To analyze the epidemiological trends of influenza in Macao Special Administrative Region of China from 2009 to 2024, and to provide scientific evidence for influenza prevention and policy-making.

Data were obtained from the mandatory reporting disease statistics on the Macao Health Bureau's website. The annual reported crude incidence rates and incidence rates by gender and age groups were calculated. Additionally, the Joinpoint regression model was used to analyze the trends of the crude incidence rate of influenza in Macao SAR, the annual percentage change (APC), the average annual percentage change (AAPC).

The median of reported influenza cases in Macao Special Administrative Region, China was 3 363 from 2009 to 2024; and the median crude incidence rate was 502.83 per 100 000; the male's (51.09%) median incidence rate was 513.62 per 100 000, and the female's (48.91%) was 492.82 per 100 000. Furthermore, the median incidence rate for the 0- < 15 age group was the highest at 2 553.50 per 100 000, which was statistically significantly different from that of other age groups (all P < 0.001). AAPC in the crude annual incidence rate of influenza for the entire population was 3.77% (95% CI: -14.31%-26.32%); the trend of APC was 12.57% (95% CI: 1.49%-24.85%, P=0.027) from 2009 to 2018, -58.41% (95% CI: -86.63%-29.36%) from 2018 to 2021, and 314.08% (95% CI: 134.79%-630.27%, P < 0.001) from 2021 to 2024.

The reported crude incidence rate of influenza in Macao has shown an increasing trend, with the most significant rise observed during 2021-2024, particularly among children and adtoolescents. Therefore, it is recommended to strengthen health education and promotion on influenza prevention and to enhance influenza vaccination coverage for children and adolescents.