Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
Influenza A and B Viral Shedding in Adults Immunized With Live Attenuated Influenza Vaccine.
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Tower Brandon M, Liu Cindy M, Diemert David J, Nelson Sydney G, Ware Chelsea E, Salazar Juan E, Pham Tony, Leventis Reed M, Rose Katherine E, Roberts Annie L S, Weber Nathan O, Sung Edward H, Aziz Maliha, Troyer Ryan M, Park Daniel E
Аннотация
BACKGROUND: Live attenuated influenza vaccine (LAIV) induces mucosal immunity through limited viral replication in the upper respiratory tract, but postvaccination viral shedding dynamics and their clinical correlates remain incompletely characterized.
METHODS: We evaluated 283 healthy adults (108 in 2023-2024, 175 during the 2024-2025 influenza seasons) following intranasal LAIV administration. Nasal swabs were collected on post-LAIV days 1, 2-4, and 5-7 to quantify influenza A and B RNA by RT-PCR. Viral detection, shedding duration and burden, clearance kinetics, and probability of detection were compared across seasons, vaccine strain compositions (quadrivalent vs trivalent), and host factors. Respiratory symptoms were assessed.
RESULTS: Early viral shedding was frequent: influenza A or B RNA was detected in 86.9% of participants on day 1, with codetection in 52.7%. Probability of detection declined from 92% on day 1% to 9% on day 7. Influenza B had longer shedding duration (median, 2.0 vs 1.0 days; P < .001) and higher shedding burden (4.2 vs 4.0 log10 RNA copies/mL; P < .001). Three clearance profiles-rapid (clearance ≤4 days), moderate (5-7 days), and slow (≥7 days)-were identified. Profiles were consistent across seasons but influenza B was disproportionately represented in slower-clearance groups (P < .001). Total viral burden (P < .01) and shedding duration (P = .01) were associated with total symptom burden.
CONCLUSIONS: LAIV replication begins within 24 h and declines over the first week, with persistent shedding uncommon after day 7. Influenza B replicates more extensively and persists longer than influenza A. Symptom burden correlates with shedding duration and viral burden.
METHODS: We evaluated 283 healthy adults (108 in 2023-2024, 175 during the 2024-2025 influenza seasons) following intranasal LAIV administration. Nasal swabs were collected on post-LAIV days 1, 2-4, and 5-7 to quantify influenza A and B RNA by RT-PCR. Viral detection, shedding duration and burden, clearance kinetics, and probability of detection were compared across seasons, vaccine strain compositions (quadrivalent vs trivalent), and host factors. Respiratory symptoms were assessed.
RESULTS: Early viral shedding was frequent: influenza A or B RNA was detected in 86.9% of participants on day 1, with codetection in 52.7%. Probability of detection declined from 92% on day 1% to 9% on day 7. Influenza B had longer shedding duration (median, 2.0 vs 1.0 days; P < .001) and higher shedding burden (4.2 vs 4.0 log10 RNA copies/mL; P < .001). Three clearance profiles-rapid (clearance ≤4 days), moderate (5-7 days), and slow (≥7 days)-were identified. Profiles were consistent across seasons but influenza B was disproportionately represented in slower-clearance groups (P < .001). Total viral burden (P < .01) and shedding duration (P = .01) were associated with total symptom burden.
CONCLUSIONS: LAIV replication begins within 24 h and declines over the first week, with persistent shedding uncommon after day 7. Influenza B replicates more extensively and persists longer than influenza A. Symptom burden correlates with shedding duration and viral burden.