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The current wave of pandemic H1N1 flu appears to have peaked, with four weeks of declines in several key indicators, the Centers for Disease Control and Prevention said Monday.

Despite those declines, the outbreak is continuing to take a heavy toll of hospitalizations and deaths, especially among children.

Widespread activity of swine flu was reported in 32 states in the week ended Nov. 21, down from 43 states in the week before and 48 a month ago.

Influenza-like illnesses accounted for 4.3 percent of all visits to doctor’s offices during the week, down from nearly double that proportion in October. That is still well above the normal level, 2.3 percent, for this time of year, however.

The CDC has estimated that at least 4,000 people have died from swine flu, 98,000 had been hospitalized and 22 million had contracted the virus.

In the week ended Nov. 21, there were 27 confirmed swine-flu deaths in infants and children younger than 18. That brings the total number of pediatric deaths from influenza to 234 since April.

A normal flu season is typically marked by about 30 to 40 pediatric deaths.

The agency noted that the number of pediatric deaths apparently has not peaked because death reporting lags behind other reports, often by three or four weeks.

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