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However, this study was performed in only a small series of women, all originating from the remote and small island of Ambae.

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Written informed consent was obtained from all individuals who participated in the study.

Ethnographic, demographic, and clinical data were obtained by interviews conducted in English or in Melanesian pidgin.

Data were collected onto a standardized form with limited information regarding age, sex, birth and living places, date and place of blood collection, and blood transfusion history.

Map of the Vanuatu archipelago showing the distribution of human T lymphotropic virus type 1 (HTLV-1) seroprevalence according to the different provinces.

The 6 administrative divisions studied were Torba Province, composed mainly of the Torres and Banks islands; Sanma Province, composed of the Esperitu Santo and Malo islands; Penama Province, composed of the Penteco'88te, Ambae, and Maewo islands; Malampa Province, composed of the Malekula, Ambrym, and Paama islands; Shefa Province, composed mainly of the Shepherds and Efate islands; and Tafea Province, composed of the Tanna, Erromango, and Aneityum islands.

The genetic characterization of the very few available strains from these Melanesian populations have indicated that such HTLV-1 strains are the most divergent ones, exhibiting from 7% to 10% divergence at the nucleotide level with the classic cosmopolitan prototype in the gene and the long terminal repeat regions [17, 18, 27, 28].

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