急性弛缓性麻痹病例中Ⅱ型脊髓灰质炎疫苗病毒变异株基因特征分析

研究Ⅱ型脊髓灰质炎(脊灰)疫苗变异株的基因特征,为我国使用口服脊灰减毒活疫苗/脊灰灭活疫苗使用策略,维持无脊灰状态和全球最终消灭脊灰提供科学依据。根据型内鉴定的检测结果,从2000~2001年AFP病例分离到的Ⅱ型脊灰疫苗变异株中选取有聚集性的5株病毒进行全基因组序列测定(贵州省3株、山东省2株),并进行核苷酸、氨基酸同源性分析。贵州省3株病毒全基因组序列完全一致,但与SabinⅢ型病毒发生重组,重组区域在3A区(nt5343~5353);与疫苗株相比,Ⅱ型区域变异10个碱基,其中VP1区变异4个,与SabinⅡ型株核苷酸同源性为99·56%,氨基酸同源性99·34%;Ⅲ型区域变异9个碱基。山东省2株病毒全基因序列共享16个突变位点,没有发生重组,与SabinⅡ型株相比,VP1区分别变异7个和4个碱基,核苷酸同源性分别为99·22%和99·56%,氨基酸同源性分别为99·0%和99·67%。上述5株病毒在重要的减毒位点nt481、nt2909均发生突变。此研究中5株病毒分属于两个不同的传播链,但是共享nt481、nt2909、nt2992三个突变位点,这3个突变位点不在重组区域内,他们的共同作用可能是影响病毒传播力的重要因素,但目前尚无证据证明脊灰疫苗病毒型间重组会增加病毒的毒力及传播力。     

急性弛缓性麻痹聚集病例病原毒力和分子特征分析

为探索脊灰病毒型内重组、位点突变等分子特征与神经毒力的关系,对2002年6月四川省攀枝花地区发生的急性弛缓性麻痹(acute flaccid paralysis,AFP)聚集病例的分离病毒株进行了转基因小鼠(PVR-Tg21 mice)神经毒力实验和全基因组核苷酸序列测定。结果显示:所测4株分离病毒(均为Ⅱ型脊灰病毒)神经毒力没有明显升高。4株病毒基因全长都是7 439bp,编码区翻译的氨基酸全长2 207aa。4株病毒的VP1区核苷酸序列完全相同。6208和6235c两株病毒是由Ⅱ型和Ⅲ型脊灰病毒在3A区重组而来,6209和6236两株病毒是由Ⅱ型和Ⅰ型脊灰病毒在2C区重组而来。4株病毒在5'非编码区nt481和VP1区的nt2 909两个强减毒位点都发生回复突变,6209和6236两株病毒重组的SabinⅠ的重要减毒位点nt6 203亦发生回复突变。结合神经毒力实验和序列分析结果可以确定脊灰病毒的型别间的重组与神经毒力没有直接关系,同时可以推论SabinⅢ的nt5 832,SabinⅡ的nt1 450和nt2 386这3个位点可能是毒力相关位点。     

福建省脊髓灰质炎疫苗转换前后AFP病例病原学监测结果分析

自2016年5月1日起,我国与全球另外154个国家和地区同步实施脊髓灰质炎(以下简称"脊灰")疫苗免疫策略转换,停用三价口服脊灰减毒活疫苗,改用二价口服脊灰减毒活疫苗.为探讨脊灰疫苗转换对福建省急性弛缓性麻痹(Acute flaccid paralysis,AFP)病例监测结果产生的变化,本研究收集2012-2018年福建省AFP病例的流行病学及实验室监测数据,对脊灰疫苗转换前后AFP病例的监测结果进行描述性分析,采集AFP病例及其接触者粪便标本,并使用RD细胞和L20B细胞进行病毒分离;对L20B阳性分离物进行脊灰病毒(Poliovirus,PV)的型内鉴别(Intratypic differentiation,ITD),对PV衣壳蛋白VP1编码区核苷酸序列测定和分析.使用SPSS 21.0软件对数据进行统计检验,比较采用X2检验.结果显示,2012-2018年福建省累计报告AFP病例1 776例,根据AFP病例分类流程确诊的AFP病例1 283例,排除的非AFP病例493例,疫苗转换前后报告发病率平均为2.83/10万和2.71/10万.实验室共检测3123份粪便标本(包括AFP病例、非AFP病例及接触者),其中合格标本采集率为92.42％,7日及时送检率为97.85％,14日内病毒分离完成率接近100％,疫苗转换前后PV平均分离率分别为1.91％(38/1986)、1.58％(18/1137),非脊灰肠道病毒平均分离率分别为10.22％(203/1 986)、5.45％(62/1 137).2016年5月1日之前分离出Ⅰ型PV6株,Ⅱ型PV 13株,Ⅲ型PV 19株;2016年5月1日之后分离出Ⅰ型PV 6株,Ⅲ型PV 12株.本研究结果提示,脊灰疫苗转换前后福建省AFP监测系统运转正常,始终保持较高的敏感性和及时性.2012-2018年福建省分离出的PV均为脊灰疫苗株,毒株血清型别以Ⅲ型为主,VP1编码区核苷酸以低变异为主,未发现疫苗衍生脊灰病毒及脊灰野病毒,疫苗转换后再未检出Ⅱ型PV,提示Ⅱ型脊灰疫苗株病毒可能已被阻断.     

云南省疫苗衍生脊髓灰质炎病毒全基因组序列遗传特征分析

为了解云南省疫苗衍生脊髓灰质炎病毒(Vaccine-derived Poliovirus,VDPV)的基因组特征,对2010年及2012年监测到的4株VDPV进行全基因组序列测定。结果显示,2株Ⅱ型VDPV的基因组全长均为7439nt,与Sabin Ⅱ疫苗株全基因组核苷酸和氨基酸的序列同源性分别为95.4%和97.7%;2株I型VDPV基因组全长均为7441nt,与Sabin I疫苗株全基因组核苷酸和氨基酸序列的同源性分别为93.9%和97.9%。减毒位点分析发现II型和I型VDPV毒株分别有两个(nt 481和nt 2909)和三个减毒位点(nt 480、nt 2795和nt 6203)发生了回复突变。VP1序列分析显示II型和I型VDPV毒株与相应Sabin株的变异分别为1%和2.3%,重组分析显示II型和I型VDPV的基因组结构分别为S2/S3和S1/S2/S1/S3,后者的重组次数高达3次,显示了重组的普遍性和复杂性,也表明了病毒在人体内复制和传播的持久性与重组的多样性成正相关。因此,从分子水平分析VDPV的特性,可掌握病毒的变异动态,为制定科学可行的VDPV控制策略提供理论依据。     

中国首例iVDPVs病例粪便标本中病毒血清型分布和Ⅲ型iVDPVs VP1区基因特征

分析中国首例免疫缺陷疫苗衍生脊髓灰质炎病毒(immunodeficient vaccine-derived polioviruses,iVDPVs)急性弛缓性麻痹(acute flaccid paralysis,AFP)病例(实验室编号为9230)12份便标本中病毒血清型分布和分离物中Ⅲ型VP1区的基因特征。31个省的疾病预防控制中心脊髓灰质炎(脊灰)实验室网络,在2005年采用细胞培养、病毒分离和微量中和试验从5231例AFP病例中的293例的便标本中分离到脊灰病毒,其中从1例编号为9230的AFP病例发病2~150天的12份便标本中分离到17株脊灰病毒株,包括Ⅱ型12株,Ⅲ型5株。用PCR-RFLP和ELISA两种方法对送检的293例AFP病例中分离的病毒进行型内鉴定,VP1区序列测定和分析发现:从9230号病例粪便标本中分离的12株Ⅱ型为混合不同变异数目的Ⅱ型iVDPVs,5株Ⅲ型病毒为单一Ⅲ型iVDPVs;除9230号病例外未发现其它iVDPVs或疫苗衍生脊灰病毒(vaccine-derived polioviruses,VDPVs)。5株Ⅲ型iVDPVs的VP1区基因和SabinⅢ相比有22~24个碱基突变,同源性为97.33%~97.56%,是中国至今发现变异最大的Ⅲ型VDPVs。9230号病例临床诊断为X-连锁低/无丙种球蛋白血症,是在中国首次发现的iVDPVs病例,该病例的病毒分离物中同时存在Ⅱ型和Ⅲ型iVDPVs,Ⅲ型iVDPVs在患者体内至少复制2.5年以上,iVDPVs病例的持续排毒已经给中国维持无脊灰状态提出了新的挑战。     

Ⅰ型脊髓灰质炎病毒壳蛋白肽图谱分析

脊髓灰质炎病毒三个血清型的野毒株与疫苗株的全基因序列业已测出,有学者比较发现,疫苗株病毒在减毒过程中有许多基因位点发生了突变。本文用单向肽图谱分析法,对Ⅰ型脊髓灰质炎病毒野毒株(Mahoney株)和减毒株(Sabin Ⅰ株)的外壳蛋白VP1,VP2,VP3分别作了比较分析。结果发现四个有差     

江西一例iVDPV病例Ⅲ型脊髓灰质炎病毒基因特征分析

分析江西一例免疫缺陷患者体内连续采集的15份粪便标本中分离到的Ⅲ型脊髓灰质炎病毒的全长VP1区基因特征。将从15份标本中分离到的14株Ⅲ型iVDPVs进行噬斑纯化,每个病毒随机挑取10个噬斑,接着进行逆转录‐聚合酶链反应扩增,测定获取到的154株iVDPVs全长VP1区序列。通过系统发育分析和BEAST程序探究iVDPV病毒的进化特征,估算其进化速率和口服脊灰减毒活疫苗(attenuated oral polio vaccine,OPV)初始感染时间。14株iVDPVs与Ⅲ型脊髓灰质炎减毒疫苗株(Sabin Ⅲ)核苷酸和氨基酸同源性分别为97.8%～98.7%和97.6%～98.3%。相较于Sabin Ⅲ,14株iVDPVs VP1区第54位氨基酸发生了A→V的突变,这可能导致温度敏感表型和衰减表型的改变。根据拓扑结构系统发育树被划分为3个Lineages,其中17049‐1‐8,17049‐2‐2和17049‐2‐9分别属于Lineage 1和Lineage 2,其余属于Lineage 3。具有Lineage 3序列特征的克隆是优势克隆,呈现出随时间持续分化的特征。BEAST程序估算...     

西安市1995-2008年检出脊髓灰质炎疫苗病毒的急性弛缓性麻痹病例流行病学分析

分析脊髓灰质炎(脊灰)病毒(PV)的急性弛缓性麻痹(AFP)病例流行病学特征,提高对疫苗衍生脊灰病毒(VDPVs)和循环的疫苗衍生脊灰病毒(cVDPVs)的认识,增加AFP病例监测系统敏感性。对西安市1995-2008年检出的PV阳性AFP病例进行流行病学分析。对疫苗变异PV采用VP1基因核苷酸序列测定方法进行分子生物性状分析。西安市1995-2008年共检出PV13株,检出率4.29%。分离到的PV以II、III型为主,AFP病例散在发生,无聚集性。未全程免疫儿童(全程免疫儿童,年龄以≤1岁儿童为主(84.62%)。麻痹残留率高达84.62%。脊灰相关病例(VAPP)的发生危险性为0.24/100万。型内特征鉴定有1株为疫苗变异PV,经VP1基因核苷酸序列测定未达到VDPV的分类标准。维持无脊灰阶段,存在着VDPV和发生cVDPVs的可能,在保持高水平脊髓灰质炎疫苗(OPV)免疫覆盖率的同时,高质量的AFP病例流行病学监测和病毒学监测工作,具有重要的现实意义。     

我国首iVDPV病例Ⅱ型脊髓灰质炎病毒分离株的基因特征

对分离于我国首例iVDPV病例的Ⅱ型脊髓灰质炎病毒分离株的基因特征进行了研究.随机选择CHN9230-F3-Ⅱ株为研究对象,将其VP1区RT-PCR产物连接到T载体上进行克隆,随机挑选45个阳性克隆进行序列测定后获得45条VP1区核苷酸序列,这45条序列的VP1基因与昆明Ⅱ型疫苗株VP1基因差异13～24个核苷酸,变异率为1.44%～2.66%.45条序列在同源进化树图上分为3组,但都来源于CHN9230-F3-Ⅱ株,组成以优势株为主的相关突变株的病毒群,是典型的居群样存在形式.经RT-PCR后直接进行序列测定,并根据序列图中优势峰判读结果得到的CHN9230-F3-Ⅱ株核苷酸序列位于序列数量最多的第2组中,然而没有任何一条序列与之完全相同,说明它可能并不能代表具体的某一种序列,而只能是代表主序列具有的一般特征.3个组中的核苷酸序列与Ⅱ型疫苗株相比平均变异率分别为97.50%、97.93%和98.31%,根据脊灰病毒的进化率和3个组VP1区核苷酸序列的变异率推测,患者共5次服脊灰减毒活疫苗(OPV)史中的前3次OPV中的Ⅱ型疫苗病毒存活下来,依照疫苗接种顺序,分别形成了第1组、第2组和第3组的病毒居群样存在形式.我国Ⅱ型iVDPV以复杂的居群样形式存在,由于其进化速率较快并且感染了免疫缺陷患者,使其在该患者体内形成了持续性感染,它已经并可能将在更长的时间内在患者体内持续存在,一旦将来我国停止使用OPV后,iVDPV病例长期持续向外环境中排毒将对我国"维持无脊灰"带来严峻的挑战.     

Characterization of a highly evolved vaccine-derived poliovirus type 3 isolated from sewage in Estonia

Two types of vaccine-derived polioviruses have been recently designated to emphasize the different origins of the evolved viruses: circulating vaccine-derived polioviruses (cVDPV) associated with outbreaks of paralytic disease and strains isolated from chronically infected immunodeficient individuals (iVDPV). We describe here a type 3 VDPV (PV3/EST/02/E252; later E252) isolated from sewage collected in Tallinn, Estonia, in October 2002. Due to aberrant properties in subtyping, the virus was subjected to detailed characterization. Partial genomic sequencing suggested that the closest relative was the oral vaccine strain PV3/Sabin, but the two virus strains shared only 86.7% of the 900 nucleotides (nt) coding for the capsid protein VP1. Phylogenetic analysis of the nearly complete genome [nt 19 to poly(A)] revealed multiple nucleotide substitutions throughout the genome and a possible Sabin 3/Sabin 1-recombination junction site in the 2C coding region. A calculation based on the estimated mutation frequency of the P1 region of polioviruses suggested that the E252 virus might have replicated in one or more individuals for approximately 10 years. No persons chronically excreting poliovirus are known in Estonia. Amino acid substitutions were seen in all known antigenic sites, which was consistent with the observed aberrant antigenic properties of the virus demonstrated by both monoclonal antibodies and human sera from vaccinated children. In spite of the apparent transmission potential, no evidence was obtained for circulation of the virus in the Estonian population.     

Sporadic Isolation of Sabin-Like Polioviruses and High-Level Detection of Non-Polio Enteroviruses during Sewage Surveillance in Seven Italian Cities,after Several Years of Inactivated Poliovirus Vaccination

Sewage surveillance in seven Italian cities between 2005 and 2008, after the introduction of inactivated poliovirus vaccination (IPV) in 2002, showed rare polioviruses, none that were wild-type or circulating vaccine-derived poliovirus (cVDPV), and many other enteroviruses among 1,392 samples analyzed. Two of five polioviruses (PV) detected were Sabin-like PV2 and three PV3, based on enzyme-linked immunosorbent assay (ELISA) and PCR results. Neurovirulence-related mutations were found in the 5′ noncoding region (5′NCR) of all strains and, for a PV2, also in VP1 region 143 (Ile > Thr). Intertypic recombination in the 3D region was detected in a second PV2 (Sabin 2/Sabin 1) and a PV3 (Sabin 3/Sabin 2). The low mutation rate in VP1 for all PVs suggests limited interhuman virus passages, consistent with efficient polio immunization in Italy. Nonetheless, these findings highlight the risk of wild or Sabin poliovirus reintroduction from abroad. Non-polio enteroviruses (NPEVs) were detected, 448 of which were coxsackievirus B (CVB) and 294 of which were echoviruses (Echo). Fifty-six NPEVs failing serological typing were characterized by sequencing the VP1 region (nucleotides [nt] 2628 to 2976). A total of 448 CVB and 294 Echo strains were identified; among those strains, CVB2, CVB5, and Echo 11 predominated. Environmental CVB5 and CVB2 strains from this study showed high sequence identity with GenBank global strains. The high similarity between environmental NPEVs and clinical strains from the same areas of Italy and the same periods indicates that environmental strains reflect the viruses circulating in the population and highlights the potential risk of inefficient wastewater treatments. This study confirmed that sewage surveillance can be more sensitive than acute flaccid paralysis (AFP) surveillance in monitoring silent poliovirus circulation in the population as well as the suitability of molecular approaches to enterovirus typing.     

Assessment of poliovirus eradication in Japan: genomic analysis of polioviruses isolated from river water and sewage in toyama prefecture

Seventy-eight poliovirus strains isolated from river water and sewage in Toyama Prefecture, Japan, during 1993 to 1995 were characterized by the PCR-restriction fragment length polymorphism (RFLP) method and by partially sequencing the VP3 and VP1 regions of the viral genome. Of these isolates, 36 were identified as Sabin vaccine strains, and 42 were identified as vaccine variant strains that had less than 1.4% nucleotide divergence from the Sabin strains, including 7 isolates with patterns different from those of Sabin strains as determined by PCR-RFLP analysis. These findings suggest that wild-type poliovirus was not circulating in Toyama Prefecture.     

Environmental Surveillance of Poliovirus in Sewage Water around the Introduction Period for Inactivated Polio Vaccine in Japan

Environmental virus surveillance was conducted at two independent sewage plants from urban and rural areas in the northern prefecture of the Kyushu district, Japan, to trace polioviruses (PVs) within communities. Consequently, 83 PVs were isolated over a 34-month period from April 2010 to January 2013. The frequency of PV isolation at the urban plant was 1.5 times higher than that at the rural plant. Molecular sequence analysis of the viral VP1 gene identified all three serotypes among the PV isolates, with the most prevalent serotype being type 2 (46%). Nearly all poliovirus isolates exhibited more than one nucleotide mutation from the Sabin vaccine strains. During this study, inactivated poliovirus vaccine (IPV) was introduced for routine immunization on 1 September 2012, replacing the live oral poliovirus vaccine (OPV). Interestingly, the frequency of PV isolation from sewage waters declined before OPV cessation at both sites. Our study highlights the importance of environmental surveillance for the detection of the excretion of PVs from an OPV-immunized population in a highly sensitive manner, during the OPV-to-IPV transition period.     

Assessment of Poliovirus Eradication in Japan: Genomic Analysis of Polioviruses Isolated from River Water and Sewage in Toyama Prefecture

Seventy-eight poliovirus strains isolated from river water and sewage in Toyama Prefecture, Japan, during 1993 to 1995 were characterized by the PCR-restriction fragment length polymorphism (RFLP) method and by partially sequencing the VP3 and VP1 regions of the viral genome. Of these isolates, 36 were identified as Sabin vaccine strains, and 42 were identified as vaccine variant strains that had less than 1.4% nucleotide divergence from the Sabin strains, including 7 isolates with patterns different from those of Sabin strains as determined by PCR-RFLP analysis. These findings suggest that wild-type poliovirus was not circulating in Toyama Prefecture.     

Molecular evolution of a type 1 wild-vaccine poliovirus recombinant during widespread circulation in China

Type 1 wild-vaccine recombinant polioviruses were isolated from poliomyelitis patients in China from 1991 to 1993. We compared the sequences of 34 recombinant isolates over the 1,353-nucleotide (nt) genomic interval (nt 2480 to 3832) encoding the major capsid protein, VP1, and the protease, 2A. All recombinants had a 367-nt block of sequence (nt 3271 to 3637) derived from the Sabin 1 oral poliovirus vaccine strain spanning the 3'-terminal sequences of VP1 (115 nt) and the 5' half of 2A (252 nt). The remaining VP1 sequences were closely (up to 99.5%) related to those of a major genotype of wild type 1 poliovirus endemic to China up to 1994. In contrast, the non-vaccine-derived sequences at the 3' half of 2A were more distantly related (<90% nucleotide sequence match) to those of other contemporary wild polioviruses from China. The vaccine-derived sequences of the earliest (April 1991) isolates completely matched those of Sabin 1. Later isolates diverged from the early isolates primarily by accumulation of synonymous base substitutions (at a rate of approximately 3.7 x 10(-2) substitutions per synonymous site per year) over the entire VP1-2A interval. Distinct evolutionary lineages were found in different Chinese provinces. From the combined epidemiologic and evolutionary analyses, we propose that the recombinant virus arose during mixed infection of a single individual in northern China in early 1991 and that its progeny spread by multiple independent chains of transmission into some of the most populous areas of China within a year of the initiating infection.     

Evolution of Type 2 Vaccine Derived Poliovirus Lineages. Evidence for Codon-Specific Positive Selection at Three Distinct Locations on Capsid Wall

Partial sequences of 110 type 2 poliovirus strains isolated from sewage in Slovakia in 2003–2005, and most probably originating from a single dose of oral poliovirus vaccine, were subjected to a detailed genetic analysis. Evolutionary patterns of these vaccine derived poliovirus strains (SVK-aVDPV2) were compared to those of type 1 and type 3 wild poliovirus (WPV) lineages considered to have a single seed strain origin, respectively. The 102 unique SVK-aVDPV VP1 sequences were monophyletic differing from that of the most likely parental poliovirus type 2/Sabin (PV2 Sabin) by 12.5–15.6%. Judging from this difference and from the rate of accumulation of synonymous transversions during the 22 month observation period, the relevant oral poliovirus vaccine dose had been administered to an unknown recipient more than 12 years earlier. The patterns of nucleotide substitution during the observation period differed from those found in the studied lineages of WPV1 or 3, including a lower transition/transversion (Ts/Tv) bias and strikingly lower Ts/Tv rate ratios at the 2^nd codon position for both purines and pyrimidines. A relatively low preference of transitions at the 2^nd codon position was also found in the large set of VP1 sequences of Nigerian circulating (c)VDPV2, as well as in the smaller sets from the Hispaniola cVDPV1 and Egypt cVDPV2 outbreaks, and among aVDPV1and aVDPV2 strains recently isolated from sewage in Finland. Codon-wise analysis of synonymous versus non-synonymous substitution rates in the VP1 sequences suggested that in five codons, those coding for amino acids at sites 24, 144, 147, 221 and 222, there may have been positive selection during the observation period. We conclude that pattern of poliovirus VP1 evolution in prolonged infection may differ from that found in WPV epidemics. Further studies on sufficiently large independent datasets are needed to confirm this suggestion and to reveal its potential significance.     

Characteristics of an Environmentally Monitored Prolonged Type 2 Vaccine Derived Poliovirus Shedding Episode that Stopped without Intervention

Vaccine derived poliovirus (VDPV) type 2 strains strongly divergent from the corresponding vaccine strain, Sabin 2, were repeatedly isolated from sewage in Slovakia over a period of 22 months in 2003–2005. Cell cultures of stool specimens from known immune deficient patients and from an identified putative source population of 500 people failed to identify the potential excretor(s) of the virus. The occurrence of VDPV in sewage stopped without any intervention. No paralytic cases were reported in Slovakia during the episode. According to a GenBank search and similarity plotting-analysis, the closest known relative of the first isolate PV2/03/SVK/E783 through all main sections of the genome was the type 2 poliovirus Sabin strain, with nucleotide identities in 5′UTR, P1, P2, P3, and 3′UTR parts of the genome of 88.6, 85.9, 87.3, 88.5, and 94.0 percent, respectively. Phenotypic properties of selected Slovakian aVDPV strains resembled those of VDPV strains isolated from immune deficient individuals with prolonged PV infection (iVDPV), including antigenic changes and moderate neurovirulence in the transgenic mouse model. One hundred and two unique VP1 coding sequences were determined from VDPV strains isolated from 34 sewage specimens. Nucleotide differences from Sabin 2 in the VP1 coding region ranged from 12.5 to 15.6 percent, and reached a maximum of 9.6 percent between the VDPV strains under study. Most of the nucleotide substitutions were synonymous but as many as 93 amino acid positions out of 301 in VP1 showed substitutions. We conclude that (1) individuals with prolonged poliovirus infection are not as rare as suggested by the studies on immune deficient patients known to the health care systems and (2) genetic divergence of VDPV strains may remain extensive during years long replication in humans.     

Serial recombination during circulation of type 1 wild-vaccine recombinant polioviruses in China

Type 1 wild-vaccine recombinant polioviruses sharing a 367-nucleotide (nt) block of Sabin 1-derived sequence spanning the VP1 and 2A genes circulated widely in China from 1991 to 1993. We surveyed the sequence relationships among 34 wild-vaccine recombinants by comparing six genomic intervals: the conserved 5'-untranslated region (5'-UTR) (nt 186 to 639), the hypervariable portion of the 5'-UTR (nt 640 to 742), the VP4 and partial VP2 genes (nt 743 to 1176), the VP1 gene (nt 2480 to 3385), the 2A gene (nt 3386 to 3832), and the partial 3D gene (nt 6011 to 6544). The 5'-UTR, capsid (VP4-VP2 and VP1), and 2A sequence intervals had similar phylogenies. By contrast, the partial 3D sequences could be distributed into five divergent genetic classes. Most (25 of 34) of the wild-vaccine recombinant isolates showed no evidence of additional recombination beyond the initial wild-Sabin recombination event. Eight isolates from 1992 to 1993, however, appear to be derived from three independent additional recombination events, and one 1993 isolate was derived from two consecutive events. Complete genomic sequences of a representative isolate for each 3D sequence class demonstrated that these exchanges had occurred in the 2B, 2C, and 3D genes. The 3D gene sequences were not closely related to those of the Sabin strains or 53 diverse contemporary wild poliovirus isolates from China, but all were related to the 3D genes of species C enteroviruses. The appearance within approximately 2.5 years of five recombinant classes derived from a single ancestral infection illustrates the rapid emergence of new recombinants among circulating wild polioviruses.