Raging influenza epidemic continues in Hungary

Key findings:

• HALF of the samples tested on the 4th week of 2025 showed infection with some kind of influenza virus;
• the influenza positivity rate for all samples tested (16.5%) has for the first time in this respiratory season exceeded the cumulated Covid positivity rate (11.3%), while switch never took place in the 2023/24 season;
• the coronavirus positivity rate was down at 1.4% from 2.8%, and
• the RSV positivity rate fell to 1.6% from 3.0%;
• the number of human metapneumovirus (HMPV) infections reached 23 or 0.5% of all samples tested, which matches the ratio a year earlier;
• the number of people hospitalised with severe acute respiratory infection (SARI) was the highest yet in the current respiratory season at 293;
• only 4.4% of those hospitalised tested positive for COVID-19, while there were already 128 people with influenza infection in hospital, i.e. almost 44% of all SARI patients;
• of the 293 people in hospital with SARI, 77 (26.3%) were aged two years or younger, slightly up from the 3rd week but down from almost 40% on the first week, while 98 (33.4%) were aged 60 years and older.

Up and away...

I mean, the number of infections, of course. On the 4th week of 2025 (20-26 January), 295,500 people sought medical help with acute respiratory infections (ARI), including 69,900 people with influenza-like illness (ILI), according to data released by the National Centre for Public Health and Pharmacy (NNGYK) on Friday instead of Thursday. Because it's not that important.

Note that both the 43rd and 44th weeks had only four working days due to national holidays, hence the fewer number of cases in the statistics and the dips in the graphs. The dataset for the 52nd week is full of holes, as the NNK published an abridged report with only some testing figures.) The respiratory season (often and erroneously referred to as 'flu season') generally peaks between the 4th and the 9th week of the year.

A short-term comparison (for the last three seasons of respiratory illnesses) shows that the number of patients with ARI, including those with ILI was much higher than at this point in the previous two respiratory seasons.

The share of flu-like symptoms in ARI was up at 23.7% from 21.8% on the 3rd week, exceeding the comparative readings from the past two seasons (15.8% and 14.2%, respectively), meaning that effectively every fourth ARI patients showed symptoms of influenza.

We also have data for ARIs and flu-like symptoms per 100,000 inhabitants, although a long-term data series is available only for the latter.

in terms both ari and flu-like symptoms per 100,000 people, the situation is currently way worse than in either of the previous two respiratory seasons.

In the graph below you can compare to the flu situation with the previous 13 respiratory seasons, and find that the situation has been worse than currently (yellow line) only once in 2016/17.

Positivity rates

A total of 487 samples were tested on the 4th week (yet another record for the current respiratory season), with 7 coming back COVID-19 positive (down from 12 on the 3rd week). The 1.4% positivity rate compares with 9.1% (27 cases) a year ago and 11.2% (13 cases) two years ago.

The share of influenza (50.1%) in the tested samples is well above the previous two years' respective prints (28.9% and 25.0%, respectively), while that of respiratory syncytial virus (RSV) remains lower (1.6%) than in 2023/24 (6.0%) and 2022/23 (9.5%).

The following graph may seem a bit fuzzy but at least it shows for a side-by side comparison the weekly positivity rates for influenza (green), Covid (orange), and RSV (blue) for the past three respiratory seasons up to the 3rd week. It is evident how the flu positivity rate stands out this year, whether we compare it to the corresponding rates in the previous two years or to the Covid and RSV positivity rates.

As regards the individual positivity rates in all the samples, the 'switch' never took place in the 2023/24 respiratory season (i.e. the total number of positive Covid tests in all samples tested remained higher than the number of positive flu tests) in and occurred by the end of the 3rd week in the 2022/23 season.

As the chart below attests, SARS-CoV-2 is no longer the main pathogen in samples, with 496 positive tests (11.3% of the 4,400 samples tested), as influenza took over with 727 positive samples (16.5% of all samples), followed by rhinovirus (49), RSV (45), human metapneumovirus (HMPV, 25), parainfluenza (5), and adenovirus (4).

Hospitalisations

293 people with severe acute respiratory infection (SARI) were hospitalised on the 4th week of 2025, of whom 36 (or 12.3%) required intensive care. The former figure is the highest so far in the current respiratory season, while the ICU/hospitalised ratio also picked up from 11.6% on the 3rd week and is the second highest ratio after 12.8% (24 patients) on the 40th week of 2024. The respective figures for the 4th week of 2024 were 222 people in hospital, and 19 (8.6%) in ICUs.

Further breakdown shows that 13 people (4.4% of SARI patients) were hospitalised with SARS-CoV-2 infection, down from 18 a week earlier and about a third of the 2024 print (41 people or 18.5% of all SARI patients), and also well below the 2023 numbers (39 or 14.5%).

A total of 128 people in hospital with SARI tested positive for influenza, which corresponds to 43.7% of all SARI patients.

This compares with only 50 influenza patients (22.5% of all SARI patients) in hospital on the 4th week of 2024 and 18 (6.7%) on the same week of 2023.

The share of RSV patients rose to 9.6% (28) from 5.6% (14), which compares with 14.9% (33 a year earlier and 31.6% (85) two years earlier.

Age distribution of hospitalised SARI patients

Of the 293 people in hospital with SARI, 77 (26.3%) were aged two years or younger, which shows a rise from 64 (25.6%) a week earlier, while 98 (33.4%) were aged 60 years and older, more than on the 3rd week (93 or 37.2%).

Also, 7 (53.8%) of the 13 COVID-19 patients were over 60 years of age, down from 11 (61.1%) on the 3rd week.

A year ago, of the 222 people in hospital with SARI, 69 (31.1%) were aged two or younger, while 89 (40.1%) were 60 or older. Also, 32 (78%) of the 41 COVID-19 patients were over 60 years of age.

The age breakdown of people seeking medical help with ARI and flu-like symptoms are shown below.

The majority of ARI patients belonged in the 0-14 age group throughout the 'flu season' last year (and so far this year too), while the share of people going to the doctor with flu-like symptoms was the highest in the 15-34 age group up to the 2nd week of last year when the youngest were in majority for nine weeks and then it was back and forth between the 13th and 20th week. You fund a heat map for the previous season in one of our previous articles here.

The number and share of children up to 14 years of age was again higher among people with flu-like symptoms than the number and share of those in the 15-34 age group, after two weeks when they switched places on the first weeks of 2025.

Almost 141,000 of people with ARI and over 29,000 of people with ILI were in the 0-14 age group on the 4th week of 2025. The former compares with some 120,000 a year earlier, while the latter is more than double of the base period's figure.

The NNGYK said in consideration of sewage samples and reports by sentinel hospitals, doctors, and the ambulance service, we should not expect a drop in the number of infections for now.

In the absence of centralised official epidemiological recommendations and regulations, individuals and small communities can take active steps to slow the spread of the epidemic and mitigate its negative effects. In this situation, individual forms of protection become more important: masks, spacing, disinfection, open air, ventilation, and preferably working at home.

The negative impact of the epidemic should include the mild or more severe consequences for the health of individuals (hospitalisations, deaths, exposure of risk groups). But the processes triggered by mass illness can also be listed here: the loss of large numbers of workers affecting sectors of the economy, and the way in which illness affects the country's critical infrastructure, the way in which it affects the very foundations of the economy's functioning. 

In such a wave, and especially at the peak of the epidemic, a worker may be temporarily out of work for a number of reasons (recovering at home, caring for their sick child, cannot get to work because of transport problems, .e.g. too many public transport drivers are off work). This brings us to the importance of critical infrastructure.

This process could easily become a snowball effect in the Hungarian economy, with certain companies and sectors being crippled by high levels of infection and disease, causing further difficulties for other companies and sectors. Critical infrastructure can also be understood as health workers.

We have recently contacted the National Centre for Public Health and Pharmacy with questions about the epidemiological situation (whether central recommendations, regulations, restrictions on visits, exposure of risk groups, vaccination uptake), but so far we have not received any answers. We will update this article as soon as we receive them.

Risk groups, excess mortality

Such a severe mass epidemic is most dangerous for the most vulnerable groups, the elderly or those with chronic illnesses. This type of risk is most commonly measured by experts in terms of excess mortality, including excess mortality in the over-65 age group.

Experts from the Centre for Epidemiology and Surveillance at Semmelweis University have been continuously monitoring trends in excess mortality in the country, and last week they updated their analysis.

These figures cannot yet include the impact of this January's outbreak, but they do identify some interesting figures from last autumn. They show that 8% excess deaths were recorded in weeks 38 to 40, and 6-8% in weeks 43 and 46. Among the elderly, 7% excess deaths were recorded between 18 September and 6 October.

Beatrix Oroszi, director of the Centre for Epidemiology and Surveillance at Semmelweis University, also spoke about excess mortality in an interview with Portfolio last year. At the time, she pointed out that the 10% excess mortality among people aged 65 and over in December 2023 could have been avoided.

Trends in excess mortality are determined by the speed of spread of the epidemic and the number of people who become ill (how widespread the disease is), as well as the protection of risk groups and the uptake of the vaccine, in this case the flu vaccine.

What we do know from information released by the NNGYK last October is that they administered the lowest number of flu vaccinations administered in the last 14 years in the 2023/2024 season.

According to aggregate data available at the NNGYK, a total of 594,465 people over the age of three received free flu vaccination, of whom 442,943 (74.5%) were aged 60 or over. While this percentage may seem high, and it is in fact the highest since the 2018/19 flu season, another comparison paints a gloomier picture.

The actual number of shots administered to Hungarians aged 60 and above was by far the lowest in the past six flu seasons. (Back in October, we asked the NNGYK for the time series going back 14 years and we'll update our charts as soon as we get the data. Don't hold your breath, though.)

If we look at the share of the elderly vaccinated as a percentage of their own age group, we also have the lowest figure (17.5%) of the past six years. So, it's all a matter of what you want to emphasise really.

The 'improvement' highlighted by the authority stems from the fact that while the number of 3Fluart shots administered in 2023/24 plummeted 50% from the 2020/21 peak during the covid pandemic, the number of shots administered in the 60+ age group went down by "only" 38%. The respective decreases compared to 2018/19 (i.e. a "normal" year) were 17.3% and 13.3%.

The whole situation, i.e. low vaccination coverage and a raging epidemic, begs the question: if the vaccine is available in sufficient quantities, why is there no awareness campaign (before the outbreak and during the season) initiated and run by the competent authority or ministry to increase vaccination uptake and thus the level of protection?

Only once this season, at the start of the upper respiratory illness season last October, did the NNGYK make an official central announcement about the flu vaccine, when it announced that free flu vaccines would be available nationwide from the end of October. As in last season, 949,000 doses of the 3Fluart flu vaccine are available for the at-risk group of people aged 3 years and over, to be used free of charge this season.

Meanwhile, whooping cough...

The number of suspected pertussis cases does not seem to be dropping, either. Based on the figures for the first three weeks of the year, it looks likely that 2025 will bring another record, unless a dramatic improvement occurs along the way.

The number of suspected whooping cough cases closed at an absolute record of 1,354 cases in 2024. After a w/w doubling of suspected cases to 17 from 8 on the 2nd week of 2025, authorities reported 17 suspected cases again for the 3rd week. with over 40% of the 42 cases so far this year being infants. Also, 52.4% of the infections were detected in the 0-14 age group and 57.1% in the 0-19 age group.

Cover image (for illustration purposes only): Getty Images