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Don't put away the hand gel... swine flu has returned. It now looks as if we are at the start of the second wave of H1N1 pandemic flu in the UK, earlier than hoped.

The number of cases last week in England is estimated to be just over 5000, compared with around 3000 in the week before. And in Scotland the numbers have doubled in the last week, from around 3300 to just over 6000.

The Chief Medical Officer for England, Sir Liam Donaldson, described the rise as "one of a number of straws in the wind that suggest we might be seeing the start of an upturn".

These straws include a rise in people in hospital with swine flu in England to 143 from 132 in the previous week, a rise in reports to GPs and a handful of outbreaks in schools (two in South Yorkshire, one in Carlisle, one in the North East, and two in London).

This early rise, following the return to school in England two weeks ago, is not unexpected, but it is early.

"We would naturally have hoped for a bit more breathing space", Sir Liam told journalists at his weekly flu update this afternoon.

The early rise steps up the pressure on the national vaccine programme. Sir Liam said he is eager to get this started, to protect the small minority for whom the virus can prove very serious. Swine flu remains a mild disease in most people.

And the good news on the vaccine front is that trials suggest one dose is enough to offer protection. This makes sense of the government's announcement today that it's prepared to donate ten per cent of UK vaccine supply to the developing world. The White House made a similar pledge this afternoon.

This follows barely disguised pleas from the World Health Organisation that well-off countries do more to help countries where access to vaccine could prove vital for millions of people who are already sick, have poor nutrition and limited access to basic health care.

Sir Liam drew attention to rising swine flu numbers elsewhere in the northern hemisphere - notably in Eastern Europe and the USA - which has seen a significant increase in the past few weeks

Sir Liam said a colleague recently returned from the US visited one college campus with 2000 students sick with the virus. This is clearly ringing alarm bells here. The UK might reasonably be expected to follow the US pattern of disease - as it did in the first wave in the Spring. Though the expert view apparently remains that we may not see a second peak in UK cases before mid October.