During the influenza A/H1N1 epidemic a total of 94 children with PCR-confirmed PIA were hospitalized in the three hospitals in Wuerzburg, Northern Bavaria, which cover the pediatric population of the city of Wuerzburg and its surroundings. The clinical course was mostly benign with cough (80%), fever (78%), and rhinorrhea (51%) as predominant symptoms. Only six percent of PIAH were admitted to an ICU; which is about three times lower than reported from Argentina, Canada and USA (17-19%) [9] [10] [11] but similar to 8% found in a UK hospital [12] and identical to 6% of ICU admissions reported from a large hospital in Hamburg (Northern Germany) [8] . In Germany, both in our study and in Hamburg, a clearly lower percentage of patients with PIA received treatment with oseltamivir (25% and 28%, respectively) and antibiotics (30% and 25%, respectively) [8] , when compared to antiviral (46-99%) [9] [10] [11] and antibiotic (74-86%) treatment in other PIAH studies [9] [10] [11] . In Argentina, oxygen was supplemented five times more often (82%) than was to be observed in our study (17%) [11] . Mechanical ventilation was required six times more often (17%) than documented in our study (3%), whereas data from USA and Canada revealed a similar frequency (6%) for hospitalized patients [9, 10] . The low rates of severe influenza cases in the present study correspond with the results of an earlier study on severe seasonal influenza in Germany [13] . Hence, on the one hand, the higher primary and secondary complication rates among hospitalized patients in other countries may reflect a real increase in the complication rate, due to delayed treatment with a limited access to primary health care. On the other hand, observed heterogeneity in the severity of hospitalized patients may result from differences in hospitalization access, with a higher threshold for hospitalization in countries with lower socio-economic status or limited health insurance (as in the USA) compared to Germany [11] .