Georgia has two more confirmed cases of novel influenza A H1N1 virus, bringing the state's total to four, said S. Elizabeth Ford, the acting director of the Georgia Division of Public Health. But there are likely close contacts of those who have the disease who will not be tested because they are already taking antiviral medication that makes testing problematic, health officials said.

The two cases reported Monday night by the Centers for Disease Control and Prevention are a 3-year-old boy in Cobb County, whose entire household is now showing symptoms, and a 36-year-old pregnant woman from DeKalb County who has apparently recovered, Georgia health officials said.

The 3-year-old was exposed to an ill relative who had traveled to Mexico, and he became ill April 29. His 2-year-old brother, a 2-month-old baby and both parents are also ill and are receiving antivirals or are being evaluated, health officials said.

"Because they were exposed to this young child who was symptomatic and who does have H1N1 novel influenza virus, we assume that their illness is the same," said Dr. Susan Lance, the senior director for protection and safety for the Division of Public Health.

Antivirals aren't tested on or recommended for children younger than 3 months, but the child's pediatrician apparently felt the benefit outweighed the risks, said Dr. Ford, who is also a pediatrician.

The 36-year-old woman had no known contact with people who were ill. Her 8-year-old son had been ill before, but it was a mild illness, Dr. Ford said.

There is still one probable case -- an 8-year-old Clayton County girl who had been attending school in Mexico before traveling to Georgia -- still pending confirmation with the CDC.

A 14-year-old Henry County boy who was confirmed earlier had a 12-year-old sister who fell ill before he did, but she also isn't included in the state's official count. The state cannot find evidence of the virus once the person is no longer ill, Dr. Lance said.

"Right now we're only counting confirmed cases, those that are confirmed by CDC," Dr. Ford said. "This is going to be an issue nationwide because we're sure that many household members and contacts of confirmed cases may or may not have had the illness at some point. But it is going to be very difficult for us as a nation to count every single case."

As of Tuesday, the state lab had received 225 specimens, and 149 of those are not considered probable cases, Dr. Ford said. Five were forwarded to the CDC, with four confirmed and one probable pending. An additional 54 samples were being processed, and a few had to be discarded because they were collected improperly, Dr. Ford said.

A large number of samples are being forwarded from Henry County, where a school was closed, but those are likely the "worried well," Dr. Ford said. Still, she expects to see more cases pop up in Georgia even as the outbreak appears to be declining in states such as California and New York where it surfaced earlier.

"We're not seeing the downward trend yet," Dr. Ford said. "Georgia just got its first case whereas New York and California have had their cases for several days. We are probably not even hitting our peak yet."