England’s respiratory virus picture stays mixed as RSV edges higher and flu remains low
England’s latest weekly surveillance report paints a familiar late-autumn pattern: influenza remains low, COVID-19 is easing, and RSV is climbing from a low base. The report covers data through week 43 of 2026, spanning 19 October to 25 October, and it captures a period in which the main respiratory threats are moving in different directions rather than surging in unison.
Influenza stayed stable across most measures, but the pattern was not flat across every setting. Emergency department attendances for influenza-like illness increased and rose above seasonally expected levels, while the number of influenza-confirmed acute respiratory infection incidents also moved higher than the prior week. Even so, the broader picture remained one of low circulation rather than a widespread rebound.
COVID-19 moved the other way. Activity decreased, test positivity fell in both hospital and general practice settings, and admission indicators remained low. RSV, meanwhile, continued its gradual seasonal rise, with positivity, primary care detection, and hospital admissions all increasing, though still at baseline levels.
Influenza transmission remains low, but early pressure appears in emergency and swabbing data
Laboratory surveillance for influenza held steady at a low level, with positivity at 6.6%, compared with 6.4% the previous Sunday. In participating general practices, the weekly influenza-like illness consultation rate remained stable at 6.5 per 100,000 registered population. Hospital admissions for influenza were also stable at 2.47 per 100,000, only slightly above 2.38 in the previous week.
The sharpest week-on-week shift appeared in more acute care settings. Influenza ICU and high-dependency unit admissions increased to 0.12 per 100,000 from 0.08 per 100,000. In practical terms, that is still a low rate, but it is the kind of movement clinicians watch closely when community transmission begins to widen and severe cases start to appear unevenly across the system.
A second signal came from swabbing in general practice, where 11.0% of tested samples were positive for influenza, up from 7.8% the previous week. The rise does not yet change the overall classification of low activity, but it suggests a modest pickup in detection that could matter if the same direction continues over the next reporting periods.
COVID-19 activity eases further while vaccine uptake remains uneven
COVID-19 activity continued to decline and stayed at low levels across the main surveillance streams. Hospital PCR positivity decreased slightly to 8.3% from 8.8% on the previous Sunday. In general practice swabbing, 8.9% of tested samples were positive for SARS-CoV-2, compared with 9.8% the week before. Hospital admission rates were stable at 2.76 per 100,000, and ICU or HDU admissions remained low at 0.07 per 100,000.
The downward trend in circulation comes alongside uneven autumn vaccination coverage. By the end of week 43, 42.5% of people aged 75 years and over in England had received an autumn 2026 dose. Among people under 75 with a weakened immune system, 18.2% had been vaccinated since 1 October 2026. Those figures do not speak to efficacy or protection directly, but they do show that coverage is still incomplete in the groups most likely to be affected by severe disease.
Influenza vaccine uptake data also offered an important operational note. This was the fourth weekly report of the season for influenza vaccination, and the dataset had earlier gaps because uptake data were unavailable or incomplete in weeks 41 and 42. Those missing cohorts were corrected in this report for week 43, though an attribution issue affecting vaccination by provider setting remains in place. Overall uptake estimates are still considered accurate reflections of the vaccination programme.
RSV rises from a low baseline as seasonal spread broadens
RSV activity increased across laboratory, primary care, and hospital indicators, but it is still being tracked at baseline levels. Laboratory positivity rose to 1.5% from 0.9% in the previous week. In general practice, 0.6% of tested samples were positive for RSV, up from 0.5%. Hospital admissions increased to 0.52 per 100,000 from 0.31 per 100,000.
The respiratory pattern fits the opening of the usual seasonal RSV curve rather than a sudden surge. Emergency department attendances for acute bronchiolitis were stable and below seasonally expected levels, which suggests that the rise is real but not yet translating into a heavy pediatric burden in emergency care. Even so, RSV has a habit of moving quickly once community spread broadens, especially when younger children begin feeding the hospital pipeline.
A brief rise from baseline is not the same thing as a wave, but it can become one without much warning.
Other respiratory viruses are shifting, with rhinovirus still the dominant non-influenza signal
The remaining respiratory viruses were mixed. Adenovirus positivity increased to 1.5% from 1.2%. Human metapneumovirus fell to 0.1% from 0.5%. Parainfluenza decreased slightly to 2.9% from 3.3%. Rhinovirus also eased, dropping to 16.5% from 18.2%, but it remained in the moderate activity range and continued to account for the largest share among the non-influenza viruses listed in the report.
These shifts matter because they frame what clinicians are likely to see in urgent care and primary care settings over the coming weeks. A patient with fever, cough, or wheeze in late October may not have a single dominant pathogen explaining the presentation. Instead, the surveillance data point to overlapping circulation of multiple viruses, each with its own age profile, severity pattern, and testing implications.
Vaccination data and surveillance gaps still shape the clinical reading
The influenza vaccination section is as important to the interpretation of the report as the virus counts themselves. Compared with the equivalent week in the previous season, vaccine uptake was lower among people aged 65 years and over, among patients aged 6 months to under 65 years in clinical risk groups, and among children aged 2 and 3 years. Uptake was higher among pregnant women.
Week-to-week surveillance is useful precisely because it shows how those coverage gaps and viral trends intersect. If influenza activity stays low, the immediate pressure on services remains manageable. If the rise in emergency department influenza-like illness and ICU admissions continues, those incomplete uptake levels become more consequential, particularly in older adults and clinical risk groups.
The current report does not show a single dominant respiratory emergency. It shows an environment in which influenza is still quiet, COVID-19 is receding, and RSV is moving upward from a low starting point. The next report will matter most for whether those early shifts in flu and RSV remain contained or begin to separate more clearly from baseline.