Increased Respiratory Virus Activity, Especially Among Children,
Early in the 2022-2023 Fall and Winter


Distributed via the CDC Health Alert Network
November 04, 2022, 3:30 PM ET

Full NHDHHS Health Alert Here

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health
Advisory about early, elevated respiratory disease incidence caused by multiple viruses occurring
especially among children and placing strain on healthcare systems. Co-circulation of respiratory syncytial
virus (RSV), influenza viruses, SARS-CoV-2, and others could place stress on healthcare systems this fall
and winter. This early increase in disease incidence highlights the importance of optimizing respiratory
virus prevention and treatment measures, including prompt vaccination and antiviral treatment, as
outlined below.
Many respiratory viruses with similar clinical presentations circulate year-round in the United States and
at higher levels in fall and winter. In the past 2 years, respiratory disease activity has been dominated by
SARS-CoV-2, and seasonal circulation of other respiratory viruses has been atypical or lower than preCOVID-19 pandemic years. Currently, the U.S. is experiencing a surge and co-circulation of respiratory
viruses other than SARS-CoV-2. CDC is tracking levels of respiratory syncytial virus (RSV), influenza,
and rhinovirus/enterovirus (RV/EV) that are higher than usual for this time of year, especially among
children, though RV/EV levels may have plateaued in recent weeks. SARS-CoV-2 also continues to
circulate in all U.S. states.
CDC surveillance has shown an increase in RSV detections and RSV-associated emergency department
visits and hospitalizations in all but two U.S. Department of Health and Human Services (HHS) regions
(regions 4 and 6), with some regions already near the seasonal peak levels typically observed in
December or January. This year, rates of RSV-associated hospitalizations began to increase during late
spring and continued to increase through the summer and into early fall. Preliminary data from October
2022 show that weekly rates of RSV-associated hospitalizations among children younger than 18 years
old are higher than rates observed during similar weeks in recent years. While RSV activity appears to be
plateauing in some places, the timing, intensity, and severity of the current RSV season are uncertain.
CDC has been tracking early and increasing influenza activity in recent weeks. The highest levels of
influenza activity have been found in the southeast and south-central parts of the country. The most
common viruses identified to date have been influenza A(H3N2) viruses, with most infections occurring in
children and young adults. Cumulative influenza-associated hospitalization rates for children (age 0–4
years and 5–17 years) and all ages combined are notably higher compared to the same time periods
during previous seasons since 2010–2011. Although the timing, intensity, and severity of the 2022–2023
influenza season are uncertain, CDC anticipates continued high-level circulation of influenza viruses this
fall and winter.
CDC data are available to monitor COVID-19 community levels, which are based on hospitalization and
case data and can be used to track SARS-CoV-2 activity. SARS-CoV-2 activity is expected to increase in
the winter as has been observed in previous years. Rates of COVID-19-associated hospitalizations
among all age groups including children have decreased since August, but rates in infants younger than 6
months remain higher than in other pediatric age groups and higher than in all adult age groups except
those 65 years and older. CDC expects continued high-level circulation of SARS-CoV-2 this fall and

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