The World Health Organization (WHO) has raised its global alert system to 5 on a 6-point scale, indicating a pandemic is imminent, as swine flu cases spread around the world.

Health experts believe it is a only a matter of time before the WHO raises the alert to phase 6, confirming a pandemic is in progress, because the disease is spreading in a sustained way from person to person in more than two regions of the world.

In both phases 5 and 6, the WHO calls on countries to implement their national pandemic plans.

The following are recommended actions for countries to take in phases 5 and 6 according to the WHO's Pandemic Influenza Preparedness and Response guidance document, revised this week:

In general the WHO does not encourage:

* pandemic-related international border closures for people and or cargo

* general disinfection of the environment during a pandemic

* use of masks in the community by well persons

* restriction of travel within national borders during a pandemic (except in a globally led rapid response and containment operation)

1. Planning and coordination

Affected countries

* maintain trust with public through commitment to transparency and credible actions

* designate special status as needed e.g. state of emergency

* provide leadership and coordination to mitigate the social and economic impact of a pandemic

* work for rational, ethical and transparent access to resources

* assess whether external assistance needed for humanitarian needs

Countries not yet affected

* finalize preparations for imminent pandemic, including activation of crisis committees and national command and control systems

* update if necessary national guidance and recommendations

2. Situation monitoring and assessment

Affected countries

- Pandemic disease surveillance

* undertake comprehensive assessment of earliest cases of pandemic flu

* document evolving pandemic including geographical spread

* maintain adequate biological surveillance to detect genetic changes and changes in susceptibility to treatment

- Monitoring and assessment of impact of pandemic

* monitor essential health-related resources such as medical supplies (e.g. antivirals, vaccines), health-care worker availability, hospital occupancy/availability, alternative health facilities, laboratory material stocks, mortuary capacity

* monitor and assess national impact for e.g. workplace and school absenteeism, regions affected, groups most affected, essential worker availability

* assess uptake and impact of mitigation measures

* forecast economic impact of pandemic

3. Reducing spread of disease

All countries

* take into account WHO guidance and information when issuing international travel advisories and health alerts

Affected countries

-- Individual/household level measures

* advise people with acute respiratory illness to stay at home and minimize contact with household members and others

* advise household contacts to minimize interaction outside home and isolate themselves at first sign of flu symptoms

* provide infection control guidance for household caregivers

-- Societal level measures

* implement social distancing measures as indicated in national plans, such as school suspensions and adjusting work patterns

* encourage reduction in travel and crowding mass transport

* assess and determine whether cancellation or restriction or modification of mass gatherings is indicated

-- International travel measures

* consider implementing exit screening as part of early global response

* provide advice to travelers

-- Pharmaceutical measures

* distribute antivirals and other medical supplies

* implement vaccine procurement plans

* plan for vaccine distribution and accelerate preparations for mass vaccination campaigns

* modify/adapt antiviral and vaccine strategies based on monitoring and surveillance

* implement medical prophylaxis campaigns for antivirals and/or vaccines according to priority status and availability

* monitor safety and efficacy of pharmaceutical interventions

Countries not yet affected

* be prepared to implement planned interventions to reduce spread of pandemic disease

* update recommendations on use of planned interventions based on experience and information from affected countries

* implement distribution and deployment plans for pharmaceuticals and other resources

* consider implementing entry screening at international borders

* implement pandemic contingency plans for full mobilization of health systems, facilities and workers

* implement and adjust triage system

* enhance infection control practices in healthcare and laboratory settings and distribute personal protective equipment

* provide medical and non-medical support for patients and their contacts in households or alternative facilities

* provide social and psychological support for healthcare workers, patients and communities

* implement corpse management procedures

Countries not yet affected

* prepare to switch to pandemic working arrangements

4. Communications

* regularly update public on what is known and unknown about pandemic disease, including transmission patterns, clinical severity, treatment and prophylaxis options

* provide regular communications to address concerns such as disruption to travel, border closures, schools or economy and society in general

* regularly update public on sources of emergency medical care, resources for dealing with urgent non-pandemic healthcare needs, resources for self-care of medical conditions.

Medicine