HTLV screening of blood donations in England between 2002 and 2021—comparison of screening strategies
File(s)
Published version
Author(s)
Harvala, Heli
Davison, Katy
Webster, Mhairi
Reynolds, Claire
Taylor, Graham P
Type
Journal Article
Abstract
Background
Human T-lymphotropic virus (HTLV) is associated with adult T-cell leukemia/lymphoma and myelopathy. Here we present virological and epidemiological data on HTLV screening of blood donations in England between 2002 and 2021, implemented to prevent its transmission via blood transfusion.
Methods
Data on HTLV testing of blood donations was reviewed; it was initially conducted in pools (2002–2012) and subsequently using individual samples (all donors, 2013–2016; first-time donors and non-leucodepleted component donors, 2017–2021). Data included annual number of donations screened, initial and repeat reactives as well as confirmed positives. Further information, such as likely source of infection, was obtained for HTLV-positives.
Results
Over the 20-year study period, a total of 30 679 741 blood donations were screened for HTLV in England. Under pooled screening strategy, the annual rate of repeat reactive donations remained <5:100 000. However, this rate increased to 51:100 000 with individual screening and further to 123:100 000 with selective screening. A total of 5032 samples were repeat reactive, of which 278 were confirmed HTLV-positives. Although the specificity under each scenario exceeded 99.9%, the rate of repeat reactives was around 50-fold higher in individual compared to pooled screening. Most HTLV infected were UK-born, most likely acquired their infection unknowingly through breast feeding or heterosexual intercourse with an individual associated with an HTLV-endemic country.
Conclusions
These data highlight that pooled testing can be advantageous in low-prevalence settings due to its high specificity and reduced non-specific reactivity. Whether pooling is an applicable strategy to tackle the burden of HTLV infection in resource-poor, HTLV-endemic countries requires further investigations.
Human T-lymphotropic virus (HTLV) is associated with adult T-cell leukemia/lymphoma and myelopathy. Here we present virological and epidemiological data on HTLV screening of blood donations in England between 2002 and 2021, implemented to prevent its transmission via blood transfusion.
Methods
Data on HTLV testing of blood donations was reviewed; it was initially conducted in pools (2002–2012) and subsequently using individual samples (all donors, 2013–2016; first-time donors and non-leucodepleted component donors, 2017–2021). Data included annual number of donations screened, initial and repeat reactives as well as confirmed positives. Further information, such as likely source of infection, was obtained for HTLV-positives.
Results
Over the 20-year study period, a total of 30 679 741 blood donations were screened for HTLV in England. Under pooled screening strategy, the annual rate of repeat reactive donations remained <5:100 000. However, this rate increased to 51:100 000 with individual screening and further to 123:100 000 with selective screening. A total of 5032 samples were repeat reactive, of which 278 were confirmed HTLV-positives. Although the specificity under each scenario exceeded 99.9%, the rate of repeat reactives was around 50-fold higher in individual compared to pooled screening. Most HTLV infected were UK-born, most likely acquired their infection unknowingly through breast feeding or heterosexual intercourse with an individual associated with an HTLV-endemic country.
Conclusions
These data highlight that pooled testing can be advantageous in low-prevalence settings due to its high specificity and reduced non-specific reactivity. Whether pooling is an applicable strategy to tackle the burden of HTLV infection in resource-poor, HTLV-endemic countries requires further investigations.
Date Issued
2025-07-01
Date Acceptance
2025-01-21
Citation
Clinical Infectious Diseases, 2025, 81 (1), pp.206-212
ISSN
1058-4838
Publisher
Oxford University Press
Start Page
206
End Page
212
Journal / Book Title
Clinical Infectious Diseases
Volume
81
Issue
1
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39895283
PII: 7997035
Subjects
HTLV
blood donation screening in England
assay specificity
pooled testing
Publication Status
Published
Coverage Spatial
United States
Article Number
ciaf053
Date Publish Online
2025-02-03