CHICAGO - The outbreak of the new H1N1 flu virus has begun to wane with the start of summer in North America, and U.S. health officials said on Thursday they are looking to lessons learned as they prepare for its return in the autumn.

There are now 11,468 probable and confirmed cases of the new H1N1 swine flu in the United States, Dr Anne Schuchat of the U.S. Centers and Disease Control and Prevention told reporters in a telephone briefing.

So far, 770 people, or 2.5 percent of cases, have required hospitalization. California reported another death on Thursday, for a total of 21 U.S. deaths.

Activity seems to be declining in the nation as a whole, but there are some areas where illness is ongoing, she said.

Schuchat said the CDC will use the current lull to take stock of the nation's response to the new H1N1 flu and attempt to patch any gaps in the public health safety net before flu season starts this fall.

This is not over. The novel H1N1 virus is in many parts of the country and of course now increasing in many parts of the Southern Hemisphere, she said.

A report by the non-profit group Trust for America's Health released on Thursday found that while the investment in pandemic planning and stockpiling of antiviral medications have paid off, recent cuts in public health departments have meant many did not have adequate resources to carry out flu plans.

It also found problems in plans for school closings and limiting mass gatherings, and even with a mild outbreak, it found hospital emergency departments and other parts of the healthcare delivery system were overwhelmed.

The group said the World Health Organization's pandemic alert phases caused confusion because they did not account for severity of infection, only its spread. WHO has put the H1N1 outbreak at 5 on its 6-point scale even though most cases have been relatively mild.

And they said international cooperation had proven to be more difficult than previously thought.


To address future outbreaks, the group urged U.S. health officials to shore up stockpiles of antiviral medications and other supplies, improve vaccine development capabilities and plan for rapid vaccination of all Americans.

It also urged government health officials to improve coordination at all levels of government and with other countries, and develop better strategies for school closings, sick-leave policies and other ways to limit public gatherings during periods of rapid infection.

The group specifically urged a halt to planned layoffs at state and local health departments, and recommended hospitals improve strategies for handling a large influx of patients.

Schuchat praised the report and said the CDC had already begun planning for how it would handle a second flu vaccination program on top of administering a seasonal flu vaccine.

A report by the U.S. Government Accountability Office this week also said much more needs to be done to close gaps in the U.S. flu preparedness plan, including improving coordination between federal, state and local governments and the private sector.

Gaps remain, Schuchat said, adding that CDC is meeting with groups representing state and local public health officials and with private sector health providers.

This is an area we are working very hard at right now to make sure we are as well prepared as we can be for the fall.

(Editing by Eric Beech)