From 21 to 27 September, Spain's rate of acute respiratory infections reached 478.2 cases per 100,000 inhabitants, up 28.2% in one week and above the epidemic threshold. The Instituto de Salud Carlos III classifies the current intensity as low.
COVID-19 is driving the increase. Influenza and respiratory syncytial virus are not.
COVID-19 incidence reached 119.2 cases per 100,000 people, up from 92.6 the previous week. In primary-care samples, SARS-CoV-2 accounted for 27.2% of positive results. Influenza accounted for 4.1%, and respiratory syncytial virus for 0.2%.
Before the overall respiratory-infection index crossed the epidemic threshold, RTVE and Spanish health-media reports had recorded estimated primary-care COVID-19 incidence climbing from 50.4 to 85 cases per 100,000 inhabitants.
The three viruses are moving in different directions. Influenza incidence fell to 12 cases per 100,000 inhabitants from 22.5. Respiratory syncytial virus reached one case, after recording none the previous week.
Last year brought a similar early-season pattern: respiratory infections had already reached the epidemic phase, at 445.6 cases per 100,000 inhabitants.
The youngest children face the clearest pressure. Among children under five, bronchitis and bronchiolitis rose to 194.3 cases per 100,000 inhabitants, an 86.3% weekly increase from 104.3. The rate for COVID-19 syndrome climbed from 21.6 to 29.4, while influenza syndrome rose from 13.9 to 16.9.
Catalan respiratory-infection surveillance recorded a roughly 26% weekly rise in infections. Reports from the region attributed the basic contribution to rhinovirus, not COVID-19. The national trend is not uniform across Spain.
Hospitals are seeing a smaller increase. The rate of hospitalisation for severe acute respiratory infection reached 9.2 cases per 100,000 inhabitants, up from nine the week before.
SARS-CoV-2 positivity in hospital samples rose to 21% from 15.3%. Influenza positivity fell to 7.1% from 10.9%, while respiratory syncytial virus stood at 0.4%.
COVID-19 hospitalisation rose to 1.7 cases per 100,000 inhabitants from 1.1. Since the season began, pneumonia has been reported in 22.5% of hospitalised COVID-19 cases. Intensive-care admission occurred in 4.3% of cases, and the case-fatality rate was 8.7%.
The corresponding influenza figures were 27.3% for pneumonia, 4.7% for intensive care and 7.3% for case fatality. For respiratory syncytial virus, the figures were 16.1%, 8% and 3.4%.
Influenza hospitalisation fell to 0.6 cases per 100,000 inhabitants from 1.1. Respiratory syncytial virus hospitalisation reached 0.1, after registering zero the previous week.
MoMo estimates put deaths in Spain at 8,137 during week 39. The expected number was 7,705.
The viral picture is shifting as Spain's vaccination campaign gets under way. Genomic sequencing identifies XFG as the dominant SARS-CoV-2 variant in recent weeks, accounting for 55.08% of characterised cases. BA.3.2 accounted for 11.08% and was declining.
On 25 September 2026, the ECDC called for close monitoring of XFG, BA.3.2 and the variant of interest BA.2.86.
The vaccination campaign began in the final week of September and will continue through October. Its timing depends on vaccine availability and type, while Spain's autonomous communities organise access locally.
People who have not received the recommended 2026 to 2027 dose may be vaccinated later in the year following an individual assessment. At least three months must have passed since their last dose or COVID-19 infection.
Sanidad prioritises people aged 70 and over, care-home residents, and people from six months of age with severe chronic disease or immunosuppression. The recommendations also cover people over 12 with specified risk conditions, pregnant women, healthcare and social-care workers, and carers or household members of highly vulnerable people.
For children, the recommendation applies only to those over six months with particular vulnerability and those aged 12 or more with defined risk conditions.
Spain has crossed the epidemic threshold, but the Instituto de Salud Carlos III describes the epidemic as low intensity. Hospital positivity is rising, yet the data do not point to health-system overload.
