Swine influenza FAQs

What is swine influenza?

Swine influenza, or “swine flu”, is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses. Morbidity tends to be high and mortality low (1-4%). The virus is spread among pigs by aerosols, direct and indirect contact, and asymptomatic carrier pigs. Outbreaks in pigs occur year round, with an increased incidence in the fall and winter in temperate zones. Many countries routinely vaccinate swine populations against swine influenza.

Swine influenza viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2). Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as swine influenza viruses. The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a "reassortant" virus. Although swine influenza viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.

What are the implications for human health?

Outbreaks and sporadic human infection with swine influenza have been occasionally reported. Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death.

Since typical clinical presentation of swine influenza infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition; therefore the true extent of this disease among humans is unknown.

Where have human cases occurred?

Since the implementation of IHR (2005) in 2007, WHO has been notified of swine influenza cases from the United States and Spain.

As of 19:15 GMT, 28 April 2009, seven countries have officially reported cases of swine influenza A/H1N1 infection. The United States Government has reported 64 laboratory confirmed human cases, with no deaths. Mexico has reported 26 confirmed human cases of infection including seven deaths. The following countries have reported laboratory confirmed cases with no deaths - Canada (6), New Zealand (3), the United Kingdom (2), Israel (2) and Spain (2).

Further information on the situation will be available on the WHO website on a regular basis.

How do people become infected?

People usually get swine influenza from infected pigs, however, some human cases lack contact history with pigs or environments where pigs have been located. Human-to-human transmission has occurred in some instances but was limited to close contacts and closed groups of people.

What about the pandemic risk?

It is likely that most of people, especially those who do not have regular contact with pigs, do not have immunity to swine influenza viruses that can prevent the virus infection. If a swine virus establishes efficient human-to human transmission, it can cause an influenza pandemic. The impact of a pandemic caused by such a virus is difficult to predict: it depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors.

Is there a human vaccine to protect from swine influenza?

There are no vaccines that contain the current swine influenza virus causing illness in humans. It is not known whether current human seasonal influenza vaccines can provide any protection. Influenza viruses change very quickly. It is important to develop a vaccine against the currently circulating virus strain for it to provide maximum protection to the vaccinated people. This is why WHO needs access to as many viruses as possible in order to select the most appropriate candidate vaccine virus.

What drugs are available for treatment?

There are two classes of such medicines:

1. adamantanes (amantadine and remantadine), and
2. inhibitors of influenza neuraminidase (oseltamivir and zanamivir).

Most of the previously reported swine influenza cases recovered fully from the disease without requiring medical attention and without antiviral medicines.

Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. The viruses obtained from the recent human cases with swine influenza in the United States are sensitive to oselatmivir and zanamivir but resistant to amantadine and remantadine.

Information is insufficient to make recommendation on the use of the antivirals in treatment of swine influenza virus infection. Clinicians have to make decisions based on the clinical and epidemiological assessment and harms and benefit of the treatment of the patient. For the ongoing outbreak of the swine influenza infection in the United States and Mexico, the national and the local authorities are recommending to use oseltamivir or zanamivir for treatment of the disease based on the virus’s susceptibility profile.

Why has the swine flu alert been upgraded from Phase 4 to 5?

Based on assessment of all available information and following several expert consultations, Dr Margaret Chan, World Health Organisation’s (WHO) Director-General raised the current level of influenza pandemic alert from phase 4 to 5. She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels. The results of these ongoing assessments will be issued as public health advice, and made publicly available. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.

This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

The Director-General recommended not to close borders and not to restrict international travel. It was considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention.

The Director-General considered that production of seasonal influenza vaccine should continue at this time, subject to re-evaluation as the situation evolves. WHO will facilitate the process needed to develop a vaccine effective against A/H1N1 virus. The Director-General stressed that all measures should conform with the purpose and scope of the International Health Regulations.

What is Phase 5?

Phase 5 is characterised by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organisation, communication, and implementation of the planned mitigation measures is short.

More information from WHO can be found at http://www.who.int/en/

In the past, human infection with swine influenza was generally mild but is known to have caused severe illness such as pneumonia.

To protect yourself, practice general preventive measures for influenza:

• Avoid close contact with people who appear unwell and who have fever and cough.
• Wash your hands with soap and water frequently and thoroughly.
• Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active.

If there is an ill person at home:

• Try to provide the ill person a separate section in the house. If this is not possible, keep the patient at least 1 metre in distance from others.
• Cover mouth and nose when caring for the ill person. Masks can be bought commercially or made using the readily available materials as long as they are disposed of or cleaned properly.
• Wash your hands with soap and water thoroughly after each contact with the ill person.
• Try to improve the air flow in the area where the ill person stays. Use doors and windows to take advantage of breezes.
• Keep the environment clean with readily available household cleaning agents.

If you are living in a country where swine influenza has caused disease in humans, follow additional advice from national and local health authorities.

A. CommInsure’s products

CommInsure’s life insurance products cover swine influenza?

The current Retail Risk products do not have any claim’s exclusion for swine flu or pandemic. This includes:

• Personal Insurance Portfolio
  • Life Care
  • Total and Permanent Disability Cover
  • Trauma Cover
  • Income Care Range
  • Business Overheads Cover
• Total Care Plan Super
• Term Life Protection (TLP)
• Home Loan Protection (HLP)
• Loan Protection
• Credit Card Plus

B. New applications

Is CommInsure accepting new life insurance applications in light of the potential for a swine influenza pandemic?

Yes, there is currently no change to our existing application process.

What is CommInsure’s position if the applicant has disclosed that they have had a "flu" recently?

If the applicant has fully recovered, with no residual symptoms, then this should be acceptable.

If symptoms are present and the applicant has recently returned from a country deemed unsafe by Department of Foreign Affairs and Trade (DFAT), as a result of the incidence of swine flu, the application will be declined. The applicant can reapply when fully recovered and will be subject to verification of good health via a Medilite health check. Any residual symptoms will considered on an individual basis.

If symptoms are present with no recent travel, we will obtain a Personal Medical Attendant Report and assess the application on the basis of the information provided by the doctor.

What is CommInsure’s stance regarding customers travelling overseas to both infected and non-infected destinations?

If the travel is intended for countries deemed unsafe, the application will be declined until the applicant has returned to Australia for a period of one month. Verification of good health will be done via a Medilite health check.

Other destinations will be treated via the usual guidelines. These may still be treated as unsafe regions due to political instability or the presence of other health conditions. In the event of an escalation of the alert status, we may impose an “Influenza Virus / Pandemic Exclusion” on all travel.

Are there any implications for customers working in the health profession or other occupations where exposure is greater?

None at this time.

Are there any other issues to be aware of?

We are actively monitoring the alert statuses and reserve the right to amend our procedures at short notice.

C. Claims

What do I do if I need to claim for swine influenza?

It is our current understanding that the effects of swine flu are likely to be no more severe or long lasting than normal seasonal flu. We therefore expect that most people will recover before the expiry of the waiting period on their income care policies. Complications can arise of course, as with seasonal flu, resulting in a longer period of incapacity.

If you believe you may be entitled to benefits under your policy, you should notify CommInsure on 131056 as soon as possible.

Will these claims be handled any differently?

No, all claims are assessed the same way. We endeavour to pay all valid claims as quickly as possible.

D. More information

For more information, please contact your adviser or call us on 13 10 56 (8:00am – 8:00pm Monday – Friday).