In Germany, influenza vaccination in children is currently recommended for risk groups, defined by chronic underlying diseases. In 2005, a regional survey in children < 24 months of age showed that 5% of all children had been vaccinated against influenza [20] . Among the severe cases reported in our study no child had been vaccinated. Eleven (55%) belonged to risk groups with chronic underlying disease, including eight (40%) of at least two years of age for whom influenza vaccines are considered to be efficacious [21] . One risk group child was below 6 months of age and, hence, too young to be immunized. Two other risk group children were under two years of age; for this age group, the efficacy of the inactivated influenza vaccines licensed in Germany is unclear, and data on safety are insufficient thus far [21] . Forty-five% of the patients with severe influenza were previously healthy children, who would not be covered by a risk-based vaccination strategy. A recommendation to vaccinate healthy children routinely against seasonal influenza is not widespread in Europe, but has been argued to have potential community benefits [22] .