Dataset Information

A Strategy for Screening and Confirmation of HTLV-1/2 Infections in Low-Endemic Areas.

ABSTRACT: Serological tests have been widely used for detecting human T-cell lymphotropic virus type 1/2 (HTLV-1/2) antibodies in the endemic areas, but their performance in low-risk populations is rarely reported. The aim of this study was to evaluate the performance of four HTLV-1/2 screening assays and to discuss a strategy for diagnosis of HTLV-1/2 infection in a non-endemic area. At the present study, 1546 specimens repeatedly reactive (RR) by one screening ELISA were collected from blood centers/banks from January 2016 to April 2019. Avioq-ELISA, Murex-ELISA, Roche-ECLIA and Fujirebio-CLIA were independently performed on each plasma sample and compared to WB and LIA confirmatory tests. Positive or indeterminate specimens with blood available were quantified by qPCR. The results showed that 48 samples were finally confirmed as HTLV-1 positive, 13 were HTLV positive, 151 were indeterminate, and 387 were negative. All the WB-positive samples were also LIA-positive. Roche-ECLIA showed the highest sensitivity that was able to detect 91.8% positives and combined with the Murex-ELISA would significantly increase the positive detection rate (98.4%). In addition, LIA yield more indeterminate and HTLV-untyped results than WB (152 vs. 27), but was able to resolve infection status of some individuals with an indeterminate WB. Besides, 3 WB indeterminate and 1 LIA-untyped samples were confirmed as HTLV-1 positive by qPCR. Based on these findings, we put forward a proper test strategy for HTLV-1/2 diagnosis in low-prevalence areas. If possible, the Roche-ECLIA with the highest sensitivity is suggested as a second screening assay in primary labs. If not, all RR specimens are recommended to be firstly retested by Roche-ECLIA and Murex-ELISA in the reference lab. Secondly, samples reactive to any one of the two tests were quantified by qPCR, and then the NAT-negatives were furtherly submitted to LIA for confirmation. Thereby, the cost can be reduced and the diagnostic accuracy would be improved.

SUBMITTER: Ji H

PROVIDER: S-EPMC7283491 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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A Strategy for Screening and Confirmation of HTLV-1/2 Infections in Low-Endemic Areas.

Ji Huimin H Chang Le L Yan Ying Y Jiang Xinyi X Sun Huizhen H Guo Fei F Wang Lunan L

Frontiers in microbiology 20200603

Serological tests have been widely used for detecting human T-cell lymphotropic virus type 1/2 (HTLV-1/2) antibodies in the endemic areas, but their performance in low-risk populations is rarely reported. The aim of this study was to evaluate the performance of four HTLV-1/2 screening assays and to discuss a strategy for diagnosis of HTLV-1/2 infection in a non-endemic area. At the present study, 1546 specimens repeatedly reactive (RR) by one screening ELISA were collected from blood centers/ban ...[more]

PMID: 32582093

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Project description:BackgroundHuman T-Cell Lymphotropic Viruses (HTLV) type 1 and type 2 account for an estimated 5 to 10 million infections worldwide and are transmitted through breast feeding, sexual contacts and contaminated cellular blood components. HTLV-associated syndromes are considered as neglected diseases for which there are no vaccines or therapies available, making it particularly important to ensure the best possible diagnosis to enable proper counselling of infected persons and avoid secondary transmission. Although high quality antibody screening assays are available, currently available confirmatory tests are costly and have variable performance, with high rates of indeterminate and non-typable results reported in many regions of the world. The objective of this project was to develop and validate a new high-performance multiplex immunoassay for confirmation and discrimination of HTLV-1 and HTLV-2 strains.Methodology/principal findingsThe multiplex platform was used first as a tool to identify suitable antigens and in a second step for assay development. With data generated on over 400 HTLV-positive blood donors sourced from USA and French blood banks, we developed and validated a high-precision interpretation algorithm. The Multi-HTLV assay demonstrated very high performance for confirmation and strain discrimination with 100% sensitivity, 98.1% specificity and 100% of typing accuracy in validation samples. The assay can be interpreted either visually or automatically with a colorimetric image reader and custom algorithm, providing highly reliable results.Conclusions/significanceThe newly developed Multi-HTLV is very competitive with currently used confirmatory assays and reduces considerably the number of indeterminate results. The multiparametric nature of the assay opens new avenues to study specific serological signatures of each patient, follow the evolution of infection, and explore utility for HTLV disease prognosis. Improving HTLV diagnostic testing will be critical to reduce transmission and to improve monitoring of seropositive patients.

Project description:BackgroundImplementation of an ivermectin-based community treatment strategy for the elimination of onchocerciasis or lymphatic filariasis has been delayed in Central Africa because of the occurrence of serious adverse events, including death, in persons with high levels of circulating Loa loa microfilariae. The LoaScope, a field-friendly diagnostic tool to quantify L. loa microfilariae in peripheral blood, enables rapid, point-of-care identification of persons at risk for serious adverse events.MethodsA test-and-not-treat strategy was used in the approach to ivermectin treatment in the Okola health district in Cameroon, where the distribution of ivermectin was halted in 1999 after the occurrence of fatal events related to L. loa infection. The LoaScope was used to identify persons with an L. loa microfilarial density greater than 20,000 microfilariae per milliliter of blood, who were considered to be at risk for serious adverse events, and exclude them from ivermectin distribution. Active surveillance for posttreatment adverse events was performed daily for 6 days.ResultsFrom August through October 2015, a total of 16,259 of 22,842 persons 5 years of age or older (71.2% of the target population) were tested for L. loa microfilaremia. Among the participants who underwent testing, a total of 15,522 (95.5%) received ivermectin, 340 (2.1%) were excluded from ivermectin distribution because of an L. loa microfilarial density above the risk threshold, and 397 (2.4%) were excluded because of pregnancy or illness. No serious adverse events were observed. Nonserious adverse events were recorded in 934 participants, most of whom (67.5%) had no detectable L. loa microfilariae.ConclusionsThe LoaScope-based test-and-not-treat strategy enabled the reimplementation of community-wide ivermectin distribution in a heretofore "off limits" health district in Cameroon and is a potentially practical approach to larger-scale ivermectin treatment for lymphatic filariasis and onchocerciasis in areas where L. loa infection is endemic. (Funded by the Bill and Melinda Gates Foundation and others.).

Project description:BackgroundIn Cambodia, internal migration involves migrants moving from non-malaria endemic areas to malaria endemic areas and vice versa. The majority of them work in farms or forests with various malaria transmission levels. In Cambodia, as one of the national approaches to ensure LLIN accessibility and use among mobile and migrant populations (MMPs), a lending scheme of long lasting insecticide treated nets (LLINs) was initiated among farm workers. Through this net lending program, LLINs and long-lasting insecticide treated hammock nets (LLIHNs) will be distributed annually at workplace (e.g. longstanding farms, plantations, industrial sites, as identified by operational district and health center staff) on a ratio of one LLIN per one worker. The main objective of this study is to assess MMPs' accessibility to LLINs through a lending scheme with plantation owners in remote malaria endemic areas of Cambodia.MethodsThe study used a cross-sectional survey among MMPs using two-stage cluster sampling method. The sampling frame is the list of farms in the four provinces of Banteay Meanchey, Battambang, Pailin, and Pursat in western and northwestern Cambodia bordering with Thailand where the LLIN lending scheme was implemented and where an estimated 100 000 MMPs worked annually. The assessment was carried out from January to February 2013 in these four provinces. It was estimated that 768 workers would be required.ResultsA total of 702 MMPs were interviewed. The ratio of male: female is 1:1. The age group of 21-60 was the largest accounting for 77.6%. About 91% of the MMPs stayed on the farm for less than 6 months. 93.2% of them owned either untreated or insecticide treated nets. LLINs and LLIHNs accounted for 89.5%; and 46.6% of them borrowed the nets from a lending scheme. Among those workers who have LLINs/LLIHNs, 99% slept under LLINs/LLIHNs the night before. However, only 87.4% knew that sleeping under LLINs/LLIHNs protects against malaria.ConclusionsLLIN lending scheme provides an important delivery channel for a substantial percentage of net accessibility (46.6%) to the Cambodian national free-net distribution campaign in remote malaria endemic areas.

Dataset Information

A Strategy for Screening and Confirmation of HTLV-1/2 Infections in Low-Endemic Areas.

Publications

A Strategy for Screening and Confirmation of HTLV-1/2 Infections in Low-Endemic Areas.

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