Technical note on good practices to prevent mother-to-child transmission of HTLV-1 in the context of the EMTCT Plus initiative

Abstract

The Pan American Health Organization (PAHO) and its Member States have committed to eliminating over 30 communicable diseases and related conditions by 2030. Central to this effort is the EMTCT Plus initiative, which aims to eliminate the mother-to-child transmission (MTCT) of HIV, syphilis, hepatitis B, and Chagas disease. Since its inception, the EMTCT Plus framework has been instrumental in supporting countries to achieve validation of the dual elimination of HIV and syphilis. By 2023, eleven countries and territories had successfully attained this milestone. Building on this success, PAHO is now expanding the scope of EMTCT Plus to include the elimination of human T-lymphotropic virus type 1 (HTLV-1). HTLV-1 is a retrovirus that causes lifelong infection and is linked to severe conditions, such as adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy (HAM). Vertical transmission, primarily through breastfeeding, poses a significant risk to infants, particularly in regions where HTLV-1 is endemic. Infections acquired early in life are associated with a higher risk of developing serious health complications later. This technical note aims to provide Member States with a comprehensive framework to address HTLV-1 MTCT as a public health problem. The document outlines a series of evidence-based interventions, such as awareness campaigns, testing strategies, education, and interventions designed to reduce transmission risks. Additionally, it highlights successful practices from countries within the Region that are already implementing measures to control HTLV-1 and protect at-risk populations. The publication targets decision-makers in ministries of health, healthcare professionals, and other stakeholders involved in maternal and child health, HIV, hepatitis, and sexually transmitted infections programs. By integrating HTLV-1 prevention into existing elimination frameworks, the Region of the Americas can further consolidate its leadership in the global efforts to eliminate communicable diseases, ensuring that vulnerable populations are protected from the impacts of vertical transmission and its long-term health consequences.