The number of confirmed cases of A/H1N1 flu in the state of North Carolina is likely much greater than the 14 that have been reported in the state, according to Dr. Jeffrey Engel, the state's public health director on Tuesday.

"They will definitely go unreported," Dr. Jeffrey Engel said. "We feel that our current (testing) method probably catches about one in 10 to one in 20 that are really happening here."

Nationwide, there are 6,764 cases of A/H1N1 flu have shown up in 48 states, with 10 deaths in six states, according to figures released by the CDC on Monday.

At least 42 countries have confirmed cases of the disease, which has sickened 11,168 people and caused 86 deaths, the World Health Organization reports.

Dr. Engel said not all suspected cases of A/H1N1 flu are tested because the volume would overwhelm the state lab. The state is testing according to guidelines issued by the CDC, he added.

"We do it by sampling. We don't do it by testing everybody," he explained.

Local reports say the state lab tests every case that involves hospitalization and special circumstances, such as people in schools, day care centers or health care settings.

On Friday, Dr. Anne Schuchat, director of CDC's national center for immunization and respiratory diseases, said the official numbers released by the CDC are "just the tip of the iceberg."

"We're estimating more than 100,000 people probably have this virus now in the United States," she added.

"We know that many people with influenza-like illness are not tested for a laboratory diagnosis, and in fact, don't think that everyone who has that condition right now needs to get a diagnostic test," Dr. Schuchat explained.

(Xinhua News Agency May 27, 2009)