{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:02:24Z","timestamp":1791396144118,"version":"4.3.3"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5R01AI168182-03"],"award-info":[{"award-number":["5R01AI168182-03"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015466","name":"Milken Institute School of Public Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015466","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007108","name":"George Washington University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated 283 healthy adults (108 in 2023\u20132024, 175 during the 2024\u20132025 influenza seasons) following intranasal LAIV administration. Nasal swabs were collected on post-LAIV days 1, 2\u20134, and 5\u20137 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 &amp;lt; .001) and higher shedding burden (4.2 vs 4.0 log10 RNA copies\/mL; P &amp;lt; .001). Three clearance profiles\u2014rapid (clearance \u22644 days), moderate (5\u20137 days), and slow (\u22657 days)\u2014were identified. Profiles were consistent across seasons but influenza B was disproportionately represented in slower-clearance groups (P &amp;lt; .001). Total viral burden (P &amp;lt; .01) and shedding duration (P = .01) were associated with total symptom burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag294","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:43:29Z","timestamp":1778067809000},"page":"e611-e618","source":"Crossref","is-referenced-by-count":0,"title":["Influenza A and B Viral Shedding in Adults Immunized With Live Attenuated Influenza Vaccine"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7452-298X","authenticated-orcid":false,"given":"Brandon M","family":"Tower","sequence":"first","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4537-173X","authenticated-orcid":false,"given":"Cindy M","family":"Liu","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2789-0512","authenticated-orcid":false,"given":"David J","family":"Diemert","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences, Department of Microbiology, Tropical Medicine and Immunology , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney G","family":"Nelson","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8347-3860","authenticated-orcid":false,"given":"Chelsea E","family":"Ware","sequence":"additional","affiliation":[{"name":"George Washington Vaccine Research Unit, George Washington Medical Faculty Associates, School of Medicine and Health Sciences, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan E","family":"Salazar","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Pham","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reed M","family":"Leventis","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0593-9140","authenticated-orcid":false,"given":"Katherine E","family":"Rose","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9715-0272","authenticated-orcid":false,"given":"Annie L S","family":"Roberts","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan O","family":"Weber","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward H","family":"Sung","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8347-5487","authenticated-orcid":false,"given":"Maliha","family":"Aziz","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8908-5853","authenticated-orcid":false,"given":"Ryan M","family":"Troyer","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University , London, ON ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-5397","authenticated-orcid":false,"given":"Daniel E","family":"Park","sequence":"additional","affiliation":[{"name":"Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2026100713435447100_ciag294-B1","volume-title":"Statpearls","author":"Kalarikkal","year":"2025"},{"key":"2026100713435447100_ciag294-B2","author":"Using Live"},{"key":"2026100713435447100_ciag294-B3","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1093\/infdis\/jir436","article-title":"Live and inactivated influenza vaccines induce similar humoral responses, but only live vaccines induce diverse T-cell responses in young children","volume":"204","author":"Hoft","year":"2011","journal-title":"J Infect Dis"},{"key":"2026100713435447100_ciag294-B4","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/21645515.2017.1377376","article-title":"Immune responses after live attenuated influenza vaccination","volume":"14","author":"Mohn","year":"2018","journal-title":"Hum Vaccin Immunother"},{"key":"2026100713435447100_ciag294-B5","first-page":"100666","article-title":"Comparative effectiveness of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) in children over multiple influenza seasons (2019\u20132023)","volume":"25","author":"Bandell","year":"2025","journal-title":"Vaccine: X"},{"key":"2026100713435447100_ciag294-B6","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-3279","article-title":"Seasonal effectiveness of live attenuated and inactivated influenza vaccine","volume":"137","author":"Chung","year":"2016","journal-title":"Pediatrics"},{"key":"2026100713435447100_ciag294-B7","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/j.1750-2659.2010.00183.x","article-title":"The relative efficacy of trivalent live attenuated and inactivated influenza vaccines in children and adults","volume":"5","author":"Ambrose","year":"2011","journal-title":"Influenza Other Respir Viruses"},{"key":"2026100713435447100_ciag294-B8","doi-asserted-by":"crossref","first-page":"e00414","DOI":"10.1128\/CVI.00414-16","article-title":"Comparisons of the humoral and cellular immune responses induced by live attenuated influenza vaccine and inactivated influenza vaccine in adults","volume":"24","author":"Hoft","year":"2017","journal-title":"Clin Vaccine Immunol"},{"key":"2026100713435447100_ciag294-B9","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1093\/cid\/ciz358","article-title":"Successes and failures of the live-attenuated influenza vaccine: can we do better?","volume":"70","author":"Matrajt","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026100713435447100_ciag294-B10","doi-asserted-by":"crossref","first-page":"8053","DOI":"10.1038\/s41467-023-43842-7","article-title":"Early mucosal events promote distinct mucosal and systemic antibody responses to live attenuated influenza vaccine","volume":"14","author":"Thwaites","year":"2023","journal-title":"Nat Commun"},{"key":"2026100713435447100_ciag294-B11","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1097\/00006454-200112000-00006","article-title":"Safety, vaccine virus shedding and immunogenicity of trivalent, cold-adapted, live attenuated influenza vaccine administered to human immunodeficiency virus-infected and noninfected children","volume":"20","author":"King","year":"2001","journal-title":"Pediatr Infect Dis J"},{"key":"2026100713435447100_ciag294-B12","doi-asserted-by":"crossref","first-page":"4322","DOI":"10.1016\/j.vaccine.2011.04.022","article-title":"Shedding of Ann Arbor strain live attenuated influenza vaccine virus in children 6\u201359 months of age","volume":"29","author":"Mallory","year":"2011","journal-title":"Vaccine"},{"key":"2026100713435447100_ciag294-B13","doi-asserted-by":"crossref","first-page":"4210","DOI":"10.1016\/j.vaccine.2008.05.054","article-title":"Shedding of live vaccine virus, comparative safety, and influenza-specific antibody responses after administration of live attenuated and inactivated trivalent influenza vaccines to HIV-infected children","volume":"26","author":"Levin","year":"2008","journal-title":"Vaccine"},{"key":"2026100713435447100_ciag294-B14","doi-asserted-by":"crossref","first-page":"ofw187","DOI":"10.1093\/ofid\/ofw187","article-title":"Influenza virus detection following administration of live-attenuated intranasal influenza vaccine in children with cystic fibrosis and their healthy siblings","volume":"3","author":"Boikos","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"2026100713435447100_ciag294-B15","doi-asserted-by":"crossref","DOI":"10.1111\/irv.13149","article-title":"Nasal shedding of vaccine viruses after immunization with a Russian-backbone live attenuated influenza vaccine in India","volume":"17","author":"Dar","year":"2023","journal-title":"Influenza Other Respir Viruses"},{"key":"2026100713435447100_ciag294-B16","doi-asserted-by":"crossref","first-page":"2505","DOI":"10.1093\/cid\/ciz719","article-title":"Viral shedding in recipients of live attenuated influenza vaccine in the 2016\u20132017 and 2017\u20132018 influenza seasons in the United Kingdom","volume":"70","author":"Jackson","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026100713435447100_ciag294-B17","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/cid\/ciy1003","article-title":"Immunogenicity and viral shedding of Russian-backbone, seasonal, trivalent, live, attenuated influenza vaccine in a phase II, randomized, placebo-controlled trial among preschool-aged children in urban Bangladesh","volume":"69","author":"Lewis","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2026100713435447100_ciag294-B18","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1093\/cid\/ciy1004","article-title":"The effect of preexisting immunity on virus detection and immune responses in a phase II, randomized trial of a Russian-backbone, live, attenuated influenza vaccine in Bangladeshi children","volume":"69","author":"Brickley","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2026100713435447100_ciag294-B19","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1086\/315246","article-title":"Comparison of the safety, vaccine virus shedding, and immunogenicity of influenza virus vaccine, trivalent, types A and B, live cold-adapted, administered to human immunodeficiency virus (HIV)-infected and non-HIV-infected adults","volume":"181","author":"King","year":"2000","journal-title":"J Infect Dis"},{"key":"2026100713435447100_ciag294-B20","doi-asserted-by":"crossref","first-page":"4940","DOI":"10.1016\/j.vaccine.2008.07.013","article-title":"Shedding and immunogenicity of live attenuated influenza vaccine virus in subjects 5\u201349 years of age","volume":"26","author":"Block","year":"2008","journal-title":"Vaccine"},{"key":"2026100713435447100_ciag294-B21","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1086\/502574","article-title":"Duration of virus shedding after trivalent intranasal live attenuated influenza vaccination in adults","volume":"26","author":"Talbot","year":"2005","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026100713435447100_ciag294-B22","volume-title":"Flumist\u00ae quadrivalent [package insert]","author":"MedImmune, LLC","year":"2023"},{"key":"2026100713435447100_ciag294-B23","volume-title":"Flumist\u00ae trivalent [package insert]","author":"MedImmune, LLC","year":"2025"},{"key":"2026100713435447100_ciag294-B24","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1007\/s11136-013-0561-z","article-title":"Item reduction of the Wisconsin upper respiratory symptom survey (WURSS-21) leads to the WURSS-11","volume":"23","author":"Obasi","year":"2014","journal-title":"Qual Life Res"},{"key":"2026100713435447100_ciag294-B25","doi-asserted-by":"crossref","first-page":"3073","DOI":"10.1128\/JCM.01209-08","article-title":"Comparative study of nasopharyngeal aspirate and nasal swab specimens for diagnosis of acute viral respiratory infection","volume":"46","author":"Sung","year":"2008","journal-title":"J Clin Microbiol"},{"key":"2026100713435447100_ciag294-B26","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/irv.12448","article-title":"Predictors of influenza a molecular viral shedding in Hutterite communities","volume":"11","author":"Wang","year":"2017","journal-title":"Influenza Other Respir Viruses"},{"key":"2026100713435447100_ciag294-B27","doi-asserted-by":"crossref","first-page":"ofaa494","DOI":"10.1093\/ofid\/ofaa494","article-title":"Associations between relative viral load at diagnosis and influenza A symptoms and recovery","volume":"7","author":"McKay","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2026100713435447100_ciag294-B28","doi-asserted-by":"crossref","first-page":"12853","DOI":"10.1038\/s41598-019-49273-z","article-title":"Epidemiological and clinical characteristics of children hospitalized due to influenza A and B in the south of Europe, 2010\u20132016","volume":"9","author":"Jan\u00e9","year":"2019","journal-title":"Sci Rep"},{"key":"2026100713435447100_ciag294-B29","doi-asserted-by":"crossref","first-page":"500","DOI":"10.15585\/mmwr.mm7432a2","article-title":"Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices\u2014United States, 2025\u201326 influenza season","volume":"74","author":"Grohskopf","year":"2025","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026100713435447100_ciag294-B30","doi-asserted-by":"crossref","first-page":"e02372","DOI":"10.1128\/mbio.02372-23","article-title":"Mucosal correlates of protection after influenza viral challenge of vaccinated and unvaccinated healthy volunteers","volume":"15","author":"Bean","year":"2024","journal-title":"mBio"},{"key":"2026100713435447100_ciag294-B31","doi-asserted-by":"crossref","first-page":"900","DOI":"10.3389\/fmicb.2017.00900","article-title":"Nasal IgA provides protection against human influenza challenge in volunteers with low Serum influenza antibody titre","volume":"8","author":"Gould","year":"2017","journal-title":"Front Microbiol"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag294\/68246846\/ciag294.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/3\/e611\/68246846\/ciag294.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/3\/e611\/68246846\/ciag294.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:44:00Z","timestamp":1791395040000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/83\/3\/e611\/8672548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,10,7]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag294","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9,15]]},"published":{"date-parts":[[2026,6,16]]}}}