Ireland is facing a challenging winter as influenza cases rise earlier than expected, with health experts warning that the weeks ahead could place significant strain on hospitals, staff and patients.
Every winter brings some level of influenza, but this season has begun several weeks ahead of schedule and is being driven mainly by a mutated A(H3N2) strain, which experts associate with more severe outbreaks. Early-start flu seasons have historically resulted in higher case numbers and greater pressure on healthcare services.
In recent years, A(H1N1) had been the dominant strain, meaning population immunity to A(H3N2) is lower. The H3N2 strain is regarded as particularly virulent and is similar to the virus responsible for the 1968 Hong Kong flu pandemic.
Professor Ronan Collins, Consultant Geriatrician at Tallaght University Hospital, warned that influenza should not be viewed as a simple respiratory illness. “It can have very important effects on the heart and is a major risk factor for stroke,” he said. He added that in some patients flu can cause delirium and acute confusion, and in others may accelerate the onset of dementia.
Up to 75% of people infected may show no symptoms, yet they can still transmit the virus, making containment difficult.
According to the Health Protection Surveillance Centre (HPSC), there were 2,944 confirmed flu cases in the week to last Saturday, with 657 hospital admissions. Since the season began, 7,506 cases have been recorded. Dublin, Cork, Westmeath, Galway and Wexford have seen the highest numbers, while Laois, Mayo and Monaghan have recorded the lowest.
The Government has said that more than three quarters of patients currently hospitalised with influenza are unvaccinated. Dr Conor Deasy, President of the Irish Association of Emergency Medicine, described the strain as “particularly nasty”, warning that the surge is hitting already overcrowded emergency departments.
So far this season, 13 deaths have been linked to influenza. In an average flu season, 200–500 deaths can occur, but in severe years that figure can rise sharply. HPSC research suggests 400–800 excess deaths may be flu-related, rising to over 1,000 in exceptionally bad seasons.
The elderly and vulnerable groups remain most at risk. Between 80% and 90% of flu-related deaths occur in older adults, often due to secondary bacterial pneumonia or the worsening of underlying heart or lung disease.
While RSV and Covid-19 are also circulating, their levels are far lower than influenza, with just 368 RSV cases and 176 Covid-19 cases reported in the same week.
Hospitals and nursing homes are seeing increasing outbreaks, with 28 hospital outbreaks and 23 in nursing homes in the past week. Nursing Homes Ireland said preparations are strong and restrictions will only be introduced if absolutely necessary. Over 80% of residents have been vaccinated, offering some protection.
Health professionals continue to stress that vaccination is the most effective defence. While ideally taken before the season starts, doctors say there is still benefit in getting vaccinated now, as protection develops within two weeks. The flu vaccine is free for many groups through GPs, pharmacies and nursing homes.
However, uptake among healthcare staff remains low. The HSE target is 75%, but this has never been achieved. For the 2024/25 season, uptake stands at 45%. Stephen McMahon of the Irish Patients Association said evidence shows vaccinating healthcare workers “significantly reduces patient mortality and hospital-acquired flu”.
Controversy has also surrounded the decision not to provide enhanced flu vaccines for over-65s, which are offered free in several other countries. While the HSE says the standard vaccine is “highly effective”, questions remain about whether enhanced vaccines could have reduced hospital pressures this winter.
With flu expected to peak over the Christmas period, hospitals may postpone more planned procedures than usual, and visiting restrictions may return in some settings.
All indicators suggest Ireland is heading into a difficult flu season, with mounting pressure on patients, healthcare workers and the wider health system in the weeks ahead.
