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Rosadas C, Costa M, Senna K, Santos M, Taylor GP. Impact and economic analysis of human T-cell lymphotropic virus type 1 (HTLV-1)-targeted antenatal screening, England and Wales, 2021. Euro Surveill 2024; 29:2300537. [PMID: 38818747 PMCID: PMC11141129 DOI: 10.2807/1560-7917.es.2024.29.22.2300537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/17/2024] [Indexed: 06/01/2024] Open
Abstract
BackgroundHuman T-cell lymphotropic virus type 1 (HTLV-1) is a neglected virus that can cause severe disease and be transmitted from mother to child through breastfeeding. Avoidance of breastfeeding prevents 80% of vertical transmission. The United Kingdom (UK) is currently assessing whether HTLV-1-targeted antenatal screening should be implemented.AimWe aimed to assess the impact and cost-effectiveness of a targeted programme to prevent HTLV-1 vertical transmission in England and Wales.MethodsWe estimated the number of pregnant women who have high risk of HTLV-1 infection based on their or their partner's country of birth. With data from 2021, we used a mathematical model to assess cost-effectiveness of HTLV-1 antenatal screening. We also estimated the annual number of infant infections and the number that could be prevented with screening and intervention.ResultsWe estimate that ca 99,000 pregnant women in England and Wales have high risk of HTLV-1 infection. In the absence of screening, 74 (range: 25-211) HTLV-1 infections in infants would be expected to occur every year in England and Wales. Implementation of targeted screening would prevent 58 (range: 19-164) infant infections annually. The intervention is effective (incremental 0.00333 quality-adjusted life years (QALY)) and cost-saving (GBP -57.56 (EUR -66.85)).ConclusionOur findings support implementation of HTLV-1 targeted antenatal screening to reduce vertical transmission from mothers to infants in the UK.
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Affiliation(s)
- Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Milene Costa
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Kátia Senna
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Marisa Santos
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Graham P Taylor
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
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Soriano V, de Mendoza C. Screening for HTLV-1 infection should be expanded in Europe. Int J Infect Dis 2024; 140:99-101. [PMID: 38307379 DOI: 10.1016/j.ijid.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) infection is spreading globally at an uncertain speed. Sexual, mother-to-child, and parenteral exposure are the major transmission routes. Neither vaccines nor antivirals have been developed to confront HTLV-1, despite infecting over 10 million people globally and causing life-threatening illnesses in 10% of carriers. It is time to place this long-neglected disease firmly into the 2030 elimination agenda. Current evidence supports once-in-life testing for HTLV-1, as recommended for HIV, hepatitis B and C, along with targeted screening of pregnant women, blood donors, and people who attended clinics for sexually transmitted infections (STIs). Similar targeted screening strategies are already being performed for Chagas disease in some Western countries in persons from Latin America. Given the high risk of rapid-onset HTLV-1-associated myelopathy, universal screening of solid organ donors is warranted. To minimize organ wastage, however, the specificity of HTLV screening tests must be improved. HTLV screening of organ donors in Europe has become mandatory in Spain and the United Kingdom. The advent of HTLV point-of-care kits would facilitate testing. Finally, increasing awareness of HTLV-1 will help those living with HTLV-1 to be tested, clinically monitored, and informed about transmission-preventive measures.
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Affiliation(s)
- Vicente Soriano
- Helath Sciences School & Medical Center, Inernational University of La Rioja (UNIR), Madrid, Spain.
| | - Carmen de Mendoza
- Department of Internal Medicine, Puerta de Hierro University Hospital, Madrid, Spain
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Encinas B, Benito R, Rojo S, Reina G, Montiel N, Aguilera A, Eiros JM, García-Costa J, Ortega D, Arco I, Hernánez-Batancor A, Soriano V, de Mendoza C. Human T-lymphotropic virus-1 infection among Latin American pregnant women living in Spain. IJID REGIONS 2024; 10:146-149. [PMID: 38304758 PMCID: PMC10831283 DOI: 10.1016/j.ijregi.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
Objectives Human T-lymphotropic virus (HTLV) antenatal screening is not mandatory in Spain. Surveys conducted decades ago reported HTLV-1 seroprevalence rates of 0.2% among foreign pregnant women in Spain. The migrant flow to Spain from HTLV-1 endemic regions in Latin America and sub-Saharan Africa has increased during the last decade. Currently, 25% of pregnant women in Spain are foreigners. Methods From January 2021 to October 2023 a cross-sectional study was carried out in all consecutive pregnant women attended at eleven Spanish clinics. A commercial enzyme immunoassay (EIA) was used for screening of serum HTLV-1/2 antibodies. Reactive samples were confirmed by immunoblot. Results A total of 9813 pregnant women with a median age of 34 years-old were examined. Native Spaniards were 6977 (76.5%). Of 2147 foreigners (23.5%), 903566 (9.9%) were Latin Americans, 416 (4.5%) North Africans, 293 (3.2%) from Romania, and 196 (2.1%) from sub-Saharan Africa. A total of 47 samples were EIA reactive but only five were confirmed as HTLV-1 positive using immunoblot. Infected women came from Paraguay, Colombia, the Dominican Republic, Venezuela and Peru. All but one were primigravida, with ages ranging from 20 to 33 years-old. One was HIV-1 positive, and another was infected with Chlamydia trachomatis. Conclusion The overall seroprevalence for HTLV-1 among pregnant women in Spain is 0.05% but rises ten-fold (0.55%) among Latin Americans. This rate is higher than in surveys conducted decades ago. Our results support that anti-HTLV testing should be part of antenatal screening in Spain in pregnant women coming from Latin America, as it is already done with Chagas disease.
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Affiliation(s)
- Begoña Encinas
- Gynecology & Obstetrics Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Rafael Benito
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Silvia Rojo
- Microbiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Gabriel Reina
- Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Natalia Montiel
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Antonio Aguilera
- Microbiology Department, University of Santiago, Santiago de Compostela, Spain
| | - José María Eiros
- Microbiology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - Juan García-Costa
- Microbiology Department, Complejo Hospitalario de Ourense, Ourense, Spain
| | - Diego Ortega
- Microbiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Irene Arco
- Microbiology Department, General University Hospital of Alicante, Pintor Baeza, Alicante, Spain
| | - Araceli Hernánez-Batancor
- Microbioligy Department, Hospital insular Unidad De Traslados, Avenida Maritima del Sur, Las Palmas de Gran Canaria, Spain
| | - Vicente Soriano
- International University of La Rioja (UNIR) Health Sciences School & Medical Center, Madrid, Spain
| | - Carmen de Mendoza
- Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
| | - Spanish HTLV Network
- Gynecology & Obstetrics Department, Puerta de Hierro University Hospital, Madrid, Spain
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Microbiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Microbiology Department, University of Santiago, Santiago de Compostela, Spain
- Microbiology Department, Rio Hortega University Hospital, Valladolid, Spain
- Microbiology Department, Complejo Hospitalario de Ourense, Ourense, Spain
- Microbiology Department, Hospital Miguel Servet, Zaragoza, Spain
- Microbiology Department, General University Hospital of Alicante, Pintor Baeza, Alicante, Spain
- Microbioligy Department, Hospital insular Unidad De Traslados, Avenida Maritima del Sur, Las Palmas de Gran Canaria, Spain
- International University of La Rioja (UNIR) Health Sciences School & Medical Center, Madrid, Spain
- Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
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Ramesh N, Cockbain B, Taylor GP, Rosadas C. How do socioeconomic determinants of health affect the likelihood of living with HTLV-1 globally? A systematic review with meta-analysis. Front Public Health 2024; 12:1298308. [PMID: 38327581 PMCID: PMC10848500 DOI: 10.3389/fpubh.2024.1298308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Human T Lymphotropic Virus type 1 (HTLV-1) is a neglected retrovirus associated with many clinical disorders, most notably Adult T-cell Leukemia/Lymphoma and HTLV-1-Associated Myelopathy (HAM). Found in endemic clusters across the world, high prevalence has been reported in minoritized groups who suffer from health inequities. This study investigates the association between HTLV-1 prevalence and the following socioeconomic determinants of health: education, income, and employment, which are markers of health inequity. Methods A systematic review was conducted by searching the following databases: Ovid/Medline, Embase, Global Health Database, Web of Science, LILACS and SciELO. Primary studies in English, Spanish and Portuguese mentioning HTLV-1 and one of education, income and/or employment were included. A random-effects meta-analysis was performed, and odds ratios (OR) were calculated to determine the association between these socioeconomic determinants of health and HTLV-1 prevalence. Results 42 studies were included. The likelihood of having HTLV-1 was higher in individuals with less than completed primary education compared to those who completed primary education (OR 1.86 [95% CI 1.34-2.57]; p < 0.01). This may be because individuals with low education have reduced access to and understanding of health information, thus increasing the prevalence of risk factors associated with HTLV-1 infection. No other determinants were found to be statistically significant. Conclusion Fewer years of schooling are associated with increased likelihood of contracting HTLV-1. Therefore, health promotion materials and public health policies regarding HTLV-1 must consider those with lower educational levels to effectively reduce disease transmission. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335004, identifier (CRD42022335004).
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Affiliation(s)
- Nydile Ramesh
- School of Public Health, Imperial College London, London, United Kingdom
| | - Beatrice Cockbain
- Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
- National Centre for Human Retrovirology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
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Ayerdi O, Benito R, Ortega D, Aguilera A, Montiel N, Pintos I, Díaz de Santiago A, Baza B, Soriano V, de Mendoza C. HTLV infection in persons with sexually transmitted diseases in Spain. Front Immunol 2023; 14:1277793. [PMID: 38143748 PMCID: PMC10740202 DOI: 10.3389/fimmu.2023.1277793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background HTLV-1 infection is a neglected disease, despite estimates of 10 million people infected worldwide and producing life-threatening illnesses in 10% of carriers. Sexual transmission is the main route of contagion. However, HTLV-1 is not listed among sexually transmitted infections (STIs). Methods Serum from all consecutive individuals who had attended six STI clinics across Spain during the last 12 months were tested for HTLV antibodies using a commercial enzyme immunoassay (EIA). Reactive samples were confirmed by immunoblot. Results A total of 2,524 samples were examined. The majority (1,936; 76.7%) belonged to men, of whom 676 (34.9%) were men who have sex with men (MSM) receiving HIV pre-exposure prophylaxis. Although native Spaniards predominated (1,470; 58.2%), up to 593 (23.5%) came from Latin America and 139 (5.5%) were African. A total of 26 individuals were initially EIA reactive and immunoblot confirmed 5 as HTLV-1 and 7 as HTLV-2. All but one HTLV-1+ case came from Latin America. Three were men and two were women. Among Latin Americans, the HTLV-1 seroprevalence was 0.67%. In contrast, all seven HTLV-2+ were native Spaniards and former injection drug users, and all but one were HIV+. Conclusion The rate of HTLV infection among individuals with STIs in Spain is 0.5%, which is greater than in the general population. These results support the introduction of universal HTLV screening in persons who attend clinics for STIs.
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Affiliation(s)
- Oskar Ayerdi
- Sexually transmitted Infections Clinic, Centro Sanitario Sandoval, Madrid, Spain
| | - Rafael Benito
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Diego Ortega
- Microbiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Antonio Aguilera
- Microbiology Department, University of Santiago, Santiago de Compostela, Spain
| | - Natalia Montiel
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ilduara Pintos
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
| | - Alberto Díaz de Santiago
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
| | - Begoña Baza
- Sexually transmitted Infections Clinic, Centro Sanitario Sandoval, Madrid, Spain
| | - Vicente Soriano
- Public Health Unit, UNIR Health Sciences School and Medical Center, Madrid, Spain
| | - Carmen de Mendoza
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
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