England’s respiratory viruses stay mostly low, but RSV is climbing
England’s latest national surveillance snapshot shows a mixed respiratory picture: influenza and COVID-19 both remained at low levels, while respiratory syncytial virus rose and reached baseline activity. The report covers data through week 44 of 2026, with the publication released on 5 November 2026 and summarising trends up to 1 November.
The pattern matters at the bedside because these viruses do not move in lockstep. One can ease while another gains traction, and hospital services often feel the pressure first in emergency departments, swabbing pathways, and admissions before broader community signals fully catch up.
Flu activity is low overall, but several indicators point in different directions
Influenza remained in a low-activity band, yet the week did not look flat. Laboratory positivity increased to 7.6% from 6.8% the previous Sunday, and influenza-related hospital admissions rose to 2.83 per 100,000 from 2.51 per 100,000. Emergency department attendances for influenza-like illness also moved upward and sat above seasonally expected levels.
At the same time, other measures softened. General practice consultations for influenza-like illness slipped slightly to 6.2 per 100,000 registered population, and confirmed influenza acute respiratory infection incidents fell compared with the prior week. ICU and high dependency admissions decreased to 0.09 per 100,000 from 0.11 per 100,000, leaving severe disease at baseline levels.
This split picture is typical of early seasonal circulation. Transmission in the community can intensify before enough vulnerable patients accumulate to shift critical care statistics, and the downward movement in ICU activity suggests that, for now, severe cases remain limited even as broader spread continues.
Vaccine uptake is uneven, and the gaps are visible in risk groups
Influenza vaccination uptake lagged behind the same point last season in several groups. Among people aged 65 years and over, uptake stood at 59.1% compared with 61.5% last season. Among patients aged 6 months to under 65 years in clinical risk groups, uptake was 27.9% versus 28.9% last season. Uptake was also slightly lower in 2-year-olds and 3-year-olds than in the equivalent period a year earlier.
Pregnant women were the exception. Uptake in this group reached 31.1%, up from 29.7% last season. The differing pattern is clinically important because influenza vulnerability is concentrated in age, comorbidity, and pregnancy-based risk strata, and even modest shortfalls can leave more people exposed when community transmission starts to accelerate.
A data-quality caveat sits behind the vaccination figures. Some vaccinations administered in pharmacies may be misclassified as being delivered in general practice or other settings, which inflates activity in those categories and suppresses the pharmacy count. Overall uptake estimates are considered reliable, but the setting-level breakdown should be interpreted carefully.
COVID-19 continues to ease, with the heaviest burden still in older adults
COVID-19 activity declined again and stayed at low levels. Emergency department attendances for COVID-19-like illness were stable, while confirmed acute respiratory infection incidents decreased compared with the previous week. Laboratory positivity in the community decreased slightly to 8.3% from 8.8% on the previous Sunday, and GP swabbing positivity fell more sharply to 7.2% from 10.2%.
Hospital settings showed a parallel decline. There were 1,730 COVID-19 cases identified in hospitals in week 44, down from 2,052 in the previous week. The rolling 7-day PCR positivity rate in hospital settings dropped to 7.6% from 8.1%. Among people aged 85 years and over, positivity remained the highest at 11.1%, holding close to the previous week’s 10.8%.
The age gradient is familiar and biologically predictable. Older adults carry more cumulative risk from immune senescence, chronic disease, and reduced physiologic reserve, so even when incidence falls across the population, the oldest patients tend to remain the most visible in hospital data.
Autumn 2026 COVID-19 vaccine delivery also remained incomplete in the eligible groups reported here. By the end of week 44, 47.7% of people aged 75 years and over in England had received an autumn 2026 dose, while 20.5% of people under 75 years with a weakened immune system had been vaccinated since 1 October.
RSV is rising first, with bronchiolitis already moving upward
RSV showed the clearest upward trend in this report. Laboratory positivity rose to 2.9% from 1.6% in the previous week, and GP swabbing positivity increased to 2.9% from 0.8%. Hospital admissions climbed to 0.80 per 100,000 from 0.57 per 100,000, while emergency department attendances for acute bronchiolitis increased and remained within seasonally expected levels.
This is the signal pediatric wards watch closely. RSV often rises before it peaks, and bronchiolitis is the clinical face of that surge in infants and young children. Even when overall levels remain at baseline, the direction of travel can translate quickly into more oxygen requirement, longer observation, and heavier use of short-stay and inpatient beds.
Other seasonal viruses are already moving, even if most remain below major thresholds
The report also tracked several non-dominant respiratory viruses. Adenovirus increased slightly to 1.6% from 1.4%, human metapneumovirus rose to 0.7% from 0.1%, and parainfluenza increased to 3.6% from 2.7%. Rhinovirus moved the other way, declining to 14.6% from 17.5% but still remaining at low levels.
These pathogens rarely dominate the seasonal conversation on their own, yet they help explain why primary care and emergency departments can feel busy before flu or COVID-19 reach higher levels. Different viruses rise in overlapping waves, and the combined effect is often more relevant to service demand than any single organism in isolation.
Surveillance remains the early warning system for winter pressure
The value of this report lies in its layered view of activity: laboratory positivity, GP consultations, emergency department attendances, hospital admissions, and intensive care use. No single number tells the whole story. A falling hospital curve can coexist with rising community transmission, and a low ICU rate does not mean the system is stable for long if RSV or influenza start accelerating at the same time.
For clinicians, the practical message is straightforward. Influenza is circulating at low levels but is no longer flat, COVID-19 is easing, and RSV is the virus currently moving upward with the most obvious momentum. The next few weeks will determine whether these separate threads remain manageable or begin to converge into a heavier winter burden on pediatric and adult services alike.