Official Statistics

National flu and COVID-19 surveillance report: 20 November 2025 (week 47)

Updated 20 November 2025

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, respiratory syncytial virus (RSV) and diseases caused by other seasonal respiratory viruses in England. The report is based on data up to week 46 of 2025 (between 10 November and 16 November 2025).

Main points

The main messages of this report are:

• Influenza activity showed mixed trends and is circulating at low levels. This is an unusually early start to the influenza season
• COVID-19 activity decreased across most indicators and is circulating at baseline levels
• RSV activity increased and is circulating at low levels
• reduced mixing due to school half-term holidays may have impacted disease trends

Summary of all respiratory virus activity

Influenza activity

Influenza activity showed mixed trends and is circulating at low levels. This is an unusually early start of the influenza season. Circulation remained high in children and young adults. Emergency department (ED) attendances for influenza-like-illness (ILI) increased. The number of influenza-confirmed acute respiratory infection (ARI) incidents decreased. Of influenza viruses subtyped at the UKHSA Respiratory Virus Unit, the majority were A(H3N2). A briefing has been issued to inform the NHS that the flu season has started. UKHSA has published early vaccine effectiveness estimates.

Compared with the equivalent week last season (2024 to 2025), influenza vaccine uptake is higher for pregnant women, and those aged 2 and 3 years, and comparable for those aged 65 years and over and those aged under 65 years in clinical risk groups.

Indicator	Trend	Level [note 1]	Comments
Laboratory surveillance	Decreased slightly	Low	Influenza positivity decreased slightly with a weekly mean positivity rate of 11.1% compared with 11.7% in the previous week
ILI general practice (GP) consultations	Stable	Baseline	The weekly ILI consultation rate remained stable at 7.4 per 100,000 registered population in participating GP practices compared with 7.1 per 100,000 in the previous week
GP swabbing positivity	Increasing	Medium	In week 46, among all tested samples, 25% were positive for influenza, compared with 14.2% in the previous week
Hospital admissions	Slightly decreasing	Low	The overall weekly hospital admission rate for influenza hospitalisations was slightly decreasing at 3.37 per 100,000 compared with 3.68 per 100,000 in the previous week
Intensive care units (ICU)/High-dependency unit (HDU) admissions	Decreasing	Baseline	The overall weekly hospital admission rate for influenza ICU-HDU was decreasing at 0.10 per 100,000 compared with 0.11 per 100,000 in the previous week. This rate was on the border between baseline and low impact range.

COVID-19 activity

COVID-19 activity decreased across most indicators and is circulating at baseline levels. ED attendances for COVID-19-like illness decreased. The number of reported SARS-CoV-2 confirmed acute respiratory infections (ARI) incidents in week 46 decreased compared with the previous week.

By the end of week 46 2025 (week ending 16 November 2025) 58.9% of all people aged 75 years and over, and 26.8% of all people aged under 75 years with a weakened immune system, have been vaccinated with an autumn 2025 COVID-19 vaccine dose

Indicator	Trend	Level [note 1]	Comments
Laboratory surveillance	Decreased	Baseline	COVID-19 PCR (polymerase chain reaction) positivity in hospital settings decreased with a weekly mean positivity rate of 3.3% compared with 4.7% in the previous week
GP swabbing positivity	Increasing	Baseline	In week 46, among all tested samples, 1.4% were positive for SARS-CoV-2, compared with 1.1% in the previous week
Hospital admissions	Decreasing	Baseline	The overall weekly hospital admission rate for COVID-19 was decreasing at 1.08 per 100,000 compared with 1.80 per 100,000 in the previous week
ICU/HDU admissions	Remained low	Baseline	The overall weekly ICU or HDU admission rate for COVID-19 remained low at 0.04 per 100,000 compared with 0.08 per 100,000 in the previous week

Respiratory syncytial virus activity

RSV activity showed increasing activity across indicators and is circulating at low levels. ED attendances for acute bronchiolitis increased.

Indicator	Trend	Level [note 1]	Comments
Laboratory surveillance	Increasing	Baseline	RSV positivity increased to 4% compared with 2.8% in the previous week.
GP swabbing positivity	Increasing	Low	In week 46, among all tested samples, 9.7% were positive for RSV compared with 3.8% in the previous week
Hospital admissions	Increasing	Low	The overall weekly hospital (excl ICU-HDU) admission rate for RSV was increasing at 1.79 per 100,000 compared with 1.33 per 100,000 in the previous week

Other viruses

Due to technical issues with DataMart the other viruses summary section was not updated this week.

Note 1: these indicators use the moving epidemic method (MEM) and the mean standard deviation method (MSD) to define thresholds to determine their respective levels of activity. Further information on these methods can be found in Influenza surveillance in Europe: establishing epidemic thresholds by the Moving Epidemic Method and Setting thresholds to determine COVID-19 activity levels using the mean standard deviation (MSD) method, England, 2022 to 2024. The MEM approach is well-established for some influenza surveillance indicators, however, for other indicators both the MEM and MSD are experimental and may be subject to future revision. Influenza laboratory surveillance (from week 1) and GP swabbing positivity (from week 2) have transitioned from using MEM to using MSD. These approaches will be considered alongside expert opinion and triangulation of other data sources.

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.

As of 30 October, a data quality issue has been identified in the SGSS surveillance system, affecting COVID-19 case counts and case rates between 19 March 2025 and 28 July 2025. 1,225 positive COVID-19 cases have been excluded from the dataset and are currently under investigation. This affects Figure 1 in the report, which shows the weekly number of COVID-19 cases.

COVID-19 cases

A technical issue in the Respiratory DataMart system has resulted in a small number of tests being unavailable in the Unified Sample Dataset for the latest week. This affects Figures 2 and 3 in the report, but the overall trends shown in these figures should remain largely unchanged.

As of 19 November 2025, there were a total of 645 COVID-19 cases identified in hospital settings in week 46, decreasing from 1,049 cases in the previous week. SARS-CoV-2 (COVID-19) PCR positivity in hospital settings decreased in week 46, with a weekly average positivity rate of 3.3% compared with 4.7% in the previous week. Positivity rates were highest in those aged 85 years and over at a weekly average positivity rate of 6%. This decreased when compared with week 45, when positivity rates were at 7.9% among those aged 85 years and over.

Figure 1. Weekly confirmed COVID-19 episodes tested in hospital settings, England.

Figure 2. Daily percentage of tests positive for SARS-CoV-2 among all reported SARS-CoV-2 tests (7-day rolling average), England 2022 to present [note 2] [note 3]

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

Note 3: testing policy and practice may change over time which can impact positivity rates, therefore comparisons over time should be interpreted with caution. Notable changes in testing policy occurred during 2022 to 2023, which are outlined in the data quality report.

Figure 3. Daily percentage of tests positive for SARS-CoV-2 among all reported SARS-CoV-2 tests by age group (7-day rolling average), England [note 4]

Note 4: the highlighted line corresponds to the age group in the subplot title, grey lines correspond to all other age groups.

Influenza cases

As of 18 November 2025, influenza positivity in week 46 decreased slightly with a weekly average positivity rate of 11.1% compared with 11.7% in the previous week. Influenza positivity rates were highest in those aged between 5 and 14 years at a weekly average positivity rate of 31.7%. This has increased from 27.1% among those aged between 5 and 14 years in week 45.

Figure 4. Daily percentage of tests positive for influenza among all reported influenza tests (7-day rolling average), England [note 2]

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

Figure 5. Daily percentage of tests positive for influenza among all reported influenza tests by age group (7-day rolling average), England [note 4]

Note 4: the highlighted line corresponds to the age group in the subplot title, grey lines correspond to all other age groups.

Respiratory DataMart System

Due to technical issues with DataMart this section of the report was not updated this week. Data below was last updated in the week 46 report.

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.

DataMart data is provisional and subject to retrospective updates.

Figure 6a. Respiratory DataMart weekly percentage of tests positive for influenza, SARS-CoV-2, RSV and rhinovirus, England [note 5]

Note 5: shading represents 95% confidence intervals.

Figure 6b. Respiratory DataMart weekly percentage of tests positive for adenovirus, hMPV and parainfluenza, England [note 5]

Note 5: shading represents 95% confidence intervals.

Figure 7. Respiratory DataMart weekly cases by influenza subtype, England

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

Figure 9. Respiratory DataMart weekly percentage testing positive for RSV by age, England [note 4]

Note 4: the highlighted line corresponds to the age group in the subplot title, grey lines correspond to all other age groups.

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 among sequenced cases is presented in Figure 10.

To account for reporting delays, we report the proportion of lineages within COVID-19 cases that have had a sequenced positive sample between 13 October 2025 and 26 October 2025. Of those sequenced in this period 39% were classified as XFG, 26% were classified as XFG.3, 12% were classified as XFG.3.4, 9.5% were classified as NB.1.8.1, 6.5% were classified as XFG.5 and 1.5% were classified as JN.1. Note that low sequencing numbers will impact the accuracy of the prevalence estimates.

Please note that lineages will be grouped independently from their parent lineage once they reach sufficient prevalence, and may be re-grouped into their parent lineage if their prevalence subsequently falls. The data quality report contains more information on lineage groupings.

Figure 10. Prevalence of SARS-CoV-2 lineages amongst available sequenced cases for England from 11 November 2024 to 2 November 2025

Influenza virus characterisation

Analysis of viruses from primary and secondary care shows that circulating A(H1N1)pdm09 and influenza B strains show genetic diversity-antigenic characterisation of currently circulating A(H1N1)pdm09 and influenza B strains is ongoing, but data from genetically similar viruses which circulated during summer looked similar antigenically to the A(H1N1)pdm09 and influenza B strains that are included in the Northern Hemisphere 2025 to 2026 vaccine.

The characterisation of circulating A(H3N2) viruses show that A(H3N2) viruses are diverse (genetically). Most sequenced viruses to date belong to genetic clade J.2.4.1 (also referred to as subclade K). Antigenic characterisation indicates low reactivity of these viruses with post infection ferret antisera raised against the Northern Hemisphere vaccine H3N2 viral components.

Early vaccine effectiveness data indicates that vaccines continue to provide protection against clinical disease despite these observations.

Genetic characterisation

Between week 40 2025 (week ending 5 October 2025) and week 46 2025 (week ending 16 November 2025), the UKHSA respiratory virus unit (RVU) has genetically characterised 290 seasonal influenza viruses, and identified 224 influenza A(H3N2) viruses, 63 influenza A(H1N1)pdm09 viruses, and 3 influenza B viruses. Details of the characterised viruses by subtype are shown in tables 1, 2 and 3. The RVU has confirmed by genome sequencing the detection of live attenuated influenza vaccine (LAIV) viruses in three influenza A positive samples collected from children aged between 2 and 16 years of age.

Please note that from this week, the reporting period in this section starts with week 40 (instead of week 35 in previous report). This explains the small drop in detections/characterisations of influenza A(H1N1)pdm09 viruses and influenza B viruses as well as the reduction of antigenically characterised influenza A(H3N2) and loss of influenza A(H1N1)pdm09 viruses in the antigenic characterisation section. These missing viruses were collected in the period from week 35 to week 39.

Table 1. Number of influenza A H1N1(pdm09) viruses characterised by genetic analysis at the UKHSA Respiratory Virus Unit since week 40 2025

Clade	Subclade	Detections
5a.2a	C.1.9.3	1
5a.2a.1	D.3.1	62

Table 2. Number of influenza A(H3N2) viruses characterised by genetic analysis at the UKHSA Respiratory Virus Unit since week 40 2025

Clade	Subclade	Detections
2a.3a.1	J.2	7
2a.3a.1	J.2.4	10
2a.3a.1	K (J.2.4.1)	206
2a.3a.1	J.2.5	1

Table 3. Number of influenza B viruses characterised by genetic analysis at the UKHSA Respiratory Virus Unit since week 40 2025

Clade	Subclade	Detections
V1A.3a.2	C.5.1	2
V1A.3a.2	C.5.7	1

Antigenic characterisation

UKHSA RVU performs antigenic characterisation of influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B viruses using haemagglutination inhibition (HI) assays. Data from these assays are used to compare how similar the currently circulating influenza viruses are to the strains included in seasonal influenza vaccines, and to monitor for changes in circulating influenza viruses. Similarity of currently circulating influenza strains to vaccine strains is defined as having an antibody titre within 4-fold when compared to reference viruses representative of the vaccine strain.

• A(H1N1)pdm09: No A(H1N1)pdm09 viruses have been antigenically characterised since week 40 2025.
• A(H3N2): Seven A(H3N2) viruses have been antigenically characterised and one was similar to reference viruses representative of the A/District of Columbia/27/2023 (H3N2)-like and A/Croatia/10136RV/2023 (H3N2)‑like Northern Hemisphere 2025/26 (H3N2) vaccine strains. The six viruses that were antigenically distant from the Northern Hemisphere 2025/26 vaccine strains belonged to the K subclade.
• B/Victoria: No influenza B viruses have been antigenically characterised since week 40 2025.

Influenza virus antiviral susceptibility surveillance

Influenza positive samples are screened for mutations in the virus neuraminidase (NA) and the cap-dependent endonuclease of the polymerase acidic protein (PA) genes known to confer neuraminidase inhibitor (Oseltamivir and Zanamivir) or Baloxavir resistance, respectively. Results from this surveillance are given in Tables 4, 5 and 6.

Table 4. Oseltamivir and Zanamivir antiviral susceptibility results of influenza positive samples tested at UKHSA-RVU since week 40 of 2025 using whole genome sequencing

Subtype	Antiviral	Normal inhibition	Reduced inhibition	Highly reduced inhibition
H1N1pdm09	Oseltamivir	63	0	0
H1N1pdm09	Zanamivir	63	0	0
H3N2	Oseltamivir	224	0	0
H3N2	Zanamivir	224	0	0
BVic	Oseltamivir	3	0	0
BVic	Zanamivir	3	0	0

Table 5. Baloxavir marboxil antiviral susceptibility results of influenza positive samples tested at UKHSA-RVU since week 40 2025 using whole genome sequencing

Subtype	Normal susceptibility	Reduced susceptibility
H1N1pdm09	61	1
H3N2	218	0
BVic	3	0

The “Highly reduced inhibition” column published in previous weeks has been removed as highly reduced inhibition is not defined for Baloxavir.

Table 6. Details on mutations detected, antiviral usage history and and patient characteristics for samples with genotypic markers of antiviral resistance

Subtype	Mutation	Detections	Oseltamivir	Zanamivir	Baloxavir	Immunocompromised
H1N1pdm09	I38T (PA)	1	0	0	1	1

Immunocompromised as reported by sending clinician.

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 reporting practices are known to vary between seasons and between regions. Any interpretation of temporal and regional trends should consider the likelihood of differences in reporting of ARI incidents over time and between regions.

There were 107 new ARI incidents reported in week 46 in England. These included:

• 76 incidents from care homes, of which 21 were due to influenza A, 6 were due to SARS-CoV-2, 4 were due to multiple pathogens, 2 were due to RSV and 1 was due to other pathogens

• 1 incident from hospitals, of which 1 was due to SARS-CoV-2

• 27 incidents from educational settings, of which 6 were due to RSV, 5 were due to influenza A, 2 were due to SARS-CoV-2, 1 was due to multiple pathogens and 1 was due to other pathogens

• 1 incident from prisons for which no tests were available

• 2 incidents from other settings, of which 1 was due to RSV and 1 was due to influenza (no type information available)

Figure 11. Number of ARI incidents by setting, England

Figure 12. Number of ARI incidents in all settings by virus type, England

FluSurvey (England)

FluSurvey is an internet-based participatory surveillance system based on the InfluenzaNet platform. It monitors trends of influenza-like illness (ILI) in the community using self-reported respiratory symptoms from registered participants.

The European Centre for Disease Control (ECDC) ILI case definition of sudden onset of symptoms with at least one of fever (chills), malaise, headache, muscle pain and at least one of cough, sore throat, shortness of breath is used for reporting. Please note that ILI is a broad definition and can include other respiratory illnesses such as COVID-19.

Healthcare use is presented as self-reported use of health services among participants meeting the ILI ECDC case definition. Where a person reports use of more than one health care service, secondary care will be indicated over primary care use and physical attendance to primary care will be indicated over use of remote services (for example, online NHS services, telephoning their GP or 111).

During week 46 2025:

• there were 1,572 participants who completed the weekly symptoms questionnaire

• 178 (11.3%) reported fever or cough and 56 (3.6%) met the ILI case definition, in the past week

• 14.3% of participants meeting the ILI case definition reported contact with healthcare services as a result of self-reported symptoms; the most frequently reported contact was a visit to the GP

• the proportion of participants meeting the ILI case definition decreased compared with the previous report week (3.6% compared with 4.9% in week 45)

Figure 13. Rates of fever or cough and influenza-like illness (ILI) per 1,000 FluSurvey participants, England

Figure 14. Proportion of healthcare use by type among FluSurvey participants meeting the influenza-like illness case definition, 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 16 November 2025, ED attendances for acute respiratory infection increased and were similar to seasonally expected levels. ED attendances for influenza-like illness continued to increase and were above seasonally expected levels. ED attendances for COVID-19-like illness decreased. ED attendances for acute bronchiolitis, a syndrome related to RSV infection, increased but remained below seasonally expected levels.

Daily NHS 111 calls for acute respiratory infections increased slightly due to increases in child age groups, particularly in those aged 1 to 4 years. NHS 111 online assessments for acute respiratory infections remained stable overall, though there was an increase in those aged 5 to 14 years (the youngest age group data is received for from this service). GP out-of-hours contacts for acute respiratory infections increased nationally. Contacts for influenza-like illness continued to increase and were above seasonally expected levels.

Figure 15a. Daily emergency department attendances for acute respiratory infection nationally, England [note 6]

Note 6: 7-day moving average is adjusted for bank holidays. Grey columns show weekends and bank holidays.

Figure 15b. Daily emergency department attendances for acute respiratory infection by age group, England [note 7]

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

Figure 16a. Daily emergency department attendances for COVID-19-like illness nationally, England [note 6]

Note 6: 7-day moving average is adjusted for bank holidays. Grey columns show weekends and bank holidays.

Figure 16b. Daily emergency department attendances for COVID-19-like illness by age group, England [note 7]

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

Figure 17a. Daily emergency department attendances for ILI nationally, England [note 6]

Note 6: 7-day moving average is adjusted for bank holidays. Grey columns show weekends and bank holidays.

Figure 17b. Daily emergency department attendances for ILI by age group, England [note 7]

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

Figure 18a. Daily emergency department attendances for acute bronchiolitis nationally, England [note 6]

Note 6: 7-day moving average is adjusted for bank holidays. Grey columns show weekends and bank holidays.

Figure 18b. Daily emergency department attendances for acute bronchiolitis by age group, England [note 7]

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

Primary care surveillance

Primary care surveillance is undertaken in collaboration with the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), using a national sentinel surveillance system of around 2,000 GP practices covering over 20 million registered patients of all ages across England. More information on the methodology can be found in the data quality report.

RCGP clinical indicators (England)

The weekly ILI consultation rate through the RCGP surveillance remained stable at 7.4 per 100,000 registered population in participating GP practices in week 46 compared with 7.1 per 100,000 in the previous week. This rate is in the baseline activity level (Figure 19). By age group, the highest rates were seen in those aged between 1 and 4 years (12.7 per 100,000), and those aged between 5 and 14 years (8.5 per 100,000).

The lower respiratory tract infections (LRTI) consultation rate decreased slightly to 85.6 per 100,000 in week 46 compared with 92.4 per 100,000 in the previous week.

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

Figure 19. RCGP ILI consultation rates per 100,000, all ages, England

MEM thresholds are based on data from the 2017 to 2018 season to the 2024 to 2025 season. Please note the 2019 to 2020, 2020 to 2021 and 2021 to 2022 seasons have been removed.

RCGP sentinel swabbing scheme in England

From week 40 2025, the RCGP sentinel swabbing scheme testing capability has been expanded to the UKHSA Bristol laboratory in addition to the UKHSA Colindale laboratory. Samples sent to Colindale are tested for influenza A and B, RSV A and B, SARS-COV-2, hMPV, adenovirus, seasonal coronavirus and enterovirus/rhinovirus while samples sent to Bristol are tested for influenza A and B, RSV and SARS-COV-2.

430 samples were taken in week 46 through the GP sentinel swabbing, 72 were tested and 26 tested positive (Figure 20). As of week 4 2024, contemporaneous enterovirus differentiation has stopped. Starting from week 48 2024, samples with more than 10 days between the sample collection date and the symptom onset date have been excluded.

In week 46, influenza positivity was 25%, SARS-CoV-2 positivity was 1.4%, and RSV positivity was 9.7% (Figure 21). All of these samples have been tested in Bristol.

In week 45, influenza positivity was 14.2%, SARS-CoV-2 positivity was 1.1%, RSV positivity was 3.8%, adenovirus positivity was 1.7%, hMPV positivity was 0.7%, seasonal coronavirus positivity was 1%, and enterovirus and rhinovirus positivity was 20.3% (Figure 3). All of these samples have been tested in Bristol and Colindale.

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

Figure 20. Number of samples tested for respiratory viruses in England by week, GP sentinel swabbing scheme [note 8]

Note 8: unknown category corresponds to samples with no result yet.

Figure 21. Percentage of detected respiratory virus among samples with completed testing for each virus in England by week, GP sentinel swabbing scheme

Figure 22. Percentage of detected respiratory viruses among samples with completed testing for each virus in England by age group, GP sentinel swabbing scheme, week 43 to week 46

Figure 23. Weekly positivity for SARS-CoV-2, influenza and RSV in England, GP sentinel swabbing scheme [note 5] [note 9]

Note 5: shading represents 95% confidence intervals.

Note 9: the latest week of data may not represents Colindale laboratory and Bristol laboratory as testing is faster in Bristol than in Colindale.

Secondary care surveillance

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 46 2025 based on 86 NHS trusts in England were as follows:

• the overall weekly hospital admission rate for COVID-19 decreased to 1.08 (compared with 1.80 per 100,000 in the previous week)

• hospital admission rates for COVID-19 were highest in the North East region (decreasing to 1.65 per 100,000 compared with 2.03 in the previous week). Please refer to the supplementary graphs and data file for regional breakdowns

• the highest hospital admission rate for COVID-19 was in those aged 85 years and over (decreasing to 10.97 per 100,000 compared with 17.50 in the previous week)

COVID-19 ICU-HDU admissions in week 46 2025 based on 74 NHS trusts in England were as follows:

• the overall ICU or HDU rate for COVID-19 remained low at 0.04 per 100,000 (compared with 0.08 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 North East region (decreasing to 0.10 per 100,000 compared with 0.21 in the previous week). Please refer to the supplementary graphs and data file for regional breakdowns

• the highest ICU or HDU admission rate for COVID-19 was in those aged between 65 and 74 years (decreasing to 0.16 per 100,000 compared with 0.31 in the previous week)

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

Figure 25. Weekly hospital admission rate by age group for new COVID-19 positive cases reported through SARI Watch mandatory surveillance, England [note 10]

Note 10: the highlighted line corresponds to the most recent 2025 to 2026 season, grey lines correspond to the previous 2024 to 2025 season.

Figure 26. Weekly overall COVID-19 ICU or HDU admission rates per 100,000 trust catchment population reported through SARI Watch mandatory surveillance, England

Figure 27. Weekly ICU or HDU admission rate by age group for new COVID-19 positive cases reported through SARI Watch mandatory surveillance, England [note 10]

Note 10: the highlighted line corresponds to the most recent 2025 to 2026 season, grey lines correspond to the previous 2024 to 2025 season.

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 46 2025 based on 26 sentinel NHS trusts in England were as follows:

• the overall weekly hospital admission rate for influenza hospitalisations was slightly decreasing at 3.37 per 100,000 compared with 3.68 per 100,000 in the previous week

• this rate is in the low impact range (1.95 to less than 6.88 per 100,000)

• hospital admission rates for influenza were highest in those aged 85 years and over (11.90 per 100,000). Please refer to the respiratory virus section of the data dashboard for regional breakdowns

• there were 397 new hospital admissions for influenza (350 influenza A(not subtyped), 9 influenza A(H1N1)pdm09, 34 influenza A(H3N2), and 4 influenza B)

Influenza ICU-HDU admissions in week 46 2025 based on 101 NHS trusts in England were as follows:

• the overall weekly hospital admission rate for influenza ICU-HDU was decreasing at 0.10 per 100,000 compared with 0.11 per 100,000 in the previous week

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

• please refer to the respiratory virus section of the data dashboard for regional breakdowns

• there were 45 new ICU or HDU admissions for influenza (38 influenza A(not subtyped), 4 influenza A(H1N1)pdm09, 3 influenza A(H3N2), and 0 influenza B)

Figure 28. Weekly overall influenza hospital admission rates per 100,000 trust catchment population with MEM thresholds, reported through SARI Watch sentinel surveillance, England

Figure 29. Weekly influenza hospital admissions by influenza type, reported through SARI Watch sentinel surveillance, England

Figure 30. Weekly hospital admission rate by age group for new influenza reported through SARI Watch sentinel surveillance, England [note 10] [note 11]

Note 10: the highlighted line corresponds to the most recent 2025 to 2026 season, grey lines correspond to the previous 2024 to 2025 season. Note 11: Please note that the y-axis has been temporarily limited to a maximum of 40 to improve the visibility of early trends in the younger age groups.

Figure 31. 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 32. Weekly influenza ICU or HDU admissions by influenza type, reported through SARI Watch mandatory surveillance, England

Figure 33. Weekly ICU or HDU admission rate by age group for new influenza cases, reported through SARI Watch mandatory surveillance, England [note 10]

Note 10: the highlighted line corresponds to the most recent 2025 to 2026 season, grey lines correspond to the previous 2024 to 2025 season.

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 submitting data volunatrily. Trusts submit weekly aggregate counts of new RSV admissions and these are summed and converted to rates by linking to catchment populations of participating trusts in that week. Please see the data quality report for additional details on SARI-Watch RSV data and other SARI-Watch collections.

Please note recent changes to the operational period of RSV surveillance. From the 2024 to 2025 season, surveillance of RSV commenced earlier (starting week 36) to routinely capture earlier activity, pausing earlier at week 14 due to substantial decreases in activity that typically occur by this time. In prior seasons, RSV surveillance operated routinely between week 40 and week 20 in the following year (except in 2023 to 2024 where surveillance paused at week 16). In order to view activity from week 36, the current season 2025-2026 is compared to 2024-2025 only. Where comparisons involve more seasons, data from week 40 to week 14 are presented.

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 46 2025 were based on 18 sentinel NHS trusts in England:

• the overall weekly hospital admission rate for RSV increased to 1.79 per 100,000 (compared with 1.33 per 100,000 in the previous week)

• in children aged under 5 years, the hospitalisation rate for RSV increased to 23.24 per 100,000 (compared with 17.09 per 100,000 in the previous week)

• in adults aged 75 years and over, the hospitalisation rate for RSV remained stable at 1.81 per 100,000 (compared with 1.88 per 100,000 in the previous week). Broken down further, rates were 1.05 per 100,000 in those aged between 75 and 84 years, and 3.77 per 100,000 in those aged 85 years and over in week 46

RSV ICU-HDU admissions in week 46 2025 were based on 18 sentinel NHS trusts in England:

• the overall weekly ICU-HDU admission rate for RSV increased to 0.14 per 100,000 (compared with 0.04 per 100,000 in the previous week)

Figure 34. Weekly overall hospital admission rates (excluding ICU or HDU) of RSV positive cases per 100,000 population reported through SARI Watch sentinel surveillance, England

Figure 35. 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 36. Weekly hospital admission rates (excluding ICU or HDU) by age group for RSV cases reported through SARI Watch sentinel surveillance, England [note 10]

Note 10: the highlighted line corresponds to the most recent 2025 to 2026 season, grey lines correspond to the previous 2024 to 2025 season.

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 the data quality report for additional information.

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

There were 3 new ECMO admissions reported in week 46 2025 in adults:

• all admissions were due to non-infectious causes

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 37. Laboratory confirmed ECMO admissions in adults (COVID-19, influenza and non-COVID-19 confirmed) to severe respiratory failure centres in the UK

Vaccine coverage

COVID-19 vaccine uptake in England

Cumulative data up to the end of week 46 2025 (Sunday 16 November 2025) was extracted from the Immunisation Information System (IIS). Data is extracted on the next working day following the end of reporting week (Monday 17 November 2025). Age is calculated as age on date of extraction.

Data is provisional and subject to change following further validation checks. Any changes to historic figures will be reflected in the most recent publication.

Autumn 2025 campaign

The autumn 2025 data reported below covers any dose administered from 1 October 2025 (ISO Week 40) provided there is at least 20 days from the previous dose. Eligible groups for the campaign are defined in Green Book chapter on COVID-19. By the end of week 46 2025 (week ending 16 November 2025) 58.9% of all people aged 75 years and over, and 26.8% of all people aged under 75 years with a weakened immune system, who are living and resident in England had been vaccinated with a autumn 2025 dose since 1 October 2025 (Figure 38).

Figure 38. Cumulative weekly COVID-19 vaccine uptake by target group in England [note 11]

Note 11: the month is taken from the Monday of an international organisation for standardisation (ISO) week.

Please note that an error was identified on 21 October 2025 that affected the data within the “National flu and COVID-19 surveillance: COVID-19 vaccine uptake coverage report” for ISO weeks 41 and 42. Further details on the issue and fix can be found in the National flu and COVID-19 surveillance report: 30 October 2025 (week 44) report. Previous versions of this data, downloaded before 23 October 2025, should not be used.

For data on the real-world effectiveness of the COVID-19 vaccines, please see the epidemiology of COVID-19 in England reports.

For COVID-19 management information on the number of COVID-19 vaccinations provided by the NHS in England, please see the COVID-19 vaccinations webpage.

For UK COVID-19 daily vaccination figures and definitions, please see the Vaccinations section of the UK COVID-19 dashboard.

Since the 19 December 2024, monthly data for frontline healthcare workers has been published. This covers vaccinations that were given between 1 September 2024 and 28 February 2025 and is available under the joint flu and COVID-19 vaccine uptake report.

Influenza vaccination

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 in the data quality report.

For the 2025 to 2026 season’s vaccination programme, as in previous seasons, children and pregnant women have been eligible since 1 September. For this current season and the previous season (2025 to 2026 and 2024 to 2025 seasons respectively), adult groups (excluding pregnant women) were eligible from the start of October (1 October 2025 and 3 October 2024 respectively), rather than 1 September as in previous seasons. See the Timing section of the annual flu letter for more information.

Up to the end of week 46 of 2025 (Sunday 16 November 2025), the provisional proportion of people in England who had received an influenza vaccine this season in targeted groups was as follows:

Adults (99.2% of GP practices reporting through Immform):

• 33.5% in those aged under 65 years in a clinical risk group

• 32.8% in all pregnant women

• 67.8% in all those aged over 65 years

Children (99.2% of GP practices reporting):

• 38.5% in children aged 2 years

• 38.8% in children aged 3 years

Figure 39. Cumulative weekly influenza vaccine uptake by target group in England

On 27 November 2025, monthly vaccine uptake data will be published for the first time this season, which covers influenza vaccinations given between 1 September and 31 October 2025 for GP patients, school-aged-children and frontline healthcare workers.

Data sources and methodology

For additional information regarding data sources please refer to the data quality report.

Background information

Related statistics

Annual epidemiological reports for the 2024 to 2025 season:

• Influenza in the UK, annual epidemiological report: winter 2024 to 2025 includes modelled influenza-attributable mortality, influenza vaccine effectiveness and influenza hospitalisations averted due to vaccination

• Epidemiology of COVID-19 in England includes COVID-19 vaccine uptake, COVID-19 vaccine effectiveness and COVID-19 seroprevalence

• RSV Surveillance winter 2024 to 2025 includes RSV related deaths in children, RSV vaccine uptake and RSV vaccine impact

Annual influenza vaccine uptake reports for the 2024 to 2025 season:

• Seasonal influenza vaccine uptake for all GP patients: annual report 2024 to 2025

• Seasonal influenza vaccine uptake for school-aged children: annual report 2024 to 2025

• Seasonal influenza vaccine uptake for frontline healthcare workers: annual report 2024 to 2025

COVID-19 deaths

For further information on COVID-19 related deaths in England please see the COVID-19 dashboard for death.

All-cause mortality assessment (England)

For further information on all-cause mortality in England please see the:

• excess mortality within England post-pandemic method report, which uses Office for National Statistics (ONS) death registration data

• the all-cause mortality surveillance report, which uses the European mortality monitoring (EuroMOMO) model to identify weeks with higher than expected mortality

• the ONS all-cause excess mortality report

Syndromic surveillance

For further information on syndromic surveillance please see the syndromic surveillance weekly summaries.

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

Official statistics

Our statistical practice is regulated by the Office for Statistics Regulation (OSR). OSR sets the standards of trustworthiness, quality and value in the Code of Practice for Statistics that all producers of official statistics should adhere to.

You are welcome to contact us directly by emailing respdsr.enquiries@ukhsa.gov.uk with any comments about how we meet these standards.

Alternatively, you can contact OSR by emailing regulation@statistics.gov.uk or via the OSR website.

UKHSA is committed to ensuring that these statistics comply with the Code of Practice for Statistics. This means users can have confidence in the people who produce UKHSA statistics because our statistics are robust, reliable and accurate. Our statistics are regularly reviewed to ensure they support the needs of society for information.