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American Journal of Epidemiology Vol. 136, No. 9: 1122-1131
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Persistent Hepatitis B Virus Infection and Hepatoma in The Gambia, West Africa

A Case-Control Study of 140 Adults and Their 603 Family Contacts

Robert W. Ryder1, Hilton C. Whittle2, Abdoulie B. K. Sanneh2, Andrew B. Ajdukiewicz2, Stevenson Tulloch2 and Bernard Yvonnet3

1Division of Epidemiology, Department of Community Medicine, Mount Sinal Medical Center New York, NY
2Medical Research Council Laboratories Fajara, The Gambia
3Faculté de Médecine et de Pharmacie, Institut de Virologie de Tours Tours, France

To determine the incidence of persistent hepatitis B virus infection and its etiologic role as a cause of hepatoma, the authors carried out a case-control investigation of 70 persons with hepatoma, 70 controls, and their families in 1981–1982 in The Gambia, West Africa. The risk of developing hepatoma after trie age of 39 years was 1.4% in men and 0.3% in women. Hepatoma occurred more than twice as frequently among persons who had four or more older siblings as among persons who had less than two older siblings. The attributable risk between persistent infection with hepatitis B virus and hepatoma was 78% for individuals aged less than 50 years and 37% for persons aged 50 years or more, witti an overall risk of 53%. The high prevalence of hepatitis B surface antigen and hepatitis B e antigen antigenemia in children under 15 years of age (14% of 341 children) and the positive correlation between late birth order and risk of developing hepatoma suggest that postnatal early childhood exposure to hepatitis B virus is an important risk factor. The use of a hepatitis B virus vaccine which provides durable immunity in very young children will probably prevent most cases of hepatoma. Am J Epidemiol 1992;136:1122–31.


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