# Stunting Increases Influenza Virus Shedding Duration in Preschool/School-Aged Children

## TL;DR

Stunted children aged 3–9 years shed influenza viruses for longer periods compared to nonstunted children, particularly for influenza B.

## Contribution

This study identifies stunting as a novel predictor of prolonged influenza virus shedding in children.

## Key findings

- Stunted children shed influenza viruses longer than nonstunted children.
- The association is strongest for influenza B viruses.
- Stunted children show slower clearance of influenza B viruses.

## Abstract

The role of undernutrition on influenza virus shedding is unclear. We assessed stunting, an indicator of chronic undernutrition, as a predictor of shedding duration in children in the Household Influenza Cohort Study, in Managua, Nicaragua. Stunted children, aged 3–9 years, shed influenza longer than their nonstunted peers. In sub-group analysis, associations were driven by H3N2 and influenza B (IB) infections. Analysis of cycle threshold (Ct) values showed slower clearance of IB viruses in stunted children. These findings suggest undernutrition may prolong influenza shedding, with implications for transmission dynamics and control strategies in low- and middle-income countries where stunting remains prevalent.

Preschool/school-aged children with stunting shed influenza virus longer than their nonstunted counterparts. This association was strongest for influenza B viruses and may be driven by slower clearance of these viruses in children with stunting.