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Prevalence of human T-cell lymphotropic virus-1/2 in Canada over 33 years: A unique contribution of blood donors to public health surveillance

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Abstract

Objectives

Estimate HTLV-1/2 (human T-cell lymphotropic viruses) prevalence in Canadian blood donors and the association of demographic variables with infection and their corresponding risk factors.

Methods

First-time blood donors in all Canadian provinces (except Quebec) from 1990 to 2022 were included. Blood samples were tested for HTLV-1/2 by enzyme-linked immunoassay, confirmed by Western blot. Multivariable logistic regression with year, age group, sex, region, neighbourhood material deprivation, and ethnocultural composition indices predicted HTLV-1/2. Since 2005, all HTLV-1/2-positive donors (cases) were invited to participate in a risk factor interview, and 4 non-positive donors (controls per case) were matched for age, sex, and region. Case–control predictors of HTLV-1/2 were analyzed using logistic regression.

Results

There were 3,085,554 first-time donors from 1990 to 2022. HTLV-1/2 prevalence remained low (12 per 100,000 in 2022, 95% CI 6.4–23.5). The odds ratios predicting HTLV-1/2 were higher in females (2.0, 95% CI 1.5–2.6), older age groups (50 + ; 6.3, 95% CI 4.3–9.2), British Columbia and Ontario, those materially deprived (1.9, 95% CI 1.2–2.9), and those in ethnocultural neighbourhoods (7.5, 95% CI 3.2–17.3). Most HTLV-1/2 in Ontario was HTLV-1, whereas in British Columbia half were HTLV-2. Forty-three of 149 (28.8%) cases and 172 of 413 (41.6%) controls completed an interview. The strongest predictor of HTLV-1/2 in case–control analysis was birth in a high-prevalence country (OR 39.8, 95% CI 7.8–204.3) but about 50% of HTLV-1 and 90% of HTLV-2 were Canadian-born.

Conclusion

HTLV-1/2 prevalence is low in blood donors. High-prevalence country of birth accounts for about half of HTLV-1; HTLV-2 positives are usually Canadian-born. HTLV-1/2 transmission likely occurs overseas and within Canada.

Résumé

Objectifs

Estimer la prévalence des sous-types du virus T-lymphotrope humain (HTLV-1 et HTLV-2) dans le sang des donneurs de sang canadiens, et évaluer le lien avec des variables démographiques et des facteurs de risque donnés.

Méthodes

Cette étude a porté sur toutes les personnes ayant fait leur premier don entre 1990 et 2022 au Canada, sauf au Québec. Les échantillons de sang ont été soumis à un test immunoenzymatique, puis à un test Western Blot de confirmation. Les données ont été analysées au moyen de la régression logistique en utilisant comme indices l’année, la tranche d’âge, le sexe, la région, le quartier, la privation matérielle et la composition ethnoculturelle. Depuis 2005, tous les donneurs positifs au HTLV-1/2 (cas) ont été conviés à un entretien ayant pour but de déterminer leurs facteurs de risque, et quatre donneurs négatifs (cas-témoins) ont été appariés à chaque cas en fonction de l’âge, du sexe et de la région. Les facteurs de prédiction d’infection au HTLV-1/2 des cas-témoins ont été analysés au moyen de la régression logistique.

Résultats

Entre 1990 et 2022, le nombre de primodonneurs s’élevait à 3 085 554. La prévalence du HTLV-1/2 est demeurée faible (12,2 sur 100 000 en 2022, IC 95%: 6,4–23,5). Le rapport de cotes était plus élevé chez les femmes (2,0, IC 95% 1,5–2,6), chez les personnes de plus de 50 ans (6,3, IC 95% 4,3–9,2), en Colombie-Britannique et en Ontario, chez les personnes touchées par la privation matérielle (1,9, IC 95% 1,2–2,9) et chez les personnes vivant dans des quartiers ethnoculturels (7,5, IC 95% 3,2–17,3). La plupart des cas de HTLV-1/2 rencontrés en Ontario concernaient le HTLV-1, tandis qu’en Colombie-Britannique, la moitié des cas concernait le HTLV-2. Quarante-trois cas sur 149 (28,8 %) et 172 cas-témoins sur 413 (41,6 %) ont passé l’entretien. L’analyse des cas-témoins a révélé que le facteur de prédiction le plus important d’infection au HTLV-1/2 était le fait d’être né dans un pays à forte prévalence (RC 39,8, IC 95% 7,8–204,3); toutefois environ 50 % des cas-témoins de HTLV-1 et 90 % des cas témoins de HTLV-2 étaient nés au Canada.

Conclusion

La prévalence du HTLV-1/2 est faible dans le sang des donneurs de sang. Pays de naissance à forte prévalence représente à peu près la moitié des cas de HTLV-1; les donneurs positifs au HTLV-2 la plupart du temps sont nés au Canada. La transmission du HTLV-1/2 survient probablement outre-mer et au Canada.

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Data availability

Summary data can be obtained by contacting the corresponding author. De-identified individual data can be made available subject to research ethics approval, internal review, and legal contracts.

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Funding

All work was funded internally by Canadian Blood Services.

Author information

Authors and Affiliations

  1. Epidemiology & Surveillance, Canadian Blood Services, Ottawa, ON, Canada

    Sheila F. O’Brien, Behrouz Ehsani-Moghaddam, Lori Osmond & Wenli Fan

  2. School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada

    Sheila F. O’Brien

  3. Centre for Studies in Primary Care, Department of Family Medicine, Queen’s University, Kingston, ON, Canada

    Behrouz Ehsani-Moghaddam

  4. Donation and Policy Studies, Canadian Blood Services, Ottawa, ON, Canada

    Mindy Goldman

  5. Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Mindy Goldman

  6. Microbiology, Canadian Blood Services, Edmonton, AB, Canada

    Steven J. Drews

  7. Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada

    Steven J. Drews

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  1. Sheila F. O’Brien
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Contributions

SFO, SJD, and MG conceived the study. LO collected data and LO, WF, and BE conducted the analysis. SFO drafted the manuscript and SJD conducted review and editing. All authors provided critical review and approved the final manuscript.

Corresponding author

Correspondence to Sheila F. O’Brien.

Ethics declarations

Ethics approval

All procedures performed in the case–control study involving human participants were in accordance with the ethical standards of the Canadian Blood Services Research Ethics Board (REB 2018.040) and with the 1964 Helsinki Declaration and its later amendments of comparable ethical standards. The surveillance data analysis was deemed exempt by the Canadian Blood Services Research Ethics Board.

Consent to participate

Informed consent was obtained from individual participants in the case–control study. All blood donors were informed that their blood would be tested for infectious markers including HTLV as part of the consent to donate process and provided informed consent.

Consent for publication

Not applicable.

Conflict of interest

SJD has received laboratory supplies from Abbott Pharmaceuticals and consulting fees from Roche.

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Appendix

Appendix

See Table 4, Table 5, Table 6 and Table 7

Table 4 Demographic comparison of first-time donors who completed vs those who did not complete the case interview
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Table 5 Output from univariate logistic regression models on HTLV case–control data with presumed HTLV positivity as the dependent variable
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Table 6 Output from multivariable logistic regression model with HTLV-1 positivity as the dependent variable (includes all Canadian provinces except Quebec from 1990 to 2022)
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Table 7 Output from multivariable logistic regression model with HTLV-2 positivity as the dependent variable (includes all Canadian provinces except Quebec from 1990 to 2022)
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O’Brien, S.F., Ehsani-Moghaddam, B., Goldman, M. et al. Prevalence of human T-cell lymphotropic virus-1/2 in Canada over 33 years: A unique contribution of blood donors to public health surveillance. Can J Public Health (2024). https://doi.org/10.17269/s41997-024-00886-6

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