Itabashi Kazuo, Miyazawa Tokuo, Sekizawa Akihiko, Tokita Akifumi, Saito Shigeru, Moriuchi Hiroyuki, Nerome Yasuhito, Uchimaru Kaoru, Watanabe Toshiki
Showa University Hospital, Tokyo, Japan.
Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.
Front Microbiol. 2020 Apr 9;11:595. doi: 10.3389/fmicb.2020.00595. eCollection 2020.
Japan has been running a nationwide antenatal human T-cell leukemia virus type-1 (HTLV-1) antibody screening program since 2010 for the prevention of HTLV-1 mother-to-child transmission. As part of the program, pregnant women are invited to take an HTLV-1 antibody screening test, usually within the first 30 weeks of gestation, during regular pregnancy checkups. Pregnant women tested positive on the antibody screening test undergo a confirmatory test, either western blotting or line immunoassay. In indeterminate case, polymerase chain reaction (PCR) is used as a final test to diagnose infection. Pregnant women tested positive on a confirmatory or PCR test are identified as HTLV-1 carriers. As breastfeeding is a predominant route of postnatal HTLV-1 mother-to-child transmission, exclusive formula feeding is widely used as a postnatal preventive measure. Although there is insufficient evidence that short-term breastfeeding during ≤3 months does not increase the risk of mother-to-child transmission compared to exclusive formula feeding, this feeding method is considered if the mother is eager to breastfeed her child. However, it is important that mothers and family members fully understand that there is an increase in the risk of mother-to-child transmission when breastfeeding would be prolonged. As there are only a few clinical studies on the protective effect of frozen-thawed breastmilk feeding on mother-to-child transmission of HTLV-1, there is little evidence to recommend this feeding method. Further study on the protective effects of these feeding methods are needed. It is assumed that the risk of anxiety or depression may increase in the mothers who selected exclusive formula feeding or short-term breastfeeding. Thus, an adequate support and counseling for these mothers should be provided. In addition to raising public awareness of HTLV-1 infection, epidemiological data from the nationwide program needs to be collected and analyzed. In most cases, infected children are asymptomatic, and it is necessary to clarify how these children should be followed medically.
自2010年以来，日本一直在开展全国性的产前人类T细胞白血病病毒1型（HTLV-1）抗体筛查项目，以预防HTLV-1母婴传播。作为该项目的一部分，孕妇通常会在妊娠的前30周内，在定期产检时被邀请进行HTLV-1抗体筛查检测。抗体筛查检测呈阳性的孕妇会接受确证检测，即免疫印迹法或线性免疫测定法。对于结果不确定的情况，聚合酶链反应（PCR）用作诊断感染的最终检测。确证检测或PCR检测呈阳性的孕妇被确定为HTLV-1携带者。由于母乳喂养是产后HTLV-1母婴传播的主要途径，纯配方奶喂养被广泛用作产后预防措施。尽管没有足够的证据表明与纯配方奶喂养相比，≤3个月的短期母乳喂养不会增加母婴传播风险，但如果母亲渴望母乳喂养其孩子，则会考虑这种喂养方式。然而，重要的是母亲和家庭成员要充分了解，延长母乳喂养时间会增加母婴传播的风险。由于关于冻融母乳喂养对HTLV-1母婴传播的保护作用的临床研究很少，几乎没有证据推荐这种喂养方式。需要对这些喂养方式的保护作用进行进一步研究。据推测，选择纯配方奶喂养或短期母乳喂养的母亲焦虑或抑郁的风险可能会增加。因此，应该为这些母亲提供充分的支持和咨询。除了提高公众对HTLV-1感染的认识外，还需要收集和分析全国性项目的流行病学数据。在大多数情况下，受感染的儿童没有症状，有必要明确如何对这些儿童进行医学随访。
