TABLE 4.

Issues needed to maximize the effects of the nationwide screening program.

Issues	Countermeasures
Selection of feeding methods	Establishment of evidence on the prevention of MTCT by STBF and FTBMF
Evaluation of effect of mother screening on MTCT prevention	To increase the rate of antibody testing after 3 years of age
Public awareness	Necessary for patient groups, scientists, clinicians, and policy makers to work together to raise public awareness about HTLV-1 infection.
Support for carrier mothers	Establishment of adequate support system for carrier mothers in each prefecture
Elimination or reduction of the benefits obtained by breastfeeding	Establishment of evidence on the prevention of MTCT by STBF and FTBMF, and development of preventive measures except for feeding methods
Very low birth weight and/or very preterm infants	Banked human milk or FTBMF
Infection during pregnancy and breastfeeding after antenatal screening test	To use a contraceptive (condom)
Delivery of pregnant women who did not test antibodies during pregnancy	To test HTLV-1 antibody for these mothers as soon as possible. In the case there is an infected sibling due to MTCT, the use of infant formula may be an option to minimize the postnatal MTCT risk until the test results are obtained.

MTCT: mother-to-child transmission, STBF: short-term breastfeeding, FTBMF: frozen-thawed breastmilk feeding.