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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\u2032 noncoding region (5\u2032NCR) of all strains and, for a PV2, also in VP1 region 143 (Ile &gt; 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.<\/jats:p>","DOI":"10.1128\/aem.00108-14","type":"journal-article","created":{"date-parts":[[2014,5,10]],"date-time":"2014-05-10T02:27:14Z","timestamp":1399688834000},"page":"4491-4501","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":24,"title":["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"],"prefix":"10.1128","volume":"80","author":[{"given":"A.","family":"Battistone","sequence":"first","affiliation":[{"name":"National Center for Immunobiologicals Research and Evaluation (CRIVIB), Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Buttinelli","sequence":"additional","affiliation":[{"name":"National Center for Immunobiologicals Research and Evaluation (CRIVIB), Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Fiore","sequence":"additional","affiliation":[{"name":"National Center for Immunobiologicals Research and Evaluation (CRIVIB), Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Amato","sequence":"additional","affiliation":[{"name":"National Center for Immunobiologicals Research and Evaluation (CRIVIB), Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Bonomo","sequence":"additional","affiliation":[{"name":"National Center for Immunobiologicals Research and Evaluation (CRIVIB), Istituto Superiore di Sanit\u00e0, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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