Research and analysis

Epidemiology of COVID-19 in England: January 2020 to December 2024

Published 1 May 2025

Executive summary

This report summarises trends in COVID-19 epidemiology in England from July to December 2024.

The main recent COVID-19 epidemiological trends between dates 1 July and 29 December are outlined below.

Cases and positivity saw 2 peaks between 1 July to 29 December 2024, with a peak of 3,991 weekly cases and 17% positivity in July and a peak of 3,524 weekly cases and 15% positivity in October. Following this, COVID-19 incidence remained at low levels until the end of 2024.

Hospital outcome rates, including A&E attendances, hospital admissions and severe hospital admissions followed the trends in cases during the time period, with peaks in July and October 2024. A&E attendances also peaked with weekly rates of 34 and 25 attendances per 1,000,000 population in July and October, respectively. Similarly, hospital attendances peaked at 32 and 27 admissions per 1,000,000 respectively. Weekly rates of severe hospital admissions were below 1 admission per 1,000,000 during the time period.

Similarly, weekly COVID-19 mortality rates peaked in July and October 2024, with rates ranging between 2 and 5 per 1,000,000.

By the end of the COVID-19 autumn vaccination campaign, 59.3% of all people aged 65 years and over, and 23.6% of all people aged under 65 years and in a clinical risk group, who are resident in England had been vaccinated with an autumn 2024 booster dose since 3 October 2024.

Incremental effectiveness of the Autumn 2024 vaccines against hospitalisation was highest in the period 2 to 4 weeks post-vaccination at 33.5%.

A supplementary spotlight section is included in this first issue of this report, which focuses on trends in COVID-19 epidemiology throughout the pandemic and contextualises changes in testing and surveillance systems. Subsequent reports will be published approximately every 6 months to describe COVID-19 activity in line with the current COVID-19 immunisation programme.

Introduction

Coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, continues to circulate among the population in England and can be associated with severe health outcomes (1). Since its emergence in 2020, trends in COVID-19 activity have changed in relation to the national vaccination programme and other public health interventions. In addition, population level immunity from infection and the evolving lineage profile of the virus have been associated with varying disease severity (2 to 7). Adaptations to testing and surveillance systems have also impacted COVID-19 trends.

This series of reports provides descriptive analyses and summarises trends in COVID-19 epidemiology in England, with a primary focus on the most recent epidemiological trends. Reports will be published approximately every 6 months and will describe COVID-19 activity in line with the current COVID-19 vaccination campaign schedules.

As this is the first issue of the report, it also includes a supplementary spotlight section that presents COVID-19 trends from 2020 to June 2024. This section focuses on trends in COVID-19 epidemiology throughout the pandemic and highlights changes in testing and surveillance systems, providing historical context for the recent COVID-19 activity that are presented as the main feature of this report. This supplementary feature will be included in this issue of the report only and not in future reports.

Data presented here is available in the accompanying data tables.

Supplementary Spotlight Section: COVID-19 historical trends

COVID-19 was declared a Public Health Emergency of International Concern (PHEIC) on 30 January 2020, and subsequently a pandemic on 11 March 2020 by the World Health Organization (WHO) (8, 9).

In England, the surveillance of COVID-19 commenced in early 2020 initially through the enhanced surveillance of the First Few X (hundred) cases of COVID-19 (10). The UK Health Security Agency (UKHSA) (formerly Public Health England) adapted and upscaled existing surveillance systems for influenza and other respiratory viruses to monitor transmission of COVID-19 in the population (11). Additionally, several COVID-19 specific surveillance systems were developed to monitor trends in COVID-19 testing, cases, severe outcomes such as hospitalisation and deaths, and vaccination coverage and effectiveness (12 to 15).

The surveillance of COVID-19 by UKHSA continues beyond the end of the PHEIC, which was declared by the WHO on 5 May 2023 (16).

Details on data sources, methodology and definitions can be found in the data sources, methods and definitions section.

History and epidemiology

In England, the first cases of COVID-19 were detected at the end of January 2020 and the first deaths were noted in March 2020 before the first national lockdown was introduced on 23 March 2020 (17). In this early period, testing was limited to polymerase chain reaction (PCR) testing in secondary healthcare settings, expanding to primary health care settings in April 2020.

Monitoring of COVID-19-related deaths also began in early 2020, which showed a peak weekly mortality rate of around 200 deaths per 100,000 population in April. A reduction of deaths was then observed the summer months Figure 5.

There were high levels of test positivity at the beginning of the COVID-19 pandemic, peaking at 40% Figure 1B. This could be explained by the limited testing during this period, which was focused on individuals with a higher pre-test probability of having COVID-19, either due to symptom severity or uniqueness (such as anosmia) or with an epidemiological link to another case (for example, a household contact). Moreover, the introduction of other testing strategies, such as NHS Test and Trace and the lighthouse laboratories in May 2020, coincides with the reduction in positivity seen during that time.

PCR symptomatic testing and testing of case contacts was made available more widely to the general public in November 2020 alongside lateral flow testing (LFT), also allowing for targeted testing in specialised settings such as care homes for older adults and prison and detention settings.

Around the same time, there was a peak in COVID-19 cases in late 2020 into early 2021, coinciding with the emergence of the Alpha lineage of SARS-CoV-2, noted for its increased transmissibility over the wildtype lineage (18) (Figure 1A and Figure 3). This was accompanied by an increase in COVID-19-related hospitalisations and deaths (2) and the implementation of non-pharmaceutical interventions such as national and regional lockdowns and travel restrictions (17). At this time, the national primary COVID-19 vaccination campaign was rolled out, with the first vaccination being issued in December 2020.

Universal free lateral flow tests for asymptomatic testing became widely available in the community from April 2021. By June 2021, all adults had been offered at least one dose of SARS-CoV-2 vaccination.

During the summer of 2021, the number of cases dropped until the emergence of the Delta lineage which was associated with increased transmissibility in June 2021 (19) (Figure 1A and Figure 3). This was followed by an increase in cases in the later part of 2021 and further non-pharmaceutical interventions such as national lockdowns being introduced from September 2021 onwards (Figure 1A). In the same time period, COVID-19-related deaths remained at a weekly rate of below 50 deaths per 100,000 and was punctuated by fluctuations associated with new SARS-CoV-2 lineages (Figure 5).

The Omicron lineage emerged in November 2021, which was associated with high transmission rates and reduced disease severity (4, 20). This corresponded with a steep increase in COVID-19 cases, resulting in the largest number of weekly cases recorded in the pandemic (Figure 1A and Figure 3). The Omicron lineage has remained the dominant lineage, with subsequent waves of activity aligning with Omicron sub-lineages.

The peak in late 2021 and early 2022 coincided with the Omicron BA.1 and BA.2 sub-lineages (Figure 1A and Figure 3). During this time, all adults in England were offered a COVID-19 booster vaccination dose, with rollout ending in February 2022. Following this, a reduction in cases was observed until June 2022, when a small peak was observed.

Most COVID-19 restrictions in England were lifted by March 2022, alongside the discontinuation of free LFDs in the community. This resulted in a reduction the detection and surveillance of COVID-19 cases in non-healthcare settings.

From Spring 2022 onwards, COVID-19 has continued to circulate in the population, causing waves of infections and severe outcomes, though not at the same level earlier in the pandemic (Figure 1A and Figure 3). To prevent further exacerbation of the disease, vaccinations have been offered to groups most vulnerable to severe disease, based on age and clinical risk, through bi-annual programmes occurring each spring and autumn (Figure 4 and Table 1).

Figure 1A. Weekly COVID-19 cases, 30 January 2020 to 30 June 2024

Figure 1B. COVID-19 test positivity, 7-day moving average, 30 January 2020 to 30 June 2024

Figure 2. COVID-19 cases by property type and pillar, 30 January 2020 to 30 June 2024

Figure 3. SARS-CoV-2 lineage prevalence, 30 January 2020 to 30 June 2024

Figure 4. COVID-19 vaccine coverage by eligible groups, Spring 2022 to Autumn 2024

Table 1. COVID-19 vaccine effectiveness of booster campaigns, Spring 2022 to Spring 2024 (21 to 26)

Vaccination campaign	Vaccines offered	VE against hospitalisations (%) (95% Confidence Intervals (CI)): 2 to 4 weeks since booster dose	VE against hospitalisations (%) (95% Confidence Intervals (CI)): 5 to 9 weeks since booster dose	VE against hospitalisations (%) (95% Confidence Intervals (CI)): 10 to 14 weeks since booster dose	VE against hospitalisations (%) (95% Confidence Intervals (CI)): 15 to 19 weeks since booster dose	VE against hospitalisations (%) (95% Confidence Intervals (CI)): 20 to 24 weeks since booster dose	VE against hospitalisations (%) (95% Confidence Intervals (CI)): 25 to 29 weeks since booster dose	VE against hospitalisations (%) (95% Confidence Intervals (CI)): ≥30 weeks since booster dose
Spring 2022 (≥75) [note 1]	BNT162b2/mRNA-1273	58.8 (54.1-63.0)	50.1 (45.6-54.2)	35.9 (30.2-41.1)	21.1 (11.6-29.5)	10.8 (-6.2-25.1)	-	-
Spring 2023 (≥75) [note 2]	GSK/Sanofi Beta [note 3]	31.4 (15.3-44.5)	32.3 (14.2-46.5)	14.9 (-8.3-33.1)	-	-	-	-
Spring 2023 (≥75) [note 2]	Pfizer Bivalent BA4/5 [note 3]	50.9 (33.1-63.9)	29.0 (6.7-45.9)	38.8 (13.8-56.6)	-	-	-	-
Spring 2023 (≥75) [note 2]	Combined Beta/Bivalent BA4/5	-	-	30.8 (8.2-47.9)	14.4 (-0.2-26.9)	-3.2 (-18.5-10.1)	-3.1 (-22.7-13.4)	-
Spring 2024 (≥75)	XBB.1.5	44.2 (35.8-51.4)	41.4 (35.1-47.1)	31.5 (24.1-38.2	22.2 (13.2-30.3)	26.6 (18.1-34.3)	8.9 (-7.7-23)	0.8 (-22.5-19.6)
Autumn 2022 (≥50) [note 2]	Pfizer Bivalent BA.1	47.4 (40.1-53.7)	44.9 (40-49.4)	34.5 (29-39.5)	28 (21.1-34.4)	25.2 (15.6-33.6)	20.8 (-41.6-55.7)	-
Autumn 2022 (≥50) [note 2]	Moderna Bivalent BA.1	58.1 (51.9-63.5)	48.1 (42.8-53)	36.9 (32.2-41.3)	31.1 (25.3-36.4)	23.6 (16.9-29.8)	19.6 (8.7-29.2)	-
Autumn 2022 (≥50) [note 2]	Combined Moderna/Pfizer	52.6 (47.7-57)	46.7 (42.8-50.2)	36.6 (32.6-40.3)	30.6 (25.7-35.2)	24.9 (18.9-30.5)	20.3 (9.6-29.6)	-
Autumn 2023 (≥65)	Bivalent BA4/5 [note 4]	45.0 (35.5-53.2)	42.4 (33.4-50.2)	34.3 (25.2-42.3)	16.9 (-8.3-36.2)	-	-	-
Autumn 2023 (≥65)	Monovalent XBB [note 4]	54.8 (46.8-61.6)	48.3 (41.0-54.7)	42.2 (32.3-50.6)	Insufficient data [note 5]	-	-	-
Autumn 2023 (≥65)	Combined Bivalent BA4/5/Monovalent XBB	50.6 (44.2-56.3)	45.7 (39.4-51.3)	36.5 (28.8-43.4)	27.9 (9.2-42.8)	24.5 (13.9-33.7)	19.2 (9.9-27.5)	10 (1.5-17.8)

Note 1: for the Spring 2022 campaign, highest interval since dose was ≥20 weeks.

Note 2: for the Autumn 2022 and Spring 2023 campaigns, highest interval since dose was ≥25 weeks.

Note 3: for the Spring 2023 estimates stratified by manufacturer, highest interval since dose was ≥10 weeks.

Note 4: for the Autumn 2023 estimates stratified by manufacturer, highest interval since dose was ≥15 weeks.

Note 5: insufficient sample size was available to calculate vaccine effectiveness at this interval since dose.

Figure 5. Rates of COVID-19 deaths per 1,000,000 population, 30 January 2020 to 30 June 2024

Case epidemiology

Laboratory and case surveillance

The Second Generation Surveillance System (SGSS) captures test result information for notifiable causative agents, including COVID-19, from laboratories in England. This data is used to identify COVID-19 cases in hospital settings in England. Address information from this data is then used to classify residential property type for each case, providing information on particular risk groups such as care home residents and prisoners.

The unified sample dataset (USD) contains all SARS-CoV-2 test results reported to UKHSA and is used in this report to calculate the percentage of tests that are positive for SARS-CoV-2 among all SARS-CoV-2 tests.

The section provides COVID-19 case epidemiology and SARS-CoV-2 test positivity from July to December 2024. All stratified rates are age standardised.

COVID-19 cases saw 2 peaks over the second half of 2024. The higher of the 2 peaks in both case numbers and positivity was in July at around 3,991 weekly cases and a positivity rate of 17%. Cases and positivity declined until August, after which it experienced another increase to the second peak in October at 3,524 weekly cases and a positivity rate of 15%. Following this, COVID-19 incidence remained at low levels until the end of the time period.

COVID-19 cases across residential property types followed largely the same trends as overall COVID-19 cases. The vast majority of cases were resident in private residential dwellings, peaking at over 3,374 cases per week. Of the non-private dwelling settings, the highest number of cases was observed in care and nursing home settings, reaching around 193 and 200 cases in the July and October peaks, respectively. Over this time period 22.3% of cases were unable to be assigned a property type, due to incomplete or missing residential address information.

During this period, COVID-19 cases and positivity was highest among those aged 85 and over (904.1 per 100,000 and 14.2% respectively), followed by 75 to 84 (392.7 and 12.4% respectively). Within the younger age groups, case rates and positivity were highest among those aged under 4 (140.3 and 5.1% respectively). Notably, positivity was similar among those aged 15 to 44 (6.4%) despite lower case rates among this age group (28.3 per 100,000).

Cases rates were marginally higher among males, compared to females throughout the time period. Overall, the case rate in males was 94.8 per 100,000, compared to females at 94.8 per 100,000. COVID-19 positivity was closely aligned between the 2 groups (9.5% compared to 9.1%).

Minimal differences in case rates were seen between geographic regions. The highest rates were observed in the North-East of England at the start of the time-period (156.6 per 100,000), and then the West Midlands from mid-September to November 2024 (137 per 100,000).

The highest case positivity was observed among those resident in the East Midlands at the start of the time-period, reaching (10.5%), and in the South-East from mid-September (11%). Positivity was lowest in London throughout the time period, reaching (6%).

The highest case rates were observed among those within the Mixed or Multiple ethnic group at 370 per 100,000. The lowest rates were among those in the White (92 per 100,000) and Asian and Asian British (87.8 per 100,000) ethnic groups.

By IMD quintile, highest rates were among those in the most deprived quintile (quintile 1) at 1,616.6 per 100,000, the rates decreased with decreasing deprivation level, with the lowest rates among the least deprived group at 948.4 per 100,000 (quintile 5).

Figure 6. Weekly COVID-19 cases, 1 July 2020 to 29 December 2024

Figure 7. COVID-19 test positivity, 7-day moving average, 1 July 2024 to 29 December 2024

Figure 8. COVID-19 cases by property type, 1 July 2024 - 29 December 2024

Laboratory and case surveillance (July 2024 to December 2024) stratified by demographic

Figure 9A. COVID-19 case rates per 100,000 by age group, 7-day moving average (1 July 2024 to 29 December 2024)

Figure 9B. Age-standardised COVID-19 case rates per 100,000 by sex, 7-day moving average (1 July 2024 to 29 December 2024)

Figure 9C. Age-standardised COVID-19 case rates per 100,000 by region, 7-day moving average (1 July 2024 to 29 December 2024)

Figure 9D. Age-standardised COVID-19 case rates per 100,000 by ethnicity group, 7-day moving average (1 July 2024 to 29 December 2024)

Figure 9E. Age-standardised COVID-19 case rates per 100,000 by index of multiple deprivation (IMD), 7-day moving average (1 July 2024 to 29 December 2024).

Figure 10A. COVID-19 test positivity by age group, 7-day moving average (1 July 2024 to 29 December 2024)

Figure 10B. COVID-19 test positivity by sex, 7-day moving average (1 July 2024 to 29 December 2024)

Figure 10C. COVID-19 test positivity by region, 7-day moving average (1 July 2024 to 29 December 2024)

Lineage surveillance

UKHSA conducts genomic surveillance of SARS-CoV-2 lineages. This section provides an overview of circulating lineages in England from July to December 2024, derived from data on sequenced PCR-positive SARS-CoV-2 samples in SGSS.

Surveillance of SARS-CoV-2 lineages provides a better understanding of how the virus is evolving, and which lineages may be responsible for changes in COVID-19 incidence, transmission, and severity.

Between July to October 2024, the dominant SARS-CoV-2 lineage was JN.1.11.1 and sub-lineages. In particular, the KP.3.1.1 lineage (a JN.1.11.1 sub-lineage) became dominant over other JN.1.11.1 sub-lineages in August, peaking at 55.5% in prevalence among sequenced COVID-19 cases in September. At the end of November, the XEC recombinant (a hybrid comprised of KS.1.1 and KP.3.3) became dominant, with a peak proportion of all sequences cases of 52.4% in early December.

This aligns with the international picture, which showed JN.1.11.1 dominance through the summer period, transitioning to XEC dominance in the winter period.

Figure 11. Prevalence of SARS-CoV-2 lineages among sequenced SARS-CoV-2 samples, 1 July 2024 - 29 December 2024

Hospitalisations and deaths

UKHSA monitors outcomes of COVID-19 using routinely collected national-level hospital admission data and death registration data. Outcomes include accident and emergency (A&E) attendances, hospital admissions, severe hospitalisations (admissions to intensive care units (ICU) and ventilation or oxygen use), and deaths. This section provides a summary of clinical outcomes of COVID-19 from July to December 2024. All stratified rates are age standardised.

Hospitalisations

The overall rates of A&E attendances and hospital admissions during this period were 462 and 466 per 1,000,000 population, respectively. A&E attendances and hospital admissions for COVID-19 largely followed incidence trends between July and December 2024, with peaks occurring in July and October. In the July peak, A&E attendances reached a weekly rate of 34 attendances per 1,000,000, followed by a peak rate of 25 attendances per 1,000,000 in October. Similarly, hospital attendances peaked at 32 admissions per 1,000,000 in July and 27 admissions per 1,000,000 in October. After the October peak, both A&E attendances and hospital admission weekly rates fell to a nadir of under 10 per 1,000,000, continuing to the end of the year.

The overall rate of severe hospital admissions during this period was 13 per 1,000,000. Weekly rates were below 1 admission per 1,000,000 in the same time period, peaking at a weekly rate of 1, 1 admissions per 1,000,000 in July and October.

A&E attendance (6,499.65 per 1,000,000), hospital admission (6,009.99 per 1,000,000) and severe hospital admission (97.26 per 1,000,000) rates were highest among infants under 6 months old, followed by those aged 80 and over at at 2,911.98, 3,516.82, and 53.03 per 1,000,000 respectively.

All hospital outcome rates were higher among males compared to females throughout the time period, with A&E attendance rates of 491.54 compared to 436.43 per 1,000,000, hospital admissions rates of 496.4 compared to 429.21 per 1,000,000, and severe hospital admission rates of 15.12 compared to 10.63 per 1,000,000.

A&E attendance and hospital admission rates were highest among those resident in the North East (74 and 56 per 1,000,000 respectively) and notably in the West Midlands from October onwards (37 and 34 per 1,000,000 respectively), followed closely by Yorkshire and the Humber for hospital admissions (31 per 1,000,000).

A&E attendance and hospital admission rates were highest among those in Other ethnic groups (855.99 and 675.04 per 1,000,000 respectively), followed by Black or Black British (487.89 and 358.54 per 1,000,000 respectively) and Asian or Asian British groups (490.22 and 439.59 per 1,000,000 respectively). There was a peak in A&E attendance and hospital admission rates among those in the White ethnic groups from late September to early November 2024 (23 and 25 per 1,000,000 respectively). The rate of severe hospital admissions was low among all ethnic groups but was highest among those of in the Black or Black British (9.01 per 1,000,000) ethnic groups from July to August 2024.

For all hospital outcomes, rates were highest among those in the most deprived quintile (quintile 1) (8,032.31, 7,621.23, and 267.54 per 1,000,000 for A&E attendances, hospital admissions, and severe hospitalisations respectively). The rates decreased with decreasing deprivation level for most time periods over all hospital outcomes.

Figure 12. Rate per 1,000,000 of COVID-19 A&E attendance by A&E attendance date, 1 July 2024 to 29 December 2024

Figure 13. Rate per 1,000,000 of COVID-19 hospital admissions by hospital admission date, 1 July 2024 to 29 December 2024

Figure 14. Rate per 1,000,000 of COVID-19 severe hospital admissions by hospital admission date, 1 July 2024 to 29 December 2024

Figure 15A. Rate per 1,000,000 of COVID-19 A&E attendance by A&E attendance date stratified by age, 1 July 2024 to 29 December 2024

Figure 15B. Age-standardised rate per 1,000,000 of COVID-19 A&E attendance by A&E attendance date stratified by sex, 1 July 2024 to 29 December 2024

Figure 15C. Age-standardised rate per 1,000,000 of COVID-19 A&E attendance by A&E attendance date stratified by region, 1 July 2024 to 29 December 2024

Table 2. Age-standardised rate per 1,000,000 of COVID-19 A&E attendance by A&E attendance date stratified by ethnicity, 1 July 2024 to 29 December 2024

Ethnicity Group	01 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
Asian or Asian British	181.67 (165.56 to 198.72) [note: 6]	144.94 (130.35 to 160.53)	111.76 (98.78 to 125.78)	51.85 (43.48 to 61.14)
Black or Black British	213.79 (187.18 to 242.65)	120.17 (100.96 to 141.48)	104.20 (85.86 to 124.87)	49.74 (37.40 to 64.38)
Mixed	137.96 (99.90 to 180.86)	93.73 (62.29 to 130.22)	81.74 (50.99 to 118.22)	25.79 (10.39 to 45.41)
White	149.10 (145.67 to 152.58)	93.03 (90.34 to 95.79)	115.36 (112.37 to 118.40)	52.39 (50.38 to 54.46)
Other Ethnic Groups	309.57 (263.01 to 360.84)	238.58 (198.81 to 282.91)	219.06 (179.04 to 264.32)	88.78 (64.65 to 117.68)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Figure 15D. Age-standardised rate per 1,000,000 of COVID-19 A&E attendance by A&E attendance date stratified by IMD, 1 July 2024 to 29 December 2024

Figure 16A. Rate per 1,000,000 of COVID-19 hospital admissions by hospital admission date stratified by age, 1 July 2024 to 29 December 2024

Figure 16B. Age-standardised rate per 1,000,000 of COVID-19 hospital admissions by hospital admission date stratified by sex, 1 July 2024 to 29 December 2024

Figure 16C. Age-standardised rate per 1,000,000 of COVID-19 hospital admissions by hospital admission date and stratified by region, 1 July 2024 to 29 December 2024

Table 3. Age-standardised rate per 1,000,000 of COVID-19 hospital admissions by hospital admission date stratified by ethnicity, 1 July 2024 to 29 December 2024

Ethnicity Group	01 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
Asian or Asian British	165.62 (149.67 to 182.60) [note 6]	132.48 (118.32 to 147.67)	94.43 (82.42 to 107.50)	47.07 (38.75 to 56.43)
Black or Black British	155.21 (131.27 to 181.75)	90.36 (72.71 to 110.45)	73.26 (57.91 to 91.04)	39.72 (28.19 to 53.84)
Mixed	112.57 (75.41 to 155.26)	102.03 (65.91 to 144.59)	82.40 (49.66 to 122.22)	28.46 (11.03 to 52.12)
White	147.20 (143.82 to 150.64)	103.01 (100.19 to 105.88)	118.37 (115.36 to 121.44)	50.98 (49.00 to 53.01)
Other Ethnic Groups	260.32 (215.43 to 310.64)	177.30 (139.87 to 220.67)	170.44 (133.59 to 213.20)	66.99 (45.14 to 94.22)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Figure 16D. Age-standardised rate per 1,000,000 of COVID-19 hospital admissions by hospital admission date stratified by IMD, 1 July 2024 to 29 December 2024

Table 4. Rate per 1,000,000 of COVID-19 severe hospital admissions by hospital admission date stratified by age, 1 July 2024 to 29 December 2024

Age Groups	01 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
<6 months	33.54 (16.06 to 61.68) [note 6]	23.48 (9.44 to 48.37)	16.77 (5.44 to 39.13)	23.48 (9.44 to 48.37)
6 monthsto <1 year	6.36 (0.77 to 22.96)	3.18 (0.08 to 17.71)	6.36 (0.77 to 22.96)	9.53 (1.97 to 27.86)
1 to 4	2.21 (0.81 to 4.82)	0.74 (0.09 to 2.66)	0.37 (0.01 to 2.06)	1.11 (0.23 to 3.23)
5 to 9	0.90 (0.18 to 2.62)	0.00 (0.00 to 1.10)	0.00 (0.00 to 1.10)	0.00 (0.00 to 1.10)
10 to 19	0.43 (0.09 to 1.26)	0.43 (0.09 to 1.26)	0.43 (0.09 to 1.26)	0.14 (0.00 to 0.80)
20 to 29	0.69 (0.22 to 1.61)	0.41 (0.09 to 1.21)	0.83 (0.30 to 1.81)	0.28 (0.03 to 1.00)
30 to 39	0.38 (0.08 to 1.10)	0.25 (0.03 to 0.91)	0.50 (0.14 to 1.29)	0.25 (0.03 to 0.91)
40 to 49	1.80 (0.96 to 3.08)	1.66 (0.86 to 2.90)	0.83 (0.31 to 1.81)	0.55 (0.15 to 1.42)
50 to 59	4.17 (2.85 to 5.89)	1.69 (0.90 to 2.90)	1.95 (1.09 to 3.22)	1.95 (1.09 to 3.22)
60 to 69	7.71 (5.71 to 10.20)	5.67 (3.97 to 7.84)	7.71 (5.71 to 10.20)	2.83 (1.68 to 4.48)
70 to 79	14.67 (11.50 to 18.44)	8.64 (6.25 to 11.64)	14.06 (10.96 to 17.77)	5.42 (3.57 to 7.89)
≥80	18.47 (13.88 to 24.10)	10.61 (7.20 to 15.05)	16.42 (12.11 to 21.77)	7.53 (4.72 to 11.40)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Table 5: Age-standardised rate per 1,000,000 of COVID-19 severe hospital admissions by hospital admission date stratified by sex, 1 July 2024 to 29 December 2024

Sex	01 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
Female	3.80 (3.13 to 4.57) [note 6]	2.55 (2.01 to 3.20)	2.92 (2.33 to 3.60)	1.37 (0.98 to 1.85)
Male	5.22 (4.38 to 6.17)	2.93 (2.31 to 3.66)	4.66 (3.87 to 5.56)	2.32 (1.78 to 2.98)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Table 6. Age-standardised rate per 1,000,000 of COVID-19 severe hospital admissions by hospital admission date stratified by region, 1 July 2024 to 29 December 2024

Region	01 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
East Midlands	5.27 (3.44 to- 7.73) [note 6]	2.63 (1.40 to 4.50)	5.70 (3.78 to 8.24)	-
East of England	4.20 (2.79 to 6.07)	2.25 (1.25 to 3.71)	3.35 (2.10 to 5.08)	-
London	6.96 (5.06 to 9.31)	4.26 (2.81 to 6.16)	2.81 (1.62 to 4.51)	2.13 (1.16 to 3.55)
North East	7.18 (4.38 to 11.08)	3.66 (1.75 to 6.75)	5.72 (3.26 to 9.29)	-
North West	5.84 (4.20 to 7.89)	3.58 (2.34 to 5.26)	4.03 (2.69 to 5.78)	2.07 (1.16 to 3.42)
South East	4.52 (3.24 to 6.13)	2.85 (1.86 to 4.17)	4.57 (3.29 to 6.18)	2.16 (1.32 to 3.34)
South West	2.80 (1.62 to 4.49)	-	2.60 (1.48 to 4.23)	1.81 (0.90 to 3.25)
West Midlands	2.42 (1.32 to 4.06)	2.11 (1.09 to 3.68)	1.87 (0.93 to 3.35)	2.38 (1.29 to 3.99)
Yorkshire and The Humber	3.27 (1.94 to 5.18)	3.01 (1.72 to 4.90)	4.87 (3.18 to 7.14)	1.96 (0.97 to 3.51)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Table 7. Age-standardised rate per 1,000,000 of COVID-19 severe hospital admissions by hospital admission date stratified by ethnicity, 1 July 2024 to 29 December 2024

Ethnicity Group	01 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
Asian or Asian British	5.37 (2.69 to 9.33) [note 6]	5.86 (3.12 to 9.81)	4.25 (1.93 to 7.84)	-
Black or Black British	9.01 (3.94 to 16.84)	-	-	-
Mixed	-	-	-	-
White	3.66 (3.14 to 4.23)	2.27 (1.86 to 2.74)	3.16 (2.68 to 3.70)	1.55 (1.22 to 1.94)
Other Ethnic Groups	-	-	-	-

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Table 8. Age-standardised rate per 1,000,000 of COVID-19 severe hospital admissions by hospital admission date stratified by IMD, 1 July 2024 to 29 December 2024

IMD Quintile	1 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
1	102.73 (81.04 to 128.41) [note 6]	52.70 (37.71 to 71.63)	80.68 (61.67 to 103.65)	31.43 (20.05 to 46.87)
2	63.76 (47.82 to 83.30)	48.35 (34.63 to 65.68)	52.75 (38.44 to 70.64)	24.15 (14.71 to 37.34)
3	47.88 (35.07 to 63.79)	24.59 (15.42 to 37.13)	33.36 (23.09 to 46.63)	21.16 (12.79 to 32.86)
4	42.18 (30.46 to 56.86)	22.28 (14.00 to 33.60)	30.31 (20.84 to 42.61)	22.41 (13.84 to 34.21)
5	30.22 (20.07 to 43.57)	20.63 (13.02 to 31.04)	31.05 (21.19 to 43.85)	16.33 (9.33 to 26.40)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Mortality

The overall weekly COVID-19 mortality rate between July and December 2024 was 3657 per 1,000,000, with peaks occurring in July and October 2024.

Mortality rates were highest among those aged ≥80 (878.18 per 1,000,000), followed by those aged 198.91 (198.91 per 1,000,000). No increased mortality rate was observed among infants.

Mortality rates were higher among males compared to females throughout the time period. At the peak in October, mortality rate in males was nearly double that in females (6.09 compared to 4.02 per 1,000,000, respectively).

When stratified by region, mortality rates were highest among those resident in the North East from July to mid-August 2024 (34.70 per 1,000,000) and from mid-August to September 2024 (18.22 per 1,000,000). Following that, the highest rates were in the West Midlands from October to mid-November (33.23 per 1,000,000), followed by the East Midlands from mid-November to December (17.40 per 1,000,000).

The highest mortality rates were observed among those in the Asian or Asian British ethnic group (46.94 per 1,000,000), followed by those in the Black or Black British group (Black or Black British per 1,000,000).

Mortality rates were highest among those in the most deprived quintile (quintile 1) (1 per 1,000,000); the rates decreased with decreasing deprivation level for most time periods.

Figure 17. Rate per 1,000,000 of COVID-19 deaths by date of death, 1 July 2024 to 29 December 2024

Table 9. Rate per 1,000,000 of COVID-19 deaths by date of death stratified by age, 1 July 2024 to 29 December 2024

Age Groups	1 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
<6 months	0.00 (0.00 to 12.37) [note 6]	3.35 (0.08 to 18.69)	3.35 (0.08 to 18.69)	0.00 (0.00 to 12.37)
6 months to <1 year	0.00 (0.00 to 11.72)	0.00 (0.00 to 11.72)	3.18 (0.08 to 17.71)	0.00 (0.00 to 11.72)
1 to 4	0.00 (0.00 to 1.36)	0.00 (0.00 to 1.36)	0.00 (0.00 to 1.36)	0.00 (0.00 to 1.36)
5 to 9	0.00 (0.00 to 1.10)	0.00 (0.00 to 1.10)	0.00 (0.00 to 1.10)	0.30 (0.01 to 1.66)
10 to 19	0.00 (0.00 to 0.53)	0.00 (0.00 to 0.53)	0.14 (0.00 to 0.80)	0.00 (0.00 to 0.53)
20 to 29	0.00 (0.00 to 0.51)	0.28 (0.03 to 1.00)	0.14 (0.00 to 0.77)	0.00 (0.00 to 0.51)
30 to 39	0.00 (0.00 to 0.46)	0.00 (0.00 to 0.46)	0.13 (0.00 to 0.70)	0.00 (0.00 to 0.46)
40 to 49	0.28 (0.03 to 1.00)	0.83 (0.31 to 1.81)	0.42 (0.09 to 1.21)	0.00 (0.00 to 0.51)
50 to 59	1.69 (0.90 to 2.90)	0.91 (0.37 to 1.88)	2.35 (1.39 to 3.71)	0.65 (0.21 to 1.52)
60 to 69	5.19 (3.57 to 7.29)	5.19 (3.57 to 7.29)	6.14 (4.36 to 8.39)	2.05 (1.09 to 3.50)
70 to 79	20.09 (16.35 to 24.44)	17.48 (14.00 to 21.56)	26.12 (21.82 to 31.02)	14.47 (11.32 to 18.22)
≥80	68.42 (59.27 to 78.59)	67.74 (58.63 to 77.86)	130.68 (117.90 to 144.47)	69.79 (60.54 to 80.05)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Figure 18. Age-standardised rate per 1,000,000 of COVID-19 deaths by date of death stratified by sex, 1 July 2024 to 29 December 2024

Table 10: Age-standardised rate per 1,000,000 of COVID-19 deaths by date of death stratified by region, 1 July 2024 to 29 December 2024

Region	1 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
East Midlands	25.68 (21.39 to 30.58) [note 6]	16.59 (13.19 to 20.59)	27.18 (22.77 to 32.19)	14.13 (11.01 to 17.85)
East of England	19.23 (16.10 to 22.80)	13.46 (10.84 to 16.51)	26.53 (22.83 to 30.66)	17.40 (14.43 to 20.80)
London	19.09 (15.73 to 22.94)	12.86 (10.14 to 16.08)	19.59 (16.20 to 23.48)	12.91 (10.18 to 16.14)
North East	34.70 (28.13 to 42.33)	18.22 (13.57 to 23.96)	27.34 (21.53 to 34.22)	15.01 (10.82 to 20.30)
North West	23.54 (20.13 to 27.35)	12.88 (10.40 to 15.78)	22.76 (19.42 to 26.51)	10.49 (8.27 to 13.13)
South East	19.34 (16.66 to 22.32)	15.17 (12.81 to 17.83)	23.89 (20.91 to 27.17)	11.84 (9.76 to 14.22)
South West	18.01 (14.94 to 21.53)	13.54 (10.91 to 16.61)	22.30 (18.86 to 26.18)	11.16 (8.79 to 13.97)
West Midlands	22.46 (18.80 to 26.62)	16.49 (13.39 to 20.10)	33.23 (28.75 to 38.21)	12.19 (9.53 to 15.35)
Yorkshire and The Humber	20.82 (17.17 to 25.01)	13.32 (10.44 to 16.76)	27.23 (23.05 to 31.96)	12.73 (9.92 to 16.09)

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Table 11D: Age-standardised rate per 1,000,000 of COVID-19 deaths by date of death stratified by ethnicity, 1 July 2024 to 29 December 2024

Ethnicity Group	1 Jul 24 to 14 Aug 24	15 Aug 24 to 28 Sep 24	29 Sep 24 to 12 Nov 24	13 Nov 24 to 29 Dec 24
Asian or Asian British	11.42 (7.14 to 17.24) [note 6]	12.75 (8.17 to 18.88)	15.64 (10.48 to 22.35)	7.14 (3.79 to 12.21)
Black or Black British	14.06 (7.22 to 24.28)	-	14.89 (8.14 to 24.72)	-
Mixed	-	-	-	-
White	6.88 (6.18 to 7.64)	5.92 (5.27 to 6.63)	10.83 (9.95 to 11.77)	5.49 (4.87 to 6.17)
Other Ethnic Groups	-	-	-	-

Note: data extracted on 9 April 2025.

Note 6: rate (lower 95% confidence interval to upper 95% confidence interval); to avoid deductive disclosure, rates were not presented for categories with fewer than 10 cases.

Figure 19. Age-standardised rate per 1,000,000 of COVID-19 deaths by date of death stratified by IMD, 1 July 2024 to 29 December 2024

Vaccine surveillance

This section contains updates on vaccination coverage, vaccine effectiveness (VE), and vaccine impact on the proportion of the population with antibodies to COVID-19 for the most recent vaccination campaigns.

COVID-19 vaccination has been shown to provide protection against hospitalisation and other severe outcomes throughout the changing disease profile of COVID-19. A primary course of COVID-19 vaccine was initially rolled out to all adults in England from 8 December 2020, followed by a booster dose launched in November 2021. From Spring 2022, vaccinations have been offered to groups most vulnerable to severe disease, based on age and clinical risk, through bi-annual programmes occurring each spring and autumn.

UKHSA undertake routine monitoring of the coverage, effectiveness and impact of vaccines as they are rolled out in the population in order to continually ensure that clinical and public health guidance on the vaccination programme is built upon the best available evidence.

The UKHSA works closely with the Medicines and Healthcare Regulatory Agency (MHRA), NHS England, and other government, devolved administration, and academic partners to monitor the COVID-19 vaccination programme through the COVID-19 vaccine surveillance strategy (27). While this report does not include information on COVID-19 vaccine safety, as with all vaccines, the safety of COVID-19 vaccines is continuously being monitored by the MHRA. They conclude that overall, the benefits of COVID-19 vaccines outweigh any potential risks (28).

Spring and Autumn 2024 campaigns

The 2024 autumn booster programme, which commenced 3 October 2024, was recommended by the Joint Committee on Vaccination and Immunisation (JCVI) for adults aged 65 years and older, residents in care homes for older people, and those aged 6 months or over in a clinical risk group. The products offered were mRNA monovalent Omicron JN.1 vaccines (Pfizer-BioNTech and Moderna).

This campaign was preceded by the 2024 spring booster programme, which commenced on 15 April 2024. This was recommended by the JCVI for adults aged 75 years and older, residents in care homes for older people, and those aged 6 months or over with a weakened immune system. The products offered were mRNA monovalent Omicron XBB.1.5 vaccines (Pfizer-BioNTech and Moderna).

Vaccine coverage

The COVID-19 vaccine uptake surveillance system provides an indication of COVID-19 vaccine coverage across England, stratified by populations of interest. It is used for the assessment of vaccine catch-up campaigns, planning and intervention by both clinicians and policy makers.

Data on the Autumn 2024 COVID-19 vaccination campaign reported below covers any dose administered from 3 October 2024 to 31 January 2025 provided there is at least 20 days from the previous dose. Eligible groups for the campaign are defined in Green Book chapter on COVID-19 (29).

By the end of the campaign, 59.3% of all people aged 65 years and over, and 23.6% of all people aged under 65 years and in a clinical risk group, who are living and resident in England had been vaccinated with an autumn 2024 booster dose since 3 October 2024.

When stratified by ethnicity, the highest uptake was seen among those in the White ethnic groups at 49% by the end of the campaign. There was lower uptake in minority ethnic groups, particularly the Black/Black British and Pakistani ethnic groups, at 7% and less than 5% respectively.

There is a positive correlation between deprivation index (IMD) and vaccine uptake, with least deprived populations having the highest uptake at 60%, and the most deprived having the lowest uptake at 20%.

Vaccine uptake was highest in the South West of England, with 50% of the population having had an Autumn 2024 dose. London saw the lowest uptake at 20% by the end of the campaign.

Figure 20A. COVID-19 vaccine coverage for last seasonal vaccine programme 1 July 2024 to 29 December 2024, by age/risk group

Figure 20B. COVID-19 vaccine coverage for last seasonal vaccine programme 1 July 2024 to 29 December 2024, by region

Figure 20C. COVID-19 vaccine coverage for last seasonal vaccine programme 1 July 2024 to 29 December 2024, by ethnicity

Figure 20D. COVID-19 vaccine coverage for last seasonal vaccine programme 1 July 2024 to 29 December 2024, by IMD

Vaccine effectiveness

VE of the Autumn 2024 booster vaccines was estimated against hospitalisation among those aged 65 years and older for both vaccine manufacturers from 3 October 2024 against all SARS-CoV-2 lineages in circulation at the time (Figure 21). The data sources, methods and definitions section outlines the methodology used for vaccine effectiveness calculations in further detail.

Incremental effectiveness of the Autumn 2024 vaccines against hospitalisation was highest in the period 10 to 14 weeks post-vaccination at 42.8%. Further follow-up time is required to assess waning for this vaccine.

Figure 21. VE of the COVID-19 autumn 2024 booster against hospitalisation amongst those aged 75 years and older in England

VE of the Spring 2024 booster vaccines was estimated against hospitalisation amongst those aged 65 years and older from 3 October 2024 against all SARS-CoV-2 lineages in circulation at the time to assess the long-term impact of the Spring 2024 vaccines (Figure 22).

Incremental long-term VE against hospitalisations for the Spring 2024 vaccine remained at 44.2% 2 to 4 weeks post-vaccination. There was evidence of waning for this vaccine, with estimates decreasing to 8.9% by 25 to 29 weeks post-vaccination.

Figure 22. Long-term VE of the COVID-19 spring 2024 booster against hospitalisation amongst those aged 65 years and older in England

Vaccine impact: Seroprevalence

The results from testing samples provided by healthy adult blood donors aged 17 years and older, supplied by the NHS Blood and Transplant (NHS BT collection) between weeks 35, 2020 and week 04, 2025 are summarised. Between week 44, 2020 and week 10, 2024, approximately 250 samples from each geographic NHS region were tested each week; from week 11, 2024 onwards, approximately 55 samples from each geographic region were tested each week.

The COVID-19 vaccination campaign began on 8 December 2020 (week 50) with a phased roll out by age and risk group. Booster doses were offered from the beginning of September 2021. Further doses have been offered in spring and autumn campaigns to populations in risk groups. The 2024 autumn booster programme began in October 2024 for:

• adults aged 65 and older
• people in clinical risk groups
• older adults in care homes
• health and social care workers and individuals who live closely with or are carers for clinically vulnerable people

The 2024 spring booster programme began in April 2024 for adults aged 75 years and older, residents of care homes and immunosuppressed individuals aged 6 months and older. We aim to monitor the current Autumn booster programme and its impact on seroprevalence and antibody levels.

The results presented here are based on testing samples from blood donors aged 17 years and older with Roche nucleoprotein (N) and Roche spike (S) antibody assays. After week 4 2025 testing has been suspended while we transition to assays that are able to detect antibodies against specific COVID-19 variants, hence this will be the final report on results with this pair of assays.

Nucleoprotein (N) assays only detect post-infection antibodies, whereas spike (S) assays will detect both post-infection antibodies and vaccine-induced antibodies. Thus, changes in seropositivity for the Roche N assay reflect the effect of natural infection. Increases in seropositivity as measured by S antibody reflect both infection and vaccination. Antibody responses to both targets reflect infection or vaccination occurring at least 2 to 3 weeks previously given the time taken to generate a COVID-19 antibody response. Currently donors are asked to defer donations for at least 7 days following resolution of any COVID-19 symptoms (previously 28 days, changes were implemented during January 2022).

This report presents N and S seropositivity estimates on the same set of samples, using a 12-week rolling prevalence for national, age group and regional estimates. Seropositivity estimates are plotted using the mid-point of a 12-weekly rolling period. This means the data will reflect seroprevalence several weeks previously. Seroprevalence estimates reported are based on seropositivity which are unadjusted for the sensitivity and specificity of the Roche assays used.

National prevalence

Overall population weighted (by age group, sex and NHS region) antibody prevalence among blood donors aged 17 years and older in England was 95.5% (94.6% to 96.3%) using the N assay and 100.0% (99.8% to 100.0%) using the S assay for the period 20 November 2024 to 24 January 2025 (week 47 2024 to week 04 2025). 2,926 out of 3,074 were N positive and 3,034 out of 3,035 samples were S positive. This compares with 94.6% (93.8% to 95.3%) N seropositivity and 100.0% (99.8% to 100.0%) S seropositivity for the period of 28 August to 15 November 2024 (week 35 to week 46 2024).

Seropositivity (weighted by region, age group and sex) varies over time. Figure 23 shows the overall 12-weekly rolling proportion seropositive over time for the N and S assays. Seropositivity estimates are plotted weekly using the mid-point of a rolling 12-weekly period. The high N seropositivity in 2024 implies that the majority of recent COVID-19 cases have experienced prior infection.

Figure 23. Overall 12-weekly rolling SARS-CoV-2 antibody seroprevalence (% seropositive) in blood donors

Regional prevalence of infection over time

Seropositivity (weighted by age group and sex) using the N assay, which detects infection only, has previously varied by region Figure 24.

N seropositivity has remained similar to the previous 12-week period Table 12. Estimates have changed by -0.9 to 2.6% between the 2 periods.

The difference in seropositivity by region has narrowed over time. Historically the highest seropositivity was observed in London and the lowest in the South West, and although these regions also had the highest and lowest seropositivity during the period weeks 47 2024 to 4 2025, the difference in seropositivity between these 2 regions was 4.6%.

Figure 24. 12-weekly rolling SARS-CoV-2 N antibody seroprevalence (% seropositive) in blood donors by region, using the Roche N assay; error bars show 95% confidence intervals

Table 12: Roche N seropositivity (95%CI) estimates by NHS region

NHS region	Weeks 35 to 46 2024	Weeks 47 2024 to 4 2025
East of England	94.4% (92.1% to 96.0%)	97.0% (95.0% to 98.2%)
London	95.4% (93.5% to 96.8%)	97.7% (96.1% to 98.6%)
Midlands	94.8% (92.4% to 96.5%)	95.8% (92.9% to 97.5%)
North East and Yorkshire	95.8% (94.1% to 97.1%)	95.7% (93.5% to 97.2%)
North West	93.2% (90.6% to 95.1%)	95.3% (92.8% to 96.9%)
South East	93.9% (91.6% to 95.6%)	93.8% (90.4% to 96.0%)
South West	94.0% (91.4% to 95.8%)	93.1% (89.1% to 95.7%)

Prevalence by age group

Seropositivity estimates by age group using the N assay are presented below.

Based on testing samples using the N assay Figure 25 as a marker of infection, the lowest seropositivity continues to be observed in those aged 70 to 84, however the gap in seropositivity between age groups has narrowed over the last year.

N seropositivity has increased slightly within all age groups Table 14 compared with the previous 12-week period.

Figure 25. Population weighted 12-weekly rolling SARS-CoV-2 antibody seroprevalence (% seropositive) in blood donors from the Roche N assay by age group

Table 13: Roche N seropositivity (95% CI) estimates by NHS region

Age group	Weeks 35 to 46 2024	Weeks 47 2024 to 4 2025
17 to 29	97.3% (94.7% to 98.6%)	98.4% (95.5% to 99.4%)
30 to 39	96.5% (94.9% to 97.6%)	97.2% (95.3% to 98.3%)
40 to 49	95.9% (94.5% to 97.0%)	97.1% (95.4% to 98.1%)
50 to 59	94.1% (92.6% to 95.3%)	94.4% (92.5% to 95.8%)
60 to 69	92.3% (90.5% to 93.8%)	94.1% (91.9% to 95.7%)
70 to 84	89.5% (86.0% to 92.1%)	90.3% (85.7% to 93.6%)

S seropositivity in blood donors has plateaued and is over 99% across all age groups. Seropositivity estimates for N antibody will underestimate the proportion of the population previously infected due to:

(i) waning of the N antibody response over time
(ii) observations from UK Health Security Agency (UKHSA) surveillance data that N antibody levels are lower in individuals who acquire infection following vaccination

These lower N antibody responses in individuals with breakthrough infections (post-vaccination) compared to primary infection likely reflect the shorter and milder infections in these patients. Patients with breakthrough infections continue to have significant increases in S antibody levels consistent with boosting of their antibody levels.

Vaccination has made an important contribution to the overall S seropositivity increases observed since the roll out of the vaccination programme. The impact of the booster vaccination programmes can be assessed by monitoring S antibody levels across the population over time.

S antibody levels by age group and N antibody status over time

The Roche S assay that the UK Health Security Agency (UKHSA) uses for serological surveillance is fully quantitative, meaning that it measures the level of antibodies in a blood sample; an antibody level above 0.8 AU/ml (approximately 1 IU/ml using the WHO standard) is deemed positive. The UKHSA surveillance since Autumn 2021 has found that over 99% of the population of blood donors test positive for S-antibodies, which may have resulted from either COVID-19 infection or vaccination. With such high seropositivity, it is important to look at population antibody levels in order to assess the impact of the vaccination booster programmes.

Figure 4 shows categorised S levels by age group. From spring 2023 the proportion of donors aged 50 years and above with very high antibody levels of 25,000+ AU/ml decreased, subsequently increasing through October and November 2023. Similar decreases are seen from spring 2024, with subsequent increases in November 2024. These trends are most prominent in older donors; and follow the autumn 2023 and autumn 2024 COVID-19 vaccine booster offers. A small increases during spring 2023 in donors aged 70 to 84 are in line with the spring 2023 COVID-19 vaccine booster offer. The profile of antibody levels is similar across donors aged 17 to 49, and is lower overall than in those aged above 60.

Figure 5 shows monthly categorised S levels over the past 2 years by N antibody status. N-antibody positive individuals are those likely to have experienced past infection. Antibody levels will be influenced by vaccination history, time since infection, variant and severity of infection, as well as individual factors such as underlying health conditions, age and genetics. N-antibody negative individuals are those who have either: never experienced infection, or who experienced infection in the past but made little N antibody response, or whose N antibody levels have waned into the negative range over time. In both panels of Figure 4, increased S-antibody levels can be seen around the time of the autumn 2023 and autumn 2024 vaccination campaigns, during the months of October to January. S antibody levels were also high during February 2024. Comparing the left and right panels, the overall higher profile of antibody levels in those who are N antibody positive is evident; vaccination post infection, breakthrough infection following vaccination and re-infection are all expected to boost existing S antibody levels.

Figure 26. Categorised Roche S antibody levels by age group and month, February 2023 to January 2025

Figure 27. Categorised Roche S antibody levels by N antibody status and month, February 2023 to January 2025

Data sources, methods and definitions

Data sources

Second Generation Surveillance System (SGSS)

Description

SGSS stores and manages laboratory test result information for notifiable infectious diseases and antimicrobial resistance from diagnostic laboratories in England. SARS-CoV-2 testing data in SGSS includes polymerase chain reaction (PCR) tests from hospital settings and PCR and lateral flow device (LFD) tests from community settings up until 1 April 2022. COVID-19 data from SGSS are used to monitor trends in COVID-19 cases and as the basis for other areas of surveillance, such as monitoring SARS-CoV-2 lineage epidemiology and residential property type of cases. SGSS holds disease and demographic characteristics on COVID-19 cases (such as age, sex, region, ethnicity, date of test). This is derived directly from laboratory reporting processes and linkage to electronic health record data. Data is held at episode-level, as defined in the methods section.

Data quality

Laboratory data from SGSS is updated daily; however, real-time data is subject to a lag of 2 to 3 days due to collection and reporting requirements. Completeness of SGSS data depends on the completeness of laboratory reporting forms and of linkage with electronic health record data. Missing data or inability to link to electronic health record data can affect the completeness of metrics.

Unified Sample Dataset (USD)

Description

The USD is a repository for all SARS-CoV-2 positive and negative PCR and LFD tests, sourced from several surveillance systems including SGSS and sentinel laboratory reporting systems. USD holds disease and demographic characteristics on COVID-19 cases (such as age, sex, region, date of test). This is derived directly from laboratory reporting processes and linkage to electronic health record data.

Data quality

Laboratory data from USD is updated weekly; hence, this data is lagged by one week in addition to a lag of 2 to 3 days due to collection and reporting requirements. Completeness of USD data depends on the completeness of laboratory reporting forms and of linkage with electronic health record data. Missing data or inability to link to electronic health record data can affect the completeness of metrics.

SARS-CoV-2 sequencing data

Description

SARS-CoV-2 genomic information is included in SGSS. In England, during the pandemic, genomic investigation and lineage assignment was coordinated by the COVID-19 Genomics UK consortium (COG-UK). A sample of eligible SARS-CoV-2 PCR samples underwent genomic investigation via:

i) whole genome sequencing (WGS)
ii) reflex (genotyping) assays to detect key mutations
iii) S-gene target status of PCR tests carried out on the TaqPath assay

Data quality

Trends in lineage prevalence will be delayed as sequenced data follows a lag of 2 to 3 weeks due to collection, sequencing, and reporting requirements.

Immunisation Information System (IIS)

Description

IIS is used to monitor the roll out of selected vaccination programmes, including flu and COVID-19. It is used to assess vaccine coverage and effectiveness, and also supports investigation and analysis of safety concerns, if and when these arise. The IIS collects person records for all individuals issued with an NHS number in England (the IIS population denominator). It was commissioned in 2020 as part of the national influenza and COVID-19 vaccination programmes. The dataset also contains information on administered vaccinations across a range of settings. This data contains detailed vaccination records for all individuals who have received at least one dose of SARS-CoV-2 vaccination. IIS holds disease and demographic characteristics on individuals eligible for SARS-CoV-2 vaccination (such as age, sex, region, ethnicity). This is derived directly from linkage to electronic health record data. IIS also includes clinical risk status data for individuals included in the population denominator. This data is derived from NHS Cohorting as a Service (CaaS) data, an NHS England service, which uses existing individual electronic health records to identify people in clinical risk groups. Risk groups are defined in the COVID-19 Green Book as those with underlying health conditions that may put them at higher risk of severe COVID-19 disease.

Data quality

Population denominator and vaccine data in the IIS are updated daily with a 24-hour lag. NHS CaaS began provision of person-level clinical risk flag data in Autumn 2022. Risk flag data available prior to this date are subject to reduced accuracy.

Death registration data

Description

COVID-19 mortality data is obtained from death registrations for England and Wales collated by the Office for National Statistics (ONS). ONS provide UKHSA a weekly extract of death registration data for routine processing of mortality statistics and for outcome assessments of specific diseases such as COVID-19. Data is reported at person level and contain information about the death and the deceased individual, including demographic information such as age and sex. Causes of death information is also provided, including underlying and primary cause of death are provided as International Classification of Diseases (ICD-10) codes.

Data quality

Death registration data is subject to an 11-day lag to account for the time between death and registration of the death.

Secondary Uses Services (SUS) and Emergency Care Dataset (ECDS)

Description

Data on A&E attendances and hospital admissions, including admission to intensive care units (ICU), were obtained from the Emergency Care Data Set (ECDS) and Secondary Users Service (SUS) data set respectively. These datasets contain national level data on hospital activity to inform management and planning of NHS services. This data is used in real time to inform severity of disease and disease-associated hospitalisations. This data includes demographic information such as age, sex, ethnicity, and region of residence. Standardised codes for procedures, diagnoses and medical conditions are captured for each episode, including information on primary diagnosis, treatment, co-morbidities and complications.

Data quality

Mandatory reporting of SUS and ECDS data occurs on a monthly and daily basis, respectively. SUS data within the most recent four months are considered provisional to account for lags in reporting and updating the data. Similarly, ECDS data within the last month are considered provisional.

Methods

Every effort is made to ensure that data quality standards are maintained by conducting regular analysis and data quality assessments.

Definitions

The below definitions are regularly reviewed in relation to data availability and quality, epidemiology, and testing of COVID-19 and may be reevaluated and updated in the future to support optimal reporting.

COVID-19 episode COVID-19 cases in England are monitored using an episode-based definition to include possible reinfections. Positive test records from SGSS are converted to cases and infection episodes, deduplicating records using the Organism-Patient-Illness Episode (OPIE) principle, whereby episodes constitute a positive organism in a defined time-period. Each COVID-19 infection episode, beginning with the earliest positive test date, is counted separately if there are at least 91 days between positive test results (PCR or LFD test).

Testing pillar Pillar 1 testing includes those with a clinical need and health and care workers and performed at an NHS laboratory. Pillar 2 testing includes symptomatic and asymptomatic individuals testing in the community, and includes community PCR testing sites, assisted-test or self-testing via Lateral Flow Device (LFD) at schools and workplaces, and home delivery.

Residential property classification To obtain residential property type information, we enhanced residential address information for all COVID-19 cases through geospatial address matching to obtain a Unique Property Reference Number (UPRN) and a Basic Land Property Unit (BLPU) class. UPRN and BLPU indicate the property type of the address, which include private residential dwellings, residential nursing or care homes, long-term care facilities, and prisons, detention centres and secure units.

A&E attendance COVID-19 A&E attendances were defined as any attendance to A&E up to 14 days after or 1 day before the earliest positive test of a COVID-19 episode with an associated respiratory diagnosis code.

Hospital admissions COVID-19 hospital admissions were defined as any hospital admission up to 14 days after or 1 day before the earliest positive test of a COVID-19 episode where the admission record was associated with a respiratory ICD-10 diagnosis code, or any hospital admission where the record was associated with a COVID-19 ICD-10 diagnosis code (including those without a record of a positive test).

Severe hospitalisations COVID-19 severe hospitalisations were defined as any COVID-19 hospital admission, as above, where the length of stay was 2 or more days, and the main specialty code or treatment function related to intensive care medicine or ventilation use or oxygen use.

Deaths COVID-19 deaths were defined as deaths of individuals whose death certificate mentioned COVID-19 as one of the causes of death.

Demographic characteristics

Age age is calculated as the difference, in years, between date of birth and the positive specimen date.

Sex information on sex is obtained from the test request or registration form. Where missing or incomplete, sex information is enriched by tracing against the Demographic Batch Service.

Ethnicity information on ethnicity is primarily obtained from self-reported ethnicity at the time of test. Where missing or incomplete, ethnicity information is enriched via linkage to healthcare records. Ethnic categories are based on ONS classifications. PCR test positivity is not presented by ethnicity because ethnicity is not reported for negative tests.

Region information on residential address is obtained from the test request or registration form. Where missing or incomplete, residential address information is enriched via linkage to healthcare records. Residential postcode is used to derive geographical groupings (LSOA, LTLA, regions and so on) through linking to ONS regional classifications.

Index of multiple deprivation (IMD) using residential address (as described above), residential lower super output area (LSOA) of residence is linked to 2019 IMD produced by Ministry of Housing, Communities & Local Government (MHCLG). IMD classifies these areas into 5 quintiles based on relative disadvantage, with quintile 1 being the most deprived and quintile 5 being the least. IMD is assigned to individuals based on the average level of deprivation for people living in the same postcode as the case and therefore does not necessarily represent the true disadvantage level for that individual. PCR test positivity is not presented by IMD because the reported postcode for negative tests has not been validated.

Metric calculations

SARS-CoV-2 test positivity

Positivity reports on the proportion of individuals who test positive for SARS-CoV-2 among all individuals tested for the respective organisms. Calculations only include tests done through PCR. Positivity is calculated as a 7-day rolling average, with the number of individuals testing positive during the preceding 7 days divided by the number of individuals tested during the preceding 7 days through PCR testing.

Rate calculations

COVID-19 case rates are calculated per 100,000 population and COVID-19 outcome and mortality rates are calculated per 1,000,000 population. Rate calculations use population denominators from mid-year 2021 estimates from ONS for age and sex, mid-year 2020 estimates from ONS for region and IMD, and 2019 estimates for ethnicity.

Rate calculations are age-standardised to adjust for differences in the age structure of populations. The standard used throughout this report is the European Standard Population 2013.

Vaccine effectiveness

Autumn 2024 vaccine effectiveness was estimated by calculating the odds of testing positive in hospital for COVID-19 in those who received an autumn booster against those who did not receive an autumn booster, regardless of previous vaccination history. The effectiveness measured is therefore the incremental protection on top of any from previous vaccinations or infections. Individuals with 2 or more autumn boosters and individuals who have received an autumn booster less than 12 weeks after their previous vaccine were excluded.

Long-term VE for the Spring 2024 campaign was calculated in a similar manner, where the odds of testing positive in hospital for COVID-19 in those who received a spring booster was calculated against those who did not receive an autumn booster, regardless of previous vaccination history.

Estimates were adjusted for clinical risk status, age, sex, week of test, region, IMD quintile, ethnicity, and previous flu vaccination status.

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