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Background  A severe seasonal influenza epidemic was observed during 2017–2018 in China, prompting questions on clinical characteristics and outcomes of severe cases with influenza.    Methods  We retrospectively collected clinical data and outcomes of laboratory-confirmed hospitalized patients (severe to critical) during Jan-2011 to Feb-2018 from five hospitals, followed by a systematic analysis of cases from 2017 to 2018 ( n  = 289) and all previous epidemics during 2011–2017 ( n  = 169).    Results  In-hospital fatality was over 5-folds higher during the 2017–2018 ( p  < 0.01) in which 19 patients died (6.6%), whereas only 2 mortalities (1.2%) were observed during 2011–2017. Of the 289 hospitalized in 2017–2018, 153 were confirmed with influenza B virus, 110 with A/H1N1pdm09, and 26 A/H3N2, whereas A/H1N1pdm09 was the predominant cause of hospitalization in previous seasons combined (45%). Fatal cases in 2017–2018 were exclusively associated with either influenza B or A/H1N1pdm09. Our results show that a significant lower proportion of patients aged 14 or greater were treated with oseltamivir, during the 2017–2018 epidemic, and exhibited higher levels of clinical severity.    Conclusions  In-hospital fatality rate might be significantly higher in the 2017–2018 season in China. A sufficient supply of oseltamivir and antiviral therapy within 48 h from onset could reduce fatality rates.    Electronic supplementary material  The online version of this article (10.1186/s12879-019-4181-2) contains supplementary material, which is available to authorized users.

Clinical characteristics and outcomes during a severe influenza season in China during 2017–2018