Abstract / Summary
The Gambia started Hepatitis B vaccination in July 1986 and achieved nationwide coverage in February 1990. However, not much is known about its effect on Hepatocellular carcinoma (HCC) in The Gambia. We assess the differences in the features of HCC in both the Hepatitis B likely vaccinated and likely unvaccinated age groups in The Gambia. The study was a prospective cohort study that recruited patients with suspected HCC referred to the Medical Research Council liver clinic, Gambia Unit (MRC) from June 2012 to September 2019. Clinical, radiological, fibroscan and laboratory data were collected in all patients. Five hundred and forty two patients were recruited into the study. The majority (91.3%) of the patients were in the likely unvaccinated age group and most (88.8%) were born in The Gambia. Those born outside The Gambia were mostly Senegalese, Sierreleonean, and Guineans. The HCC patients in the hepatitis B likely unvaccinated age group were likely to be born in The Gambia 448 (90.5%) vs. 33 (70.2%) (p = < 0.001) as compared to the likely vaccinated age group. They were also less likely to have a positive HBsAg 332 (67.9%) vs. 40 (86.9%) ( p = 0.007) but had a lower AFP levels3897 (1.07-135000) vs. 9969 (3- 80000) ( p = 0.007) and a higher FIB4 score 5.2 (0.4–69.9) vs. 1.9 (0.5–57.9) (p = < 0.001) as compared to those HCC patients in the likely vaccinated age group. There were no differences in clinical manifestations, liver function tests and median survival. The majority of the HCC patients were in the likely unvaccinated age group and were also born in The Gambia. This suggest that the early introduction of nationwide Hepatitis B vaccination in 1990 into the EPI program in The Gambia may have had a positive effect in the incidence of Hepatocellular Carcinoma in the vaccinated age group. To strengthen these gains, a nationwide screening and treatment program needs to be implemented for those in the unvaccinated age groups.