FLU rates in Scotland are now the highest in five years following a sudden spike in cases.
Public Health Scotland has rated influenza levels as 'extraordinary' - the highest possible category - after laboratory-confirmed incidence "increased sharply" to 24.9 cases per 100,000 in the most recent week.
Flu rates are now the highest since the 2017/18 winter, which was unusually bad for influenza and for overall excess winter deaths.
Dr Nick Phin, medical director at PHS, said: "It's a very sharp increase. At this point we don't know whether it will continue or whether we've reached the peak and will start to see a dip down.
"There are things that work in our favour. One is that we are coming up to the Christmas period where schools typically take time off and we know that children tend to be fairly active spreaders of the flu amongst themselves and in the community.
"That is part of the reason that flu vaccines are offered to primary school children, to offer them a degree of protection and the spin off that is it will reduce the amount of flu that we see circulating."
The PHS report also shows that by week 49 - the week beginning December 5 - there were 410 people in hospital with a positive influenza test, and 20 new admissions to intensive care or high-dependency units for people with the infection.
Dr Phin added that he would expect to see flu-related hospital admissions lag around seven to 10 days behind cases in the community.
He said: "The numbers of notifications that we get usually precede activity in hospital probably by around a week to 10 days, so we would expect to see the current level in hospitals continue for the forthcoming week or so."
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Flu vaccine uptake among the elderly in Scotland has been high, with around 85 per cent of over-65s vaccinated.
Dr Phin encouraged parents of under-fives in particular to get children vaccinated against influenza if they have not already done so.
Flu vaccines typically provide around 40-50% protection against infection, but much higher defences against serious illness.
"It's not too late to get vaccinated," said Dr Phin.
"Vaccination is still the most effective intervention we have."
The current flu rates follow two winters where the virus virtually disappeared due to Covid restrictions.
Dr Jim McMenamin, a consultant epidemiologist at PHS, said its surveillance is monitoring how well-matched the flu vaccine in use this winter is likely to be for the flu strain in circulation.
He said the "vast majority" of flu cases appear to be caused by forms of influenza A.
Dr McMenamin said: "It's really important that we start to drill down and say 'are [the vaccines] likely to be affected by any differences between what's circulating in the community and what [strains] people are being vaccinated against?'.
"In the community overall, 73% of the cases to date have been H3N2 whereas only 12% have been H1N1."
READ MORE: NHS preparing for 'significant' excess deaths this winter
He said they were paying close attention to H1N1 in particular because a so-called 'Norwegian strain' of H1N1 is believed to have mutations that could make vaccines less protective.
Dr McMenamin added that H1N1 infections appear to be over-represented among hospital patients.
He said: "The majority of the H1N1 ones where they've been typed - even though they represent only a small number of what's been circulating in the community - the majority of that small number are this Norwegian subtype.
"When we look at hospital cases we can see that something like 65% of influenza As have been H3 in the most recent week, and 25% have been H1s - so for those presenting to hospital, they are presenting proportionately more with H1N1.
"That might give us something we need to look at in more detail."
Meanwhile, Dr Phin said cases of Strep A "may have turned a corner".
He added: "The numbers appear to have plateaued and we're expecting that we will see a reduction in the numbers over the next week or so. The school holidays will be a way of naturally breaking chains of transmission."
There have been a total of 13 invasive Group A Strep cases - the more dangerous form of the infection - among children in Scotland, but that too appears to be slowing with only one case in the most recent week.
Dr Phin said: "We've not seen an increase in levels of iGAS, which is good, and we think that a lot of the activity we've seen with Group A strep - which is normally a mild condition - has been what we call ascertainment bias.
"In other words people are more aware of the condition and have been seeking advice which has artificially inflated the numbers."
READ MORE: Is this year's Strep A outbreak really worse than normal?
Dr Phin added that PHS is not expecting to see an increase in serious Covid illness over the winter, despite rising infections.
He said: "One of the variants, BQ.1, we've seen growing over the last few weeks but it's not having an impact - so just because it's a new variant doesn't necessarily mean it's actually escaping the vaccine or causing any more serious illness.
"There's no indication at the current time that there is a variant we would be concerned about."
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