About this release

This weekly release by Public Health Scotland presents epidemiological information on respiratory infection activity, including COVID-19, across Scotland.

Main points

Overall assessment 20 November 2023 to 26 November 2023 (ISO week 47):

  • Measures of respiratory symptoms in the community and via attendances at GP consultations (NHS24 and GP ILI) show Baseline activity levels of respiratory disease activity during the reporting period.
  • In the CARI community surveillance system, which tests for ten different pathogens, rhinovirus swab positivity decreased from 27.2% in the previous week to 24.5% in week 47. This was followed by RSV with a swab positivity of 13.2%, which was a decrease from 14.3% the previous week. Swab positivity for Mycoplasma pneumoniae was 10.0%, which was an increase from previous week’s 7.0%. Influenza A had a swab positivity of 6.8% in week 47, which was an increase from 3.7% in week 46.
  • Virology data show influenza circulated at Low activity level, with the under 1 age group and the 65-74 age group increasing from Baseline to Low activity level. RSV remained at Extraordinary activity level. For RSV, the 1-4 and 5-14 age groups remained at Extraordinary activity level and the under 1 age group decreased from Extraordinary to High activity level. Thirteen of the 14 NHS Health Boards were above Baseline activity level, with three health boards showing Extraordinary activity level. Mycoplasma pneumoniae and rhinovirus remained at Low activity level.
  • The overall number of emergency hospital admissions because of RSV, influenza and COVID-19 decreased since the last week. However, hospital admissions for influenza increased slightly. The largest proportion of admissions were for RSV. ICU/HDU admissions remained low.
  • All-cause excess mortality for week 44 (week ending 5 November 2023, the latest week not impacted by reporting delays) remained at Baseline activity level overall. Apart from the previously reported increase in the 0-4 age group to Low activity level (and not related to respiratory-specific causes), all other age groups remained at Baseline activity level.
  • Since 4 September 2023 (the current Winter 2023 vaccination programme) 1,421,694 Influenza (Adult 18+), 431,513 Influenza (Children 6 months to 17 years) and 1,184,220 COVID-19 vaccines were administered in Scotland. Among adults aged 75 years and older, 78.5% have been vaccinated against influenza and 78.1% have been vaccinated against COVID-19 during the current vaccination programme.


Tracking infectious respiratory diseases, including COVID-19 and influenza, is essential, especially in the winter when the disease burden can be highest. In Scotland, respiratory infection and associated morbidity are monitored using enhanced surveillance. This approach combines data from microbiological sampling and laboratory test results from community and hospital settings with data from syndromic surveillance of NHS 24 calls, primary care consultations for respiratory symptoms, hospital (including intensive care) admissions and other settings.

The intelligence generated from surveillance of laboratory, syndromic and settings provide a comprehensive picture of current respiratory illness in Scotland. The data presented in this report provide a comprehensive and timely epidemiological picture that is essential for understanding transmission of infection and supporting patient care and NHS service planning and policy.

Seasonality patterns / seasonal variations

Respiratory illnesses are associated with seasonal increase in the autumn and winter. Seasonality patterns for both influenza viruses and non-influenza respiratory pathogens have been established through many years of surveillance data. Most influenza and non-influenza pathogens circulate in the autumn and winter in Scotland, although some are known to circulate in the spring and summer. Notably, COVID-19 transmission has been occurring in waves throughout the year as observed from surveillance data since the start of the pandemic in 2020.

Further information

The next release will be 7 December 2023.

Find out more

Previous Publications

Versions of the Weekly national respiratory report publication released before 30 November 2022 may be found on the Public Health Scotland website.

Versions of the COVID-19 weekly statistical report publication released before 30 November 2022 may be found on the Public Health Scotland website.

Open data

Open data from this publication is available from the following weblinks:

Further data

  • The COVID-19 Vaccine Wastage datafile was updated on 18 April 2024 to include the most recent information.
  • The COVID-19 in Adult Care Homes in Scotland datafile was updated on 27 July 2023 to include more recent information.
  • 28 September 2022 COVID-19 statistical report publication contains information on COVID-19 infection and vaccination in pregnancy in Scotland.
  • 2 March 2022 COVID-19 statistical report publication contains information on Highest Risk (shielding patients list)
  • 7 November 2023 Community Acute Respiratory Infection (CARI) surveillance in primary care contains information on flu Vaccine effectiveness in community settings.
  • 25 May 2023 Interim 2022/23 influenza vaccine effectiveness: six European studies, October 2022 to January 2023, contains information on flu Vaccine effectiveness in hospital settings.
  • 13 January 2024 Estimated number of lives directly saved by COVID-19 vaccination programs in the WHO European Region, December 2020 to March 2023, contains information on lives saved due to COVID-19 vaccination

General enquiries

If you have an enquiry relating to this publication, please email phs.flu@phs.scot.

Media enquiries

If you have a media enquiry relating to this publication, please contact the Communications and Engagement team.

Requesting other formats and reporting issues

If you require publications or documents in other formats, please email phs.otherformats@phs.scot.

To report any issues with a publication, please email phs.generalpublications@phs.scot.

Older versions of this publication

Versions of this publication released before 16 March 2020 may be found on the Data and Intelligence, Health Protection Scotland or Improving Health websites.

Last updated: 21 March 2024
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