Screening for HTLV-1 infection should be expanded in Europe.

HTLV-1 infection is spreading globally at an uncertain speed. Sexual, mother-to-child and parenteral exposure are the major transmission routes. Neither vaccines nor antivirals have been developed to confront HTLV-1, despite infecting over 10 million people globally and causing life-threatening illnesses in 10% of carriers. It is time to place this long neglected disease firmly into the 2030 elimination agenda. Current evidence supports once in life testing for HTLV-1, as recommended for HIV, hepatitis B and C, along with targeted screening of pregnant women, blood donors and people attended at clinics for sexually transmitted infections. Similar targeted screening strategies are already being performed for Chagas disease in some Western countries in persons from Latin America. Given the high risk of rapid-onset HTLV-1 associated myelopathy, universal screening of solid organ donors is warranted. To minimize organ wastage, however, the specificity of HTLV screening tests must be improved. HTLV screening of organ donors in Europe has become mandatory in Spain and the UK. The advent of HTLV point-of-care kits would facilitate testing. Finally, rising awareness on HTLV-1 will help that those living with HTLV-1 are tested and clinically monitored, as well as informed about transmission preventative measures.