Abstract
BackgroundBrazil has at least 800,000 HTLV-1 infected individuals. HTLV-1 can be transmitted via sexual intercourse, contact with blood and from mother to child, mainly by breastfeeding. Treatments for the high morbidity/mortality associated diseases (ATL and HAM/TSP) are limited, therefore, infection prevention is of utmost importance. However, antenatal screening is not routinely performed in Brazil. A lack of data regarding the number of individuals infected via breastfeeding impairs the development of government policies. The objective is to estimate the number of HTLV-1 infections occurring annually due to mother to child transmission (MTCT) in Brazil, nationally and regionally.MethodologyTo estimate HTLV-1 MTCT in Brazil the following variables are modelled: number of births, prevalence of HTLV-1 infection in pregnant women, breastfeeding duration rate and transmission risk according to breastfeeding period. The number of cases of HAM/TSP and ATL attributable to MTCT are also estimated.Principal findingsIn 2008, there were 2,934,828 live births in Brazil. HTLV prevalence in pregnant women in Brazil ranges between 0.1–1.05% by region. An estimated 16,548 HTLV-1 infected women are pregnant each year. According to the breastfeeding pattern and HTLV-1 prevalence of each region there are an estimated 3,024 new cases of HTLV-1 infection due to MTCT annually of which 2,610 are preventable through infant feeding advice. These 3,024 transmissions will result in 120–604 cases of ATL and 8–272 of HAM/TSP. North-East region comprises the high number of MTCT cases, followed by South-East.Conclusions/significanceA high number of new HTLV-1 infections due to MTCT occur every year in Brazil. Antenatal screening and avoiding breastfeeding are essential to prevent subsequent development of HTLV-1-associated diseases.
Highlights
The human T-cell lymphotropic virus type 1 (HTLV-1) infects at least 5–10 million individuals throughout the world
In the present study we estimate the number of HTLV-1 infections that occur annually due to mother to child transmission (MTCT) in Brazil and within its regions
The high number of estimated cases due to MTCT (3,024) which will give rise in adult life to HTLV-1associated diseases suggest the importance of performing HTLV-1 antenatal screening in Brazil to reduce the dissemination of this infection and to prevent a blood cancer to which most individuals succumb within 8 months of presentation and in others a disabling disease of the spinal cord
Summary
The human T-cell lymphotropic virus type 1 (HTLV-1) infects at least 5–10 million individuals throughout the world. Brazil has approximately 800,000 carriers [1] This virus can be transmitted via sexual intercourse, contact with infected blood and from mother to child, mainly through breastfeeding[1]. The diseases associated with this infection, such as HTLV-1-associated myelopathy / tropical spastic paraparesis (HAM/TSP) and adult T cell leukaemia (ATL) have high morbidity and mortality[1,2,3]. Half of all patients who develop HAM/TSP become wheelchair dependent HTLV-1 can be transmitted via sexual intercourse, contact with blood and from mother to child, mainly by breastfeeding. Treatments for the high morbidity/mortality associated diseases (ATL and HAM/ TSP) are limited, infection prevention is of utmost importance. The objective is to estimate the number of HTLV-1 infections occurring annually due to mother to child transmission (MTCT) in Brazil, nationally and regionally
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