This interactive bulletin reports on the latest epidemiology of
COVID-19, influenza, respiratory syncytial virus (RSV) and other
respiratory viruses (ORVs) in Ireland. HPSC monitors several integrated
respiratory virus surveillance systems that are included in this
bulletin. This report will be published weekly during the winter season
(week 40 to week 20).
How to use this interactive bulletin
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Key messages
During week 46 2024, influenza activity remained stable. RSV cases
and hospitalisations increased, particularly in those aged 0-4 years.
COVID-19 activity remained at low-moderate levels. Rhinoviruses and
enteroviruses were circulating at high levels. Other seasonal
respiratory viruses remained at low levels.
Summary for week 46
2024
Primary Care Surveillance
The sentinel GP Acute Respiratory Infection (ARI) consultation rate
increased for the second week in a row to 70.8/100,000 population during
week 46, with the highest rates in the 0-4 year age group. Sentinel
percentage positivity for rhinovirus or enterovirus was 26.5% in week
46. Rhino or enterovirus positivity has been above the 10% positivity
threshold since week 35 2024. All other respiratory pathogens remained
below the 10% threshold. The proportion of GPOOH calls for self-reported
cough remained stable for all age-groups and was over the threshold
overall and for those aged <64 years in week 46. Calls for
self-reported flu cases remained below the threshold.
COVID-19
COVID-19 activity remained at low-moderate levels across all
indicators in week 46. COVID-19 cases increased by 5.0% from 193 cases
notified in week 45 to 203 cases in week 46. Hospitalised cases
increased by 14.0%, with 83 cases in week 46 compared to 73 cases in
week 45. ICU admissions and deaths remained low. KP.3.1.1 is the
dominant sub-lineage, accounting for 39.2% of samples sequenced between
weeks 40 and 44 2024. Emerging variant XEC continued to increase and
accounted for 23.7% of sequences between weeks 40 and 44 2024.
SARS-CoV-2 viral loads in wastewater decreased in most catchment areas
in week 46 2024.
Influenza
Influenza activity remained stable in week 46 2024. The overall
notification rate was 2.4/100,000 population and was highest in those
aged less than one year. There were 123 cases notified during week 46,
compared to 155 cases in week 45. There were 33 hospitalisations, and no
ICU cases or deaths reported during week 46 2024. Influenza A virus is
currently the dominant type accounting for 84% of cases.
RSV
RSV activity increased in week 46. The overall notification rate was
2.3/100,000 population and was highest in those aged less than one year
at 51.9/100,000 population. There were 121 cases (compared to 48
reported in week 45), 59 hospitalisations and no ICU admissions or
deaths reported. The number of notified and hospitalised cases increased
in those aged less than four years.
Severe Acute Respiratory Infection (SARI)
Based on data from the three sentinel hospital sites, SARI case
numbers decreased in week 46, with 50 cases reported, compared to 53 in
week 45 (5.7% decrease). This was driven by a 30.4% decrease in
paediatric (aged <15 years) cases (16 from 23 cases) whereas adult
(≥15 years) cases increased by 13.3% (34 cases from 30). In week 46 and
compared to the previous week, influenza positivity increased slightly
to 5.9%, from 5.0%, SARS-CoV-2 positivity decreased to 2.9% from 7.5%,
and RSV decreased to 5.9% compared to 7.5%.
Outbreaks
COVID-19 outbreaks increased by 30% in week 46 compared to week 45
2024. A total of 13 COVID-19 outbreaks were reported including six in
hospitals and six in nursing homes. During week 46, two ARI outbreaks
were reported, one in a nursing home and one in a hospital. No influenza
or RSV outbreaks were reported.
Technical notes
General
Data are provisional and subject to ongoing review, validation and
update. As a result, figures in this report may differ from previously
published figures.
The weekly calendar runs from Sunday to Saturday for respiratory
virus notifications on CIDR (as per the Infectious Disease Regulations
1982 and subsequent amendments) and Monday to Sunday for the sentinel GP
and SARI surveillance systems (as per ISO week). Further information on
epidemiological dates and weeks can be found on the HPSC website.
Definitions
The case definitions for COVID-19, influenza and RSV are available
here. Only data on laboratory-confirmed cases, including cases diagnosed
using near patient molecular tests, are included in this report.
Sentinel GP ARI consultations are consultations to sentinel GP
practices for Acute Respiratory Infection (ARI), with ARI defined as
Sudden onset of symptoms AND at least one of the following four
respiratory symptoms: Cough, sore throat, shortness of breath, coryza
AND a clinician’s judgement that the illness is due to an infection.
GP out of hours calls refer to calls to GP out of hours services from
persons with self-reported clinical symptoms of ‘flu’ or ‘cough’.
Emergency Department cases refer to cases treated in emergency
departments, with no indication on CIDR that they have subsequently been
admitted to hospital.
Hospitalised cases are inpatients with laboratory confirmed
SARS-CoV-2, influenza or RSV and includes inpatients with incidental
infections, where the infection is not the reason for their
admission.
Bed occupancy refers to the number of laboratory confirmed cases
admitted to acute inpatient sites at 08:00 hrs on the day of
reporting.
A SARI case is defined as a person hospitalised for at least 24 hours
with acute respiratory infection, with at least one of the following
symptoms: cough, fever, shortness of breath OR sudden onset of anosmia,
ageusia or dysgeusia with onset of symptoms within 14 days prior to
hospital admission. A SARI case refers to an individual patient episode
of care.
As of September 2024, ICU admissions for COVID-19, influenza and RSV
refer to those admitted to intensive care where COVID-19, influenza or
RSV were the primary or contributory cause of admission. Prior to
September 2024, ICU admissions for influenza and RSV included all
admissions where the patient tested positive for influenza or RSV,
irrespective of whether these pathogens were the cause of admission.
COVID-19, influenza and RSV deaths are defined as a death in a person
with laboratory confirmed COVID-19, influenza or RSV infection see case
definitions (this includes cases detected postmortem) and where
COVID-19, influenza or RSV is reported in any of the four cause of death
fields on the death certificate. Deaths where there is a clear
alternative cause of death (e.g. trauma, suicide) are not recorded as
COVID-19/influenza/RSV deaths. Deaths where there is a period of
complete recovery (as assessed by a clinician) between a COVID-19,
influenza or RSV episode of illness and death, are also not recorded as
deaths.
Test Positivity: Positive tests refer to all positive specimens and
includes duplicates and individuals who were re-tested.
Outbreaks are defined as two or more cases of acute respiratory
infection with the same pathogen (SARS-CoV-2, influenza or respiratory
syncytial virus (RSV)) confirmed by a laboratory test or near patient
test carried out by a health professional, and where there is reason to
consider that these cases may be epidemiologically linked in place and
time.
Other Acute Respiratory Infection (ARI) outbreaks are defined as: Two
or more cases of acute respiratory infection arising within the same
48hr period epidemiologically linked in place: Outbreaks are classified
as Suspect ARI outbreaks, where testing has not been completed, is
pending or has been negative for Influenza, RSV and SARS-CoV-2.
Outbreaks are classified as confirmed if other respiratory pathogens
(ORVs), e.g. Rhinovirus, hMPV, Coronavirus OC43 etc are identified via
laboratory confirmation. The outbreak data presented in this report
includes both confirmed and suspect outbreaks.
Variant working definitions for ‘SARS-CoV-2 variants of concern’
(VOC), ‘SARS-CoV-2 variants of interest’ (VOI) and ‘SARS-CoV-2 variants
under monitoring’ (VUM) are available on the WHO
website and ECDC
website.
Data Sources
The Computerised Infectious Disease Reporting (CIDR) system: CIDR is
the source of statutory notification data on laboratory-confirmed
COVID-19, influenza, RSV (including data on notified, emergency
department, hospitalised and ICU cases and data on cases who died) and
data on outbreaks.
The type/subtype of laboratory confirmed influenza notifications are
reported on the CIDR system. The number of cases hospitalised and
admitted to ICU described in this report relate only to cases notified
during this reporting period, with known hospitalisation/ICU status at
the time of reporting.
Regional Departments of Public Health currently prioritise the
investigation and reporting of outbreaks in settings that benefit most
from public health and clinical intervention. The outbreak data reported
here focuses on these key settings/groups. These settings include acute
hospitals, nursing homes, community hospital/long-stay units,
residential institutions (centres for disabilities, centres for older
people, children’s/TUSLA residential centres and mental health
facilities) and other healthcare settings.
Population denominator data for analyses of CIDR data on notified,
emergency department, hospitalised and ICU cases and deaths are taken
from Census 2022.
Sentinel GP surveillance system: This includes 100 participating
general practices (located in all HSE Health Regions). These practices
report electronically on a weekly basis, the number of patients who
consulted with acute respiratory infection (ARI) and influenza-like
illness (ILI) (identified using International Classification of Primary
Care 2 codes R74 and R80). These practices provide overall and
age-stratified denominator data on the number of registered patients who
have sought care at the practice during the previous three years. The
combined patient population in these practices is estimated to be
approximately 10% of the national population. Sentinel GPs take a
combined nose and throat swab from the first five patients attending
their practice each week who meet the ARI case definition and send these
to the NVRL for testing.
GP Out-of-hours (GPOOHs) services: Five out of 14 GPOOHs services
provide weekly data on the total and age-stratified number of out of
hours calls for 1) all reasons, 2) for self-reported cough and 3) for
self-reported flu. The denominator for calculations of percentage of
calls is the total number of calls for all reasons.
The HSE Performance Management and Improvement Unit (PMIU) provides
daily data on bed occupancy (the number of currents inpatients with
laboratory confirmed COVID-19, influenza and RSV).
Severe Acute Respiratory Infections (SARI) surveillance system: SARI
cases are identified from new admissions through the Emergency
Department, based on clinical symptoms. Patients that develop SARI
during their admission, or who are admitted through alternate routes,
are not included.
National Virus Reference Laboratory (NVRL): The NVRL routinely test
sentinel GP and non-sentinel respiratory specimens for SARS-CoV-2,
influenza, RSV and a panel of other seasonal respiratory viruses (ORV).
The NVRL report on influenza type/subtype of sentinel GP ARI and
non-sentinel respiratory specimens on a weekly basis.
National SARS-CoV-2 Whole Genome Sequencing Surveillance Programme
(NSWGSSP): The SARS-CoV-2 sequencing sampling framework currently
focuses on notified COVID-19 cases with severe disease (hospitalisation,
ICU admission) and deaths, COVID-19 outbreaks in health and care
settings, sentinel surveillance programmes in the community and acute
hospitals and targeted sequencing based on public health risk
assessment/clinical requests and virological changes e.g. new variant of
concern. There is typically a lag time of 1-3 weeks between a COVID-19
case being notified, selected for sequencing and SARS-CoV-2 sequencing
being completed. Therefore, the proportion of notified COVID-19 cases
notified in this time period from whom specimens are ultimately
sequenced will be higher than currently reported here. The HPSC link
sequencing results received from laboratories to epidemiological data on
COVID-19 cases reported on the CIDR system. This report summarises WGS
results and epidemiological data for COVID-19 cases that have been
sequenced in Ireland since week 40 2023 (specimen dates between
01/10/2023 and 02/11/2024). The SARS-CoV-2 sequencing results included
in this report reflect all data available as of 18/11/2024.
National SARS-CoV-2 Wastewater Surveillance Programme: A detailed
description of the process involved for wastewater collection, sampling
and analyses is available in the routinely published national SARS-CoV-2
wastewater surveillance programme reports available here
Appendix
Appendix Table 1: Notified
laboratory confirmed cases of COVID-19, influenza and RSV by age, sex
and HSE health region, from week 40 2024, to week 46 2024. Data source:
CIDR.
Number of cases (incidence per 100,000 population) |
|---|
| All pathogens | COVID-19 | Influenza | RSV |
|---|
Cases | 2,890 (56.1) | 2,025 (39.3) | 580 (11.3) | 285 (5.5) |
Age groups (years) |
|
|
|
|
<1 | 173 (299.3) | 81 (140.1) | 13 (22.5) | 79 (136.7) |
1-4 | 228 (96.0) | 42 (17.7) | 60 (25.3) | 126 (53.0) |
5-14 | 118 (16.5) | 21 (2.9) | 91 (12.7) | 6 (0.8) |
15-44 | 452 (21.9) | 287 (13.9) | 149 (7.2) | 16 (0.8) |
45-64 | 508 (39.3) | 372 (28.8) | 119 (9.2) | 17 (1.3) |
65-79 | 658 (110.5) | 557 (93.6) | 80 (13.4) | 21 (3.5) |
>80 | 753 (416.0) | 665 (367.3) | 68 (37.6) | 20 (11.0) |
Median age (IQR) | 64 (32-80) | 72 (50-82) | 41 (11-65) | 2 (0-26) |
Sex |
|
|
|
|
Male | 1,372 (53.9) | 936 (36.8) | 284 (11.2) | 152 (6.0) |
Female | 1,516 (58.2) | 1,088 (41.8) | 296 (11.4) | 132 (5.1) |
HSE Health Regions |
|
|
|
|
Dublin and North East | 653 (12.7) | 502 (42.3) | 99 (8.3) | 52 (4.4) |
Dublin and Midlands | 500 (9.7) | 342 (31.7) | 99 (9.2) | 59 (5.5) |
Dublin and South East | 598 (11.6) | 439 (45.2) | 97 (10) | 62 (6.4) |
South West | 427 (8.3) | 322 (43.5) | 98 (13.2) | 7 (0.9) |
Mid West | 243 (4.7) | 150 (36.3) | 68 (16.5) | 25 (6.1) |
West and North West | 469 (9.1) | 270 (35.5) | 119 (15.7) | 80 (10.5) |
Appendix Table 2:
Hospitalised laboratory confirmed cases of COVID-19, influenza and RSV
by age, sex and HSE health region, from week 40,2024, to week 46 2024.
Data source: CIDR.
Number of cases (incidence per 100,000 population) |
|---|
| All pathogens | COVID-19 | Influenza | RSV |
|---|
Cases | 1,159 (22.5) | 844 (16.4) | 175 (3.4) | 140 (2.7) |
Age groups (years) |
|
|
|
|
<1 | 79 (136.7) | 32 (55.4) | 8 (13.8) | 39 (67.5) |
1-4 | 111 (46.7) | 20 (8.4) | 26 (10.9) | 65 (27.4) |
5-14 | 60 (8.4) | 13 (1.8) | 42 (5.9) | 5 (0.7) |
15-44 | 95 (4.6) | 76 (3.7) | 14 (0.7) | 5 (0.2) |
45-64 | 163 (12.6) | 133 (10.3) | 22 (1.7) | 8 (0.6) |
65-79 | 295 (49.6) | 251 (42.2) | 33 (5.5) | 11 (1.8) |
>80 | 356 (196.7) | 319 (176.2) | 30 (16.6) | 7 (3.9) |
Median age (IQR) | 70 (33-82) | 75 (59-83) | 42 (7-73) | 2 (0-5) |
Sex |
|
|
|
|
Male | 611 (24.0) | 434 (17.1) | 100 (3.9) | 77 (3.0) |
Female | 548 (21.0) | 410 (15.7) | 75 (2.9) | 63 (2.4) |
HSE Health Regions |
|
|
|
|
Dublin and North East | 166 (3.2) | 136 (11.5) | 11 (0.9) | 19 (1.6) |
Dublin and Midlands | 203 (3.9) | 143 (13.3) | 29 (2.7) | 31 (2.9) |
Dublin and South East | 195 (3.8) | 138 (14.2) | 20 (2.1) | 37 (3.8) |
South West | 209 (4.1) | 170 (23) | 35 (4.7) | 4 (0.5) |
Mid West | 135 (2.6) | 83 (20.1) | 34 (8.2) | 18 (4.4) |
West and North West | 251 (4.9) | 174 (22.9) | 46 (6.1) | 31 (4.1) |
Appendix Table 3: Number
and percentage positive Sentinel GP ARI specimens by respiratory virus,
for week 45 2024, week 46 2024, and the 2024/2025 season. Data source:
NVRL.
| Week 45 2024 (N = 116) | Week 46 2024 (N = 102) | 2024/2025 (N = 741) |
|---|
Virus | Total positive | % positive | Total positive | % positive | Total positive | % positive |
|---|
SARS-CoV-2 | 4 | 3.4 | 4 | 3.9 | 39 | 5.3 |
Influenza Virus | 9 | 7.8 | 7 | 6.9 | 44 | 5.9 |
Respiratory Syncytial Virus (RSV) | 2 | 1.7 | 5 | 4.9 | 12 | 1.6 |
Rhino/enterovirus | 34 | 29.3 | 27 | 26.5 | 206 | 27.8 |
Adenovirus | 0 | 0.0 | 2 | 2.0 | 6 | 0.8 |
Bocavirus | 1 | 0.9 | 1 | 1.0 | 6 | 0.8 |
Human metapneumovirus (hMPV) | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
Parainfluenza virus type 1 (PIV-1) | 2 | 1.7 | 4 | 3.9 | 14 | 1.9 |
Parainfluenza virus type 2 (PIV-2) | 1 | 0.9 | 6 | 5.9 | 16 | 2.2 |
Parainfluenza virus type 3 (PIV-3) | 0 | 0.0 | 2 | 2.0 | 7 | 0.9 |
Parainfluenza virus type 4 (PIV-4) | 1 | 0.9 | 3 | 2.9 | 8 | 1.1 |
Appendix Table 4: Number
and percentage positive NVRL non-sentinel respiratory specimens by
respiratory virus, week 45 2024, week 46 2024, and the 2024/2025 season.
Data source: NVRL.
| Week 45 2024 (N = 200) | Week 46 2024 (N = 123) | 2024/2025 (N = 1176) |
|---|
Virus | Total positive | % positive | Total positive | % positive | Total positive | % positive |
|---|
SARS-CoV-2 | 7 | 3.5 | 2 | 1.6 | 62 | 5.3 |
Influenza Virus | 12 | 6.0 | 8 | 6.5 | 58 | 4.9 |
Respiratory Syncytial Virus (RSV) | 8 | 4.0 | 6 | 4.9 | 24 | 2.0 |
Rhino/enterovirus | 35 | 17.5 | 29 | 23.6 | 251 | 21.3 |
Adenovirus | 6 | 3.0 | 0 | 0.0 | 18 | 1.5 |
Bocavirus | 0 | 0.0 | 1 | 0.8 | 7 | 0.6 |
Human metapneumovirus (hMPV) | 0 | 0.0 |
|
|
|
|
Parainfluenza virus type 1 (PIV-1) | 3 | 1.5 | 0 | 0.0 | 17 | 1.4 |
Parainfluenza virus type 2 (PIV-2) | 2 | 1.0 | 4 | 3.3 | 12 | 1.0 |
Parainfluenza virus type 3 (PIV-3) | 2 | 1.0 | 0 | 0.0 | 2 | 0.2 |
Parainfluenza virus type 4 (PIV-4) | 4 | 2.0 | 2 | 1.6 | 16 | 1.4 |
Appendix Table 5:
Influenza type and sub-type distribution among sentinel GP ARI and
non-sentinel respiratory influenza positive specimens, for week 45 2024,
week 46 2024, and the 2024/2025 season. Data source: NVRL.
| | | Influenza A | Influenza B |
|---|
Time period | Specimen source | Total influenza positive | Total | A(H1)pdm09 | A(H3) | A(not subtyped) | Total | B Victoria | B (upspecified) |
|---|
Week 45 2024 | Sentinel GP ARI | 9 | 7 | 3 | 3 | 1 | 2 | 0 | 2 |
Non-sentinel respiratory | 12 | 12 | 10 | 1 | 1 | 0 | 0 | 0 |
Total | 21 | 19 | 13 | 4 | 2 | 2 | 0 | 2 |
Week 46 2024 | Sentinel GP ARI | 7 | 6 | 5 | 0 | 1 | 1 | 0 | 1 |
Non-sentinel respiratory | 8 | 7 | 7 | 0 | 0 | 1 | 0 | 1 |
Total | 15 | 13 | 12 | 0 | 1 | 2 | 0 | 2 |
Season to date | Sentinel GP ARI | 44 | 41 | 22 | 12 | 7 | 3 | 0 | 3 |
Non-sentinel respiratory | 58 | 52 | 38 | 10 | 4 | 6 | 0 | 6 |
Total | 102 | 93 | 60 | 22 | 11 | 9 | 0 | 9 |
Appendix Table 6: RSV type
distribution among sentinel GP ARI and non-sentinel respiratory RSV
positive specimens, for week 45, 2024 week 46 2024, and the 2024/2025
season. Data source: NVRL.
Time period | Specimen source | Total RSV positive | RSV A | RSV B | RSV (unspecified) |
|---|
Week 45 2024 | Sentinel GP ARI | 2 | 0 | 2 | 0 |
Non-sentinel respiratory | 8 | 5 | 3 | 0 |
Total | 10 | 5 | 5 | 0 |
Week 46 2024 | Sentinel GP ARI | 5 | 1 | 4 | 0 |
Non-sentinel respiratory | 6 | 2 | 4 | 0 |
Total | 11 | 3 | 8 | 0 |
Season to date | Sentinel GP ARI | 12 | 3 | 9 | 0 |
Non-sentinel respiratory | 24 | 12 | 12 | 0 |
Total | 36 | 15 | 21 | 0 |
