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The World Health Organization has raised its pandemic alert for swine flu by one level to phase 4, two steps short of declaring a full-blown pandemic.

WHO says the phase 4 alert means sustained human-to-human transmission is causing outbreaks in at least one country. It signals a significant increase in the risk of a global epidemic, but doesn't mean a pandemic is inevitable.

“The pandemic phase alert should increase from Phase 3 to Phase 4,” said Dr. Keiji Fukuda, assistant director for health security and environment.

On the advice of the agency’s emergency committee meeting also agreed to continue production of seasonal flu vaccine, instead of switching to immediate manufacture of a targeted vaccine.

The group also agreed to focus on mitigating the effects of the outbreak instead of trying to contain it.

“This virus is too widespread to make containment a feasible operation,” Fukuda said. Many experts think it may be impossible to contain a flu virus already spreading in several countries.

The WHO did not recommend closing borders or restricting travel, because it would have little effect, if any, on stemming the spread of infection.

“At this time, closing of borders would not be effective at doing that,” Fukuda said.
He urged people who are ill not to travel and to seek medical attention.

Nevertheless, WHO has been working on developing a human vaccine against this virus, especially as the Southern Hemisphere moves into flu season, Fukuda said.

Perhaps some companies could work on producing swine flu vaccine and seasonal vaccine at the same time, Fukuda said. 

But  officials need to move forward with making a swine flu vaccine so that it’s available as soon as possible. In general, it would take four to six months to develop a vaccine and to have the first batches of vaccine available.

In the past few years, vaccine production capacity has increased considerably based on the work done with avian flu viruses.

WHO has confirmed human cases of swine flu in Mexico, the United States, Canada and Spain. Only Mexico has reported deaths from the new strain. The head of the Homeland Security Department says the United States is preparing as if the swine flu outbreak is a full pandemic.

Secretary Janet Napolitano told reporters Monday that the World Health Organization is operating at level three, with level six a full pandemic. She said officials at the WHO were meeting Monday to consider whether to raise the level.

Napolitano said the U.S. is proceeding as if it were preparing for a full pandemic.

"Everybody is getting prepared, everybody is leaning forward, everybody's dusting off their pandemic flu preparation plans in case this is in fact a major pandemic," she said.

The disease started in Mexico and has spread to the United States and beyond, with 40 reported cases in the U.S.

U.S. officials advised Americans against most travel to Mexico on Monday as a swine flu virus that began there spread to the United States and beyond. With 40 cases now confirmed in the United States, President Barack Obama said there was reason for concern but not yet "a cause for alarm."

Dr. Richard Besser, acting director of the Centers of Disease Control and Prevention, said that so far the disease in the United States seems less severe than the outbreak in Mexico, where more than 1,600 cases have been reported and where the suspected death toll has climbed to 149. No deaths have been reported in the U.S, and only one hospitalization.

"I wouldn't be overly reassured by that," Besser told reporters at CDC's headquarters in Atlanta. He raised the possibility of more severe cases in the United States.

"We are taking it seriously and acting aggressively," Besser said. "Until the outbreak has progressed, you really don't know what it's going to do."

The U.S. stepped up checks of people entering the country by air, land and sea.

And Besser said a new U.S. travel advisory was being prepared suggesting "nonessential travel to Mexico be avoided."

The confirmed cases announced on Monday were double the 20 initially reported by the CDC. Besser said this was due to further testing — not further spreading of the virus — in New York at a school in Queens, bringing the New York total to 28. Besser said other cases have been reported in Ohio, Kansas, Texas and California.

The best way to keep the disease from spreading, he said, is by taking everyday precautions such as frequent handwashing, covering up coughs and sneezes and staying away from work or school if not feeling well.

While the cases reported so far in the United States seem relatively mild, Besser said, far more will be known about the disease's transmission traits and severity in a week or two. He said the particular virus at issue had not been seen before, either in the United States nor Mexico.

He said authorities are not currently recommending that people across the country put on masks in the workplace to protect against infection. The evidence "is not that strong" that the wearing of protective masks effectively limits the outbreak of such diseases, he said.

Interactive map Swine flu in the U.S. A state-by-state look at confirmed cases around the country. msnbc.com

He said about 11 million doses of flu-fighting medications from a federal stockpile have been sent to states in case they are needed. That's roughly one quarter of the doses in the stockpile, he said.

There is no vaccine available to prevent the specific strain now being seen, he said. However, there are antiflu drugs that do work once someone is sick.

If a new vaccine eventually is ordered, the CDC already has taken a key preliminary step — creating what's called seed stock of the virus that manufacturers would use.

The quickening pace of developments in the United States in response to some nearly 2,000 swine flu infections in neighboring Mexico — with a suspected 149 deaths — was accompanied by a host of varying responses around the world. The European Union advised against nonessential travel to the U.S. and Mexico, while China, Taiwan and Russia considered quarantines and several Asian countries scrutinized visitors arriving at their airports.

Screening at U.S. borders
U.S. customs officials began checking people entering U.S. territory. Officers at airports, seaports and border crossings were watching for signs of illness, said Customs and Border Protection spokesman Lloyd Easterling.

If a traveler says something about not feeling well, the person will be questioned about symptoms and, if necessary, referred to a CDC official for additional screening, Easterling said. The customs officials were wearing personal protective gear, such as gloves and masks, he said.

Multiple airlines, including American, United, Continental, US Airways, Mexicana and Air Canada, said they were waiving usual penalties for changing reservations for anyone traveling to, from, or through Mexico, but had not canceled flights.

Besser described the new U.S. border initiative as "passive screening." He said authorities were "asking people about fever and illness, looking for people who are ill."

'Taking very aggressive measures'
The U.S. declared a national health emergency in the midst of uncertainty about whether the mounting sick count meant new infections were increasing or health officials had simply missed something that had been simmering for weeks or months.

Besser said he was not reassured by the fact that so far in the U.S., no one had died from the disease.

"From what we understand in Mexico, I think people need to be ready for the idea that we could see more severe cases in this country and possibly deaths," he said. "That's something people have to be ready for and we're looking for that. So far, thankfully, we haven't seen that. But we're very concerned and that's why we're taking very aggressive measures."

A private school in South Carolina was closed Monday because of fears that young people who recently returned from Mexico might have been infected.

Officials of Newberry Academy in South Carolina said Monday that seniors from the school were in Mexico earlier this month and some had flu-like symptoms when they returned.

State Department of Health and Environmental Control spokesman Jim Beasley said test results on the students could come back as early as Monday afternoon. The agency has stepped up efforts to investigate all flu cases in South Carolina. There have been no confirmed swine flu cases in the state.

A New York City school where eight cases were confirmed was closed Monday and is expected to remain closed Tuesday. In addition, 14 schools in Texas, including a high school where two cases were confirmed, will be closed for at least the next week. Some schools in California and Ohio also were closing after students were found or suspected to have the flu.