Virus Research 191 (2014) 134–137 Contents lists available at ScienceDirect Virus Research j ournal homepage: www.elsevier.com/locate/virusres 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 a National Institutes for Food and Drug Control, Beijing, China b Xiamen Blood Center, Xiamen, Fujian Province, China c Guangzhou Blood Center, Guangzhou, Guangdong Province, China d Shenzhen Blood Center, Shenzhen, Guangdong Province, China e Zhejiang Blood Center, Hangzhou, Zhejiang Province, China f Liaoning Blood Center, Shenyang, Liaoning Province, China g Henan Red Cross Blood Center, Zhengzhou, Henan Province, China h Shandong Provincial Hospital, Jinan, Shandong Province, China i Urumqi Blood Center, Urumqi, Xinjiang Province, China j Jiangxi Blood Center, Nanchang, Jiangxi Province, China k Shanghai Blood Center, Shanghai, China l Ningde Blood Center, Ningde, Fujian Province, China m Putian Blood Center, Putian, Fujian Province, China n Zhangzhou Blood Center, Zhangzhou, Fujian Province, China o Longyan Blood Center, Longyan, Fujian Province, China p Zhoushan Blood Center, Zhoushan, Zhejiang Province, China q Ningbo Blood Center, Ningbo, Zhejiang Province, China r Jiaxing Blood Center, Jiaxing, Zhejiang Province, China s Taizhou Blood Center, Taizhou, Zhejiang Province, China t 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. © 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND 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). 1 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 0168-1702/© 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). 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.