Wang X, Li Y, O'Brien KL, et al. - Researchers sought to update estimates of the global number of cases, hospital admissions, and mortality from influenza-virus-associated respiratory infections in children under 5 years in 2018 via incorporating new data. A systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies were assessed for the regional and global burden of influenza-associated respiratory infections in children under 5 years. Incidence and hospitalization rates of influenza-virus-associated respiratory infections were assessed by severity, case ascertainment, region, and age. By combining hospital admissions and in-hospital case-fatality ratios of influenza virus  acute lower respiratory infection (ALRI), in-hospital deaths from influenza virus ALRI were assessed. In 2018, they reported an estimated 109·5 million influenza virus episodes, 10·1 million influenza-virus-associated ALRI cases; 870,000 influenza-virus-associated ALRI hospital admissions (543,000–1,415,000), 15,300 in-hospital deaths (5,800–43,800), and up to 34,800 (13,200–97,200) overall influenza-virus-associated ALRI deaths among children under 5 years globally. Nearly 23% of the hospital admissions and 36% of the in-hospital deaths were reported in infants under 6 months. Low-income and lower-middle-income countries account for nearly 82% of the in-hospital deaths. This suggests the occurrence of a large proportion of the influenza-associated burden among young infants and in low-income and lower middle-income countries. New and important evidence was gained for maternal and pediatric influenza immunization, and consideration should be given to this in future immunization policy especially in low-income and middle-income countries.