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This study delved into the effect of the genetic evolution of complete PV genomes, from MHC class II\u2010deficient patients, on the excretion duration and clinical outcomes. Stool samples from three PID patients underwent analysis for PV detection through inoculation on cell culture and real\u2010time PCR, followed by VP1 partial sequencing and full genome sequencing using the Illumina technology. Our findings revealed a low number of mutations for one patient who cleared the virus, while two exhibited a high intra\u2010host diversity favoring the establishment of severe outcomes. Neurovirulence\u2010reverse mutations were detected in two patients, possibly leading to paralysis development. Furthermore, a recombination event, between type 3 Vaccine\u2010Derived Poliovirus and Sabin\u2010like1 (VDPV3\/SL1), occurred in one patient. Our findings have suggested an association between intra\u2010host diversity, recombination, prolonged excretion of the virus, and emergence of highly pathogenic strains. Further studies on intra\u2010host diversity are crucial for a better understanding of the virus evolution as well as for the success of the Global Polio Eradication Initiative.<\/jats:p>","DOI":"10.1002\/jmv.29918","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T07:40:07Z","timestamp":1727077207000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Reversion of neurovirulent mutations, recombination and high intra\u2010host diversity in vaccine\u2010derived poliovirus excreted by patients with primary immune deficiency"],"prefix":"10.1002","volume":"96","author":[{"given":"Imene","family":"Ben Salem","sequence":"first","affiliation":[{"name":"Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis University of Tunis El Manar Tunis Tunisia"},{"name":"Laboratory of Virus, Hosts and Vectors 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