“…These studies characterized mutations conferring attenuation of neurovirulence and/or increased temperature sensitivity, which correlates with attenuation, throughout the genome (e.g., nt 21 (5 -UTR), 189 (5 -UTR), 480 (5 -UTR), 935 (VP4-65), 2438 (VP3-225), 2795 (VP1-106), 2879 (VP1-134), 6203 (3D-73), 7441 (3 -UTR)) and identified the mutation at nt position 480 as one of the most critical, although the degree to which each potential attenuating mutation influences neurovirulence remains unclear. (77,81,82,97,111) Several studies show that some of the attenuating mutations of OPV1 revert in primary vaccine recipients over the period of excretion, although reversion at nt position 480, which can occur by direct reversion or by a compensating substitution at nt position 525, varies with respect to the proportion of primary vaccine recipients and time in different studies. (18,79,112) The virus strains isolated from type 1 VAPP cases also show the reversion of several attenuating mutations, most notably at nt position 480.…”