History and Update of HTLV Infection in China

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Virus Research 191 (2014) 134–137

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Short communication

History and update of HTLV infection in China

a,1 b,1 a b c d

Jialiang Du , Changrong Chen , Jiamei Gao , Jinzhen Xie , Xia Rong , Xiaoxun Xu ,

e f g h i j

Yongjun Wang , Fang Wang , Jianbin Li , Zhiming Lu , Weipeng Guo , Guoliang Li ,

k l m n o p

Zhongying Wang , Dongfeng Xu , Jianfeng Weng , Zhijian Zhao , Wei Weng , Haoru Li ,

q r s t a,∗

Yong Du , Song Li , Chaohui Zhen , Baolin Liu , Tai Guo

National Institutes for Food and Drug Control, Beijing, China

Xiamen Blood Center, Xiamen, Fujian Province, China

Guangzhou Blood Center, Guangzhou, Guangdong Province, China

Shenzhen Blood Center, Shenzhen, Guangdong Province, China

Zhejiang Blood Center, Hangzhou, Zhejiang Province, China

Liaoning Blood Center, Shenyang, Liaoning Province, China

Henan Red Cross Blood Center, Zhengzhou, Henan Province, China

Shandong Provincial Hospital, Jinan, Shandong Province, China

Urumqi Blood Center, Urumqi, Xinjiang Province, China

Jiangxi Blood Center, Nanchang, Jiangxi Province, China

Shanghai Blood Center, Shanghai, China

Ningde Blood Center, Ningde, Fujian Province, China

Putian Blood Center, Putian, Fujian Province, China

Zhangzhou Blood Center, Zhangzhou, Fujian Province, China

Longyan Blood Center, Longyan, Fujian Province, China

Zhoushan Blood Center, Zhoushan, Zhejiang Province, China

Ningbo Blood Center, Ningbo, Zhejiang Province, China

Jiaxing Blood Center, Jiaxing, Zhejiang Province, China

Taizhou Blood Center, Taizhou, Zhejiang Province, China

Wenzhou Blood Center, Wenzhou, Zhejiang Province, China

a r a

t i b s

c t

l e i n f o r a c t

Article history: Human T-lymphotropic virus (HTLV) infection is a high risk factor for lymphoproliferative, inﬂammatory,

Received 8 May 2014

and infectious disorders. The epidemiology of HTLV-I, II in industrialized countries has been intensively

Received in revised form 30 July 2014

investigated, and mandatory screening of blood supplies for HTLV-I/II was implemented in mid-1980s in

Accepted 30 July 2014

most developed and several developing countries, yet no expanding investigation has been executed in

Available online 7 August 2014

China so far and also been considered as a non-endemic region. However, Gessain et al. reported that the

current number of HTLV carriers in the highly populated China is very probably much higher. Therefore,

Keywords:

gaining insight into the epidemiology of HTLV infections is essential for avoiding HTLV-induced risk. To

History

Update introduce the history and renew the HTLV infection in China, we reviewed literatures and conducted an

investigation among blood donors in 9 provinces in China. Concluded from the historical and renewed

HTLV infection

China data, the HTLV screen in China can be divided into three stages.

license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Human T-lymphotropic virus (HTLV) infection causes lym- supplies for HTLV-I/II was implemented in mid-1980s in most

phoproliferative, inﬂammatory, and infectious disorders. The developed and several developing countries, yet no expanding

epidemiology of HTLV-I/II in industrialized countries has been investigation has been executed in China so far (Zeng et al., 1984;

intensively investigated, and mandatory screening of blood Chen et al., 1989; Geng et al., 1998; Cao et al., 1998; Wang et al.,

2005; Ma et al., 2013) and also been considered as a non-endemic

region. However, Gessain et al. reported that the current number

∗ of HTLV carriers in the highly populated China is very probably

Corresponding author. Tel.: +86 10 67095366.

much higher (Gessain and Cassar, 2012). Therefore, gaining insight

E-mail addresses: [email protected] (J. Du), [email protected] (C. Chen),

into the epidemiology of HTLV infections is essential for avoiding

[email protected], [email protected] (T. Guo).

Co-ﬁrst authors. HTLV-induced risk. To introduce the history and renew the HTLV

http://dx.doi.org/10.1016/j.virusres.2014.07.036

J. Du et al. / Virus Research 191 (2014) 134–137 135

Table 1

HTLV-1/-2 prevalence information collected from the referenced literatures and this study in China.

Periods Reference Year Population Investigated No. of samples Reactive cases Conﬁrmed positives Positivity rate

regions (%)

First ten years 1 1985 General Nationwide 10,013 8 ND ND

population and

patients

Second ten years 3 1995–1997 Blood donors Northeastern 1645 1 0 0

China

4 1998 Blood donors Southern China 3913 12 2 0.05

Others 484 3 0 0

5 2005 Blood donors Nationwide 1,45,293 30 19 (HTLV-1) 0.01

Third ten years 6 2008–2011 Blood donors Central China 3548 17 3 (2 HTLV-1, 1 HTLV-2) 0.09

Others 1932 7 (5 HTLV-1,2 HTLV-2) 0.36

This study 2012–2013 Blood donors Nationwide 1,22,468 224 38 (37 HTLV-1, 1 HLTV-1/-2) 0.03

infection in China, we reviewed literatures and conducted an Fujian province, and the positive rate was 0.08% which is 2.5-fold

investigation among blood donors in 9 provinces in China. Con- of average level and 0.03% higher than the study in 2005 (Wang

cluded from the historical and renewed data, the HTLV screen in et al., 2005). Two positives live in Guangdong, and two in Zhejiang

China can be divided into three ten years periods (Table 1). province. No positives were detected in inland provinces (Henan,

The ﬁrst ten years periods about HTLV screen started in early Xinjiang, Jiangxi) and northern China (Liaoning and Shandong). To

1980s, when the migratory route has been determined to be from be noted, 22 of the 34 positives in Fujian live in Ningde city, 10

Japan. In 1984, the pioneer study in Beijing and other 28 provinces in Putian city, 1 in Zhangzhou city and 1 in Longyan city, which

in China (Zeng et al., 1984) collected 9303 samples from normal means the region with high HTLV infection rate restricted to par-

population, 700 from patients with leukemia and 10 from sus- ticular smaller region(s). We should further inquire the potential

pected ATL patients. Only 8 (0.08%) were positive, among them 3 factor(s) of higher HTLV infection rate in Fujian province, espe-

were Japanese living in China, 2 were from Taiwan also living in cially in Ningde and Putian cities. Both Ningde and Putian are

mainland China, 2 Chinese ladies were from mainland China and coastal/port cities, and neighboring with Japan which has a high

their husbands are positive Japanese and Taiwanese individuals, prevalence of HTLV-1, so the answer would be the interaction with

the other one was an ALT patient. These ﬁndings strongly sug- Japanese trader or ﬁshermen, as descripted in early 1980s. More-

gest that the virus may be transmitted from Japanese to Chinese, over, after the introduction of HTLV to China, the risk of HTLV

because most of the HTLV antibody positive individuals came from prevalence among Chinese through blood transfusion or other

Japan or contact with Japanese closely. In addition, the hypothe- routes in particular regions cannot be ignored. To be noted, except

sis that blood transfusion possibly linkages with infection of HTLV for the coastal cities, HTLV infection in central China, including

and development of ATLL had been mentioned in 1989 (Chen et al., Henan and Hubei was found in the ﬁrst large-scale cross-sectional

1989). study in Central China from January 2008 to December 2011 (Ma

The second ten years periods for HTLV screen were undertaken et al., 2013). However, the prevalence rate in central China is

during 1990s and early 2000s (Geng et al., 1998; Cao et al., 1998; lower than the coastal areas, which may be attributed to the dif-

Wang et al., 2005). In this stage, HTLV infection investigations were ferent individual susceptibility or habits and customs of people

primarily performed to ﬁnd whether the HTLV infection expanded. living in and away the coastal areas, which need further explor-

The data suggest that HTLV is non-endemic throughout China. ing.

The representative investigation conducted in 13 provinces and a In this study, we also found an inner family transmission case.

total of 145,293 sera samples were collected from volunteer blood The blood donor, who is a 41 year old female peasant, was con-

donors in 2005. Thirty were positive for anti-HTLV by ELISA and ﬁrmed be infected by HTLV using PCR and WB. Her parents were

only 19 (0.05%) samples from Fujian province were conﬁrmed pos- also conﬁrmed to be HTLV positive, and her husband and child

itive. No conﬁrmed positive samples were found in other provinces. were negative. This provides us a clue to ﬁnd the transmission

To be noted, positives for anti-HTLV by ELISA can be found in several types within family and the potential factors which protected

cities, but the conﬁrmed positives were restricted to a particular her child from infection. However, this is a complicated issue

region-Fujian province, a coastal province in southeastern China. to answer. We think the answer may be newly infection of

The third ten year periods study started in late 2000s and 2010s, the woman through a certain route. In the other hand, not all

and the results showed that HTLV infection expanded to other infected mother can transfer the virus to her child as mentioned

provinces including Guangdong, Zhejiang, Henan and Hubei (Ma by Hino et al. (Hino et al., 1996) that the incidence of serocon-

et al., 2013) instead of limiting to Fujian province. Our investi- version in children who were breast-fed over 12 months was

gation performed from January 2012 to July 2013 in 9 provinces 15.7%.

containing 19 blood banks in China (Table 2). There were 122,468 In summary, China is, as a whole, a low HTLV-1 endemic area

sera samples tested. The results showed, after antibody screen- with however some regions with a higher endemic situation. Fur-

ing using HTLV(1 + 2) antibodies ELISA diagnosis kit manufactured thermore, in these areas of higher HTLV-1 prevalence, as the Fujian

by Beijing Wantai Biological Pharmacy in China, 38 (0.03%) of the region, it is important to underline that no systematic strategies

ELISA-positives were conﬁrmed to be HTLV-1 positive by both are implemented to prevent HTLV infection. However, blood borne

Western blot (HTLV BLOT 2.4, Genelabs, Inc., Singapore) and PCR transmission is a potential risk. In China, except for a few hospitals

method which designed to measure ampliﬁcation products from and blood centers in particular regions detecting sera of patients

the gag-pro-pol polyprotein gene of HTLV-I (Xie et al., 2009), while and blood donors, mandatory screening for HTLV has not been per-

only one sample from Ningde was conﬁrmed to be both HTLV-1 formed nationwide and no systematic strategies are made for HTLV

and HTLV-2 antibody positive by WB. The 38 conﬁrmed positi- prevention and control. Therefore, it is urgent to carry out fur-

ves distributed in 3 provinces, including Fujian, Guangzhou and ther investigations to help developing effective control strategies

Zhejiang (Fig. 1). In details, among the 38 positives, 34 live in toward HTLV infection in China.

136 J. Du et al. / Virus Research 191 (2014) 134–137

Table 2

Prevalence of anti-HTLV among blood donors from various regions of China.

Provinces Cities No. of samples Reactive cases Conﬁrmed cases

No. Rate (%) No. Rate (%)

Fujian 41,042 139 0.34 34 0.08

Xiamen 14,013 47 0.34 0 0.00

Putian 6931 26 0.38 10 0.14

Ningde 5554 41 0.74 22 0.40

Zhangzhou 8000 28 0.35 1 0.01

Longyan 6544 17 0.26 1 0.02

Guangdong 18,452 23 0.12 2 0.01

Guangzhou 9232 9 0.10 1 0.01

Shenzhen 9220 14 0.15 1 0.01

Zhejiang 22,000 14 0.06 2 0.01

Hangzhou 5000 2 0.04 0 0.00

Ningbo 4000 1 0.03 0 0.00

Zhoushan 3000 1 0.03 1 0.03

Jiaxing 3000 3 0.10 0 0.00

Taizhou 3000 5 0.17 1 0.03

Wenzhou 4000 2 0.05 0 0.00

Liaoning 9000 5 0.06 0 0.00

Henan 8800 7 0.08 0 0.00

Shandong 4196 2 0.05 ND ND

Xinjiang 1941 2 0.10 ND ND

Jiangxi 8682 10 0.12 ND ND

Shanghai 8355 2 0.02 ND ND

Total 1,22,468 224 0.18 38 0.03

Note: ND – nondetected owing to the lack of samples.

Fig. 1. The investigated Chinese provinces and regions with the location of HTLV-1 endemic foci. Note: HTLV screening has been carried in the light gray labeled provinces

and regions; the cities where exist HTLV positives are shown in red square, and the numbers in the bracket represent the number of positives. (For interpretation of the

references to color in this ﬁgure legend, the reader is referred to the web version of the article.)

J. Du et al. / Virus Research 191 (2014) 134–137 137

Acknowledgment Cao, F., Ji, Y., Huang, R., Lin, S., 1998. Prevalence of antibodies to HTLV-I/II in blood

donors and risk populations in South China. Vox Sang. 75, 154.

Wang, Y., Li, X., Song, A., Zhang, C., Chen, Y., Chen, C., Lin, Y., Shun, L., Li, L., Liu, Y.,

This project was funded by the 12th Five-year National Science

Yang, J., Yang, B., Tang, Q., Harrison, T.J., 2005. Prevalence and partial sequence

& Technology Major Project (No. 2012ZX10004702) sponsored by analysis of human T cell lymphotropic virus type I in China. J. Med. Virol. 76,

613–618.

Ministry of Science and Technology of the People’s Republic of

Ma, Y., Zheng, S., Wang, N., Duan, Y., Sun, X., Jin, J., Zang, W., Li, M., Wang, Y., Zhao, G.,

China.

2013. Epidemiological analysis of HTLV-1 and HTLV-2 infection among different

population in central China. PLOS ONE 8, e66795.

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