1887
Research Open Access
Like 0

Abstract

Background

Human 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.

Aim

We aimed to assess the impact and cost-effectiveness of a targeted programme to prevent HTLV-1 vertical transmission in England and Wales.

Methods

We 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.

Results

We 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)).

Conclusion

Our findings support implementation of HTLV-1 targeted antenatal screening to reduce vertical transmission from mothers to infants in the UK.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.22.2300537
2024-05-30
2024-12-21
/content/10.2807/1560-7917.ES.2024.29.22.2300537
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/22/eurosurv-29-22_3.html?itemId=/content/10.2807/1560-7917.ES.2024.29.22.2300537&mimeType=html&fmt=ahah

References

  1. National Health Service (NHS). Screening tests in pregnancy. London: NHS; 2023. Available from: https://www.nhs.uk/pregnancy/your-pregnancy-care/screening-tests
  2. National Screening Committee. Screening programmes across the UK. London: gov.uk; 2021. Available from: https://www.gov.uk/guidance/screening-programmes-across-the-uk
  3. Schierhout G, McGregor S, Gessain A, Einsiedel L, Martinello M, Kaldor J. Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies. Lancet Infect Dis. 2020;20(1):133-43.  https://doi.org/10.1016/S1473-3099(19)30402-5  PMID: 31648940 
  4. Imaizumi Y, Iwanaga M, Nosaka K, Ishitsuka K, Ishizawa K, Ito S, et al. Prognosis of patients with adult T-cell leukemia/lymphoma in Japan: A nationwide hospital-based study. Cancer Sci. 2020;111(12):4567-80.  https://doi.org/10.1111/cas.14658  PMID: 32976684 
  5. World Health Organization (WHO). Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240053779
  6. World Health Organization (WHO). Human T-lymphotropic virus type 1: technical report. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240020221
  7. Gessain A, Ramassamy J-L, Afonso PV, Cassar O. Geographic distribution, clinical epidemiology and genetic diversity of the human oncogenic retrovirus HTLV-1 in Africa, the world’s largest endemic area. Front Immunol. 2023;14:1043600.  https://doi.org/10.3389/fimmu.2023.1043600  PMID: 36817417 
  8. European Centre for Disease Prevention and Control (ECDC). Geographical distribution of areas with a high prevalence of HTLV-1 infection. Stockholm: ECDC; 2015. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/geographical-distribution-areas-high-prevalence-HTLV1.pdf
  9. Laperche S, Worms B, Pillonel J, European Network of Transfusion Medecine Societies, Steering Committee. Blood safety strategies for human T-cell lymphotropic virus in Europe. Vox Sang. 2009;96(2):104-10.  https://doi.org/10.1111/j.1423-0410.2008.01136.x  PMID: 19076337 
  10. Rosadas C, Harvala H, Davison K, Taylor GP. HTLV-1 screening of blood donations: We are systematically missing opportunities. Br J Haematol. 2023;202(6):1220-3.  https://doi.org/10.1111/bjh.18988  PMID: 37487701 
  11. Pan American Health Organization (PAHO). International Health Policy Forum for the Elimination of HTLV: Advancing HTLV Health Policies around the World. Meeting Report, 10 November 2021. Washington D.C.: PAHO; 2022. Available from: https://iris.paho.org/handle/10665.2/56052
  12. Ades AE, Parker S, Walker J, Edginton M, Taylor GP, Weber JN. Human T cell leukaemia/lymphoma virus infection in pregnant women in the United Kingdom: population study. BMJ. 2000;320(7248):1497-501.  https://doi.org/10.1136/bmj.320.7248.1497  PMID: 10834889 
  13. Rosadas C, Taylor GP. Current interventions to prevent HTLV-1 mother-to-child transmission and their effectiveness: a systematic review and meta-analysis. Microorganisms. 2022;10(11):2227.  https://doi.org/10.3390/microorganisms10112227  PMID: 36363819 
  14. Pan American Health Organization/World Health Organization Regional Office for the Americas (PAHO/WHO). The diagnosis of human T lymphotropic virus (HTLV) and strategies to expand HTLV screening in the context of maternal and child health. Meeting Report (virtual), 7 July 2023. Washington, D.C.: PAHO/WHO; 2024. Available from: https://www.paho.org/en/documents/diagnosis-human-t-lymphotropic-virus-htlv-and-strategies-expand-htlv-screening-context
  15. National Screening Committee. Antenatal screening programme: HTLV. London: gov.uk; 2022. Available from: https://view-health-screening-recommendations.service.gov.uk/htlv
  16. Office for National Statistics. Dataset: Parent`s country of birth. London: gov.uk; 2021. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/parentscountryofbirth
  17. World Health Organization (WHO). Global status report on blood safety and availability 2021. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240051683
  18. Rosadas C, Senna K, da Costa M, Assone T, Casseb J, Nukui Y, et al. Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model. Lancet Glob Health. 2023;11(5):e781-90.  https://doi.org/10.1016/S2214-109X(23)00065-7  PMID: 37061315 
  19. National Health Service (NHS) Digital. Infant feeding survey UK, 2010. London: NHS; 2012. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010
  20. The National Institute for Health and Care Excellence (NICE). NICE health technology evaluations: the manual. Manchester: NICE. [Accessed: 17 May 2024]. Available from: https://www.nice.org.uk/process/pmg36/chapter/committee-recommendations
  21. Office for Health Improvement and Disparities. Sexually transmitted infections (STIs): migrant health guide. London: gov.uk. [Accessed: 15 Sep 2023]. Available from: https://www.gov.uk/guidance/sexually-transmitted-infections-stis-migrant-health-guide
  22. Oliveira de Jesus A, do Valle S, Archanjo E, Brandão MC, Feitosa AMS, HTLV-1 Advocacy Group from Brazil. Women living with HTLV-1 should have the opportunity to make informed decisions on prevention of mother-to-child transmission. Lancet Glob Health. 2023;11(8):e1180.  https://doi.org/10.1016/S2214-109X(23)00264-4  PMID: 37474223 
  23. Meyerowitz EA, Mukerji SS, Kyle Harrold G, Erdil RM, Chen ST, Rudmann EA, et al. Mogamulizumab for treatment of human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis: a single-center US-based series. Clin Infect Dis. 2023;77(6):851-6.  https://doi.org/10.1093/cid/ciad281  PMID: 37157862 
  24. Nishijima T, Shimada S, Noda H, Miyake K. Towards the elimination of HTLV-1 infection in Japan. Lancet Infect Dis. 2019;19(1):15-6.  https://doi.org/10.1016/S1473-3099(18)30735-7  PMID: 30587282 
  25. Kowada A. Cost-effectiveness of human T-cell leukemia virus type 1 (HTLV-1) antenatal screening for prevention of mother-to-child transmission. PLoS Negl Trop Dis. 2023;17(2):e0011129.  https://doi.org/10.1371/journal.pntd.0011129  PMID: 36809372 
  26. Malik B, Taylor GP. Can we reduce the incidence of adult T-cell leukaemia/lymphoma? Cost-effectiveness of human T-lymphotropic virus type 1 (HTLV-1) antenatal screening in the United Kingdom. Br J Haematol. 2019;184(6):1040-3.  https://doi.org/10.1111/bjh.15234  PMID: 29676441 
  27. de Mendoza C, Pérez L, Fernández-Ruiz M, Pena MJ, Ramos JM, Richart A, et al. Late presentation of human T-lymphotropic virus type 1 infection in Spain reflects suboptimal testing strategies. Int J Infect Dis. 2022;122:970-5.  https://doi.org/10.1016/j.ijid.2022.07.043  PMID: 35902023 
  28. Rosadas C, Taylor GP. Health inequities and HTLV-1. Lancet Microbe. 2022;3(3):e164.  https://doi.org/10.1016/S2666-5247(21)00330-X  PMID: 35544072 
  29. Sampaio GCL, Ribeiro JR, de Almeida CN, Boa-Sorte N, Galvão-Castro B, Grassi MFR, et al. Human T cell lymphotropic virus type 1 global prevalence associated with the human development index: systematic review with meta-analysis. AIDS Res Hum Retroviruses. 2023;39(4):145-65.  https://doi.org/10.1089/aid.2021.0230  PMID: 36571250 
  30. de Mendoza C, Taylor G, Gessain A, Thoma-Kress AK, Bangham C, Vesterbacka J, et al. Virology, pathogenesis, epidemiology and clinical management of HTLV-1 infection. Proceedings of the 30th HTLV European research network (HERN 2023). Neuroimmune Pharmacol Ther. 2024;3(1):61-9.  https://doi.org/10.1515/nipt-2023-0025 
  31. Wilkie R, Davison K, Brailsford S, Taylor G. Perceived importance and likelihood of anxiety caused by antenatal screening among HTLV national register survey respondents in the UK. AIDS Rev. 2023;25(1) Suppl;28.
  32. Itabashi K, Miyazawa T, Nerome Y, Sekizawa A, Moriuchi H, Saito S, et al. Issues of infant feeding for postnatal prevention of human T-cell leukemia/lymphoma virus type-1 mother-to-child transmission. Pediatr Int. 2021;63(3):284-9.  https://doi.org/10.1111/ped.14356  PMID: 32574414 
  33. Nerome Y, Kojyo K, Ninomiya Y, Ishikawa T, Ogiso A, Takei S, et al. Current human T-cell lymphotropic virus type 1 mother-to-child transmission prevention status in Kagoshima. Pediatr Int. 2014;56(4):640-3.  https://doi.org/10.1111/ped.12385 
  34. National AIDS Trust (NAT). Policy Briefing: Access to formula milk for mothers living with HIV in the UK. London: NAT; 2017. Available from: https://www.nat.org.uk/sites/default/files/publications/Access%20to%20Formula%20Milk%20Briefing%20FINAL.pdf
  35. Department of Chronic Conditions Diseases and Sexually Transmitted Infections. Nota Informativa No 4/2021-CGIST/DCCI/SVS/MS. Dispõe sobre a recomendação do medicamento cabergolina 0,5mg e da fórmula láctea infantil na prevenção da transmissão verti cal do HIV e do HTLV. [Newsletter No. 4/2021-CGIST/. DCCI/SVS/MS. Provides for the recommendation of cabergoline 0.5mg and infant milk formula for the prevention of vertical transmission of HIV and HTLV.] Brasilia: Ministry of Health; 2021. Portuguese. Available from: http://antigo.aids.gov.br/pt-br/legislacao/nota-informativa-no-42021-cgistdccisvsms
  36. Rosadas C, Assone T, Yamashita M, Adonis A, Puccioni-Sohler M, Santos M, et al. Health state utility values in people living with HTLV-1 and in patients with HAM/TSP: The impact of a neglected disease on the quality of life. PLoS Negl Trop Dis. 2020;14(10):e0008761.  https://doi.org/10.1371/journal.pntd.0008761  PMID: 33064742 
  37. Ye L, Taylor GP, Rosadas C. Human T-cell lymphotropic virus type 1 and Strongyloides stercoralis co-infection: a systematic review and meta-analysis. Front Med (Lausanne). 2022;9:832430.  https://doi.org/10.3389/fmed.2022.832430  PMID: 35237633 
  38. Haziot ME, Gascon MR, Assone T, Fonseca LAM, Luiz ODC, Smid J, et al. Detection of clinical and neurological signs in apparently asymptomatic HTLV-1 infected carriers: Association with high proviral load. PLoS Negl Trop Dis. 2019;13(5):e0006967.  https://doi.org/10.1371/journal.pntd.0006967  PMID: 31042700 
  39. Tanajura D, Castro N, Oliveira P, Neto A, Muniz A, Carvalho NB, et al. Neurological manifestations in human T-cell lymphotropic virus type 1 (HTLV-1)-infected individuals without HTLV-1-associated myelopathy/tropical spastic paraparesis: a longitudinal cohort study. Clin Infect Dis. 2015;61(1):49-56.  https://doi.org/10.1093/cid/civ229  PMID: 25820277 
  40. Miller ME, Shah DJ, Barton EN, Gray AH, Yeates CB. Human T-cell lymphotropic virus-1-associated renal disease in Jamaican children. Pediatr Nephrol. 2001;16(1):51-6.  https://doi.org/10.1007/s004670000458  PMID: 11198604 
  41. Talukder MR, Woodman R, Pham H, Wilson K, Gessain A, Kaldor J, et al. High human T cell leukaemia virus type 1c proviral loads are associated with diabetes and chronic kidney disease: results of a cross-sectional community survey in central Australia. Clin Infect Dis. 2023;76(3):820.  https://doi.org/10.1093/cid/ciac614  PMID: 35903021 
  42. Einsiedel LJ, Pham H, Woodman RJ, Pepperill C, Taylor KA. The prevalence and clinical associations of HTLV-1 infection in a remote Indigenous community. Med J Aust. 2016;205(7):305-9.  https://doi.org/10.5694/mja16.00285  PMID: 27681971 
  43. The T- and B-cell Malignancy Study Group. The third nation-wide study on adult T-cell leukemia/lymphoma (ATL) in Japan: characteristic patterns of HLA antigen and HTLV-I infection in ATL patients and their relatives. Int J Cancer. 1988;41(4):505-12.  https://doi.org/10.1002/ijc.2910410406  PMID: 2895748 
  44. Office for Health Improvement and Disparities. NHS Fetal Anomaly Screening Programme (FASP). NHS screening programmes in England: 2020 to 2021. London: gov.uk. [Accessed: 17 May 2024]. Available from: https://www.gov.uk/government/publications/nhs-screening-programmes-annual-report/nhs-screening-programmes-in-england-2020-to-2021#nhs-fetal-anomaly-screening-programme-fasp
  45. National Health Service (NHS). NCARDRS Congenital Anomaly Official Statistics Report, 2020. London: NHS England; 2022. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/ncardrs-congenital-anomaly-statistics-annual-data/ncardrs-congenital-anomaly-statistics-report-2020/prevalence-t21-t18-t13#top
  46. Percher F, Jeannin P, Martin-Latil S, Gessain A, Afonso PV, Vidy-Roche A, et al. Mother-to-child transmission of HTLV-1 epidemiological aspects, mechanisms and determinants of mother-to-child transmission. Viruses. 2016;8(2):40.  https://doi.org/10.3390/v8020040  PMID: 26848683 
  47. National Health Services (NHS) Business Services Authority. NHS Electronic drug tariff, VIIIA products C. London: NHS; 2017. Available from: https://www.drugtariff.nhsbsa.nhs.uk/#/00446515-DC_2/DC00446029/Part
  48. Secretaria de Estado da Saúde Pública do Estado do Rio Grande do Norte. Ofício Circular no 3/2022/SESAP- recomendação da dispensação de fórmula láctea infantil. [Recommendation for provision of infant formula milk.] Natal: SESAP; 2022. Portuguese.
/content/10.2807/1560-7917.ES.2024.29.22.2300537
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error