The nation’s flu markers for the week ending Nov 19 climbed higher, with most of the continental US reporting high or very high activity and reports of five more deaths in children, the Centers for Disease Control and Prevention (CDC) said today in its latest update.

The early-season surge is occurring alongside brisk respiratory syncytial virus (RSV) activity that has overwhelmed some children’s hospitals. Also, COVID-19 variants continue to shift, with cases, hospitalizations, and deaths showing small rises.

H3N2 still dominant, but vaccines still a good match

In its latest FluView update, the CDC said 35 states are experiencing high or very high activity, with only 6 still reporting low activity, mostly in the north. At the national level, the percentage of respiratory samples that tested positive for flu at clinical labs rose from 14.7% to 18.2%. Positivity rose in most CDC regions, remained stable in the south-central states, and declined in the southeast.

H3N2 is still the dominant strain, making up 78% of influenza A samples. Seasons dominated by H3N2 are known to be tough on seniors and young children, and the virus is known to evolve to evade protection from the H3N2 component of the vaccine. But so far, the CDC said the majority of flu viruses tested are similar to the viruses included in this year’s seasonal flu vaccines.

The percentage of outpatient visits for flulike illness, which can reflect activity from other respiratory viruses, rose slightly from 5.8% to 6%.

For hospitalizations, the cumulative rate per 100,000 population was 11.3%, the highest for this point in the year since the 2010-2011 flu season. The highest rates are in seniors, followed by children ages 0 to 4 years old.

Five more pediatric flu deaths were reported, bringing the season’s total to 12. The deaths occurred between early October and the middle of November. All involved influenza A. Of two subtyped viruses, one was H1N1 and the other was H3N2.

US COVID markers edge upward

Meanwhile, the 7-day average for new daily COVID-19 cases today is 43,692, up 8% compared to a week ago, according to the Washington Post tracker. Similarly, the daily average for deaths is 379, up 24% from last week. And likewise, hospitalizations are up 5%.

Though small, the uptick in COVID-19 activity is occurring against the backdrop of the steadily rising proportion of Omicron subvariants BQ.1 and BQ.1.1, which are known to more easily evade earlier protection from vaccination or previous infection.

In its last variant proportion estimates, the CDC said the original BA.5 Omicron subvariant now makes up only 19.4% of sequenced samples. BQ.1 now makes up 27.9%, with BQ.1.1 making up 29.4%. XBB, an Omicron variant recombinant fueling outbreaks in Asia, is rising slowly and currently makes up 3.1%.

In other COVID developments, protests in China over the country’s “zero COVID” policy flared in at least 10 major cities over the past several days, with the country experiencing a sharp rise in daily cases.

In Shanghai, for example, protesters clashed with police and called for the removal of China’s president and the end of Chinese Community Party rule, according to CBS News. The rare protests were partly triggered by anger over the deaths of 10 people in an apartment fire in which the response was reportedly delayed due to excessive lockdown measures.

For more information, visit CIDRAP, Center for Infectious Disease Research and Policy.