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DiVISION OF COMMUNICABLE DISEASE CONTROL

Respiratory Virus Reporting Guidance for Local Health Jurisdictions: Update for 2025-2026 

October 2025

This Respiratory Virus Reporting Guidance for Local Health Jurisdictions (LHJ) webpage summarizes the California Department of Public Health (CDPH) reporting guidance for LHJs for COVID-19, influenza, RSV and other respiratory viruses for the duration of respiratory season (MMWR Week 27- Week 26). This webpage replaces both the COVID-19 Quicksheet and the Influenza, COVID-19, and Respiratory Illness Outbreak Quicksheet.  

Respiratory Virus Reporting Highlights 

  • A new case definition for pediatric COVID-19 deaths will be effective January 1, 2026, and a new condition will be available in CalREDIE to complete this required reporting. Continue reporting pediatric influenza and RSV fatalities as usual - there are no reporting changes for these conditions. 
  • Outbreak reporting updates: Community settings should follow local guidance for outbreak reporting. In community settings, CDPH recommends reporting acute respiratory illness clusters of public health concern. For healthcare settings see: Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities​.
  • LHJs should continue working with local clinical partners (e.g., hospital clinicians and clinical laboratories) and public health laboratories (PHL) to prioritize influenza specimens from severe cases, suspect novel influenza cases, and respiratory outbreaks for further subtyping and characterization. For more information see the CDPH Influenza Guidance for Local Health Departments. 

For additional resources, see the CDPH Respiratory Virus Healthcare Professionals Hub which contains clinical, laboratory, and LHJ resources on Respiratory Viruses.  

Respiratory Virus Disease Reporting 

Specific diseases and conditions are required by law to be reported to LHJs under Title 17, California Code of Regulations (CCR). This applies to the following conditions for respiratory viruses: 

Disease in​cidents 

COVID-19 

  • Hospitalizations 
    • Previously all cases and deaths were reportable, now only COVID-19 hospitalizations are required to be reported. 
    • Note: the mechanism for reporting is determined by each LHJ – for some LHJs, reporting via National Healthcare Safety Network (NHSN) may suffice. 
  • Multi-system Inflammatory Syndrome in Children (MIS-C) 
    • Health care professionals are required to report MIS-C cases per Title 17. Multi-system Inflammatory Syndrome in Adults (MIS-A) is not a reportable condition under Title 17. 
    • Use the “Multisystem Inflammatory Syndrome Associated with Coronavirus Disease 2019 (COVID-19)" condition in CalREDIE to report MIS-C cases in patients age <21. For those not reporting through CalREDIE, please use the CDC case report form. 
  • Pediatric COVID-19 Death Reporting 
    • In June 2025, the Council of State and Territorial Epidemiologists (CSTE) approved a new case definition for pediatric COVID-19 deaths, which will be effective January 1, 2026. Pediatric COVID-19 deaths will be nationally notifiable under this new definition. A new pediatric death condition will be available in CalREDIE to complete this reporting. 
    • Note: COVID-19 Death Determination Guidance: In accordance with CSTE COVID-19 death classification guidance, COVID-19 coded deaths in death certificates will be the sole source of adult death surveillance data for CDPH. LHJs may also continue to investigate and report deaths via the COVID-19 registry. These deaths will not be used for CDPH enumeration. Clinical case investigation of pediatric deaths will be required under the new death definition effective January 1, 2026. 

INFLUENZA  

  • Pediatric Influenza Death Reporting 
    • LHJs should report laboratory-confirmed influenza-associated fatal pediatric cases <18 years of age using the CalREDIE “Influenza Death 0-64 years old" condition. 
    • Report suspect influenza-associated pediatric deaths immediately upon notification.  
    • Once the resolution status of an influenza-associated pediatric death is set as “confirmed" in CalREDIE, it will be included in the state weekly counts and reported as confirmed to CDC. 
    • Influenza-associated deaths in children <5 years of age who are co-infected with RSV should be reported for both conditions. 
    • CDPH collects additional seasonal influenza vaccine information for influenza-associated fatal pediatric cases. If your jurisdiction reports a case meeting the criteria, you will receive a supplemental form for pediatric cases ≥6 months, or a birthing parent vaccine history form for pediatric cases <6 months. 
  • Optional reporting: Pediatric Influenza Associated Encephalopathy (IAE) 
    • Healthcare providers and local health jurisdictions are strongly encouraged to voluntarily report in CalREDIE using the “Pediatric Influenza Associated Encephalopathy" Condition. Please enter and upload neuroimaging results in CalREDIE.  

NOVEL/AVIAN INFLUENZA 

  • Report any suspect, presumptive positive, probable, or confirmed human influenza case with recent exposure to animals known to transmit respiratory illness (such as swine) or contact with animals confirmed or suspected to have avian influenza, their environment, or their raw products; or contact with a suspected, presumptive positive, probable or confirmed human case of avian, variant, or novel influenza.   

RSV 

  • Pediatric RSV Death Reporting 
    • LHJs should report laboratory-confirmed RSV-associated fatal cases age <5 years old by using the CalREDIE “Respiratory Syncytial Virus (RSV) Death <5 years old" Condition 
    • The resolution status should be set to “confirmed" in CalREDIE once the death meets the case definition. If fatal cases reported by your jurisdiction meeting the case definition have a “suspect" status, please confirm them as soon as your investigation permits. This will help us minimize the lag in reporting of fatal cases and allow our state weekly counts to be consistent with what is being reported by LHJs. 
    • Once the resolution status of an RSV-associated death in a child <5 years of age is set as “confirmed" in CalREDIE, it will be included in the state weekly counts. 
    • RSV-associated deaths in children <5 years of age who are co-infected with influenza should be reported for both conditions. 

Notes on Pediatric Fatal Case Reporting for COVID-19, Influenza and RSV 

  • Please upload medical records, laboratory results, and any other relevant materials to the electronic filing cabinet in CalREDIE when available. Please do NOT upload death certificates to the electronic filing cabinet in CalREDIE; coroner's reports and autopsy notes may be uploaded. 
  • If you plan to issue a press release regarding your jurisdiction's pediatric death(s), please ensure the case(s) has been reported to CDPH (i.e., “confirmed" in CalREDIE or paper case report form has been emailed). Please also notify the CDPH Office of Public Affairs (media@cdph.ca.gov) prior to the press release. 

Respiratory Virus Outbreak Reporting 

All outbreaks are reportable to the LHJ per Title 17. Schools are required to report outbreaks of any disease per Title 17 Section 2508. Employers must follow any local requirements in place regarding Respiratory Virus outbreak reporting in their jurisdiction and should consult the Cal/OSHA COVID-19 Prevention Non-Emergency Regulations and the ATD Standard for additional requirements pertaining to respiratory outbreaks in the workplace. 

Outbreaks are defined and managed by setting-specific guidance linked below. The following guidance serves as a model and does not replace LHJ or established local community settings outbreak thresholds and/or reporting requirements. Non-healthcare community settings should refer to their LHJ for any specific setting guidance in their jurisdiction. LHJs may have additional, setting-specific reporting, investigation and response guidelines not described in this document.  

Healthcare settings

Non-healthcare Community Settings

  • ​Non-healthcare community settingsdefinition: settings that generally do not provide healthcare to individuals, although healthcare staff such as nurses may be employed. Examples of community settings include assisted living facilities, correctional/detention facilities, shelters, non-healthcare workplaces, adult day care facilities, childcare facilities and TK-12 schools and other programs serving pre-school and school-aged children.​

Outbreak Definitions 

  • Community settings outbreak of concern definition: a cluster of acute respiratory illness (ARI) cases of public health concern.  
  • Acute respiratory illness (ARI)definition: new onset of any two or more of the following symptoms (not better explained by chronic conditions, e.g., seasonal allergies): fever or chills, cough, sore throat, runny or stuffy nose, difficulty breathing, body aches; and/or has tested positive for a specific respiratory pathogen, including COVID-19, influenza, or RSV. 
    • This ARI definition can be used for other respiratory viruses when there are outbreaks of public health concern. For additional reporting requirements for respiratory pathogens, see: Disease Info and Reports.

When to report Outbreaks of Concern in Community Settings: 

  • Community settings should report ARI outbreaks of public health concern, which include, but are not limited to:   
    • A greater than expected number of ARI cases who are linked in time or place (i.e. a certain area of the setting or across the setting) and are not close contacts in another setting, especially during a time that is not considered typical.  
    • Increased severity of illness, such as hospitalizations or fatalities among cases.  
    • Evidence indicating that standard respiratory infection control measures have been ineffective or difficult to implement and/or a need for additional support.  
    • Additionally, any case with recent exposure to animals known to transmit respiratory illness (such as swine, or contact with animals confirmed or suspected to have avian influenza, their environment or their raw products), or contact with a confirmed or probable human case of avian, variant, or novel influenza should be reported.   
  • LHJs and/or employers in a community setting may opt to follow the healthcare settings outbreak thresholds for respiratory viruses when there are populations in the setting at risk for severe outcomes or the risk of transmission is increased, such as assisted living facilities, shelters, and correctional facilities.  

How to Report ARI Outbreaks    

LHJs should report outbreaks to CDPH using CalREDIE or an alternate established process. If LHJs need assistance with outbreak reporting, please contact influenzasurveillance@cdph.ca.gov. 

Diseas​e Type
Where to Report to CDPH
COVID-19 outbreaks   “Novel Coronavirus 2019 (nCoV-2019)" condition in CalREDIE 
Influenza, RSV, and/or other respiratory viruses or undiagnosed respiratory virus outbreaks  “Respiratory, non-TB outbreak condition“ in CalREDIE
Any avian influenza A(H5N1) human cases 

“Influenza - H5N1" CalREDIE condition or email the Streamlined Case Report Form for Avian Influenza A(H5N1) to avianinfluenza@cdph.ca.gov. 

Additional exposure monitoring can be completed via CalCONNECT. 
For novel influenza human cases that are not H5N1   “Influenza - Novel Strain (not H5N1 or 2009 H1N1)" CalREDIE condition 

Testing Reporting Guidance 

While COVID-19 may occur year-round, influenza and RSV typically start increasing in the fall and peak during winter months. When respiratory viruses are co-circulating, multiplex panels for influenza, RSV, and COVID should be utilized. For clinical resources on testing, visit the Respiratory Virus Professionals Hub.

Influenza Subtyping Guidance for LHJs 

Influenza testing by rRT-PCR should be encouraged in situations where sequencing or subtyping may be needed, including: 

  • Severe cases, such as hospitalized, intensive care unit (ICU), and/or fatal cases 
  • Acute respiratory illness outbreaks of public health concern  
  • Persons with recent close contact or exposures within 10 days of symptom onset that are concerning for avian, variant, or novel influenza infection (e.g., variant influenza A (H3N2)v, (H1N2)v, or (H1N1)v, or avian influenza H5N1 or H7N9). See Avian/Novel Influenza section above.  

LHJs should work with local clinical partners to remind them of the importance of saving specimens so that further subtyping and characterization can be performed at a Public Health Lab (PHL). Specimens should be collected within the first 24–72 hours of symptom onset and no later than 5 days after symptom onset. For patients suspected of having avian, variant, or novel influenza, specimens may be collected no later than 10 days after symptom onset. For ICU/hospitalized cases, specimens should be submitted to RLNs as soon as possible, preferably within 24-48 hours of collection. For more information on PHL surveillance guidance and reporting for respiratory viruses, see the CDPH Influenza Guidance for Local Health Departments​.  

Influenza rRT-PCR testing and further subtyping is available at CDPH Viral and Rickettsial Disease Laboratory (CDPH-VRDL) and at 24 RLN PHLs. Please send appropriate specimens to your Public Health Lab (PHL). Contact your PHL for specific shipping instructions. For information on collection of and submitting Respiratory Viral specimens, see: VRDL Test Catalog. 

Reporting or Surveillance Questions 

Contact the COVID Control Branch by email:  

Resources 

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