Ⅳ. Criteria for Determining whether Infection with the H1N1 Flu Virus is an Occupational Illness or Not (Employee Welfare Corporation, September 2009)

A. Summary of the H1N1 Flu Virus
The Influenza A (H1N1) flu virus (hereinafter referred as “the H1N1 flu virus”) is a new type of varietal virus that causes respiratory problems, and has infected people all over the world.





B. Determining an H1N1 Viral Infection Is an Occupational Illness

1. Criteria for Determination as an Occupational Illness
The H1N1 flu virus is a new type of varietal virus, and has a variety of infection routes and causes. If an employee’s infection with the H1N1 flu virus is to be considered an occupational illness, contraction shall clearly be attributable to the work, and there shall be considerable causal relationship between the work being performed and contraction of the virus.
Because the H1N1 flu virus spreads in much the same way as seasonal flu viruses (through droplets in the air from infected people), in cases where an employee working in the health and medical field has been infected with H1N1, the illness shall be regarded as an occupational illness according to Article 34 of the Enforcement Decree to the IACI Act and its Table 3 (21-A).
In other employees who do not work in the health and medical field, if there is definitely a considerable medical causal relationship (exposure period to the H1N1 flu virus, intensity, scope, occurrence, etc.) between the work required and infection (unavoidability of exposure during performance of work duties), it shall be regarded, in a limited way, as an occupational illness according to Article 34 of the Enforcement Decree to the IACI Act and its Table 3 (21-B).
2. Handling guidelines

- In cases where employees working in hospital or medical accommodation facilities are infected with the H1N1 flu virus, if such infection is medically determined to have been caused by contact with infected patients in the course of work performance, it is regarded as an occupational illness.
- It is not so simple to determine infection of other employees as an occupational illness, but if there is considerable medical evidence of a causal relationship (exposure period to H1N1, intensity, scope, occurrence, etc.) between the work and infection (unavoidability of exposure during performance of work duties), it shall be regarded, in a limited way, as an occupational illness.
1) Regarding those who are engaged in the health and medical field (Article 34 of the Enforcement Decree to the IACI Act and its Table 3 (paragraph 21-A)
Medical personnel who work at a designated hospital that accommodates or treats patients infected with the H1N1 flu virus, and become infected by the H1N1 flu virus, are considered to have caught an occupational illness, because the infection route is quite apparent. Infection that occurs after a sufficient latent period in employees who are in close contact with patients diagnosed with the H1N1 flu virus, is estimated to be related to work. “In close contact” means that the employee is with the patient for at least one hour, at a distance of one to two meters.
Besides medical professionals, infection of other medical staff who handle patients’ clothing or blankets, handkerchiefs, books, etc., and are infected with the H1N1 flu virus, can be accepted as an occupational illness as the H1N1 flu virus can survive for 12 to 24 hours away from a host. However, as the H1N1 flu virus can be transmitted from person to person, if there is a possibility that the employee was infected from the community outside the workplace, it will be difficult to prove the infection is an occupational illness.
2) Those who do not work in the health and medical field (Article 34 of the Enforcement Decree to the IACI Act and its Table 3 (21-B), Article 44 of the Enforcement Decree to the LSA and its Table 5 (38))
The H1N1 flu virus is transmitted from person to person through contact or the air. In each case, it is difficult to find the exact reason for infection, so if the infected employee unknowingly spent time exposed to the H1N1 flu virus, it is difficult to prove the infection came from work. To be considered an occupational illness, the employee’s work and duties shall be supervised by the employer, according to the employment contract. Infection shall come due to the risk associated with the work, not from any contact with the patient outside of work, or with family, friends, or the outside community. When an infected employee has an occupation that involves a high risk of coming into contact with the H1N1 flu virus, or who is frequently at risk of infection during work performance, the infection can be accepted as an occupational illness. Some examples follow in “Target Employees” after the next paragraph.
However, even though an employee becomes infected with the H1N1 flu virus while on a business trip to one of the eleven countries where risk of infection is greatest, or even though multiple employees in the same company become infected with the H1N1 flu virus, this infection cannot be recognized as an occupational illness unless the patient can satisfy the criteria required to determine that it is so.


【Target Employees】
- A quarantine officer inspecting an airport, port, etc.
- An employee traveling on business to a country where risk of infection from the H1N1 flu virus is highest:
※ The US, Mexico, Canada, Chile, England, Spain, Thailand, Australia, New Zealand, the Philippines, Hong Kong, or other countries later determined to be in the high-risk category;
- A person taking care of a patient on an airplane, or a person traveling for one hour or longer in the same seat row or within three rows before and behind a person a) diagnosed with the H1N1 flu virus and b) not wearing a face mask;
- An employee infected by a coworker with the H1N1 flu virus due to occupational contact.

【Requirements for Determination as an Occupational Illness】
- For employees in the above situations, infection with the H1N1 flu virus shall be declared an occupational illness if the following conditions are met:
① There shall be a match between the scope of occupational activities and the infection route;
② There shall be visible duties where infection is likely;
③ There shall be medically acceptable evidence of exposure to the H1N1 flu virus;
④ Infection did not occur from activities outside of work (contact with infected family or relatives).

C. Related Laws


Criteria for Recognition of Work-related Accidents (Article 37 of the IACI Act)
① If a worker sustains an injury, a disability or illness, or dies from any of the causes described in the following subparagraphs, the injury, illness, disability or death shall be considered a work-related accident. This shall not apply in cases where there is no causal relationship between the work and the accident:
② Work-related illnesses
A. An illness which occurs due to the handling of, or exposure to, harmful or hazardous elements while the worker is performing his/her duties;
B. Other illnesses which occur in relation to work.
③ The specific criteria for recognizing work-related accidents shall be prescribed by Presidential Decree.
【Criteria for Recognition of Work-Related Illnesses】(Article 34 of the Enforcement Decree to the IACI Act)
① If a worker’s illness is included in the scope of work-related illnesses referred to in Article 44 (1) and Table 5 of the Enforcement Decree to the Labor Standards Act, and meets all of the following conditions, the illness shall be seen as a work-related illness under Article 37(1) 2 A of the Act.
1. The worker has handled, or been exposed to, harmful or hazardous elements while performing his/her duties;
2. It is deemed possible for the illness to arise in light of the number of hours which the worker has handled or been exposed to harmful or hazardous elements, the period during which the worker has been engaged in such work, work environment, etc.; and
3. It shall be medically recognized that the worker’s exposure to or handling of harmful or hazardous elements has caused the illness.
※ Reference
【Scope, etc. of Occupational Illness (Article 44 of the Enforcement Decree to the Labor Standards Act)】
① The scope of occupational disease and medical treatment as prescribed in Article 78 (2) of the Act is shown in Table 5.
【The scope of occupational illness and medical treatment (Table 5)】
33. Various contagious diseases encountered while carrying out duties of a job with potential risk of being contaminated while diagnosing, treating, and nursing patients or by doing other similar activities.
38. Other diseases that occur and are attributable to work-related activities.
③ Specific criteria for recognition of an illness as an occupational illness under paragraph (1) are shown in Table 3.
【Specific criteria for recognition of an illness as an occupational illness (Table 3)】
21. Illnesses occurring due to causative agents like bacteria and viruses
In cases where infection is confirmed from causative agents, where the employee contacted infectious bacteria or other sources of infection, and where the latent period was long enough for infection to occur after contact, the illness shall be regarded as an occupational illness if there is causality between the infection and work.
A. Infection considered to be work-related for those who are working in health and medical facilities or related collective accommodations:
1) Employees infected by diseases transmitted through blood, such as Hepatitis B, Hepatitis C, Syphilis, AIDS, etc.
2) Employees infected by diseases transmitted through the air, such as Tuberculosis, Rubella, Measles, Influenza, etc.
3) Employees infected by other contagious diseases, such as Hepatitis A.
B. Infection considered to be work-related for those who are not engaged in health or medical facilities:
1) Leptospirosis due to working in humid workplaces;
2) Scrub Typhus from working outdoors;
3) Anthrax, Erysipelas, Brucellosis from handling animals and their carcasses, animal fur, skin, etc.;
4) Epidemic Hemorrhagic Fever and Malaria occurring in those engaged in or organizing outdoor activities in workplaces where Epidemic Hemorrhagic Fever and Malaria exist, or in employees working in a laboratory;
5) Legionella infection from contaminated coolant.