May 25 (Bloomberg) — Swine flu is spreading more widely than official figures indicate, with outbreaks in Europe and Asia showing it’s gained a foothold in at least three regions.

One in 20 cases is being officially reported in the U.S., meaning more than 100,000 people have probably been infected nationwide with the new H1N1 flu strain, according to the Centers for Disease Control and Prevention. In the U.K., the virus may be 300 times more widespread than health authorities have said, the Independent on Sunday reported yesterday.

Japan, which has reported the most cases in Asia, began reopening schools at the weekend after health officials said serious medical complications had not emerged in those infected. The virus is now spreading in the community in Australia, Jim Bishop, the nation’s chief medical officer, said yesterday.

“I think we will see the number rise,” Bishop told Australian Broadcasting Corp. radio today after confirming the nation’s 17th case and saying test results are pending on 41 others. “This is going to be a marathon rather than a sprint.”

Forty-six countries have confirmed 12,515 cases, including 91 deaths, according to the World Health Organization’s latest tally. Almost four of every five cases were in Mexico and the U.S., where the pig-derived strain was discovered last month. Most of those infected experience an illness similar to that of seasonal flu. The main difference is that the new H1N1 strain is persisting outside the Northern Hemisphere winter.

Summer Disease?

“While we are seeing activities decline in some areas, we should expect to see more cases, more hospitalizations and perhaps more deaths over the weeks ahead and possibly into the summer,” Anne Schuchat, CDC’s interim deputy director for science and public health program, told reporters on a May 22 conference call.

The U.S. has officially reported 6,552 probable and confirmed cases, Schuchat said. “These are just the tip of the iceberg. We are estimating more than 100,000 people probably have this virus now in the U.S.”

There have been nine deaths and more than 300 known hospitalizations, she said. The fatalities exclude a woman in her 50s who died in New York over the weekend.

China reported cases today in Shanghai and the eastern province of Zhejiang, taking its tally of confirmed infections to 12. Taiwan confirmed the island’s first domestically transmitted case and reported two imported infections, giving it nine. South Korea confirmed 12 more cases, bringing its total to 22, while the Philippines confirmed a second infection today.

Caribbean Honeymoon

Russia’s health ministry confirmed the country’s second case, in a man who honeymooned in the Dominican Republic. He returned from the Caribbean May 18 and was hospitalized two days later in the Kaluga region southwest of Moscow, Gennady Onishchenko, head of the ministry’s public health department, said on state television today. His wife wasn’t infected.

Japan has the most cases outside North America, with 345 as of today, according to the health ministry. Chile’s tally reached 74 after 19 cases were recorded yesterday, while Argentina’s total increased by three to five.

Eighteen European countries have confirmed 349 cases, a third of whom were probably infected in their home country, the Stockholm-based European Centre for Disease Prevention and Control said in a report yesterday. The U.K. and Spain have the most reported cases, with 133 each. About 60 percent of cases in the U.K. are linked to “in-country transmission,” ECDC said.

Thousands of people have caught the virus in the U.K. and suffered mild symptoms, or none at all, over the past weeks, John Oxford, professor of virology at the University of London, told the Independent.

Already a Pandemic

Community spread of the new virus in a second region means WHO’s criteria for a pandemic has been met, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy of the University of Minneapolis.

Britain’s Health Secretary Alan Johnson told WHO Director- General Margaret Chan at the organization’s annual meeting last week that disease severity and other determinants besides geographic spread need to be considered before the pandemic alert is raised to the highest of WHO’s 6-level scale.

“The move to phase 6 means that emergency plans are instantly triggered around the globe, and in the U.K. this would mean increased vigilance and activation of the UK’s own ‘inter- pandemic’ phases,” the U.K.’s Department of Health said in a May 18 statement.

At phase 6, many pharmaceutical companies would switch from making seasonal flu shots to pandemic-specific vaccine, potentially creating shortages of an immunization to counter the normal winter flu season, the department said.

‘Risk of Harm’

WHO is reviewing its pandemic response plans, including the prerequisites for a pandemic, in the wake of the swine flu threat, said Keiji Fukuda, the agency’s assistant director- general of health security and environment. A move to phase 6 would “signify a really substantial increase in risk of harm to people,” Fukuda told reporters during a May 22 briefing.

Some of the guidelines were prepared in anticipation of a pandemic sparked by the H5N1 strain of avian flu, which killed 61 percent of 429 people confirmed to have contracted that virus, Chan told the World Health Assembly on May 18. “This has left our world better prepared, but also very scared,” she said.

Rather than redefine what constitutes a pandemic, health officials should help people understand the current threat may resemble the 1957 or 1968 pandemics, in which fewer than 4 million people died, rather than the 1918 Spanish flu, blamed for killing about 50 million, said Osterholm at the University of Minneapolis.

“The bigger problem is scientific integrity,” he said. “If they want to change the definition, then go ahead. But don’t say that we are not in phase 6 right now because we don’t want to go there.”

To contact the reporter on this story: Jason Gale in Singapore at j.gale@bloomberg.net

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