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2020 G4 EA H1N1 publication
G4 EA H1N1, also known as the G4 swine flu virus (G4) is a swine influenza virus strain discovered in China.[64] The virus is a variant genotype 4 (G4) Eurasian avian-like (EA) H1N1 virus that mainly affects pigs, but there is some evidence of it infecting people.[64] A 2020 peer-reviewed paper from the Proceedings of the National Academy of Sciences (PNAS) stated that "G4 EA H1N1 viruses possess all the essential hallmarks of being highly adapted to infect humans ... Controlling the prevailing G4 EA H1N1 viruses in pigs and close monitoring of swine working populations should be promptly implemented."[65]
Michael Ryan, executive director of the World Health Organization (WHO) Health Emergencies Program, stated in July 2020 that this strain of influenza virus was not new and had been under surveillance since 2011.[66] The Chinese CDC said it had implemented an influenza surveillance program in 2010, analyzing more than 400,000 tests annually, to facilitate early identification of influenza.[67] Of those, 13 A(H1N1) cases were detected, of which three were of the G4 variant.[67]
The study stated that almost 30,000 swine had been monitored via nasal swabs between 2011 and 2018.[65] While other variants of the virus have appeared and diminished, the study claimed the G4 variant had sharply increased since 2016 to become the predominant strain.[65][68] The Chinese Ministry of Agriculture and Rural Affairs rebutted the study, saying that the number of pigs sampled was too small to demonstrate G4 had become the dominant strain and that the media had interpreted the study "in an exaggerated and nonfactual way".[69] They also said the infected workers "did not show flu symptoms and the test sample is not representative of the pig population in China".[67]
According to the study, between 2016 and 2018, 338 swine production workers in China were tested for antibodies of the virus, and 35 (10.4%) had tested positive. Of those workers between the ages of 18 and 35, 20.5% had tested positive.[65][70] Among another 230 people screened who did not work in the swine industry, 10 (4.4%) tested positive for antibodies, indicating prior infection.[64][65] Three cases of infection caused by the G4 virus had been documented as of July 2020, with no confirmed cases of human-to-human transmission.[64]
The U.S. Centers for Disease Control and Prevention (CDC) said the study suggested that human infection by the G4 virus is more common than it was thought to be.[64] Both the European Centre for Disease Prevention and Control (ECDC)[71] and the US CDC[64] stated that, like all flu viruses with pandemic potential, the variant is a concern that will be monitored.[71] The WHO assesses the risk of influenza viruses with the Tool for Influenza Pandemic Risk Assessment,[71] and the US CDC uses the Influenza Risk Assessment Tool.[64] The ECDC stated that "the most important intervention in preparing for the pandemic potential of influenza viruses is the development and use of human vaccines ...".[71] The US CDC announced in July 2020 that it would request a sample of the virus from China and create a new vaccine if needed.[64] Health officials (including Anthony Fauci) have said that the virus should be monitored, particularly among those in close contact with pigs, but it is not an immediate threat.[72][73] While there have been no reported cases or evidence of the virus outside of China as of July 2020,[73] Smithsonian magazine reported in July 2020 that scientists agree that the virus should be closely monitored, but because it "so far cannot jump from person to person", it should not be a cause for alarm.[74]