A uracil-to-cytosine mutation at nucleotide position 472 of oral poliovirus vaccine type 3 (OPV3) contributes to the development of vaccine-associated paralytic poliomyelitis (VAPP). To analyze OPV3 shedding patterns, we previously used the multistep method of mutant analysis by PCR and enzyme cleavage (MAPREC). This involves conventional reverse transcription-PCR to detect OPV3, followed by a restriction digest to quantify position 472 reversion. Real-time PCR detects and quantifies nucleic acid as PCR occurs and avoids postreaction processing. The goal of this study was to compare a real-time PCR method to MAPREC. Seventy-three stool samples from Mexican OPV recipients underwent the reverse transcription-PCR step of MAPREC and real-time PCR. Real-time PCR identified 23% more OPV3-positive samples than conventional reverse transcription-PCR. When reversion was compared, the revertant proportion (RP), defined as the percentage of revertants in a sample, differed by <10% in 21/25 (84%) samples. The four samples differing by >10% were obtained within 5 days of OPV administration. The real-time PCR assay identified samples with an RP of >85% with 94% sensitivity and 86% specificity compared to MAPREC. The mean difference in RP between the two methods was 3.6% (95% confidence interval, ؊0.3 to 7.5%). Real-time PCR methods reliably detect OPV3, and reversion estimates correlate more consistently with MAPREC when OPV3 reversion rates are high. Detecting VAPP-related mutations by real-time PCR is rapid and efficient and can be useful in monitoring ongoing global polio eradication efforts.Vaccination using the trivalent, live attenuated oral poliomyelitis vaccine (OPV) led to the elimination of poliomyelitis in the United States and several regions of the world (15, 26). Specifically, OPV is transmitted by the fecal-oral route and by contact with pharyngeal secretions and thereby confers immunity to unvaccinated individuals (10). However, OPV strains also undergo mutations and recombination during replication in humans (13), with the attenuating OPV sequences often being selected against in the human intestinal tract (21). The transmission of these revertant strains leads to vaccine-associated paralytic poliomyelitis (VAPP) (2).Although many industrialized countries have adopted inactivated polio vaccine (IPV) into their immunization programs due to the risk of VAPP (7), several resource-poor nations cannot afford this policy change. Currently, the global VAPP burden is estimated to be 250 to 500 cases annually (14), with most cases occurring in resource-poor settings, and the risk of paralytic polio due to OPV will continue until as long as the oral vaccine is in use.Most cases of VAPP in the United States and in Latin America were due to serotype 3 (1, 7). A point mutation at position 472 of Sabin OPV3 within the 5Ј noncoding region and its internal ribosomal entry site is known to be an attenuating sequence for this serotype, and reversion of this nucleotide has been associated with VAPP (9). These back-mutations of ...