Blocking HTLV-1/2 silent transmission in Brazil: Current public health policies and proposal for additional strategies

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Abstract

Human T-cell lymphotropic viruses 1 and 2 (HTLV-1/2) are relatively common in Brazil but remain silent and neglected infections. HTLV-1 is associated with a range of diseases with high morbidity and mortality. There is no curative treatment for this lifelong infection, so measures to prevent transmission are essential. This narrative review discusses HTLV-1/2 transmission routes and measures to prevent its continuous dissemination. The public health policies that are currently implemented in Brazil to avoid HTLV-1/2 transmission are addressed, and further strategies are proposed.

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Epidemiological Aspects and World Distribution of HTLV-1 Infection

Antoine Gessain, Olivier Cassar, Jinyun Tang (2013)

The human T-cell leukemia virus type 1 (HTLV-1), identified as the first human oncogenic retrovirus 30 years ago, is not an ubiquitous virus. HTLV-1 is present throughout the world, with clusters of high endemicity located often nearby areas where the virus is nearly absent. The main HTLV-1 highly endemic regions are the Southwestern part of Japan, sub-Saharan Africa and South America, the Caribbean area, and foci in Middle East and Australo-Melanesia. The origin of this puzzling geographical or rather ethnic repartition is probably linked to a founder effect in some groups with the persistence of a high viral transmission rate. Despite different socio-economic and cultural environments, the HTLV-1 prevalence increases gradually with age, especially among women in all highly endemic areas. The three modes of HTLV-1 transmission are mother to child, sexual transmission, and transmission with contaminated blood products. Twenty years ago, de Thé and Bomford estimated the total number of HTLV-1 carriers to be 10–20 millions people. At that time, large regions had not been investigated, few population-based studies were available and the assays used for HTLV-1 serology were not enough specific. Despite the fact that there is still a lot of data lacking in large areas of the world and that most of the HTLV-1 studies concern only blood donors, pregnant women, or different selected patients or high-risk groups, we shall try based on the most recent data, to revisit the world distribution and the estimates of the number of HTLV-1 infected persons. Our best estimates range from 5–10 millions HTLV-1 infected individuals. However, these results were based on only approximately 1.5 billion of individuals originating from known HTLV-1 endemic areas with reliable available epidemiological data. Correct estimates in other highly populated regions, such as China, India, the Maghreb, and East Africa, is currently not possible, thus, the current number of HTLV-1 carriers is very probably much higher.

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Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies

Gill Schierhout, Skye McGregor, Antoine Gessain … (2019)

Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus that causes a lifelong infection. Several diseases, including an aggressive form of leukaemia, have been designated as associated with HTLV-1, whereby having HTLV-1 is a necessary condition for diagnosis. Beyond these diseases, there is uncertainty about other health effects of HTLV-1. We aimed to synthesise evidence from epidemiological studies on associations between health outcomes and HTLV-1.

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Establishment of the milk-borne transmission as a key factor for the peculiar endemicity of human T-lymphotropic virus type 1 (HTLV-1): the ATL Prevention Program Nagasaki

Shigeo Hino (2011)

In late 2010, the nation-wide screening of pregnant women for human T-lymphotropic virus type 1 (HTLV-1) infection was implemented in Japan to prevent milk-borne transmission of HTLV-1. In the late 1970s, recognition of the adult T-cell leukemia (ATL) cluster in Kyushu, Japan, led to the discovery of the first human retrovirus, HTLV-1. In 1980, we started to investigate mother-to-child transmission (MTCT) for explaining the peculiar endemicity of HTLV-1. Retrospective and prospective epidemiological data revealed the MTCT rate at ∼20%. Cell-mediated transmission of HTLV-1 without prenatal infection suggested a possibility of milk-borne transmission. Common marmosets were successfully infected by oral inoculation of HTLV-1 harboring cells. A prefecture-wide intervention study to refrain from breast-feeding by carrier mothers, the ATL Prevention Program Nagasaki, was commenced in July 1987. It revealed a marked reduction of HTLV-1 MTCT by complete bottle-feeding from 20.3% to 2.5%, and a significantly higher risk of short-term breast-feeding (<6 months) than bottle-feeding (7.4% vs. 2.5%, P < 0.001).

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Author and article information

Contributors

Ran Wang: Role: Editor

Journal

Journal ID (nlm-ta): PLoS Negl Trop Dis

Journal ID (iso-abbrev): PLoS Negl Trop Dis

Journal ID (publisher-id): plos

Title: PLoS Neglected Tropical Diseases

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Print): 1935-2727

ISSN (Electronic): 1935-2735

Publication date (Electronic): 23 September 2021

Publication date Collection: September 2021

Volume: 15

Issue: 9

Electronic Location Identifier: e0009717

Affiliations

[1 ] Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom

[2 ] Departamento Materno-Infantil, Faculdade de Ciências Médicas, Universidade de Pernambuco, Pernambuco, Brazil

[3 ] Centro Integrativo e Muldisciplinar de Atendimento ao Portador de HTLV (CHTLV), Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil

[4 ] Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil

[5 ] Programa de Pós-Graduação em Doenças Infecciosas, Universidade Federal do Espírito Santo, Espírito Santo, Brazil

[6 ] Laboratório de Pesquisa em HTLV, Centro de Imunologia, Instituto Adolfo Lutz, São Paulo, Brazil

[7 ] Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Pará, Brazil

Beijing Children’s Hospital, Capital Medical University, CHINA

Author notes

The authors have declared that no competing interests exist.

* E-mail: c.rosadas@ 123456imperial.ac.uk (CR); rishak@ 123456ufpa.br (RI)

Author information

Carolina Rosadas https://orcid.org/0000-0002-3922-5667

Maria Luiza B. Menezes https://orcid.org/0000-0001-7001-2005

Bernardo Galvão-Castro https://orcid.org/0000-0002-0644-6471

Tatiane Assone https://orcid.org/0000-0003-0993-4523

Angélica E. Miranda https://orcid.org/0000-0002-5556-8379

Mayra G. Aragón https://orcid.org/0000-0001-6631-1790

Adele Caterino-de-Araujo https://orcid.org/0000-0003-0155-6580

Graham P. Taylor https://orcid.org/0000-0002-3773-2390

Article

Publisher ID: PNTD-D-21-00432

DOI: 10.1371/journal.pntd.0009717

PMC ID: 8460035

PubMed ID: 34555019

SO-VID: 1fb21b47-558f-40a1-a72b-0dcec9b80ab0

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Page count

Figures: 1, Tables: 1, Pages: 14

Funding

Funded by: FAPESP

Award ID: 2016/03025-2

Award Recipient :

ORCID: https://orcid.org/0000-0003-0993-4523

Tatiane Assone

Funded by: FIOTEC

Award Recipient :

ORCID: https://orcid.org/0000-0001-6631-1790

Mayra G. Aragón

Funded by: Imperial NIHR Biomedical Research Centre

Award Recipient :

ORCID: https://orcid.org/0000-0002-3773-2390

Graham P. Taylor

Funded by: CNPq

Award ID: PQ Grant #312979/2018-5

Award Recipient : Ricardo Ishak

The authors received no specific funding for this work. TA is supported by FAPESP 2016/03025-2, MA by FIOTEC, GPT by Imperial NIHR Biomedical Research Centre and RI by CNPq PQ Grant #312979/2018-5. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Blocking HTLV-1/2 silent transmission in Brazil: Current public health policies and proposal for additional strategies

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European Respiratory Society: COVID-19

Most cited references 69

Epidemiological Aspects and World Distribution of HTLV-1 Infection

Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies

Establishment of the milk-borne transmission as a key factor for the peculiar endemicity of human T-lymphotropic virus type 1 (HTLV-1): the ATL Prevention Program Nagasaki

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