidents due to this change.

There were 82 new ARI incidents reported in week 40 in England. These included:

• 74 incidents from care homes, of which 53 were due to SARS-CoV-2, 3 due to influenza A, 1 due to multiple pathogens and 1 due to other pathogens

• 3 incidents from hospitals of which 3 were due to SARS-CoV-2

• 1 incident from educational settings for which no tests were available

• 1 incident from prisons of which 1 was due to multiple pathogens

• 3 incidents from other settings of which 3 were due to SARS-CoV-2

Figure 10. Number of ARI incidents by setting, England

Figure 11. Number of ARI incidents in all settings by virus type, England

Flu Detector

Flu Detector is a web-based model which assesses internet-based search queries for influenza-like-illness (ILI) in the general population.

Daily ILI rate estimates are based on uniformly averaged search query frequencies for a weeklong period (including the current day and the 6 days before it).

For week 40, the average daily ILI query rate decreased compared to the previous week and was below baseline activity (Figure 12).

Figure 12. Daily estimated ILI Google search query rates per 100,000 population, England

Syndromic surveillance

Syndromic surveillance collects data from various healthcare sources where presentations are classified by patterns of symptoms compatible with specific infections. In some settings, the syndromic diagnosis can be supplemented by (rapid) testing. In this report, ED attendances are displayed. Further details and data from other syndromic surveillance systems can be found in the syndromic surveillance weekly summaries.

During the week ending on 6 October 2024, ED attendances for acute respiratory infection increased slightly and were above seasonally expected levels. ED attendances for influenza-like illness increased and were at seasonally expected levels. ED attendances for COVID-19-like illness increased slightly. ED attendances for acute bronchiolitis, a syndrome related to RSV infection, increased slightly and were below seasonally expected levels.

Figure 13a. Daily emergency department attendances for acute respiratory infection nationally, England [note 4]

Note 4: 7-day moving average is adjusted for bank holidays. Grey columns show weekends and bank holidays.

Figure 13b. Daily emergency department attendances for acute respiratory infection by age group, England [note 5]

Note 5: scales vary in each graph to enable trend comparisons. The black line is the 7-day moving average adjusted for bank holidays.

Figure 14a. Daily emergency department attendances for COVID-19-like illness nationally, England [note 4]

Note 4: as above.

Figure 14b. Daily emergency department attendances for COVID-19-like illness by age group, England [note 5]

Note 5: as above.

Figure 15a. Daily emergency department attendances for ILI nationally, England [note 4]

Note 4: as above.

Figure 15b. Daily emergency department attendances for ILI by age group, England [note 5]

Note 5: as above.

Figure 16a. Daily emergency department attendances for acute bronchiolitis nationally, England [note 4]

Note 4: as above.

Figure 16b. Daily emergency department attendances for acute bronchiolitis by age group, England [note 5]

Note 5: as above.

Primary care surveillance

Primary care surveillance is undertaken in collaboration with the Royal Collage of General Practitioners Research and Surveillance Centre (RCGP RSC), using a national sentinel surveillance system of around 2,000 GP practices covering over 19 million registered patients of all ages across England. More information on the methodology can be found in the RCGP methodology report.

RCGP clinical indicators (England)

The weekly ILI consultation rate through the RCGP surveillance increased to 3.2 per 100,000 registered population in participating GP practices in week 40 compared with 2.5 per 100,000 in the previous week.

This rate corresponds with a baseline activity level (Figure 1). By age group, the highest rates were seen in those aged between 15 and 44 years (3.7 per 100,000), followed by those aged between 45 and 64 years (3.5 per 100,000).

The lower respiratory tract infections (LRTI) consultation increased to 85.2 per 100,000 in week 40 compared with 75.3 per 100,000 in the previous week.

Further details are available in the weekly RSC communicable and respiratory disease report for England.

Figure 17. RCGP ILI consultation rates per 100,000, all ages, England

MEM thresholds are based on data from the 2016 to 2017 season to the 2023 to 2024 season. Please note the 2019 to 2020, 2020 to 2021 and 2021 to 2022 seasons have been removed.

RCGP sentinel swabbing scheme in England

Starting from week 51 2023, testing for enterovirus and rhinovirus has been delayed. There were fewer than 50 results for week 40.

532 samples were taken in week 39 through the GP sentinel swabbing, and 30 tested positive (Figure 2).

Among all tested samples, 9.9% were positive for SARS-CoV-2, 0.4% for influenza, 0.4% for RSV, 1.8% for adenovirus, 0.4% for hMPV, 0% for rhinovirus, and 0% for enterovirus (Figure 3).

Due to the number of samples which have not yet been categorised, data should be interpreted with caution when compared with previous weeks. The proportion of detections among all tested samples is not calculated when the number of samples with a result is fewer than 50.

Figure 18. Number of samples tested for respiratory viruses in England by week, GP sentinel swabbing scheme [note 6] [note 7]

Note 6: unknown category corresponds to samples with no result yet.

Note 7: starting from week 40 2024, testing for seasonal coronavirus has been suspended.

Figure 19. Percentage of detection of respiratory virus among all samples with completed testing in England by week, GP sentinel swabbing scheme [note 8] [note 9]

Note 8: Data from the most recent week is not shown on this graph due to reporting delays.

Note 9: Starting from week 40 2024, testing for seasonal coronavirus has been suspended.

Figure 20. Percentage of detected respiratory viruses among all samples with completed testing in England by age group, GP sentinel swabbing scheme, week 36 to week 39 [note 8]

Note 8: Data from the most recent week is not shown on this graph due to reporting delays.

Figure 21. Weekly positivity for SARS-CoV-2, influenza and RSV in England, GP sentinel swabbing scheme

Secondary care

COVID-19 hospital and ICU or HDU admissions

Surveillance of COVID-19 hospitalisations to all levels of care and admissions to intensive care units (ICU) or high dependency units (HDU) are both mandatory, with data required from all acute NHS trusts in England.

Please note that SARI Watch data is provisional and subject to retrospective updates. ICU or HDU admission rates may also be affected by lags from admission to hospital to an ICU or HDU ward. Rates are presented per 100,000 trust catchment population.

COVID-19 hospitalisations for all levels of care in week 40 2024 based on 87 NHS trusts in England were as follows:

• the overall weekly hospital admission rate for COVID-19 increased to 4.55 (compared with 3.72 per 100,000 in the previous week)

• hospital admission rates for COVID-19 were highest in the North East region (increasing to 8.12 per 100,000 compared with 6.64 in the previous week). Please refer to the slideset and supplementary data file for regional breakdowns

• the highest hospital admission rate for COVID-19 was in those aged 85 years and over (increasing to 52.48 per 100,000 compared with 40.39 in the previous week)

COVID-19 ICU-HDU admissions in week 40 2024 based on 77 NHS trusts in England were as follows:

• the overall ICU or HDU rate for COVID-19 decreased to 0.12 per 100,000 (compared with 0.14 per 100,000 in the previous week). Note that with low rates in critical care, small random fluctuations may occur

• ICU or HDU admission rates for COVID-19 were highest in the East of England region (increasing to 0.17 per 100,000 compared with 0.05 in the previous week). Please refer to the slideset and supplementary data file for regional breakdowns

• the highest ICU or HDU admission rate for COVID-19 was in those aged between 75 and 84 years (increasing to 0.55 per 100,000 compared with 0.31 in the previous week)

Figure 22. Weekly overall COVID-19 hospital admission rates per 100,000 trust catchment population reported through SARI Watch mandatory surveillance, England

Figure 23. Weekly hospital admission rate by age group for new COVID-19 positive cases reported through SARI Watch mandatory surveillance, England

Figure 24. Weekly overall COVID-19 ICU or HDU admission rates per 100,000 trust catchment population reported through SARI Watch mandatory surveillance, England

Figure 25. Weekly ICU or HDU admission rate by age group for new COVID-19 positive cases reported through SARI Watch mandatory surveillance, England

Influenza hospital and ICU or HDU admissions

Surveillance of influenza hospitalisations to all levels of care is based on data from a small sentinel network of acute NHS trusts in England. Surveillance of admissions to ICU or HDU for influenza is mandatory, with data required from all acute NHS trusts in England.

Please note that SARI Watch data is provisional and subject to retrospective updates. Rates are presented per 100,000 trust catchment population.

Influenza hospitalisations to all levels of care in week 40 2024 based on 22 sentinel NHS trusts in England were as follows:

• the overall weekly hospital admission rate for influenza was 0.61 per 100,000 (this surveillance formally starts in week 40 so comparisons to the previous week are not possible)

• this rate is in the baseline impact range (less than 1.77 per 100,000)

• hospital admission rates for influenza were highest in those aged 0 to 4 years (2.40 per 100,000). Please refer to the slideset and supplementary data file for regional breakdowns

• there were 58 new hospital admissions for influenza (45 influenza A(not subtyped), 6 influenza A(H1N1)pdm09, 3 influenza A(H3N2), and 4 influenza B)

Influenza ICU-HDU admissions in week 40 2024 based on 81 NHS trusts in England were as follows:

• the overall ICU or HDU rate for influenza 0.00 per 100,000 (this surveillance formally starts in week 40 so comparisons with the previous week are not possible). Note that with low rates in critical care, small random fluctuations may occur

• this rate is in the baseline impact range (less than 0.1 per 100,000)

• please refer to the slideset and supplementary data file for regional breakdowns

• there was one new ICU or HDU admission for influenza (0 influenza A(not subtyped), 1 influenza A(H1N1)pdm09, 0 influenza A(H3N2), and 0 influenza B)

Figure 26. Weekly overall influenza hospital admission rates per 100,000 trust catchment population with MEM thresholds, reported through SARI Watch sentinel surveillance, England

Figure 27. Weekly influenza hospital admissions by influenza type, reported through SARI Watch sentinel surveillance, England

Figure 28. Weekly hospital admission rate by age group for new influenza reported through SARI Watch sentinel surveillance, England

Figure 29. Weekly overall influenza ICU or HDU admission rates per 100,000 trust catchment population with MEM thresholds, reported through SARI Watch mandatory surveillance, England

Figure 30. Weekly influenza ICU or HDU admissions by influenza type, reported through SARI Watch mandatory surveillance, England

Figure 31. Weekly ICU or HDU admission rate by age group for new influenza cases, reported through SARI Watch mandatory surveillance, England

RSV hospital admissions

Surveillance of respiratory syncytial virus (RSV) hospitalisations (excluding ICU or HDU admissions) is based on data from a small sentinel network of acute NHS trusts in England.

Please note that SARI Watch data is provisional and subject to retrospective updates. Rates are presented per 100,000 trust catchment population.

RSV hospitalisations, excluding ICU or HDU admissions, in week 40 2024 based on 19 sentinel NHS trusts in England were as follows:

• the overall weekly hospital admission rate for RSV increased to 0.39 (compared with 0.28 per 100,000 in the previous week)

• in children aged under 5 years, the hospitalisation rate for RSV increased to 5.79 per 100,000 (compared with 4.08 per 100,000 in the previous week)

• in adults aged 75 years and over, the hospitalisation rate for RSV remained stable at 0.15 per 100,000 (compared with 0.15 per 100,000 in the previous week). Broken down further, rates were 0.20 per 100,000 in those aged between 75 and 84 years, and 0.00 per 100,000 in those aged 85 years and over in week 40

Figure 32. Weekly hospital admission rates (excluding ICU or HDU) of RSV positive cases per 100,000 population reported through SARI Watch sentinel surveillance, England

Figure 33. Weekly hospital admission rates (excluding ICU or HDU) of RSV positive cases per 100,000 population in those aged under 5 years and aged over 75 years reported through SARI Watch sentinel surveillance, England

Figure 34. Weekly count of hospital admissions of RSV positive cases reported through SARI Watch sentinel surveillance by level of care, England

Figure 35. Weekly hospital admission rates (excluding ICU or HDU) by age group for RSV cases reported through SARI Watch sentinel surveillance, England

ECMO admissions

Surveillance of extra corporeal membrane oxygenation (ECMO) admissions is based on data from Severe Respiratory Failure (SRF) centres in the UK. Please refer to Sources of surveillance data for influenza, COVID-19 and other respiratory viruses for additional information.

Please note that SARI Watch data is provisional and subject to retrospective updates.

There were no new ECMO admissions (any cause) reported in week 40 2024 in adults.

Please note that the other group includes other viral, bacterial or fungal ARI, suspected ARI, non-infection (such as asthma, primary cardiac and trauma) and sepsis of non-respiratory origin.

Figure 36. Laboratory-confirmed ECMO admissions in adults (COVID-19, influenza and non-COVID-19 confirmed) to Severe Respiratory Failure centres in the UK

Vaccine coverage

Influenza vaccine uptake in GP patients

Weekly vaccine uptake data is provisional.

Influenza vaccination is reported by GP practice through the ImmForm website. ImmForm provides a secure online platform for vaccine uptake data collection for several immunisation surveys, including the seasonal influenza vaccine uptake collection. Details can be found at Sources of surveillance data for influenza, COVID-19 and other respiratory viruses.

For the 2024 to 2025 season’s vaccination programme, children and pregnant women have been eligible since 1 September, while clinical risk groups, older adults (those aged 65 years and over) and frontline healthcare workers have been eligible since 3 October. See the annual flu letter for more information. In previous seasons, these cohorts have all been eligible from 1 September.

Up to the end of week 40 of 2024 (Sunday 6 October 2024), the provisional proportion of people in England who had received an influenza vaccine this season in targeted groups was as follows.

Adults (97.2% of GP practices reporting through Immform):

• 6.5% in those aged under 65 years in a clinical risk group

• 7.8% in all pregnant women

• 16.2% in all those aged 65 years and over

Children (96.8% of GP practices reporting):

• 18.0% in children aged 2 years of age

• 17.7% in children aged 3 years of age

Figure 37. Cumulative weekly influenza vaccine uptake by target group in England

On 28 November 2024, monthly data which cover vaccinations that were given between 1 September and 31 October 2024 for GP patients, school-aged-children and frontline healthcare workers will be published for the first time this season.

Data sources and methodology

For additional information regarding data sources please refer to the Sources of surveillance data for influenza, COVID-19 and other respiratory viruses.

Further information and contact details

Feedback and contact information

To provide feedback and for all queries relating to this document, please contact respdsr.enquiries@ukhsa.gov.uk.

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