Mother-to-child transmission of human T-cell lymphotropic virus type I (HTLV-1) in Jamaica: association with antibodies to envelope glycoprotein (gp46) epitopes

To study mother-to-child transmission of HTLV-I in Jamaica, we screen antenatal patients in Kingston, Jamaica, from 1983 to 1985. Of 2,329 women, 81 (3.5 percent) were HTLV-I seropositive. Two to three years later, 36 seropositive mothers were recontacted, and blood was drawn from them and their children. All sera were tested for HTLV-I antibodies, and mother's sera were additionally tested for HTLV-I whole-virus antibody titer, syncytium-inhibition neutralizing antibody liter, and titers to six synthetic peptides from the HTLV-I envelope glycoprotein gp46. Seventeen of 74 (23 percent) [95 percent confidence interval (CI) 15-34 percent] children were seropositive. HTLV-I transmission was associated with breast-feeding duration > 6 months [relative risk (RR) 3.2; CI 0.4-22.1], maternal age > 30 years (RR 2.8; CI 1.0 - 7.8), and higher maternal whole-virus antibody titer (RR 3.3; CI 1.3 - 8.5). After controlling for higher whole-virus antibody titer, transmission remained associated with higher titer of neutralizing antibody and higher titer of antibody to the peptide sp4al, corresponding to amino acids 196 - 209 of the gp46 envelope glycoprotein. We conclude that mother-to-child transmission of HTLV-I in Jamaica is associated with longer duration of breast-feeding, older age, and higher HTLV-I antibody titer, in particular to a certain immunogenic portion of the gp46 envelope glycoprotein.(AU)

Maternal infant transmission of HTLV-I in Jamaica - abstract

HTLV-I has been aetiologically linked with adult T-cell leukaemia and tropical spastic paraparesis. Studies from Japan have shown that transmission from mother to child is the principal mode of early-life infection; breast milk has been implicated as the route of this transmission. To study the frequency of, and risk factors for, maternal-infant transmission in Jamaica, we screened women attending a Kingston antenatal clinic for the presence of HTLV-I antibodies. Of 2,329 women screened, 81 (3.5 percent) were seropositive. Two to three years following screening, 35 seropositive mothers were successfully recontacted, a questionnaire was administered, and blood was collected from the mothers and the child of the original pregnancy (index child) as well as any other children. Five of 34 (15 percent) index children and 8 of 31 (26 percent) siblings were seropositive. Having a seropositive child was significantly associated with older maternal age (p<0.05) and a higher level of maternal antibody titre (p<0.05). Seropositive index children tended to breast feed for longer than seronegative index children (11 months vs 1 month; p=0.18). We conclude that HTLV-I transmission occurs in Jamaica at rates similar to those seen in Japan. Older age and measures of higher "viral load" such as elevated antibody titre are associated with transmission. Although the evidence is suggestive that transmission occurs through breast-milk, a larger study is currently underway to this tissue (AU)

Vulvovaginitis, the gonococcus, and child abuse - abstract

Records of 424 girls under 12 years of age, who presented consecutively to University Hospital of the West Indies with a history of vaginal discharge, were kept on an on-going basis in a separate register for one year from November, 1983. The vaginal swabs showed non-specific flora in 49 percent, N. gonorrhoea in 14 percent, S. pneumoniae in 8 percent, H. influenzae Type B in 5 percent, C. albicans in 3 percent, other organisms in 13 percent, and unknown or culture negative results in 5 percent. Of the 58 children with gonorrhoea, 52 percent were under 6 years of age. Information available on 60 percent of these revealed possible sexual contact in 36 percent. Forty per cent of these were reportedly incestuous (father, brother, uncle, cousin), 30 percent involved step-father or mother's consort, and 30 percent family friends or neighbours. These figures may be underestimates. This report documents the occurrence in this age group of S. pneumoniae (not previously reported), N. gonorrhoeae, C. albicans among near-pubertal girls, T. Vaginalis in the 2 to 10 year-olds, the hidden problem of intrafamilial child abuse, and condylomata acuminata as an unusual manifestation of child abuse. Attention is drawn to vulvovaginitis in the hope that a high index of suspicion and family investigations for child abuse, gonorrhoea and incest will be encouraged; that health education for parents and schools will include information specific to perineal hygiene and sexually transmitted diseases; and that the child population, affected as it is by the increasing incidence of adult gonorrhoea, will be included in programmes for the control of this disease. The authors acknowledge with thanks the valuable assistance of the staff of their respective Departments (AU)