Swine flu continues to wane across the United States, but it has killed more than 30 children since the last count, U.S. health officials said on Monday.

The latest update on the H1N1 virus, posted at www.cdc.gov/flu/weekly/, shows the infection is still at epidemic levels but below its October peak, the Centers for Disease Control and Prevention reported.

Since March, 198 children have been reported killed by H1N1, although the true number is likely far higher because many people with the flu don't go to the doctor and only a few who do are tested for swine flu.

The CDC said just over 20 percent of specimens sent for testing from patients with flu-like illness were positive for H1N1 swine flu, meaning that 80 percent of patients had something else. At the worst, this proportion was over 30 percent.

Swine flu continues to dominate, with 99 percent of flu cases being due to the H1N1 strain.

The proportion of outpatient visits for influenza-like illness was 4.3 percent, which is above the national baseline of 2.3 percent, the report reads.

The CDC got reports in the week ending November 21 of 35 children who died, although one died from seasonal influenza in March -- bringing to 128 the confirmed pediatric death toll from seasonal flu in 2008-2009.

A total of 198 deaths in children associated with 2009 influenza A (H1N1) virus infection have been reported to CDC, the report reads.

Many of the children who died had bacterial infections known to worsen a flu infection. Thirty-one percent of the children who died and who were tested for bacterial infections had one, and nearly a third of these had Staphylococcus aureus.

The virus remains mostly treatable by oseltamivir, the flu pill made by Roche AG and Gilead Sciences under the brand name Tamiflu. A total of 23 cases of oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States since April 2009, the CDC said.

All viruses tested, including those resistant to Tamiflu, can be treated with Relenza, GlaxoSmithKline Plc and Biota's inhaled drug also known as zanamivir.

The CDC estimates that more than 22 million Americans have been infected with H1N1 and that 3,900 have died. The U.S. government has ordered 250 million doses of vaccine but companies have been struggling to make it, leading to widespread shortages.

The World Health Organization reports that more than 207 countries and overseas territories or communities have reported laboratory-confirmed cases of H1N1, with more than 7,820 confirmed deaths -- numbers the WHO says are the tip of the iceberg.

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