The Infectious diseases impacting England 2025 report shows a rise in both endemic disease and vaccine-preventable infections. Infectious diseases were the primary reason for over 20% of hospital bed usage, at an annual cost of almost £6bn in 2023 to 2024. Developing scientific capability and effective interventions are having positive impacts, but more action is needed.
The report shows the re-emergence, re-establishment and an unrelenting rise in a number of infectious diseases since 2022 to 2023, with particular increases in endemic diseases and vaccine-preventable infections. The agency acknowledges that the return of social mixing, international travel and migration following the COVID-19 pandemic have contributed to these patterns.
The report also shows some really positive impact in some areas due to the introduction of new public health interventions.
An intense influenza and RSV (respiratory syncytial virus) season was seen in 2024 to 2025, for the second consecutive year after the pandemic, with activity and hospital admissions at similar levels seen post-pandemic in 2022 to 2023. The introduction of the new RSV vaccine programmes for the elderly, and pregnant women are already helping to reduce winter pressures. Interim findings published today confirm a 30% reduction in the rate of RSV hospital admissions in the winter of 2024 to 2025 in 75 to 79 year olds; this cohort are eligible for vaccination under the new programme.
COVID-19 transmission has declined, with the virus circulating at baseline levels of activity for much of the current winter season. Incremental vaccine effectiveness was around 45% against hospitalisation, with vaccine uptake in older age groups at 60% to 70%. Vaccination of priority groups, in particular the elderly, remained an important intervention to protect against severe disease.
Tuberculosis (TB) cases have increased by 11% in 2023 compared to 2022, with provisional data for 2024 showing a further increase of 13%, which amounted to more than 600 additional notifications of people being diagnosed in 2024 compared to 2023. This trajectory would see the UK lose its World Health Organization (WHO) low incidence status if not reversed. UKHSA continues to work with NHSE and other partners on the TB action plan, which sets out steps to improve the prevention and detection of TB.
Continued progress in eliminating viral Hepatitis C (HCV) as a public health problem by 2030 has been made, with the number of people living with chronic HCV infection falling dramatically by 57% from 2015 to the end of 2023. England is also meeting and exceeding the WHO’s absolute targets on Hepatitis B virus (HBV) related mortality, incidence, mother-to-child transmission and vaccine coverage.
There has been surge in cases of measles in children under the age of 10 and an outbreak of whooping cough (pertussis) in 2024, with 433 cases in infants under 3 months of age, of whom 10 died. Both outbreaks highlight the critical importance of vaccination in eligible groups.
UKHSA analysis found that over 20% of secondary care bed days in 2023 to 2024 in NHS hospitals (admitted care) were primarily attributable to infectious disease, at a cost of £5.9bn. These infections are also distributed unevenly; in England, from 2023 to 2024, hospital admission rates due to infectious
Diseases and infections were nearly twice as high for people in the 20% most deprived areas compared to the least deprived. UKHSA is undertaking further work to better understand these disparities.
UKHSA continues to be at the forefront of the work being done to tackle the spread of TB, working closely with the NHS and local systems to ensure optimal prevention and control measures are implemented, for example. Also crucial is developing the evidence base for new interventions to support further policy development to help reduce transmission of the disease.
There are also novel interventions on the horizon for sexually transmitted infections (STIs), based on UKHSA evidence. A routine gonorrhoea programme using the 4CMenB vaccine for GBMSM (gay, bisexual and men who have sex with men) at high risk has been advised. UKHSA has also worked with the British Association for Sexual Health and HIV to develop their evidence-based clinical guideline for the use of doxycycline post-exposure prophylaxis for the prevention of syphilis, which is currently out for public consultation.
Richard Pebody, Director of Epidemic and Emerging infections at UKHSA, said
It is clear that a number of factors altered the rates and impact of endemic and epidemic infectious diseases in England over recent years, and the reductions in transmission related to the COVID-19 pandemic have been followed by a rise in a range of infections since 2022 to 2023 due to the return of social mixing, international travel and migration.
We have also seen vaccine uptake decrease for a number of infectious diseases, including measles, whooping cough and in certain groups eligible for the flu vaccine, such as under 65 at risk, pregnant women and health care workers.
This winter has demonstrated that rises in rates of infectious diseases can cause significant strain, not only on the individuals directly affected, but also on the NHS. It is vital that we are not complacent about infections where we can reduce the burden of disease via interventions such as our world-class vaccination programmes.
Dame Jenny Harries, Chief Executive of the UK Health Security Agency, said
Our scientific capability and the introduction of new interventions are all helping to keep people safe and well, but our report also highlights that we have plenty of work and opportunities ahead.
Along with our partners across the healthcare sector, we need to be bolder. Behind this data there are real people, people who are sick or at risk of becoming sick, and in some cases dying. This brings with it a cost to our economy too. Yet much of this harm and distress is preventable.
Our rich data sources provide us with a huge amount of knowledge, and we will continue to use it, carefully and confidentially, to reduce the burden of infectious disease across the country, ensuring our interventions reach the people who need them most.’
