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Lebbie W, Allan-Blitz LT, Nyama ET, Swaray M, Lavalie D, Mhango M, Patiño Rodriguez M, Gupta N, Bitwayiki R. Barriers to longitudinal follow-up for hepatitis B treatment in rural Sierra Leone: A mixed methods study of retention in care. Clin Liver Dis (Hoboken) 2024; 23:e0225. [PMID: 38831767 PMCID: PMC11146505 DOI: 10.1097/cld.0000000000000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/03/2024] [Indexed: 06/05/2024] Open
Abstract
HBV disproportionately affects resource-limited settings, and retaining patients in longitudinal care remains challenging. We conducted a mixed methods investigation to understand the causes of losses to follow-up within an HBV clinic in rural Sierra Leone. We developed a multivariable logistic regression model of baseline clinical and sociodemographic factors predicting losses to follow-up, defined as failing to present for a follow-up visit within 14 months of enrollment. We included patients enrolled between April 30, 2019 and March 1, 2020, permitting 14 months of follow-up by April 30, 2021. We then developed a survey to solicit patient perspectives on the challenges surrounding retention. We interviewed randomly selected patients absent from HBV care for at least 6 months. Among 271 patients enrolled in the Kono HBV clinic, 176 (64.9%) did not have a follow-up visit within 14 months of the study end point. Incomplete baseline workup (aOR 2.9; 95% CI: 1.6-4.8), lack of treatment at baseline (aOR 5.0; 95% CI: 1.7-14.4), and having cirrhosis at baseline (aOR 3.3; 95% CI: 0.99-10.8) were independently associated with being lost to follow-up. For the patient survey, 21 patients completed the interview (median age 34 years [IQR: 25-38]). Travel-related factors were the most frequently reported barrier to retention (57%). Almost 30% suggested improved customer care might support retention in care; 24% requested to be given medication. In our setting, factors that might reduce losses to follow-up included expanded criteria for treatment initiation, overcoming transportation barriers, reducing wait times, ensuring against stockouts, and scaling up point-of-care testing services.
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Affiliation(s)
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Mohamed Swaray
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
| | - Daniel Lavalie
- Ministry of Health and Sanitation, Freetown, Sierra Leone, Britannica, WA
| | - Michael Mhango
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
| | | | - Neil Gupta
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Remy Bitwayiki
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
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Camara M, Tantuoyir MM, SeyedAlinaghi S, Ghiasvand F, Ahmadinejad Z. Prevalence of hepatitis B infection in the Gambian population: A narrative review of recent developments. Prev Med Rep 2023; 36:102401. [PMID: 37719791 PMCID: PMC10500481 DOI: 10.1016/j.pmedr.2023.102401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Hepatitis B is a "silent epidemic", fifty to a hundred (50-100) times more infectious than HIV, a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). HBV can cause acute and chronic infection and subsequently results in a high risk of death from cirrhosis and liver cancer. Despite the availability of a safe and effective vaccine, HBV continues to be a global burden including in The Gambia. This study reviewed the recent trends in the epidemiological characteristics of HBV in the Gambia. The researchers conducted an online literature search for primary studies on HBV prevalence published in the past two decades from Jan 1992 to Feb 2022 inclusive on Google Scholar, PubMed, and Scopus. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness, and methodological coherence. We found that HBV infection prevalence is above 8% in The Gambia. Moreover, HBV is the most common cause of hepatocellular carcinoma (HCC) in Gambia. Liver cirrhosis and HCC have the highest mortality contribution among hepatitis patients, with occult HBV carriers as major culprits. Also, vaccination coverage has declined from 91% to 88% according to reports from current literature. To achieve the WHO goal of eliminating HBV by 2030, policies targeting infection transmission control among risk groups, community awareness programs, research, price reduction of drugs, mass vaccinations, and diagnostics should be urgently instituted.
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Affiliation(s)
- Muhammed Camara
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Edward Francis Small Teaching Hospital, Banjul, the Gambia
| | - Marcarious M. Tantuoyir
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ghiasvand
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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3
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Bittaye SO, Kambi A, Tekanyi MAI, Tamba S, Sanneh L, Sisawo MM, Jatta A, Fatty G, Jeng A, Jallow MS, Leigh O, Njie R. Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients. BMC Gastroenterol 2023; 23:321. [PMID: 37730538 PMCID: PMC10510158 DOI: 10.1186/s12876-023-02952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND As a result of the lack of screening programs and the difficulty in making a proper diagnosis, the majority of hepatocellular carcinoma (HHC) patients present late in low-resource countries. The study therefore assesses the clinical features, stage and prognostic variables of patients with HCC in The Gambia. METHODS From December 2015 to January 2019, patients with a confirmed diagnosis of HCC were enrolled. All patients' medical history, ultrasound scan, FibroScan and laboratory details were collected. RESULTS Two hundred and sixty (260) patients were enrolled. The mean age of HCC patients was 40 years, and 210 (80.7%) of them were male. The most common gastrointestinal symptoms were early satiety 229 (88.1%) and abdominal pain 288 (87.7%), while the most common constitutional symptoms were weight loss 237 (91.2%) and easy fatiguability 237 (91.2%). Hepatomegaly 205 (78.8%) was the most common sign. On ultrasound scan, lesions were mostly multifocal 175 (67.3%), and the median FibroScan score was 75 kPa. The median fibrosis 4 and aspartate transferase platelet ratio index were 4.6 and 2.2, respectively. Hepatitis B surface antigen (HBsAg) was positive in 170 (65.4%) patients, and the median AFP level was 3263 ng/ml. HCC patients with positive HBsAg were more likely to be male 145 (85.3%) vs 62 (72.1%) (p = 0.011), much younger 39.9 vs 51.4 yrs (p = < 0.0001), more likely to have abdominal pain 156 (91.8%) vs 68 (79.1%) (p = 0.002), jaundice 78 (45.9%) vs 29 (33.7%) (p = 0.042), dark urine 117 (68.8%) vs 46 (53.5%) (p = 0.018), raised transaminases (Aspartate transaminases 224.5 (32-7886) vs 153 (18-610), p = < 0.01, Alanine transferases 71 (5-937) vs 47 (8-271), p = < 0.001) and decreased platelet count 207 (33-941) vs 252 (52- 641) (p = 0.021) compared to patients with HCC who were HBsAg-negative. CONCLUSIONS The prognosis of patients with HCC is poor in developing countries such as The Gambia, where screening programs and treatment modalities are scarce. Young males are disproportionately affected, and HBV is a major cause of HCC in The Gambia.
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Affiliation(s)
- Sheikh Omar Bittaye
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia.
| | - Abubacarr Kambi
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Momodou A I Tekanyi
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Saydiba Tamba
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Lamin Sanneh
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Momodou Musa Sisawo
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Abdoulie Jatta
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Gibril Fatty
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Adam Jeng
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Momodou Salieu Jallow
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
- Pathology Department, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ousman Leigh
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
- Pathology Department, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- American International University, Serekunda, Gambia
| | - Ramou Njie
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
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Sowe A, Namatovu F, Cham B, Gustafsson PE. Impact of a performance monitoring intervention on the timeliness of Hepatitis B birth dose vaccination in the Gambia: a controlled interrupted time series analysis. BMC Public Health 2023; 23:568. [PMID: 36973797 PMCID: PMC10041491 DOI: 10.1186/s12889-023-15499-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances. METHODS We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend. RESULTS Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively. CONCLUSION The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement.
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Affiliation(s)
- Alieu Sowe
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
- Expanded Program On Immunization, Ministry of Health, Banjul, The Gambia.
| | - Fredinah Namatovu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bai Cham
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Bakau, The Gambia
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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5
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Flores JE, Thompson AJ, Ryan M, Howell J. The Global Impact of Hepatitis B Vaccination on Hepatocellular Carcinoma. Vaccines (Basel) 2022; 10:vaccines10050793. [PMID: 35632549 PMCID: PMC9144632 DOI: 10.3390/vaccines10050793] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 12/17/2022] Open
Abstract
Over 1.5 million preventable new hepatitis B infections continue to occur each year and there are an estimated 296 million people living with chronic hepatitis B infection worldwide, resulting in more than 820,000 deaths annually due to liver cirrhosis and hepatocellular carcinoma (HCC). Hepatitis B vaccination remains the cornerstone of public health policy to prevent HCC and a vital component of the global hepatitis B elimination response. The WHO has set a 90% vaccination target to achieve hepatitis B elimination by 2030; however, there is wide variability in reported birth dose coverage, with global coverage at only 42%. In this review, we outline the global trends in hepatitis B vaccination coverage and the impact of hepatitis B vaccination on HCC incidence and discuss the challenges and enabling factors for achieving WHO 2030 hepatitis B vaccination coverage targets.
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Affiliation(s)
- Joan Ericka Flores
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence:
| | - Alexander J. Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Marno Ryan
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Jessica Howell
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton, VIC 3800, Australia
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6
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Qama A, Allard N, Cowie B, Davis JS, Davies J. Hepatitis B in the Northern Territory: insights into the changing epidemiology of an ancient condition. Intern Med J 2021; 51:910-922. [PMID: 32975893 PMCID: PMC8362129 DOI: 10.1111/imj.15069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 01/04/2023]
Abstract
Background Aboriginal and Torres Strait Islander people are disproportionately affected by hepatitis B virus (HBV) infection. A proposed mismatch between standard vaccines and the HBV/C4 sub‐genotype prevalent in Aboriginal people in the Northern Territory (NT) may reduce vaccine effectiveness. Aims To determine HBV prevalence in the NT by Indigenous status and to explore patterns of immunity following implementation of universal vaccination, using a large longitudinal diagnostic dataset. Methods A retrospective analysis of all available HBV serology results in the NT from 1991 to 2011 was conducted, with HBV prevalence and vaccination status analysed according to adigenous status, age and sex using individuals' patterns of HBsAg, anti‐HBs and anti‐HBc serology over repeated tests. Results 100 790 individuals were tested (33.4% Indigenous) between 1991 and 2011 (26.1% of the 2011 NT population), with a total of 211 802 tests performed. In 2011, the proportion of HBV positive individuals in the NT was 3.17% (5.22% in Indigenous populations) compared to previous 2011 estimates of 1.70% (3.70% in Indigenous populations). The vaccine failure rate was lower than expected with only one presumed vaccinated person subsequently developing HBsAg positivity (0.02%). Evidence of suboptimal vaccine efficacy by breakthrough anti‐HBc positivity in vaccinated individuals was demonstrated in 3.1% of the vaccinated cohort, of which 86.4% identified as Indigenous (HR 1.17). No difference in HBeAg positivity or seroconversion was observed between Indigenous and non‐Indigenous individuals living with CHB. Conclusions The burden of CHB in Indigenous people in the NT has previously been underestimated. A higher HBV prevalence in the NT than described in previous cross‐sectional studies was found, including a higher prevalence in Indigenous people. Evidence of suboptimal vaccine efficacy was demonstrated predominantly in Indigenous individuals.
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Affiliation(s)
- Ashleigh Qama
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.,cohealth, Parkville, Victoria, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joshua S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Division of Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jane Davies
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,The Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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7
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Omonisi AE, Liu B, Parkin DM. Population-Based Cancer Registration in Sub-Saharan Africa: Its Role in Research and Cancer Control. JCO Glob Oncol 2020; 6:1721-1728. [PMID: 33180635 PMCID: PMC7713579 DOI: 10.1200/go.20.00294] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Abidemi Emmanuel Omonisi
- Department of Anatomic Pathology, Ekiti State University, Ado-Ekiti, Nigeria
- Ekiti Cancer Registry, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Biying Liu
- African Cancer Registry Network, Oxford, United Kingdom
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- International Agency for Research on Cancer, Lyon, France
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8
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Mahale P, Aka P, Chen X, Pfeiffer RM, Liu P, Groover S, Mendy M, Njie R, Goedert JJ, Kirk GD, Glenn JS, O’Brien TR. Hepatitis D virus infection, cirrhosis and hepatocellular carcinoma in The Gambia. J Viral Hepat 2019; 26:738-749. [PMID: 30661282 PMCID: PMC6529252 DOI: 10.1111/jvh.13065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/17/2018] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) incidence is high in The Gambia, and hepatitis B virus (HBV) infection is the main cause. People coinfected with HBV and hepatitis D virus (HDV) have an even greater risk of HCC and cirrhosis. Using a new HDV quantitative microarray antibody capture (Q-MAC) assay, we evaluated the association between HDV infection and HCC or cirrhosis among participants in The Gambia Liver Cancer Study. In this case-control study, cases had HCC (n = 312) or cirrhosis (n = 119). Controls (n = 470) had no clinical evidence of liver disease and normal serum alpha-foetoprotein. Participants were previously tested for hepatitis B surface antigen (HBsAg); we tested HBsAg+ specimens by HDV Q-MAC, western blot and RNA assays. We evaluated separate cut-offs of the Q-MAC assay for predicting anti-HDV and RNA positivity. Q-MAC correctly identified 29/29 subjects who were western blot-positive (sensitivity = 100%, specificity = 99.4%) and 16/17 who were RNA-positive (sensitivity = 94.1%, specificity = 100%). Compared to controls, cases more often had HBV monoinfection (HBsAg+/HDV RNA-; 54.1% vs 17.0%; odds ratio [OR] = 6.28; P < 0.001) or HBV-HDV coinfection (HBsAg+/HDV RNA+; 3.9% vs 0%; P < 0.001). Risk estimates (for HCC or cirrhosis) based on HDV antibody status and adjusted for covariates (demographics, alcohol, smoking, body mass index, anti-HCV and aflatoxin B1 exposure) yielded consistent results for both HBV monoinfection (adjusted OR = 8.29; 95% confidence interval = 5.74-11.98) and HBV-HDV coinfection (adjusted OR = 30.66; 95% confidence interval = 6.97-134.95). In this Gambian population, HDV Q-MAC had high sensitivity and specificity for both anti-HDV and HDV RNA. HDV infection contributed to the high risk of HCC in The Gambia.
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Affiliation(s)
- Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Peter Aka
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
- International Health Division, Demographic and Health Surveys, ICF International, Rockville, Maryland, USA
| | - Xiaohua Chen
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Infectious Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Ping Liu
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sarah Groover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
- Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Maimuna Mendy
- International Agency for Research on Cancer, Lyon, France
| | - Ramou Njie
- International Agency for Research on Cancer, Lyon, France
- Hepatitis Unit, Disease Control & Elimination, Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - James J. Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeffrey S. Glenn
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Palo Alto, California
| | - Thomas R. O’Brien
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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9
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Bittaye M, Idoko P, Ekele BA, Obed SA, Nyan O. Hepatitis B virus sero-prevalence amongst pregnant women in the Gambia. BMC Infect Dis 2019; 19:259. [PMID: 30876397 PMCID: PMC6419830 DOI: 10.1186/s12879-019-3883-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 03/06/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Infection with Hepatitis B virus (HBV) is a serious public health problem worldwide, with over 360 million carriers. Sixty million of these are resident in Sub-saharan Africa. Hepatitis B infection is the cause of Hepatocellular carcinoma (HCC), which is the second commonest cause of death from cancers among women in The Gambia. Vertical transmission is the commonest route of spread of Hepatitis B Virus in many endemic areas. The main aim of the study was to determine the sero-prevalence of Hepatitis B surface antigen (HBsAg) among pregnant women attending antenatal clinic at the Edward Francis Small Teaching Hospital, Banjul, The Gambia. METHODS Four hundred and twenty six pregnant women were recruited from our antenatal clinics and tested for HBsAg. Serum Hepatitis B surface antigen (HBsAg) was tested using commercial rapid diagnostic Elisa kits at the point of care. RESULTS A prevalence rate of 9.20% among all pregnant women studied was found. Women who were likely to have been vaccinated had a prevalence rate of 2.30% whiles those unlikely to have been vaccinated had a prevalence of 13.71%. There was a statistically significant difference between those likely to have been vaccinated and those unlikely to have been vaccinated. CONCLUSION The prevalence of hepatitis B infection is very high among pregnant women at EFSTH as in the high endemic zone that is more than 8%. However the prevalence rate is lower than the national average of 15%. The prevalence is of moderate endemicity among the women who likely received vaccination during childhood. More interventions during pregnancy need to be undertaken if more successes are to be registered.
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Affiliation(s)
- Mustapha Bittaye
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine & Allied Health Sciences, University of The Gambia, Brikama, Gambia
| | - Patrick Idoko
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine & Allied Health Sciences, University of The Gambia, Brikama, Gambia
| | | | - Samuel Amenyi Obed
- Korle Bu Teaching Hospital, School of Medicine, University Of Ghana, Accra, Ghana
| | - Ousman Nyan
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine & Allied Health Sciences, University of The Gambia, Brikama, Gambia
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10
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Williams JR, Manfredi P, Melegaro A. The potential impact of the demographic transition in the Senegal-Gambia region of sub-Saharan Africa on the burden of infectious disease and its potential synergies with control programmes: the case of hepatitis B. BMC Med 2018; 16:118. [PMID: 30041645 PMCID: PMC6058373 DOI: 10.1186/s12916-018-1100-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/14/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) continues to suffer high communicable disease burdens as its demographic transition (DT) proceeds. Although the consequent changes in population structures influence age-specific contact patterns relevant for transmission, the age distribution of immunity, and the disease burden, investigation of the potential of DT to affect infectious disease epidemiology in regions of SSA has hitherto been overlooked. With a substantial disease burden and complex epidemiology, hepatitis B virus (HBV) represents a prime example of an infection whose epidemiology may be significantly influenced by the DT. METHODS An age-structured mathematical model for HBV in the Senegal and Gambia (SG) region was set within a demographic framework with varying vital rates mirroring the entire course of the DT there over 1850-2100, to investigate the effects of the DT on HBV epidemiology, with and without the combined action of vaccination. The model was run from its reconstructed ancien régime (old order) demo-epidemiologic equilibrium and calibrated against SG 1950 age-distribution estimates and Gambian pre-vaccination HBV age-prevalence data. RESULTS The model, which reproduced well demographic and HBV age-prevalence data, predicted a complex transition of HBV epidemiology over the course of the DT. This included a prolonged epoch of expansion alongside population growth and rejuvenation until 1990-2000, followed by a dramatic retreat, mainly reflecting projected fertility decline during the twenty-first century. This transitional pattern was mostly explained by the underlying demographically driven changes in horizontal transmission resulting from the changes in the age structure of the population. During 2000-2150 the HBV burden is predicted to decline by more than 70% even in the absence of vaccination. CONCLUSIONS Demographic change alone may strongly affect HBV disease burden and shape HBV endemicity. The onset of the demographically driven decline in HBV prevalence, aligned with the expansion of HBV vaccination, forms a synergy potentially boosting effectiveness of control. Such a synergy currently appears to be presenting a "window of opportunity" facilitating HBV elimination which it would be important to exploit and which underlines the importance of taking demographic change into account when assessing the potential longer term impact of vaccination and other control measures.
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Affiliation(s)
- John R Williams
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
| | - Piero Manfredi
- Dipartimento di Economia e Management, University of Pisa, via Ridolfi 10, 56124, Pisa, Italy
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policy and Department of Social and Political Science, Bocconi University, Via Roentgen 1, 20136, Milan, Italy
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11
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Yindom LM, Mendy M, Bodimeade C, Chambion C, Aka P, Whittle HC, Rowland-Jones SL, Walton R. KIR content genotypes associate with carriage of hepatitis B surface antigen, e antigen and HBV viral load in Gambians. PLoS One 2017; 12:e0188307. [PMID: 29149205 PMCID: PMC5693433 DOI: 10.1371/journal.pone.0188307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/04/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) causes over 800,000 deaths worldwide annually, mainly in low income countries, and incidence is rising rapidly in the developed world with the spread of hepatitis B (HBV) and C (HCV) viruses. Natural Killer (NK) cells protect against viral infections and tumours by killing abnormal cells recognised by Killer-cell Immunoglobulin-like Receptors (KIR). Thus genes and haplotypes encoding these receptors may be important in determining both outcome of initial hepatitis infection and subsequent chronic liver disease and tumour formation. HBV is highly prevalent in The Gambia and the commonest cause of liver disease. The Gambia Liver Cancer Study was a matched case-control study conducted between September 1997 and January 2001 where cases with liver disease were identified in three tertiary referral hospitals and matched with out-patient controls with no clinical evidence of liver disease. METHODS We typed 15 KIR genes using the polymerase chain reaction with sequence specific primers (PCR-SSP) in 279 adult Gambians, 136 with liver disease (HCC or Cirrhosis) and 143 matched controls. We investigated effects of KIR genotypes and haplotypes on HBV infection and associations with cirrhosis and HCC. RESULTS Homozygosity for KIR group A gene-content haplotype was associated with HBsAg carriage (OR 3.7, 95% CI 1.4-10.0) whilst telomeric A genotype (t-AA) was associated with reduced risk of e antigenaemia (OR 0.2, 95% CI 0.0-0.6) and lower viral loads (mean log viral load 5.2 vs. 6.9, pc = 0.022). One novel telomeric B genotype (t-ABx2) containing KIR3DS1 (which is rare in West Africa) was also linked to e antigenaemia (OR 8.8, 95% CI 1.3-60.5). There were no associations with cirrhosis or HCC. CONCLUSION Certain KIR profiles may promote clearance of hepatitis B surface antigen whilst others predispose to e antigen carriage and high viral load. Larger studies are necessary to quantify the effects of individual KIR genes, haplotypes and KIR/HLA combinations on long-term viral carriage and risk of liver cancer. KIR status could potentially inform antiviral therapy and identify those at increased risk of complications for enhanced surveillance.
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MESH Headings
- Adult
- Carcinoma, Hepatocellular/complications
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/pathology
- Case-Control Studies
- Chromosomes, Human, Pair 19/chemistry
- Female
- Gambia
- Gene Expression
- Genotype
- Hepatitis B Surface Antigens/genetics
- Hepatitis B Surface Antigens/immunology
- Hepatitis B e Antigens/genetics
- Hepatitis B e Antigens/immunology
- Hepatitis B virus/genetics
- Hepatitis B virus/immunology
- Hepatitis B virus/pathogenicity
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/genetics
- Hepatitis B, Chronic/immunology
- Hepatitis B, Chronic/pathology
- Humans
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Liver Cirrhosis/complications
- Liver Cirrhosis/genetics
- Liver Cirrhosis/immunology
- Liver Cirrhosis/pathology
- Liver Neoplasms/complications
- Liver Neoplasms/genetics
- Liver Neoplasms/immunology
- Liver Neoplasms/pathology
- Male
- Receptors, KIR/classification
- Receptors, KIR/genetics
- Receptors, KIR/immunology
- Tertiary Care Centers
- Viral Load/genetics
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Affiliation(s)
- Louis-Marie Yindom
- University of Oxford, Nuffield Department of Medicine, Oxford, United Kingdom
- Medical Research Council (UK), Fajara, The Gambia
| | - Maimuna Mendy
- Medical Research Council (UK), Fajara, The Gambia
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Peter Aka
- Medical Research Council (UK), Fajara, The Gambia
- Demographic and Health Surveys, ICF International, Rockville, Maryland United States of America
| | - Hilton C. Whittle
- Medical Research Council (UK), Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah L. Rowland-Jones
- University of Oxford, Nuffield Department of Medicine, Oxford, United Kingdom
- Medical Research Council (UK), Fajara, The Gambia
| | - Robert Walton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
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12
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Nayagam S, Conteh L, Sicuri E, Shimakawa Y, Suso P, Tamba S, Njie R, Njai H, Lemoine M, Hallett TB, Thursz M. Cost-effectiveness of community-based screening and treatment for chronic hepatitis B in The Gambia: an economic modelling analysis. Lancet Glob Health 2016; 4:e568-78. [PMID: 27443782 DOI: 10.1016/s2214-109x(16)30101-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the high burden of hepatitis B virus (HBV) infection in sub-Saharan Africa, absence of widespread screening and poor access to treatment leads to most people remaining undiagnosed until later stages of disease when prognosis is poor and treatment options are limited. We examined the cost-effectiveness of community-based screening and early treatment with antiviral therapy for HBV in The Gambia. METHODS In this economic evaluation, we combined a decision tree with a Markov state transition model to compare a screen and treat intervention consisting of adult community-based screening using a hepatitis B surface antigen (HBsAg) rapid test and subsequent HBV antiviral therapy versus current practice, in which there is an absence of publicly provided screening or treatment for HBV. We used data from the PROLIFICA study to parameterise epidemiological, primary screening, and cost information, and other model parameter inputs were obtained from a literature search. Outcome measures were cost per disability-adjusted life-year (DALY) averted; cost per life-year saved; and cost per quality-adjusted life-year (QALY) gained. We calculated the incremental cost-effectiveness ratios (ICERs) between current practice and the screen and treat intervention. Costs were assessed from a health provider perspective. Costs (expressed in 2013 US$) and health outcomes were discounted at 3% per year. FINDINGS In The Gambia, where the prevalence of HBsAg is 8·8% in people older than 30 years, adult screening and treatment for HBV has an incremental cost-effectiveness ratio (ICER) of $540 per DALY averted, $645 per life-year saved, and $511 per QALY gained, compared with current practice. These ICERs are in line with willingness-to-pay levels of one times the country's gross domestic product per capita ($487) per DALY averted, and remain robust over a wide range of epidemiological and cost parameter inputs. INTERPRETATION Adult community-based screening and treatment for HBV in The Gambia is likely to be a cost-effective intervention. Higher cost-effectiveness might be achievable with targeted facility-based screening, price reductions of drugs and diagnostics, and integration of HBV screening with other public health interventions. FUNDING European Commission.
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Affiliation(s)
- Shevanthi Nayagam
- Division of Digestive Diseases, St Mary's Hospital, Imperial College, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK.
| | - Lesong Conteh
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
| | - Elisa Sicuri
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Yusuke Shimakawa
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Penda Suso
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Saydiba Tamba
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Ramou Njie
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Harr Njai
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Maud Lemoine
- Division of Digestive Diseases, St Mary's Hospital, Imperial College, London, UK; Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
| | - Mark Thursz
- Division of Digestive Diseases, St Mary's Hospital, Imperial College, London, UK
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13
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Villain P, Gonzalez P, Almonte M, Franceschi S, Dillner J, Anttila A, Park JY, De Vuyst H, Herrero R. European Code against Cancer 4th Edition: Infections and Cancer. Cancer Epidemiol 2015; 39 Suppl 1:S120-38. [PMID: 26589774 DOI: 10.1016/j.canep.2015.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 12/15/2022]
Abstract
Of the 2,635,000 new cancer cases (excluding non-melanoma skin cancers) occurring in the European Union (EU) in 2012, it is estimated that approximately 185,000 are related to infection with human papillomaviruses (HPVs), hepatitis B and C viruses (HBV and HCV), and Helicobacter pylori (H. pylori). Chronic infection with these agents can lead to cancers of the cervix uteri, liver, and stomach, respectively. Chronic infection with HCV can also lead to B-cell non-Hodgkin lymphoma. Human immunodeficiency virus (HIV) infection continues to be of major public health importance in several EU countries and increases cancer risk via HIV-induced immunosuppression. The fourth edition of the European Code Against Cancer presents recommendations on effective and safe preventive interventions in order to reduce the risk of infection-related cancers in EU citizens. Based on current available evidence, the fourth edition recommends that parents ensure the participation of their children in vaccination programs against HBV (for newborns) and HPV (for girls). In the 'Questions and Answers' (Q&As) section about vaccination and infections in the website for the European Code Against Cancer, individuals who are at risk of chronic HBV or HCV are advised to seek medical advice about testing and obtaining treatment when appropriate. Individuals most at risk of HIV are advised to consult their doctor or healthcare provider to access counselling and, if needed, testing and treatment without delay. Information about H. pylori testing and treatment is also provided as testing might currently be offered in some high-risk areas in Europe. The rationale and supporting evidence for the recommendations on vaccination in the European Code Against Cancer, and for the main recommendations on vaccination and infection in the Q&As, are explained in the present review.
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Affiliation(s)
- Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Paula Gonzalez
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Silvia Franceschi
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 77 Stockholm, Sweden
| | - Ahti Anttila
- Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland
| | - Jin Young Park
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Hugo De Vuyst
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France.
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14
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Hughes JP, Granston TS, Heagerty PJ. Current issues in the design and analysis of stepped wedge trials. Contemp Clin Trials 2015; 45:55-60. [PMID: 26247569 PMCID: PMC4639463 DOI: 10.1016/j.cct.2015.07.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/24/2015] [Accepted: 07/05/2015] [Indexed: 11/26/2022]
Abstract
The use of stepped wedge designs in cluster-randomized trials and implementation studies has increased rapidly in recent years but there remains considerable debate regarding the merits of the design. We discuss three key issues in the design and analysis of stepped wedge trials - time-on-treatment effects, treatment effect heterogeneity and cohort studies.
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Affiliation(s)
- James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - Tanya S Granston
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, United States
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15
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Gyedu A, Shrauner WR, Kingham TP. No patients to resect or transplant: an analysis of patients with hepatocellular carcinoma admitted to a major African referral hospital. World J Surg 2015; 39:231-6. [PMID: 25167899 DOI: 10.1007/s00268-014-2762-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to describe the characteristics of patients diagnosed with hepatocellular carcinoma (HCC) at the Komfo Anokye Teaching Hospital (KATH) in Ghana and to determine their treatment options per the Barcelona Clinic Liver Cancer (BCLC) algorithm. METHODS We reviewed the medical records of patients diagnosed with HCC at KATH in the period 2007-2013. Patient demographics, medical history, investigations, management, and outcome were extracted. BCLC staging was applied to determine their treatment options. Results were expressed as descriptive statistics. RESULTS The charts for 206/465 patients were available for review. The male:female ratio was 2:1 and mean age was 44.0 ± 14.5 years. Common presenting complaints were abdominal distension, abdominal pain, and jaundice. hepatitis B virus (HBV) positivity was 52 %. Almost all patients received only supportive treatment. None underwent surgery, ablation, or transarterial chemoembolization. BCLC staging could be completed for 118 patients. Using predicted INR values in cases without the result, < 8 % of patients were eligible for resection, transplantation, or ablation; 25-53 % were eligible for embolization or sorafenib therapy. Up to 72 % were eligible only for supportive care. Seventy-six percent of patients reviewed were discharged alive; 71 % of patients whose charts were not available died during an admission. Thus, of the 465-patient cohort, 50 % died in the hospital. CONCLUSIONS The majority of HCC in our population is caused by HBV. Up to 61 % of patients may be eligible for curative treatment, transarterial chemoembolization, or sorafenib treatment. This percentage may be increased with a robust surveillance program for patients at increased risk for HCC. Hepatitis B vaccination must also be a public health priority.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Private Mailbag, University Post Office, Kumasi, Ghana,
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16
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Abstract
The epidemiology of hepatitis B virus (HBV) infection is geographically diverse, with population prevalence, age and mode of acquisition, and likelihood of progression to chronic infection mutually interdependent. The burden of chronic HBV infection is increasingly being recognized, with cirrhosis and liver cancer attributable to HBV continuing to increase. The outcomes of chronic HBV infection are affected by a range of factors, including viral genotype, the presence of coinfections with other blood-borne viruses, and the impact of other causes of liver disease. The increased recognition of HBV infection as a leading cause of death globally has resulted in the development of new structures and policies at the international level; immediate attention to implementing these strategies is now required.
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Affiliation(s)
- Jennifer H MacLachlan
- Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria 3000, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria 3050, Australia
| | - Benjamin C Cowie
- Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria 3000, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria 3050, Australia Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
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17
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Traoré F, Gormally E, Villar S, Friesen MD, Groopman JD, Vernet G, Diallo S, Hainaut P, Maiga MY. Molecular characteristics of Hepatitis B and chronic liver disease in a cohort of HB carriers from Bamako, Mali. BMC Infect Dis 2015; 15:180. [PMID: 25886382 PMCID: PMC4403772 DOI: 10.1186/s12879-015-0916-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/27/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatitis B (HB) infection is common in Mali. However, there is little information on molecular and biochemical characteristics of HB carriers. METHODS A group of 1466 adult volunteers was recruited in the district of Bamako. Confirmed HB carriers were tested for HB viral load by quantitative PCR and HBV was genotyped by sequencing of HBS. Fibrosis and hepatitis activity were measured using the Fibrotest-Actitest. A mutation of TP53 at codon 249 (R249S), specific for exposure to aflatoxin, was detected in cell-free DNA extracted from plasma. RESULTS Overall, 276 subjects were HBsAg-positive (18.8%). Among 152 subjects tested for HBV load, 49 (32.2%) had over 10(4) copies/mL and 16 (10.5%) had levels below the limit of detection. The E genotype was found in 91.1% of carriers. Fibrotest scores ≥ F2 were observed in 52 subjects (35.4%). Actitest scores ≥ A2 were detected in 15 subjects (10.2%) and were correlated with Fibrotest scores (p = 0.0006). Among 105 subjects tested, 60% had detectable levels of R249S copies (>40 copies/mL plasma). CONCLUSION Chronic HB carriage in adults in Bamako district is well over epidemic threshold. About 1/3 of carriers have moderate to severe liver fibrosis and 60% have detectable aflatoxin-related TP53 R249S mutation. These results support introduction of anti-HB therapies to reduce the progression towards severe liver disease.
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Affiliation(s)
- Fatou Traoré
- Centre d'Infectiologie Charles Mérieux, Bamako, République du Mali.
| | - Emmanuelle Gormally
- Université de Lyon, UMRS 449 ; Laboratoire de Biologie générale, Université Catholique de Lyon ; Reproduction et développement comparé, EPHE, Lyon, France.
| | | | - Marlin D Friesen
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - John D Groopman
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - Guy Vernet
- Laboratoire des Pathogènes Emergents Fondation Mérieux, Lyon, France.
- Centre Pasteur du Cameroun, Yaoundé, Cameroun.
| | | | - Pierre Hainaut
- International Prevention Research Institute, Lyon, France.
| | - Moussa Y Maiga
- Service de Gastroentérologie et Hépatologie, Centre Hospitalier Universitaire Gabriel Touré, Bamako, République du Mali.
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18
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Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, Bannon F, Ahn JV, Johnson CJ, Bonaventure A, Marcos-Gragera R, Stiller C, Azevedo e Silva G, Chen WQ, Ogunbiyi OJ, Rachet B, Soeberg MJ, You H, Matsuda T, Bielska-Lasota M, Storm H, Tucker TC, Coleman MP. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015; 385:977-1010. [PMID: 25467588 PMCID: PMC4588097 DOI: 10.1016/s0140-6736(14)62038-9] [Citation(s) in RCA: 1632] [Impact Index Per Article: 181.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. FUNDING Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).
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Affiliation(s)
- Claudia Allemani
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helena Carreira
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rhea Harewood
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Devon Spika
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Xiao-Si Wang
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Finian Bannon
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Jane V Ahn
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Audrey Bonaventure
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rafael Marcos-Gragera
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Departament de Salut, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Charles Stiller
- South East Knowledge and Intelligence Team, Public Health England, Oxford, UK
| | - Gulnar Azevedo e Silva
- Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wan-Qing Chen
- National Office for Cancer Prevention and Control and National Central Cancer Registry, National Cancer Center, Beijing, China
| | - Olufemi J Ogunbiyi
- Ibadan Cancer Registry, University City College Hospital, Ibadan, Nigeria
| | - Bernard Rachet
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Soeberg
- New South Wales Central Cancer Registry, Australian Technology Park, Sydney, NSW, Australia
| | - Hui You
- Cancer Institute NSW, Sydney, NSW, Australia
| | - Tomohiro Matsuda
- Population-Based Cancer Registry Section, Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Magdalena Bielska-Lasota
- Department of Health Promotion and Postgraduate Education, National Institute of Public Health and National Institute of Hygiene, Warsaw, Poland
| | - Hans Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - Thomas C Tucker
- Kentucky Cancer Registry, University of Kentucky, Lexington, KY, USA
| | - Michel P Coleman
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
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19
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Kingham TP, Alatise OI. Establishing Translational and Clinical Cancer Research Collaborations Between High- and Low-Income Countries. Ann Surg Oncol 2015; 22:741-6. [DOI: 10.1245/s10434-014-4342-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Indexed: 11/18/2022]
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20
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Busolo DS, Woodgate RL. Cancer prevention in Africa: a review of the literature. Glob Health Promot 2014; 22:31-9. [DOI: 10.1177/1757975914537094] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/19/2014] [Indexed: 11/16/2022]
Abstract
Cancer is an emerging crisis in Africa. Cancer was the seventh leading cause of death in 2004. If not controlled, cancer incidence in Africa is expected to reach 1.28 million cases annually and claim 970,000 lives yearly by 2030. This paper presents a review of the literature on current cancer prevention approaches in Africa, and consists of cancer prevention studies conducted in African countries (e.g. South Africa and Nigeria) from PubMed, Scopus, and CINAHL databases. Common female cancers in Africa are breast and cervical cancer while prostate cancer is the most common neoplasm among African males. Other common cancers are liver, colorectal, and non-Hodgkin’s lymphoma. Mortality related to these cancers comes as a result of delays in screening and treatment, unfamiliarity with cancer and cancer prevention, inaccessibility and unaffordability of care, and inefficiency of healthcare systems. Cancer prevention efforts are deficient because many governments lack cancer prevention and control policies. Also contributing to the lack of cancer prevention and control policies are low levels of awareness, scarce human and financial resources, and inadequacy of cancer registries. Overall, governments grapple with limited funds and competing healthcare priorities. As cancer continues to increase in Africa, the need for rigorous interdisciplinary research on cancer etiology and monitoring in Africa has never been timelier. Cost-effective cancer prevention programs, coordination of donor funding, advocacy, and education should be aggressively pursued. The call for more collaborative approaches in research and policy is urgently needed.
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Affiliation(s)
- David S. Busolo
- University of Manitoba - Cancer Control Program, Winnipeg, Canada
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Shimakawa Y, Lemoine M, Mendy M, Njai HF, D’Alessandro U, Hall A, Thursz M, Njie R. Population-based interventions to reduce the public health burden related with hepatitis B virus infection in the gambia, west Africa. Trop Med Health 2014; 42:59-64. [PMID: 25425952 PMCID: PMC4204052 DOI: 10.2149/tmh.2014-s08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In The Gambia, West Africa, the prevalence of chronic hepatitis B virus (HBV) infection in adults exceeds eight percent and hepatocellular carcinoma (HCC) has been the most frequent type of malignancy. Two population-based intervention studies to control HBV infection, namely, GHIS (Gambia Hepatitis Intervention Study) and PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), are discussed. The GHIS started in 1986 as a nation-wide trial of the HBV vaccine to evaluate the effectiveness of infant HBV vaccination in preventing HCC in adulthood. The vaccine was progressively introduced into the Expanded Program of Immunization (EPI) of The Gambia over four years in a phased manner, called the "stepped-wedge" design. This was because instantaneous universal vaccination in the country was impossible for logistic and financial reasons. However, this design also allowed the study to have an unvaccinated control group which consisted of the newborns of the areas where HBV vaccine has not yet been incorporated in the EPI. To assess the outcome, a national cancer registry was founded and all HCC patients in this birth cohort are linked with the vaccine trial database. The study is still ongoing to answer whether the HBV vaccine in infancy prevent HCC in adulthood in The Gambia. Although the universal HBV vaccination since 1990 has been successful in reducing the prevalence of chronic HBV infection in young Gambians, the number of HCC cases may not decline over the next decades as people infected prior to the immunization program are likely to continue to develop the diseases. To reduce the HCC incidence through community-based screening of HBV infection and provision of antiviral therapy, the PROLIFICA project started in 2011. Study hypothesis and design of these two studies, GHIS and PROLIFICA, are further discussed.
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Affiliation(s)
- Yusuke Shimakawa
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Maud Lemoine
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- Department of Hepatology, Imperial College London, UK, Norfolk Place, London, W2 1NY, UK
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC). 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Harr Freeya Njai
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Umberto D’Alessandro
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Andrew Hall
- International Agency for Research on Cancer (IARC). 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Mark Thursz
- Department of Hepatology, Imperial College London, UK, Norfolk Place, London, W2 1NY, UK
| | - Ramou Njie
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- Gambia Hepatitis Intervention Study (GHIS), IARC, c/o MRC Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
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Abstract
Vaccine probe studies have emerged in the past 15 years as a useful way to characterise disease. By contrast, traditional studies of vaccines focus on defining the vaccine effectiveness or efficacy. The underlying basis for the vaccine probe approach is that the difference in disease burden between vaccinated and unvaccinated individuals can be ascribed to the vaccine-specific pathogen. Vaccine probe studies can increase understanding of a vaccine's public health value. For instance, even when a vaccine has a seemingly low efficacy, a high baseline disease incidence can lead to a large vaccine-preventable disease burden and thus that population-based vaccine introduction would be justified. So far, vaccines have been used as probes to characterise disease syndromes caused by Haemophilus influenzae type b, pneumococcus, rotavirus, and early infant influenza. However, vaccine probe studies have enormous potential and could be used more widely in epidemiology, for example, to define the vaccine-preventable burden of malaria, typhoid, paediatric influenza, and dengue, and to identify causal interactions between different pathogens.
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Affiliation(s)
- Daniel R Feikin
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; London School of Hygiene and Tropical Medicine, London, UK
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Adewole I, Martin DN, Williams MJ, Adebamowo C, Bhatia K, Berling C, Casper C, Elshamy K, Elzawawy A, Lawlor RT, Legood R, Mbulaiteye SM, Odedina FT, Olopade OI, Olopade CO, Parkin DM, Rebbeck TR, Ross H, Santini LA, Torode J, Trimble EL, Wild CP, Young AM, Kerr DJ. Building capacity for sustainable research programmes for cancer in Africa. Nat Rev Clin Oncol 2014; 11:251-9. [PMID: 24614139 PMCID: PMC4403794 DOI: 10.1038/nrclinonc.2014.37] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cancer research in Africa will have a pivotal role in cancer control planning in this continent. However, environments (such as those in academic or clinical settings) with limited research infrastructure (laboratories, biorespositories, databases) coupled with inadequate funding and other resources have hampered African scientists from carrying out rigorous research. In September 2012, over 100 scientists with expertise in cancer research in Africa met in London to discuss the challenges in performing high-quality research, and to formulate the next steps for building sustainable, comprehensive and multi-disciplinary programmes relevant to Africa. This was the first meeting among five major organizations: the African Organisation for Research and Training in Africa (AORTIC), the Africa Oxford Cancer Foundation (AfrOx), and the National Cancer Institutes (NCI) of Brazil, France and the USA. This article summarizes the discussions and recommendations of this meeting, including the next steps required to create sustainable and impactful research programmes that will enable evidenced-based cancer control approaches and planning at the local, regional and national levels.
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Affiliation(s)
- Isaac Adewole
- Gynecologic Oncology Unit, Department of Obsterics and Gynecology, College of Medicine, University of Ibadan, PMB 5017, GPO, Ibadan, Nigeria
| | | | | | | | | | | | | | | | | | | | - Rosa Legood
- London School of Hygiene and Tropical Medicine, UK
| | | | | | | | | | | | | | | | | | - Julie Torode
- Union for International Cancer Control, Switzerland
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Peto TJ, Mendy ME, Lowe Y, Webb EL, Whittle HC, Hall AJ. Efficacy and effectiveness of infant vaccination against chronic hepatitis B in the Gambia Hepatitis Intervention Study (1986-90) and in the nationwide immunisation program. BMC Infect Dis 2014; 14:7. [PMID: 24397793 PMCID: PMC3898092 DOI: 10.1186/1471-2334-14-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/04/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gambian infants were not routinely vaccinated against hepatitis B virus (HBV) before 1986. During 1986-90 the Gambia Hepatitis Intervention Study (GHIS) allocated 125,000 infants, by area, to vaccination or not and thereafter all infants were offered the vaccine through the nationwide immunisation programme. We report HBV serology from samples of GHIS vaccinees and unvaccinated controls, and from children born later. METHODS During 2007-08, 2670 young adults born during the GHIS (1986-90) were recruited from 80 randomly selected villages and four townships. Only 28% (753/2670) could be definitively linked to their infant HBV vaccination records (255 fully vaccinated, 23 partially vaccinated [1-2 doses], 475 not vaccinated). All were tested for current HBV infection (HBV surface antigen [HBsAg]) and, if HBsAg-negative, evidence of past infection (HBV core-protein antibody [anti-HBc]). HBsAg-positive samples (each with two age- and sex-matched HBsAg-negative samples) underwent liver function tests. In addition, 4613 children born since nationwide vaccination (in 1990-2007) were tested for HBsAg. Statistical analyses ignore clustering. RESULTS Comparing fully vaccinated vs unvaccinated GHIS participants, current HBV infection was 0.8% (2/255) vs 12.4% (59/475), p < 0.0001, suggesting 94% (95% CI 77-99%) vaccine efficacy. Among unvaccinated individuals, the prevalence was higher in males (p = 0.015) and in rural areas (p = 0.009), but adjustment for this did not affect estimated vaccine efficacy. Comparing fully vaccinated vs unvaccinated participants, anti-HBc was 27.4% (70/255) vs 56.0% (267/475), p < 0.00001. Chronic active hepatitis was not common: the proportion of HBsAg-positive subjects with abnormal liver function tests (ALT > 2 ULN) was 4.1%, compared with 0.2% in those HBsAg-negative. The prevalence of antibodies to hepatitis C virus was low (0.5%, 13/2592). In children born after the end of GHIS, HBsAg prevalence has remained low; 1.4% (15/1103) in those born between 1990-97, and 0.3% (9/35150) in those born between 1998-2007. CONCLUSIONS Infant HBV vaccination achieves substantial protection against chronic carriage in early adulthood, even though approximately a quarter of vaccinated young adults have been infected. This protection persists past the potential onset of sexual activity, reinforcing previous GHIS findings of protection during childhood and suggesting no need for a booster dose. Nationwide infant HBV vaccination is controlling chronic infection remarkably effectively.
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Affiliation(s)
- Thomas J Peto
- Medical Research Council Laboratories, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok, 10400, Thailand
| | - Maimuma E Mendy
- Medical Research Council Laboratories, Fajara, The Gambia
- International Agency for Research on Cancer, Lyon, France
| | - Yamundow Lowe
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hilton C Whittle
- Medical Research Council Laboratories, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew J Hall
- London School of Hygiene and Tropical Medicine, London, UK
- International Agency for Research on Cancer, Lyon, France
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Hadler SC, Fuqiang C, Averhoff F, Taylor T, Fuzhen W, Li L, Xiaofeng L, Weizhong Y. The impact of hepatitis B vaccine in China and in the China GAVI Project. Vaccine 2013; 31 Suppl 9:J66-72. [DOI: 10.1016/j.vaccine.2013.03.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/11/2013] [Accepted: 03/26/2013] [Indexed: 02/05/2023]
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Bah E, Carrieri MP, Hainaut P, Bah Y, Nyan O, Taal M. 20-years of population-based cancer registration in hepatitis B and liver cancer prevention in the Gambia, West Africa. PLoS One 2013; 8:e75775. [PMID: 24098724 PMCID: PMC3787012 DOI: 10.1371/journal.pone.0075775] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 08/16/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Gambia Hepatitis Intervention Study (GHIS) was designed as a randomised control trial of infant hepatitis B vaccination applied to public health policy, with the main goal of preventing primary liver cancer later in adult life in The Gambia. To that effect, the National Cancer Registry of The Gambia (NCR), a population-based cancer registry (PBCR), was established in 1986 to actively collect data on all cancer diagnosis nation-wide. We extracted 20-years (1990-2009) of data to assess for the first time, the evolution of the most common cancers, also describe and demonstrate the role of the PBCR in a hepatitis B and liver cancer prevention programme in this population. METHODS AND FINDINGS We estimated Age-Standardised Incidence Rates (ASR (W)) of the most common cancers registered during the period by gender. The registration period was divided into four 5-year intervals and incidence rates were estimated for each interval. The most common cancers in males were liver, prostate, lung plus bronchus, non-Hodgkin lymphoma (NHL) and stomach, accounting for 60%, 5%, 4%, 5% and 3%, respectively. Similarly, cancers of the cervix uteri, liver, breast and NHL, were the most common in females, accounting for 33%, 24%, 11% and 4% of the female cancers, respectively. CONCLUSIONS Cancer incidence has remained relatively stable over time, but as shown elsewhere in sub-Saharan Africa the disease is a threat in The Gambia. The infection related cancers which are mostly preventable (HBV in men and HPV/HIV in women) were the most common. At the moment the data is not enough to detect an effect of hepatitis B vaccination on liver cancer incidence in The Gambia. However, we observed that monitoring case occurrence through PBCR is a key public health pre-requisite for rational planning and implementation of targeted interventions for improving the health of the population.
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Affiliation(s)
- Ebrima Bah
- Ministry of Health and Social Welfare, Banjul, The Gambia
- National Cancer Registry, Fajara, The Gambia
- University of Tampere, Tampere, Finland
- The Gambia Hepatitis Intervention Study (GHIS) project, Fajara, The Gambia
| | | | - Pierre Hainaut
- International Prevention Research Institute (iPRI), Lyon, France
| | - Yusupha Bah
- National Cancer Registry, Fajara, The Gambia
- The Gambia Hepatitis Intervention Study (GHIS) project, Fajara, The Gambia
| | - Ousman Nyan
- University of The Gambia, Brikama, The Gambia
| | - Makie Taal
- Ministry of Health and Social Welfare, Banjul, The Gambia
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27
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Davies J, Littlejohn M, Locarnini SA, Whiting S, Hajkowicz K, Cowie BC, Bowden DS, Tong SYC, Davis JS. Molecular epidemiology of hepatitis B in the Indigenous people of northern Australia. J Gastroenterol Hepatol 2013; 28:1234-41. [PMID: 23432545 DOI: 10.1111/jgh.12177] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The hepatitis B surface antigen was first described in the blood of an Indigenous Australian man, yet little is known about its molecular epidemiology in this population, in which it is endemic. The study aimed to determine the clinical and molecular epidemiology of hepatitis B virus (HBV) in Indigenous people from northern Australia. METHODS Following ethics approval and informed consent, blood specimens and clinical details from Indigenous adults known to be infected with HBV and who were born and raised in Indigenous communities in northern Australia were obtained. HBV genotypes were determined in isolates with sufficient HBV DNA by polymerase chain reaction by sequencing of the polymerase/surface gene. RESULTS Between June 2010 and June 2012, 65 patients were recruited from six different regions of northern Australia. Thirty-two patients (49%) were hepatitis B e-antigen-positive, and 48% were hepatitis B e-antibody-positive. No patients were found to be coinfected with hepatitis C virus or human immunodeficiency virus. Of the 49 samples with sufficient viral load for genotyping, 100% were infected with genotype C4, previously only reported from two Indigenous Australians. All isolates had wild-type polymerase gene sequences despite 14 currently or previously receiving antiviral treatment. The canonical sG145R vaccine-escape variant was detected in the surface antigen of virus from two patients. CONCLUSIONS The exclusive HBV genotype in this ancient population is genotype C4. Whole genome sequencing and clinical follow-up of this cohort are in progress, with the aim of exploring the clinical significance of these findings.
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Affiliation(s)
- Jane Davies
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
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28
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Palliyaguru DL, Wu F. Global geographical overlap of aflatoxin and hepatitis C: controlling risk factors for liver cancer worldwide. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2013; 30:534-40. [PMID: 23281740 DOI: 10.1080/19440049.2012.751630] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
About 85% of hepatocellular carcinoma (HCC, liver cancer) cases occur in low-income countries, where the risk factors of dietary aflatoxin exposure and chronic hepatitis B and C (HBV and HCV) viral infection are common. While studies have shown synergism between aflatoxin and HBV in causing HCC, much less is known about whether aflatoxin and HCV synergise similarly. From an exposure perspective, it was examined whether there is a geographical overlap in populations worldwide exposed to high dietary aflatoxin levels and with high HCV prevalence. While HCV is one of the most important risk factors for HCC in high-income nations (where aflatoxin exposure is low), it is found that HCV prevalence is much higher in Africa and Asia, where aflatoxin exposure is also high. However, within a given world region, there are some inconsistencies regarding exposure and cancer risk. Therefore, there is a need to control risk factors such as aflatoxin and hepatitis viruses in a cost-effective manner to prevent global HCC, while continuing to evaluate biological mechanisms by which these risk factors interact to increase HCC risk.
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Affiliation(s)
- D L Palliyaguru
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA
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29
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FitzSimons D, Hendrickx G, Vorsters A, Van Damme P. Hepatitis B vaccination: a completed schedule enough to control HBV lifelong? Milan, Italy, 17-18 November 2011. Vaccine 2012; 31:584-90. [PMID: 23142301 DOI: 10.1016/j.vaccine.2012.10.101] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 10/24/2012] [Accepted: 10/26/2012] [Indexed: 12/13/2022]
Abstract
The Viral Hepatitis Prevention Board (VHPB) organized an international meeting in Milan in November 2011 on the question of whether completing a course of hepatitis B vaccination confers lifelong protection against hepatitis B virus infection and its complications. Presentations covered vaccine efficacy including factors influencing long-term protection; breakthrough infections; the immunological effect of natural boosting; the effectiveness of universal hepatitis B vaccination in different countries, and issues relating to national, regional and global policies on booster vaccination. Findings from four continents were presented at the meeting, with data now extending to follow-up for nearly 30 years after full primary vaccination. The results reported add to the extensive and growing body of knowledge, demonstrating that in spite of subsequent decline and ultimate loss of detectable serum anti-HBs, a full primary course of hepatitis B vaccine confers complete protection against acute clinical disease and chronic hepatitis B infection for long periods of time. Our understanding of the role and functions of T and B cells in protective immunity deepens, although the picture is still complex. A framework for future work in several areas emerged from the meeting, including monitoring and surveillance of vaccination programmes, breakthrough infections, hepatitis B in immigrant populations, and vaccine-escape viral mutants. One further concrete recommendation is the setting up of a working group to standardize definitions on terms such as "immunity", "protection", "immune memory", "non-responders", "long-term", "anamnestic response", "breakthrough" and "vaccine failure".
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Affiliation(s)
- David FitzSimons
- Office of Governing Bodies, WHO, World Health Organization, Avenue Appia 20, CH-1211 Geneva, Switzerland
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30
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Lavanchy D. Viral hepatitis: global goals for vaccination. J Clin Virol 2012; 55:296-302. [PMID: 22999800 DOI: 10.1016/j.jcv.2012.08.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 08/21/2012] [Accepted: 08/27/2012] [Indexed: 12/16/2022]
Abstract
In countries where hepatitis A is highly endemic, exposure to hepatitis A virus (HAV) is almost universal before the age of 10 years, and large-scale immunization efforts are not required. In contrast, in areas of intermediate endemicity or in transition from high to intermediate endemicity, where transmission occurs primarily from person to person in the general community (often with periodic outbreaks), control of hepatitis A may be achieved through widespread vaccination programmes. Hepatitis B virus (HBV) is one of the world's most widespread infectious agents and the cause of millions of infections each year. Between 500,000 and 700,000 people die each year from chronic infection-related cirrhosis, hepatocellular carcinoma (HCC) or from acute hepatitis B. Hepatitis B vaccine provides protection against infection and its complications including liver cirrhosis and HCC. It is therefore, the first vaccine against a cancer, the first vaccine protecting from a sexually transmitted infection, and the first vaccine against a chronic disease ever licensed. Control and significant reduction in incidence of new HBV infections as well as hepatocellular carcinoma has repeatedly been reported in countries in East Asia (i.e. Taiwan) and Africa (i.e. The Gambia). Two experimental vaccines against hepatitis E have been developed; one of them has been recently licensed but is not yet widely available. Attempts to develop a hepatitis C vaccine were so far unsuccessful.
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31
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Gouas DA, Villar S, Ortiz-Cuaran S, Legros P, Ferro G, Kirk GD, Lesi OA, Mendy M, Bah E, Friesen MD, Groopman J, Chemin I, Hainaut P. TP53 R249S mutation, genetic variations in HBX and risk of hepatocellular carcinoma in The Gambia. Carcinogenesis 2012. [PMID: 22759751 DOI: 10.1093/carcin/bgs135] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In regions with high prevalence of chronic hepatitis B virus (HBV) infection and dietary aflatoxin B(1) (AFB(1)) exposure, hepatocellular carcinomas (HCCs) often contain TP53 mutation at codon 249 (R249S). Furthermore, a C-terminal truncated HBx protein expressed from hepatocyte integrated HBV is associated with HCC development. This study evaluates the association between R249S and HBX status in relation to HCC in West African population. HBX (complete or 3'-truncated) and HBS genes were assessed by PCR in cell-free DNA (CFDNA) from plasma of subjects recruited in a hospital-based case-control study (325 controls, 78 cirrhotic patients and 198 HCC cases) conducted in The Gambia. These samples had been previously analyzed for R249S and HBV serological status. Complete HBX sequence was frequently detected in CFDNA of HCC-R249S positive (77%, 43/56) compared with HCC-R249S-negative cases (44%, 22/50). Conversely, the proportion of 3'-truncated HBX gene was significantly higher in HCC-R249S negative than positive cases (34%, 17/50, compared with 12%, 7/56) (χ(2) = 12.12; P = 0.002; distribution of R249S negative and positive according to HBX status). Occult HBV infection (detected by PCR) was present in 24% of HCC previously considered as negative by HBV serology. Moreover, HBV mutation analysis revealed that double mutation at nucleotides 1762(T)/1764(A) was associated with diagnosis of cirrhosis or HCC {cirrhosis: odds ratio (OR): 9.50 [95% confidence interval (CI) 1.50-60.11]; HCC: OR: 11.29 [95% CI 2.07-61.47]}. These findings suggest that in HCC from The Gambia, complete HBX sequences are often associated with the presence of TP53 R249S mutation.
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Affiliation(s)
- Doriane A Gouas
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, Lyon, France
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32
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Coppola RC, Meloni A, Campagna M. Impact of universal vaccination against hepatitis B: the italian model. HEPATITIS MONTHLY 2012; 12:417-9. [PMID: 23008720 PMCID: PMC3437450 DOI: 10.5812/hepatmon.6396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 05/27/2012] [Accepted: 06/18/2012] [Indexed: 12/11/2022]
Affiliation(s)
- Rosa Cristina Coppola
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Monserrato, Italy
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33
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Gouas DA, Villar S, Ortiz-Cuaran S, Legros P, Ferro G, Kirk GD, Lesi OA, Mendy M, Bah E, Friesen MD, Groopman J, Chemin I, Hainaut P. TP53 R249S mutation, genetic variations in HBX and risk of hepatocellular carcinoma in The Gambia. Carcinogenesis 2012; 33:1219-24. [PMID: 22759751 PMCID: PMC3388490 DOI: 10.1093/carcin/bgs068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/13/2012] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
In regions with high prevalence of chronic hepatitis B virus (HBV) infection and dietary aflatoxin B(1) (AFB(1)) exposure, hepatocellular carcinomas (HCCs) often contain TP53 mutation at codon 249 (R249S). Furthermore, a C-terminal truncated HBx protein expressed from hepatocyte integrated HBV is associated with HCC development. This study evaluates the association between R249S and HBX status in relation to HCC in West African population. HBX (complete or 3'-truncated) and HBS genes were assessed by PCR in cell-free DNA (CFDNA) from plasma of subjects recruited in a hospital-based case-control study (325 controls, 78 cirrhotic patients and 198 HCC cases) conducted in The Gambia. These samples had been previously analyzed for R249S and HBV serological status. Complete HBX sequence was frequently detected in CFDNA of HCC-R249S positive (77%, 43/56) compared with HCC-R249S-negative cases (44%, 22/50). Conversely, the proportion of 3'-truncated HBX gene was significantly higher in HCC-R249S negative than positive cases (34%, 17/50, compared with 12%, 7/56) (χ(2) = 12.12; P = 0.002; distribution of R249S negative and positive according to HBX status). Occult HBV infection (detected by PCR) was present in 24% of HCC previously considered as negative by HBV serology. Moreover, HBV mutation analysis revealed that double mutation at nucleotides 1762(T)/1764(A) was associated with diagnosis of cirrhosis or HCC {cirrhosis: odds ratio (OR): 9.50 [95% confidence interval (CI) 1.50-60.11]; HCC: OR: 11.29 [95% CI 2.07-61.47]}. These findings suggest that in HCC from The Gambia, complete HBX sequences are often associated with the presence of TP53 R249S mutation.
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Affiliation(s)
- Doriane A. Gouas
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Stéphanie Villar
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Sandra Ortiz-Cuaran
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Pénélope Legros
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Gilles Ferro
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Gregory D. Kirk
- Gambia Hepatitis Intervention Study, Laboratories Fajara, Banjul, The Gambia
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olufunmilayo A. Lesi
- Gambia Hepatitis Intervention Study, Laboratories Fajara, Banjul, The Gambia
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Maimuna Mendy
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ebrima Bah
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
- Gambia Hepatitis Intervention Study, Laboratories Fajara, Banjul, The Gambia
| | - Marlin D. Friesen
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Groopman
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabelle Chemin
- Inserm U1052, Centre de Recherche en Cancérologie de Lyon, Hépatocarcinogenése et infection virale, Lyon, France
| | - Pierre Hainaut
- International Agency for Research on Cancer, Molecular Carcinogenesis Group, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
- Present address: International Prevention Research Institute, 96 cours Franklin Roosevelt, 69006 Lyon, France
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Hennig BJ, Hall AJ. Host genetic factors in hepatitis B infection, liver cancer and vaccination response: a review with a focus on Africa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 423:202-209. [PMID: 20970823 DOI: 10.1016/j.scitotenv.2010.09.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 09/21/2010] [Accepted: 09/21/2010] [Indexed: 05/30/2023]
Abstract
The disease burden due to hepatitis B virus (HBV) infection remains significant; 350 million people are infected world-wide, and around half a million deaths each year are due to HBV-related liver disease and hepatocellular carcinoma (HCC). Infant immunisation against infection was introduced in the early 1980s, the vaccine is routinely administered across regions where the disease is endemic and has been shown to be safe and effective. However, the large number of older individuals with persistent infection means that disease will not be reduced significantly for several decades. Furthermore, failure to respond to the vaccination has been observed in about 5% of vaccinees and to date we have limited information on the durability of vaccine protection against infection. Hepatitis B infection and disease pathogenesis are known to be influenced by a number of factors including host genetics factors. This review aims to give an overview of the role of genetic variation in persistent HBV infection and the development of liver disease including HCC. Vaccine-induced immunity is, at least in part, heritable and we also discuss findings on the genetic control of responses to HBV vaccination. The epidemiology of HBV infection differs by world region, as does the genetic makeup of individuals originating from different regions. This review focuses on the situation in Africa, where hepatitis B is highly endemic.
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Affiliation(s)
- Branwen J Hennig
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Franco E, Bagnato B, Marino MG, Meleleo C, Serino L, Zaratti L. Hepatitis B: Epidemiology and prevention in developing countries. World J Hepatol 2012; 4:74-80. [PMID: 22489259 PMCID: PMC3321493 DOI: 10.4254/wjh.v4.i3.74] [Citation(s) in RCA: 235] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 03/14/2012] [Accepted: 03/17/2012] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a serious global public health problem. The infection may be transmitted through sexual intercourse, parenteral contact or from an infected mother to the baby at birth and, if contracted early in life, may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma. On the basis of the HBV carrier rate, the world can be divided in 3 regions of high, medium and low endemicity. The major concern is about high endemicity countries, where the most common route of infection remains vertical transmission from mother to child. Screening of all pregnant women and passive immunization with human hepatitis B immunoglobulin are not affordable for many developing countries. The infection rate can be reduced by modifying behavior, improving individual education, testing all blood donations, assuring asepsis in clinical practice and screening all pregnant women. However, availability of a safe and efficacious vaccine and adoption of appropriate immunization strategies are the most effective means to prevent HBV infection and its consequences. The unsolved problem for poorest countries, where the number of people currently infected is high, is the cost of the vaccine. A future challenge is to overcome the social and economic hurdles of maintaining and improving a prevention policy worldwide to reduce the global burden of the disease.
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Affiliation(s)
- Elisabetta Franco
- Elisabetta Franco, Laura Zaratti, Department of Public Health, University Tor Vergata, via Montpellier 1, 00133 Rome, Italy
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Sylla BS, Wild CP. A million africans a year dying from cancer by 2030: what can cancer research and control offer to the continent? Int J Cancer 2012; 130:245-50. [PMID: 21796634 PMCID: PMC3244688 DOI: 10.1002/ijc.26333] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 07/13/2011] [Indexed: 01/09/2023]
Abstract
In Africa, there were an estimated 681,000 new cancer cases and 512,000 deaths in 2008. Projections to 2030 show a startling rise, with corresponding figures of 1.27 million cases and 0.97 million deaths resulting from population growth and aging alone. The figures make no assumptions about incidence rates which may increase due to the further introduction of tobacco and a more westernized lifestyle. The current situation in many parts of Africa with respect to health care systems suggests that improved cancer treatment would be an insufficient response to this increasing burden. Much could be achieved through cancer prevention by applying current knowledge about major risk factors and the natural history of the disease. For example, vaccination against hepatitis B virus and human papilloma viruses would prevent the occurrence of two of the most common cancers in Africa, liver and cervix, respectively, in the long-term. Strong measures to prevent the widespread introduction of tobacco must be a priority. Early detection and treatment of cervical and breast cancers using approaches applicable now in Africa would provide immediate value, as would the management of human immunodeficiency virus (HIV) infection in respect to HIV-associated malignancies. In parallel, further research is needed into the causes of cancer and the barriers to implementation of promising prevention strategies. Underpinning all is the need for African governments to look forward and prioritize cancer through national cancer control plans, to invest in public health infrastructure and to ensure the adequate training and support for people in cancer prevention and control. Given this core commitment from within Africa, international partners can provide complementary support in a cooperation that permits action now to mitigate the impending tragedy of cancer in the continent of Africa.
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Affiliation(s)
- Bakary S. Sylla
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Christopher P. Wild
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
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Sankaranarayanan R, Sauvaget C, Ramadas K, Ngoma T, Teguete I, Muwonge R, Naud P, Nessa A, Kuhaprema T, Qiao Y. Clinical trials of cancer screening in the developing world and their impact on cancer healthcare. Ann Oncol 2011; 22 Suppl 7:vii20-vii28. [DOI: 10.1093/annonc/mdr422] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evaluation of Large-Scale Combination HIV Prevention Programs: Essential Issues. J Acquir Immune Defic Syndr 2011; 58:e23-8. [DOI: 10.1097/qai.0b013e318227af37] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sighoko D, Curado MP, Bourgeois D, Mendy M, Hainaut P, Bah E. Increase in female liver cancer in the Gambia, West Africa: evidence from 19 years of population-based cancer registration (1988-2006). PLoS One 2011; 6:e18415. [PMID: 21490972 PMCID: PMC3072390 DOI: 10.1371/journal.pone.0018415] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 03/03/2011] [Indexed: 12/25/2022] Open
Abstract
Background Hepatocellular Carcinoma (HCC) is a common malignancy worldwide with a high burden in West Africa. Male to female ratios show consistent bias toward males, the biological bases and variations of which are not well understood. We have used data from the Gambian National Cancer Registry to compare trends in incidence of HCC in both genders. Methods and Findings Two periods were compared, 1988–1997 (early) and 1998–2006 (recent). In addition, the regression program joinpoint was used to assess trends over 19 years. Differences with self-reported ethnicity were assessed for the recent period using population data from 2003 census. Male to female ratio showed a significant decrease between the two periods from 3.28∶1 (95% CI, [2.93–3.65]) to 2.2∶1 (95% CI, [1.99–2.43]). Although rates in males were relatively stable (38.36 and 32.84 for, respectively, early and recent periods), they increased from 11.71 to 14.9 in females with a significant Annual Percentage Change of 3.01 [0.3–5.8] over 19 years and an increase in number of cases of 80.28% (compared to 26% in males). Significant variations in HCC risk, but not in gender ratio were observed in relation with ethnicity. Conclusion This analysis of the only national, population-based cancer registry in West Africa shows a significant increase in HCC in females over recent years. This increase may be the consequence of major changes in lifestyle or viral risk factors, in particular obesity and hepatitis C, which have both been documented to increase in West Africa during recent years.
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Affiliation(s)
- Dominique Sighoko
- International Agency for Research on Cancer, Lyon, France
- Faculté d'Odontologie, Méthodes et Algorithmes pour l'Aide à la Décision, Lyon, France
| | | | - Denis Bourgeois
- Faculté d'Odontologie, Méthodes et Algorithmes pour l'Aide à la Décision, Lyon, France
| | | | - Pierre Hainaut
- International Agency for Research on Cancer, Lyon, France
- * E-mail:
| | - Ebrima Bah
- International Agency for Research on Cancer, Lyon, France
- Gambia Hepatitis Intervention Study, Fajara, The Gambia
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Abstract
Substantial changes in large parts of the developing world have materialised in the last three decades. These are extremely diverse countries with respect to culture, societal values and political arrangements, but sharing one feature--prevalent poverty and limited resources to protect the health of individuals. The control of emerging chronic diseases in low-resource countries is a formidable challenge. For this reason any intervention should be kept logistically simple and incorporated into a general plan aiming at building gradually the infrastructure that is necessary to bring care to the population at large. The present contribution summarizes some of the priorities in cancer prevention in developing countries and the underlying evidence base, and addresses some of the challenges.
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Montesano R. Preventing primary liver cancer: the HBV vaccination project in the Gambia (West Africa). Environ Health 2011; 10 Suppl 1:S6. [PMID: 21489216 PMCID: PMC3073198 DOI: 10.1186/1476-069x-10-s1-s6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Gambia Hepatitis Intervention Study (GHIS) consisted in the progressive introduction of HBV plasma-derived vaccine in different zones of this African country during the period 1986-1990. The study was launched and coordinated by IARC and is one of the most effective examples of an intervention project that both substantially contributed to our knowledge and to the health of local populations. Similar intervention studies have been carried out in South-East Asia. The studies indicate that the natural history of HBV infection differs in different populations , having a direct relevance for the implementation of HBV vaccination programmes in various parts of the world.
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Epidemiological changes in hepatitis B prevalence in an entire population after 20 years of the universal HBV vaccination programme. Epidemiol Infect 2010; 139:1159-65. [PMID: 21156099 DOI: 10.1017/s0950268810002827] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A universal hepatitis B vaccination programme has been conducted in Long An county since 1986. To investigate the epidemiological changes in hepatitis B virus (HBV) infection we conducted a serosurvey there in 2005. A total of 4686 subjects were enrolled and vaccination history and blood samples collected. HBV infective markers were determined by radioimmunoassay. The results were compared with the data of 1985. Our results show that the overall HBsAg prevalence was 7·5%, less than half of the prevalence reported in 1985. HBsAg and anti-HBc antibody prevalence in people born after 1985 decreased markedly. The gender difference in HBsAg prevalence was abolished in subjects aged <20 years. The administration of a first dose of vaccine within 24 h could reduce the HBsAg prevalence by half. In conclusion, the marked epidemiological changes in HBV prevalence found in this serosurvey indicate that the implementation of HBV vaccination was highly successful.
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Jobarteh M, Malfroy M, Peterson I, Jeng A, Sarge-Njie R, Alabi A, Peterson K, Cotten M, Hall A, Rowland-Jones S, Whittle H, Tedder R, Jaye A, Mendy M. Seroprevalence of hepatitis B and C virus in HIV-1 and HIV-2 infected Gambians. Virol J 2010; 7:230. [PMID: 20843322 PMCID: PMC2949835 DOI: 10.1186/1743-422x-7-230] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 09/15/2010] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of HIV/hepatitis co-infection in sub-Saharan Africa is not well documented, while both HIV and HBV are endemic in this area. Objective The aim of this study is to determine the seroprevalence of HBV and HCV virus in HIV-infected subjects in the Gambia. Methods Plasma samples from HIV infected patients (190 individuals with clinically defined AIDS and 382 individuals without AIDS) were tested retrospectively for the presence of HBV sero-markers and for serum HBV DNA, screened for HCV infection by testing for anti-HCV antibody and HCV RNA. Results HBsAg prevalence in HIV-positive individuals is 12.2%. HIV/HBV co-infected individuals with CD4 count of <200 cells uL-1 have a higher HBV DNA viral load than patients with higher CD4 count (log 4.0 vs. log 2.0 DNA copies/ml, p < 0.05). Males (OR = 1.8, 95% CI: 1.0, 3.2) were more likely to be HBsAg positive than female. HCV seroprevalence was 0.9% in HIV-positive individuals. Conclusion The prevalence of HBsAg carriage in HIV- infected Gambians is similar to that obtained in the general population. However co-infected individuals with reduced CD4 levels, indicative of AIDS had higher prevalence of HBeAg retention and elevated HBV DNA levels compared to non-AIDS patients with higher CD4 count.
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Affiliation(s)
- Modou Jobarteh
- Medical Research Council, Fajara, P O Box 273, Banjul, The Gambia
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Jiang W, Wang XW, Unger T, Forgues M, Kim JW, Hussain SP, Bowman E, Spillare EA, Lipsky MM, Meck JM, Cavalli LR, Haddad BR, Harris CC. Cooperation of tumor-derived HBx mutants and p53-249(ser) mutant in regulating cell proliferation, anchorage-independent growth and aneuploidy in a telomerase-immortalized normal human hepatocyte-derived cell line. Int J Cancer 2010; 127:1011-20. [PMID: 20017137 DOI: 10.1002/ijc.25118] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common cancer, and hepatitis B virus (HBV) is a major etiological agent. Convincing epidemiological and experimental evidence also links HCC to aflatoxin, a naturally occurring mycotoxin that produces a signature p53-249(ser) mutation. Recently, we have reported that tumor-derived HBx variants encoded by HBV exhibited attenuated transactivation and proapoptotic functions but retained their ability to block p53-mediated apoptosis. These results indicate that mutations in HBx may contribute to the development of HCC. In this study, we determined whether tumor-derived HBx mutants along, or in cooperation with p53-249(ser), could alter cell proliferation and chromosome stability of normal human hepatocytes. To test this hypothesis, we established a telomerase immortalized normal human hepatocycte line HHT4 that exhibited a near diploid karyotype and expressed many hepatocyte-specific genes. We found that overexpression one of the tumor-derived HBx mutants, CT, significantly increased colony forming efficiency (CFE) while its corresponding wild-type allele CNT significantly decreased CFE in HHT4 cells. p53-249(ser) rescued CNT-mediated inhibition of colony formation. Although HHT4 cells lacked an anchorage independent growth capability as they did not form any colonies in soft agar, the CT-expressing HHT4 cells could form colonies, which could be significantly enhanced by p53-249(ser). Induction of aneuploidy could be observed in HHT4 cells expressing CT, but additionally recurring chromosome abnormalities could only be detected in cells coexpressing CT and p53-249(ser). Our results are consistent with the hypothesis that certain mutations in HBx and p53 at codon 249 may cooperate in contributing to liver carcinogenesis.
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Affiliation(s)
- Weidong Jiang
- Laboratory of Human Carcinogenesis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Colditz GA, Taylor PR. Prevention trials: their place in how we understand the value of prevention strategies. Annu Rev Public Health 2010; 31:105-20. [PMID: 20070190 DOI: 10.1146/annurev.publhealth.121208.131051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Several key factors bear on the interpretation of prevention trials and observational studies that inform prevention strategies. These factors include the underlying disease process and aspects of the intervention: sustainability of behavior change, the time course of the intervention within the disease process, dose and duration of exposure needed to effect risk reduction, durability of the impact of intervention, and methodological problems in implementing and interpreting randomized trials and observational studies to evaluate prevention strategies. The question asked through an intent-to-treat analysis of a randomized controlled trial (RCT) differs from that in the observational setting. Furthermore, the long duration necessary to conduct prevention trials and the resulting lack of adherence to therapy can bias results toward the null. A broader range of approaches to evaluate prevention interventions and programs with improved knowledge synthesis and translation to public health practice will speed our progress toward achieving public health and prevention of chronic diseases.
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Affiliation(s)
- Graham A Colditz
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110, USA.
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Abstract
This article reviews the prevalence, disease burden, genotype distribution, and transmission patterns of hepatitis B virus (HBV) and hepatitis C virus in the 6 World Health Organization regions. The global epidemiology of hepatitis B and C demonstrates a predominantly declining prevalence of the diseases. Improvement in the control of hepatitis B has been largely achieved with implementation of a more universal HBV vaccine program, although a large gap still remains in the effort toward global prevention of hepatitis B. The transmission of hepatitis C has been greatly impacted by mandatory screening of blood donors in most countries in the world, although intravenous drug use continues to be a major source of infection. Public education regarding the risks of exposure to infected paraphernalia as well as household items such as razors is necessary in the continuing effort to curb this disease.
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Affiliation(s)
- Helen S Te
- Liver Transplantation, Center for Liver Diseases, Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 7120, Chicago, IL 60637, USA.
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Chemin I. Evaluation of a hepatitis B vaccination program in Taiwan: impact on hepatocellular carcinoma development. Future Oncol 2010; 6:21-3. [DOI: 10.2217/fon.09.158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Evaluation of: Chang MH, You SL, Chen CJ et al.; Taiwan study group: Decreasedincidence of hepatocellular carcinoma in hepatitis B vaccinees: a 20 years followupstudy. J. Natl Cancer Inst. 101, 1348–1355 (2009). This population-based studyaimed to investigate whether a universal Taiwanese program, launched in 1984,has been able to prevent hepatocellular carcinoma (HCC) beyond childhood.The Incidence of HCC in Taiwan from 1983 to 2004 was assessed through twonational cancer registries where age and sex-specific incidence were comparedamong a vaccinated and unvaccinated birth cohort with regression models. Thisstudy further characterized the 64 vaccinated cases that developed HCC inorder to discriminate specific risk factors.
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Affiliation(s)
- Isabelle Chemin
- INSERM, U871, 151 Cours A Thomas, 69003 Lyon, France and, Université Lyon 1, IFR62 Lyon-Est, 69008 Lyon, France
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Rots NY, Wijmenga-Monsuur AJ, Luytjes W, Kaaijk P, de Graaf TW, van der Zeijst BAM, Boog CJP. Hepatitis B vaccination strategies tailored to different endemicity levels: some considerations. Vaccine 2009; 28:893-900. [PMID: 19932217 DOI: 10.1016/j.vaccine.2009.10.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/25/2009] [Accepted: 10/23/2009] [Indexed: 01/05/2023]
Abstract
Hepatitis B is a serious public health problem. Worldwide three different levels of hepatitis B endemicity (high, intermediate and low) can be distinguished. Areas with different levels of endemicity require tailored vaccination strategies to fit the needs for individuals at risk and/or countries, depending on the infection risk per age group, vaccination rate, duration of protection after vaccination, cost effectiveness of vaccination strategies and ease of implementation in the national immunization schedules.This opinion paper evaluates these factors and proposes a combination of infant risk group and universal adolescent vaccination for low endemic countries thus targeting the different groups at risk. A universal infant vaccination schedule starting with a newborn vaccination within 24h after birth is more appropriate in intermediate- and high-endemic regions.
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Affiliation(s)
- N Y Rots
- Netherlands Vaccine Institute (NVI), Regulatory and Medical Unit (RMU), Bilthoven, The Netherlands.
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Plymoth A, Viviani S, Hainaut P. Control of hepatocellular carcinoma through hepatitis B vaccination in areas of high endemicity: perspectives for global liver cancer prevention. Cancer Lett 2009; 286:15-21. [PMID: 19836128 DOI: 10.1016/j.canlet.2009.08.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are approximately 360 millions chronic carriers of Hepatitis B virus worldwide. Patterns of HB carriage are variable from one region to the other. Regions with rates of carriage over 8% are commonly considered as "high endemicity" regions. HB carriers have a very significant lifetime risk of developing chronic liver diseases such as cirrhosis and/or liver cancer (hepatocellular carcinoma, HCC). An efficient HB vaccine is available since the early eighties and has been used since for universal infant vaccination in regions of high endemicity. Observations from Taiwan, where universal infant vaccination was introduced from 1984, show a remarkable, long-lasting protection against carriage and reduction of HCC rates in adolescent and young adults born after the initiation of the programme. Two population-based trials have been set up in the mid-eighties to evaluate lifelong protective effects of infant HB vaccine against liver cancer, in The Gambia (West Africa) and in the area of Qidong, China. In other high-endemicity regions of Asia and Africa, universal infants vaccination has consistently showed a long-lasting high protection against chronic carriage and this is expected to lead to a dramatic decrease of chronic liver disease and liver cancer within the next decades. Here we briefly review the lessons of vaccination programmes and trials in high-endemicity regions, based on data gathered during 15-20years of implementation.
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Affiliation(s)
- Amelie Plymoth
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
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