Abstract
BackgroundScreening of pregnant women carrying human T-lymphotropic virus type 1 (HTLV-1) has a crucial role in reducing the number of HTLV-1 carriers. A national HTLV-1 screening program for pregnant women was started in 2011 in Japan. The purpose of this study is to report on the implementation of this nationwide screening program.MethodsThis was a retrospective repeated cross-sectional study. We used datasets from surveys of HTLV-1-antibody-positive pregnant women performed by the Japan Association of Obstetricians and Gynecologists in 2011, 2013, and 2016. Outcomes for evaluation included the number of persons (pregnant women) who conducted the screening test, the number of positive persons (women) identified by these tests, and the proportion of positive persons to the number of persons (women) who conducted the tests.ResultsNumbers of target facilities changed yearly: 1857 in 2011, 2544 in 2013, and 2376 in 2016. The mean number of screening-test participants increased per facility, but the median increased or decreased. The mean number of positive individuals identified decreased. Multivariate analysis results revealed the number of screenings was slightly reduced yearly, although areas (Kanto and Kinki) and high volume in facility types increased. Regarding the positive rates, some areas (Hokkaido/Tohoku, Kanto, and Chugoku/Shikoku) exhibited decreases or increases by facility type. The number of western blotting (WB) implementations decreased in 2016, positive rates identified by WB decreased in 2016 in all areas, and the number of facility types increased. The number of PCR participants increased in 2016 in Kanto and Kinki, but a decrease in facility type was observed. Positive rates were decreased in all areas (except the central region) but facility types were increased.ConclusionsThe nationwide screening program for HTLV-1 in Japan was almost fully implemented. However, regional variations in screening tests were observed during this implementation. Thus, some incentives are needed to encourage proper implementation across all regions.
Highlights
Screening of pregnant women carrying human T-lymphotropic virus type 1 (HTLV-1) has a crucial role in reducing the number of HTLV-1 carriers
The purpose of this study was to report on the implementation of the nationwide screening for HTLV-1 in pregnant women conducted since 2011
The change in screening coverage is shown by regions on a map of Japan (Fig. 2)
Summary
Screening of pregnant women carrying human T-lymphotropic virus type 1 (HTLV-1) has a crucial role in reducing the number of HTLV-1 carriers. HTLV-1 causes adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy, HTLV-1 uveitis [1], and infective dermatitis [2] These HTLV-1-related diseases can develop in HTLV-1-infected persons, most patients are asymptomatic carriers [1]. Detection of pregnant women carrying HTLV-1 is crucial for reducing the number of HTLV-1 carriers because HTLV-1 is primarily transmitted vertically from mother to child. If this epidemiological trend remains, the implementation of a prenatal screening program will be an important public policy in Japan. Because ATL likely develops after a long incubation period of more than 20 years in HTLV-1 carriers via MTCT, the prevention of milk-borne transmission is the most efficient and feasible way to reduce the disease burden
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