the District of Columbia and Puerto Rico . See where H1N1 flu cases are in the U.S. '' The U.S. death toll is expected be higher when the CDC releases its latest figures Friday , said Anne Schuchat , director of the National Center for Immunization and Respiratory Diseases . New England -- particularly Massachusetts -- and the New York and New Jersey areas have been hit the hardest , Schuchat said Thursday at a CDC news conference . The Phase 6 pandemic designation had been widely expected for weeks . `` Further spread is considered inevitable , '' Chan said at a news conference at WHO headquarters in Geneva , Switzerland . `` The scientific criteria for an influenza pandemic have been met . '' The announcement came after a meeting of the WHO 's Emergency Committee , which has debated since April whether the spread of a novel H1N1 flu virus was fast and widespread enough to warrant a Phase 6 designation . Phase 6 , Chan said , is meant as a signal to countries to recalibrate their strategies to minimize the harm from swine flu . In countries where the virus and the response to it
-LRB- CNN -RRB- -- The World Health Organization raised the swine flu alert Thursday to its highest level , saying the H1N1 virus has spread to enough countries to be considered a global pandemic . Kindergarten students , some wearing masks , attend school in a residential estate in Hong Kong on Thursday . Increasing the alert to Phase 6 does not mean that the disease is deadlier or more dangerous than before , just that it has spread to more countries , the WHO said . `` This is an important and challenging day for all of us , '' WHO Director General Margaret Chan said in a briefing with reporters . `` We are moving into the early days of the first flu pandemic of the 21st century . '' The last previous pandemic occurred in 1968 . As of Thursday , the virus had spread to 74 countries , the health agency said . There were 28,774 confirmed cases and 144 deaths . The United States had 13,217 cases and 27 deaths , the Centers for Disease Control and Prevention said June 5 in its weekly update . Cases have been reported in all 50 states ,