WHO clinical expert Niki Shindo said the agency would issue new guidelines targeting three key groups in countries where the A(H1N1) virus is spreading, to avoid severe cases that could kill within a week.

However, Shindo emphasised that the "vast majority" of pandemic swine flu cases were mild and victims recovered within days without the need for treatment or hospitalisation.

"Firstly, people in at-risk groups need to be treated with antivirals as soon as possible when they have flu symptoms, this includes pregnant women, children under two years old, and people with underlying conditions," she said.

The other two groups were people with rapidly worsening symptoms, such as breathing difficulties and high fever for more than three days, while those found with pneumonia should be treated immediately with antivirals and antibiotics.

"I want to stress that people who are not from the at-risk groups... need not take antivirals," Shindo told journalists during a conference call.

"We are not recommending taking antivirals if otherwise healthy people are experiencing only mild illness, or as a preventive measure."

When asked in recent months about the preventive administration of antivirals in some European nations, WHO officials had largely left it up to countries to decide.

The UN health agency refined its guidance after in-depth studies of swine flu cases and clinical treatment found that early administration of drugs like Tamiflu in some instances could avoid potentially fatal severe cases.

"The virus is quite stable, the disease pattern did not change either," Shindo said.

"The reason we are updating now is that we can confidently say now that early antiviral treatment can make a difference in terms of preventing severe illness and death."

Shindo noted that Ukraine, Afghanistan and Mongolia had reported hospitals and clinics being "overwhelmed" by pandemic flu cases.

However, in Ukraine, the proportion of severe cases was less than those found in the southern hemisphere, and people appeared to have been admitted to hospitals there with "milder symptoms than needed" for intensive care, she added.

In Mongolia, pregnant women were "over-represented" amongst hospitalised flu cases, Shindo said, without giving details.

The WHO recently added Ukraine, Afghanistan, Belarus and Azerbaijan to the list of poorer countries receiving deliveries from the agency's aid stockpile of antiviral drugs.

The global death toll from flu pandemic passed the 6,000 mark last week according to the UN health agency.

The A(H1N1) virus has swept around the world since it was first identified in Mexico and the UNited States in April 2008, spreading into at least 199 countries.

The pandemic is currently surging in the northern hemisphere with the onset of colder weather.

earlier related report
Swine flu has killed nearly 4,000 in US: estimates
Washington (AFP) Nov 12, 2009 - Swine flu is thought to have killed nearly 4,000 people in the United States, including more than 500 children, health officials said after a new counting method yielded an estimate six times higher than the last.

The new system is based on more precise figures provided by 10 states, the Centers for Disease Control and Prevention (CDC) said. The previous estimated death toll from H1N1 was 672.

While still imprecise, the new numbers provide "a bigger picture of what has been going on in the first six months of the pandemic," Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, told a press conference.

She said previous estimates were based on "laboratory confirmed cases of hospitalization and death, potentially giving an incomplete picture of the story of this pandemic."

According to the new estimates, the total deaths since the swine flu virus first appeared in April total about 3,900, the CDC said, noting that figures were rounded to the nearest 10. The CDC also posted the new set of figures on its website.

The new swine-flu death toll for children under 18 years of age is 540, four times higher than the previous estimate.

Still considered the tip of the iceberg compared to the real, full extent of the swine-flu pandemic, the new estimates are based on more precise data provided by hospitals in 10 states, Schuchat said.

Those figures were extrapolated to the national level, she added.

The CDC cautioned that methodology was "not a predictive tool and cannot be used to forecast the number of cases, hospitalizations and deaths that will occur going forward over the course of the pandemic because they are based on actual surveillance data."

Schuchat said the estimated range of all H1N1 fatalities in the United States from April to mid-October was 2,500-6,100, with the mid-level range at 3,900.

Broken down by age group, the range was 300-800 deaths for children up to 17 years of age (mid-level range 540); 1,900-4,600 for ages 18-64 (2,920), and 300-700 for people above 65 years of age (440).

In all, 22 million Americans were infected by the swine flu virus during the period studied, with 98,000 hospitalized, according to the new CDC estimates.

Schuchat also said that 41.6 million doses of the H1N1 vaccine were made available Thursday for distribution around the country.

While the volume of vaccine deliveries shows the progress made in production facilities, it remains far below initial estimates and expectations, she added.

US health authorities have recently acknowledged greater shortfalls than anticipated in the vaccine supply, as long queues form outside authorized clinics and health centers in the inoculation drive.

Education Secretary Arne Duncan stressed Thursday that schools will soon begin offering the vaccine to students.

"Schools have done an extraordinary job of staying open and keeping sick students home," Duncan told CNN.

"Many are opening their doors so students can receive the vaccine within the school building."

Meanwhile, the global death toll from the pandemic passed the 6,000 mark last week according to the World Health Organization.

The H1N1 virus has swept around the world since it was first identified in Mexico and the United States in April, spreading into at least 199 countries.

The pandemic is currently surging in the northern hemisphere with the onset of colder weather.

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