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Journal of Clinical Microbiology, May 2007, p. 1515-1522, Vol. 45, No. 5
0095-1137/07/$08.00+0 doi:10.1128/JCM.02189-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
Multiple Genotypes of Influenza B Viruses Cocirculated in Taiwan in 2004 and 2005
Guang-Wu Chen,1,2,5,
Shin-Ru Shih,1,3,4,5,
Mei-Ren Hsiao,3,4
Shih-Cheng Chang,1,3,4,5
Shu-Hung Lin,2
Chien-Fen Sun,3,4 and
Kuo-Chien Tsao1,3,4,5*
Research Center for Emerging Viral Infections,1
Department of Computer Science & Information Engineering,2
Department of Medical Biotechnology & Laboratory Science, Chang Gung University,3
Clinical Virology Laboratory, Department of Clinical Pathology,4
Chang Gung Memorial Hospital, Taoyuan, Taiwan5
Received 26 October 2006/
Returned for modification 18 December 2006/
Accepted 19 February 2007

ABSTRACT
An influenza B outbreak occurred in Taiwan in 2004 and 2005,
during which both Victoria (Vic) and Yamagata (Ya) lineages
cocirculated. This study examined 36 influenza B viral genomes
isolated during the outbreak to reveal their reassortment patterns.
According to the isolate groupings in phylogenetic analysis,
we were able to categorize those 36 isolates as being of either
the Victoria or Yamagata lineage for all eight influenza B virus
genomic segments, except for the NS gene, in which clades A
and B existed. Based on these groupings, three genome patterns
clearly emerged, namely, pattern I (Vic+Vic+Ya+Vic+Ya+Ya+Ya+A,
from segments 1 to 8), pattern II (Ya+Ya+Ya+Ya+Ya+Ya+Ya+B),
and pattern III (Ya+Ya+Ya+Ya+Ya+Ya+Ya+A). According to the timeline
of those isolates under investigation, it appears that pattern
I and II viruses could have generated pattern III via reassortment
of the NS gene. On the other hand, a genomewide comparison of
all six pattern III Taiwanese viruses with 37 international
influenza B viral genomes showed that two international strains,
B/Oslo/71/04 and B/England/23/04, were consistently clustered
with the pattern III viruses isolated in Taiwan in 2004 and
2005, suggesting that Taiwanese pattern III viruses might also
have been imported due to their matching genomic composition.

INTRODUCTION
Belonging to the
Orthomyxoviridae family, influenza B virus
contains a single-stranded, negative-sense, segmented genome.
The eight gene segments that code for 11 proteins are as follows:
segments 1, 2, and 3 code for the polymerase proteins PB2, PB1,
and PA; segment 4 codes for hemagglutinin (HA); segment 5 codes
for the nucleoprotein NP; segment 6 codes for the neuraminidase
(NA) and an integral membrane protein, NB; segment 7 codes for
the matrix protein M1 and another BM2 protein with unclear function;
and segment 8 codes for the nonstructural protein NS1 and a
nuclear export protein, NS2 (also called NEP) (
3). No antigenic
shift has ever been detected in influenza B viruses, and no
subtype divisions of surface antigens exist, as seen in influenza
A viruses. The evolution of influenza B viruses has long been
characterized by cocirculation of antigenically and genetically
distinct lineages for extended periods of time. Two lineages,
as defined by the phylogenetic relationship of the HA gene,
have diverged since 1983 (
2). One lineage, B/Victoria/2/87,
is known as the "Victoria lineage" (Vic87), whereas the other,
an antigenic variant B/Yamagata/16/88 strain that emerged in
1988, is known as the "Yamagata lineage" (Yam88) (
9). Each of
these two viruses achieves predominance at different times and
in different geographical regions, as indicated by recommendations
for inclusion in influenza vaccines (
10). Since 1991, viruses
of the Vic87 lineage have been infrequently isolated in Africa,
America, and Europe, but have continued to circulate in Asia
and have been the predominant influenza B virus in certain Asian
countries for years. The segmented genome of influenza viruses
allows genetic exchange to occur via a process called reassortment.
Reassortment occurs frequently among influenza B viruses and
likely allows unrestricted lineage mixing (
4). An influenza
B outbreak occurred in Taiwan during the 2004 and 2005 influenza
season, in which both Vic87 and Yam88 lineages cocirculated
(
12). In addition to analyzing 36 influenza B viral genomes
isolated during the outbreak to identify their reassortment
patterns, this study examines their genetic characteristics
when both Vic87 and Yam88 lineages were cocirculating.

MATERIALS AND METHODS
Specimen collection and transportation.
Clinical isolates from patients with symptoms of respiratory
tract infections, including coughing, sore throat, tonsillitis,
pharyngitis, pneumonia, and bronchiolitis, were obtained from
Chang Gung Memorial Hospital. Throat or nasopharyngeal swabs
were collected and placed in transport medium containing 2 ml
Eagle's minimum essential medium (pH 7.2) with gelatin (5 mg/liter),
penicillin (400 U/liter), streptomycin (400 µg/liter),
gentamicin (50 µg/liter), and amphotericin B (Fungizone)
(1.25 µg/liter). Specimens were placed on ice and transported
to the Clinical Virology Laboratory at Chang Gung Memorial Hospital
within 24 h after collection.
Virus isolation and identification.
Respiratory specimens were inoculated into Madin-Darby canine kidney cells. Influenza viruses were typed using an immunofluorescent assaywith type-specific monoclonal antibodies (Chemicon International, Inc., Temecula, CA).
RNA extraction and RT-PCR.
Viral RNA was extracted using a viral RNA extraction Miniprep system kit (Viogene, Sunnyvale, CA). Briefly, 300 µl culture medium was mixed with 700 µl RNA extraction virus buffer. After sitting at room temperature for 10 min, 700 µl 100% ethanol was added to the mixture. The whole mixture was then applied to the spin column, followed by addition of 650 µl washing solution buffer. The RNA was eluted in 50 µl RNA-free H2O, from which 6 µl RNA was used as the template. The Reverse iT one-step reverse transcription-PCR (RT-PCR) kit (Abgene, Epsom, Surrey, United Kingdom) was used with 25 µl reaction mixture under the following conditions: 0.5 µl of kit-supplied enzyme mixture, 1 µl of 10 µM of each primer, 12.5 µl of 2x RT-PCR master mix, and 6 µl RNA template. The following RT-PCR program was used for the PB2, HA, NP, M, and NS genes: 42°C for 1 h and 94°C for 4 min, followed by 40 cycles of 94°C for 30 s, 58°C for 30 s, and 72°C for 5 min, and with a final elongation step of 72°C for 10 min. The same RT-PCR conditions were used for NA and PA genes, except the annealing temperature was reduced to 55°C. Also, the same RT-PCR conditions were utilized for the PB1 gene, except the annealing temperature was decreased to 50°C. Final products were stored at 4°C and analyzed by gel electrophoresis on 1% agarose gel containing 2 µg/ml ethidium bromide. The DNA bands were visualized and photographed via UV transillumination. Table 1 lists the primer sets used for specific target gene amplification by RT-PCR.
Nucleotide sequence analysis.
The nucleotide sequence of the purified fragments was determined
using an automated ABI 3730 DNA sequencer (PE-Applied Biosystems,
Foster City, CA). Sequence assembly was performed using EditSeq
in Lasergene software, version 3.18 (DNASTAR, Madison, WI) (
1).
Pairwise sequence identities were computed by the NEEDLE program
in the EMBOSS software package (
8). Multiple sequence alignment
was conducted using Clustal W, version 1.83 (
11). Phylogenetic
analysis was performed using PHYLIP (
6,
7), version 3.63, with
a Kimura two-parameter distance matrix (program DNADIST) and
the neighbor-joining method (NEIGHBOR program). Support for
tree topology was determined via bootstrap analysis with 1,000
pseudoreplicate data sets generated using the SEQBOOT program
in PHYLIP. A consensus tree was obtained utilizing the CONSENSE
program in PHYLIP, and the topology was viewed with TreeView,
version 1.6.6 (
5). Partial nucleotide sequences under investigation
were as follows: PB2, 49 to 693; PB1, 121 to 1147; PA, 370 to
1117, HA, 238 to 945, NP, 796 to 1596; NA, 40 to 1398; M, 64
to 1059; and NS, 73 to 843, according to coding sequences of
B/Hong Kong/330/01.
Nucleotide sequence accession number.
The nucleotide sequence data reported in this work have been deposited in the GenBank nucleotide sequence database under accession no. EF041529 to EF041816.

RESULTS AND DISCUSSION
In total, 121 influenza B viruses were isolated in Clinical
Virology Laboratory during the outbreak of December 2004 to
April 2005, including 74 Victoria-like and 47 Yamagata-like
strains according to their HA nucleotide sequences. As both
lineages were cocirculating, the question arose as to whether
a genetic reassortment occurred during that outbreak. Partial
nucleotide sequences from all eight genomic segments of 20 randomly
selected Taiwanese isolates were obtained and analyzed during
the outbreak (December 2004 to April 2005). Furthermore, six
isolates that represent the first monthly isolate in the preceding
6 months (May 2004 to November 2004) were included in the analysis,
in addition to 10 isolates that represent the first monthly
isolate in the previous four influenza seasons (May 2000 to
February 2004). Phylogenetic analysis of eight gene segments
of those 36 Taiwanese isolates (listed in Table
2), together
with B/Lee/40 (used as an outgroup node for phylogenetic inference),
B/Victoria/2/87, and B/Yamagata/16/88, is shown in Fig.
1. According
to the grouping of isolates to either Victoria-like or Yamagata-like
clusters, the isolates were labeled "Vic" or "Ya" (Table
2).
For the NS gene, 36 Taiwanese isolates were grouped to neither
Victoria-like nor Yamagata-like clusters and were assigned to
clade A or B based on the tree topology (Fig.
1).
Table
2 presents the three patterns of genome composition that
clearly emerged. In the 2004 and 2005 winter outbreak (strains
labeled with * in Table
2), 11 of 20 isolates belonged to pattern
I (Vic+Vic+Ya+Vic+Ya+Ya+Ya+A, from segments 1 to 8), six belonged
to pattern II (Ya+Ya+Ya+Ya+Ya+Ya+Ya+B), and three belonged to
pattern III (Ya+Ya+Ya+Ya+Ya+Ya+Ya+A). In the six isolates from
the six months (June 2004 to November 2004) immediately preceding
the 2004 and 2005 outbreak, one isolate belonged to pattern
I, two belonged to pattern II, and three belonged to pattern
III. In the 10 isolates from the four previous influenza seasons
(2000 to 2004), 2 had pattern I in 2003 and 8 had pattern II;
no isolate had pattern III.
According to this analysis, pattern III viruses first appeared in the summer of 2004 (B/Taiwan/71024/04, B/Taiwan/71426/04, and B/Taiwan/71540/04) and continued to be active in the subsequent winter influenza outbreak (February and March 2005). The two major patterns (I and II) of influenza B viruses that were circulating in the 2004 and 2005 season originated in previous years. For example, pattern II viruses have been observed since mid-2000, and pattern I viruses emerged in early 2003. Thus, we speculate that pattern III viruses either likely originated from a local reassortment of pattern I and II viruses as early as the summer of 2004 or were imported from other countries. To test this hypothesis, we performed a genomewide comparison of the six Taiwanese pattern III viruses with 37 international influenza B viral genomes available from the Influenza Virus Resource of NCBI. Phylogenetic trees of each of the eight genomic segments were constructed (Fig. 2). Two international strains, B/Oslo/71/04 and B/England/23/04, were consistently clustered together with the six putative reassortants isolated in Taiwan in 2004 and 2005, suggesting that the Taiwanese reassortants may not have completely originated from a mixing of local Taiwanese strains.
In this study, we performed phylogenetic analysis of all eight
genomic segments of Taiwanese influenza B virus isolates from
2002 to 2005. Our results were consistent with the observations
of Tsai et al. (
12) that locally circulated influenza B virus
strains in 2005 were dominated by reassortants with the Victoria
lineage of hemagglutinin and the Yamagata lineage of neuraminidase.
We additionally analyzed Victoria and Yamagata lineage groupings
of the six internal genes and noted that only the NS genes could
be assigned to neither the Victoria nor Yamagata lineage. In
particular, the grouping of NS genes has crossed the boundary,
as depicted by the other seven genes (Table
2). Accordingly
we have labeled them clades A and B. Based on these groupings
of the eight influenza B segments, we have revealed three distinct
phylogenetic patterns for those Taiwanese strains under consideration,
namely patterns I, II, and III. From the timeline of these isolates,
it was speculated that pattern III viruses might have originated
from a local mixing of pattern I and II viruses. On the other
hand, we cannot completely rule out the possibility that pattern
III viruses might have been imported because, as shown in Fig.
2, all six Taiwanese pattern III viruses consistently cluster
together with B/Oslo/71/04 and B/England/23/04 and are well
separated from the rest of the other international reference
strains. The NS gene can encode NS1 and NS2 proteins, of which
NS1 protein is a multifunctional protein for influenza virus
replication. This would be important for further investigation
of the impact of observed NS genetic diversity on influenza
B virus infection.

ACKNOWLEDGMENTS
The authors thank Chang Gung Memorial Hospital (grants CMRPD250031,
CMRPG350331, and CMRPD150161) and the National Science Council
of the Republic of China, Taiwan (grants NSC94-2213-E-182-027
and NSC93-2317-B-182A-001) for financially supporting this research.

FOOTNOTES
* Corresponding author. Mailing address: Department Clinical Pathology, Chang Gung Memorial Hospital, no. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, 333 Taiwan. Phone: 886-3-3281200, ext. 2523. Fax: 886-3-2118174. E-mail:
kctsao{at}adm.cgmh.org.tw 
Published ahead of print on 28 February 2007. 
G.-W.C. and S.-R.S. contributed equally to this work. 

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Journal of Clinical Microbiology, May 2007, p. 1515-1522, Vol. 45, No. 5
0095-1137/07/$08.00+0 doi:10.1128/JCM.02189-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
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