OBJECTIVE: This report updates for 1996 and 1997 our 2 earlier reports on the use of influenza vaccination in various countries. METHODS: Methods for obtaining information on influenza vaccine use from 1980 to 1995 in each country are described in our earlier reports. The current report includes data for 29 countries. RESULTS: Among 16 countries of Western Europe, vaccine use increased substantially in The Netherlands, Finland (1996) and in Ireland (1997). In the remaining 13 countries, vaccine use increased somewhat or remained the same. In the US, vaccine use increased steadily throughout the 1990s, reaching a level of 281 doses per 1000 population in 1997. In New Zealand, there was a substantial increase in 1997, while vaccine use remained relatively unchanged in Canada, Australia and Korea. In Japan and Singapore, little or no influenza vaccine was used. In 1997, 6 countries in Central Europe used modest amounts of influenza vaccine. Among all 29 countries, in 1997 all but 3 (the UK, Ireland and Denmark) had age-based recommendations for influenza vaccination. This changed in 1998 when the UK and Denmark recommended vaccination for persons > or = 75 years and > or = 65 years of age, respectively. Ireland is considering an age-based recommendation. Many countries provide reimbursement for influenza vaccination through national or social health insurance, at least for some recommended groups. In virtually all countries, however, many persons pay for vaccination themselves. The levels of vaccine use in different countries are not related to per capita healthcare spending. Instead, they reflect different levels of awareness of influenza as an important disease and the effectiveness of vaccination in its prevention. CONCLUSIONS: Influenza vaccination has continued to increase or has stabilised in most developed countries, and vaccine is also being used in several developing countries. In spite of much progress, however, the full benefits of influenza vaccination have yet to be achieved in any country.