Arboviruses and HTLV, co-infections, and the increased exposure of women and pregnant women over the lifetime: Improvements in diagnostics for co-infections, collection of data, and management.
Arboviruses, HTLV, maternal health, co-infections, sustainable development goals, life cycle.
The Brazilian population faces multiple endemic arboviruses that persist and continue to haunt the population in the last 50 years. HTLV is an endemic retrovirus in the country, with multiple subtypes in circulation, HTLV-I, HTLV-II, HTLV-III, and HTLV-IV. In addition, dengue virus (DENV), chikungunya (CHIKV), Zika virus (ZIKV) and yellow fever are the most common arboviruses in the country. HTLV-I and HTLV-II are the most studied HTLV subtypes in Brazil where HTLV-I can lead to severe cases of leukemia called adult T-cell leukemia (ATL). Currently, HTLV is studied in specic populations and regions of the country. Most infections with arboviruses and HTLV are asymptomatic, co-infections not captured, and the diagnosis and related data are not easily accessible to the public. Women and mothers are at a greater risk of exposure to infections due to transmission route, lack of diagnostics, inconsistent data and access to data over the lifetime, and the lack of information on immune proles over the lifetime. In this data assessment and review of the state of the art of diagnostics for arboviruses and co-infections with HTLV in Brazil, we evaluate national and international databases and the diagnostic scenario for HTLV and the various arboviruses in the country and abroad. Finally, we proposed new metrics for data collection, improved diagnostics, and tools for better data collection, management, and evaluation of co-infections in Brazil. Data on lifelong infections, such as the availability of diagnostics and data on arbovirus IgG serology, dierential diagnosis of HTLV-I and HTLVII, and the availability of data in a streamlined manner are highly needed in Brazil as part of the public health system. This is critical to assess infections and co-infections throughout the lifetime. Both arboviral testing and HTLV testing should be available at the point-of-care and laboratory settings. A more detailed evaluation of the strategy for diagnostic testing and screening is needed to account for the potential for lifetime infections andmultiple infections at one time, and the increased risk to women and pregnant women. National and nternational databases must be interconnected and available for better assessment. We hope that the proposed improvements to the collection, capture, and integration of data for arbovirus infections and co-infections over the lifetime and HTLV-I or HTLV-II infections, will greatly improve the screening of infections in the country, and will support improved health for all, in particular for women, and preg.