title: 20 years into the Gambia Hepatitis Intervention Study: assessment of initial hypotheses and prospects for evaluation of protective effectiveness against liver cancer.
abstract: Primary hepatocellular carcinoma is the commonest cancer in The Gambia. The Gambia Hepatitis Intervention Study (GHIS) was established in 1986 to evaluate the protective effectiveness of infant hepatitis B immunization in the prevention of chronic liver disease, particularly, hepatocellular carcinoma and cirrhosis later in adult life. This program was designed based on a series of assumptions. Here, we used data from observational and epidemiologic studies developed since 1986 to examine the validity of these assumptions. We found that (a) hepatitis B vaccine coverage was 15% more than originally assumed, (b) protection against hepatitis B virus (HBV) infection was not dependent on the number of vaccine doses received, (c) perinatal infection with HBV was of negligible importance, and (d) the HBV attributable risk of hepatocellular carcinoma at age < 50 was 70% to 80%, lower than initially assumed. Based on these data, the final outcome of the GHIS should be measurable from 2017, sooner than originally assumed. The GHIS strategy takes into account-specific patterns of virus epidemiology and natural history of hepatocellular carcinoma in Africa and provides a model for integrating and evaluating new vaccines into the Expanded Programme of Immunization of sub-Saharan African countries.
authors.affiliation: IARC, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Viviani
authors.forename: Patrizia
authors.initials: P
authors.lastname: Carrieri
authors.forename: Ebrima
authors.initials: E
authors.lastname: Bah
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hall
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Maimuna
authors.initials: M
authors.lastname: Mendy
authors.forename: Ruggero
authors.initials: R
authors.lastname: Montesano
authors.forename: Amelie
authors.initials: A
authors.lastname: Plymoth
authors.forename: Omar
authors.initials: O
authors.lastname: Sam
authors.forename: Marianne
authors.initials: M
authors.lastname: Van der Sande
authors.forename: Hilton
authors.initials: H
authors.lastname: Whittle
authors.forename: Pierre
authors.initials: P
authors.lastname: Hainaut
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology*; D008297:Male
chemical_list: D017325:Hepatitis B Vaccines