Title

Trial of Two Versus Three Doses of Human Papillomavirus (HPV) Vaccine in India
Randomised Trial of Two Versus Three Doses of Human Papillomavirus (HPV) Vaccine in India
  • Phase

    Phase 4
  • Study Type

    Interventional
  • Study Participants

    22729
The primary study hypothesis wasthat a two-dose human papillomavirus (HPV) vaccine regimen would offer similar immunogenicity and protection as that of a three-dose regimen to girls against persistent HPV infection and cervical neoplasia caused by HPV types included in the vaccine. The Government of India stopped vaccination in all the HPV vaccine trials in the country in April 2010 due to reasons not related to this study.
The suspension of vaccination resulted in girls receiving 3 doses (days 1, 60 and ≥180), receiving 2 doses (days 1 and ≥180), receiving 2 doses at days 1 and 60 due to incomplete treatment ("by default"), and receiving one dose by default. A first age and site-matched cohort of unvaccinated married women was recruited, starting in May 2012 to serve as the unvaccinated control group of women for the analysis of HPV incidence and persistence outcomes. A second age and site-matched (age and site matched to the vaccinated women undergoing screening) cohort of unvaccinated married women is being recruited starting in June 2017 and is to be used in addition to the first unvaccinated cohort for the assessment of the cervical neoplasia outcome.
Study Started
Sep 30
2009
Primary Completion
Jan 31
2017
Study Completion
Jul 31
2026
Anticipated
Results Posted
Oct 20
2022
Last Update
Sep 28
2023

Biological Prophylactic quadrivalent HPV vaccine Merck (Gardasil®)

The participants received either one, two or three doses of the avaccine. Each injection contains 20 microgram type 6, 40 microgram type 11, 40 microgram type 16, and 20 microgram type 18.

  • Other names: Gardasil®

3-dose Active Comparator

The participants received three doses of the Prophylactic quadrivalent HPV vaccine Merck (Gardasil®) at days 1, 60 and 180+.

2-dose Experimental

The participants received two doses of the Prophylactic quadrivalent HPV vaccine Merck (Gardasil®) at days 1 and 180+.

2 doses by default Experimental

The participants received two doses of the Prophylactic quadrivalent HPV vaccine Merck (Gardasil®) at days 1 and 60 by default (incomplete doses)

Single-dose Experimental

The participants received one dose of the Prophylactic quadrivalent HPV vaccine Merck (Gardasil®) by default (incomplete doses)

Unvaccinated No Intervention

A cohort of unvaccinated women

Criteria

Inclusion Criteria:

Apparently healthy, ambulant girls aged 10 - 18 years
Unmarried girls
Girls with intact uterus
Resident in the villages chosen for the study

Exclusion Criteria:

Girls with any severe and/or debilitating illness
Past history of allergy to any medication

Summary

3-dose

2-dose

2 Doses by Default

Single-dose

Unvaccinated

All Events

Event Type Organ System Event Term 3-dose 2-dose 2 Doses by Default Single-dose Unvaccinated

Median Florescent Intensities (MFI) of the Total Antibodies to Vaccine-included HPV Types (16/18/6/11) at Different Time Points

Samples were treated with EDTA and analysed with Luminex (Austin, TX, USA) based multiplex serology to assess the concentration of binding antibodies against the major capsid protein L1 as mean median fluorescence intensity (MFI). MFI values as a measure of antibody concentration quantified by use of HPV multiplex serology are directly comparable with optical densities measured with ELISA.

3-dose

5460.0
median flow intensities (Geometric Mean)
95% Confidence Interval: 5195.0 to 5738.0

2-dose

6125.0
median flow intensities (Geometric Mean)
95% Confidence Interval: 5785.0 to 6485.0

2 Doses by Default

437.0
median flow intensities (Geometric Mean)
95% Confidence Interval: 398.0 to 480.0

Single-dose

106.0
median flow intensities (Geometric Mean)
95% Confidence Interval: 96.0 to 116.0

Unvaccinated

Frequency of Persistent HPV 16/18/6/11 Infection.

The first cervical cell samples were collected from women 18 months after married or 6 months after the first delivery. After that, 3 extra annual collections were obtained. The HPV genotyping method involved HPV-type-specific E7 PCR bead-based multiplex genotyping. The multiplex HPV-type-specific E7 PCR uses HPV type-specific primers targeting the E7 region for the detection of 19 high-risk or probable high-risk HPV types (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68a, 68b, 70, 73, and 82), and two low-risk HPV types (6 and 11), with detection limits ranging from ten to 1000 copies of the viral genome.

3-dose

1.0
Infections

2-dose

1.0
Infections

2 Doses by Default

4.0
Infections

Single-dose

1.0
Infections

Unvaccinated

32.0
Infections

Frequency of HPV 16/18-associated Precancerous Lesions and Cancer.

Pathology Panel diagnosis of: CIN 2, CIN 3 (including squamous carcinoma in situ), adenocarcinoma in situ, invasive squamous cervical carcinoma, or invasive adenocarcinoma of the cervix and detection of HPV 16 and/or HPV 18 by PCR in the same biopsy tissue sample.

Outcome Measure Data Not Reported

Frequency of Infection by Other Non-targeted High-risk HPV Types.

The HPV genotyping method involved HPV-type-specific E7 PCR bead-based multiplex genotyping. The multiplex HPV-type-specific E7 PCR uses HPV type-specific primers targeting the E7 region for the detection of 19 high-risk or probable high-risk HPV types (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68a, 68b, 70, 73, and 82), and two low-risk HPV types (6 and 11), with detection limits ranging from ten to 1000 copies of the viral genome.

Outcome Measure Data Not Reported

Frequency of Cervical Neoplasia Associated With Non-included HPV Types.

Pathology Panel diagnosis of: CIN 2, CIN 3 (including squamous carcinoma in situ), adenocarcinoma in situ, invasive squamous cervical carcinoma, or invasive adenocarcinoma of the cervix and detection of other non vaccine included HPV types by PCR in the same biopsy tissue sample.

Outcome Measure Data Not Reported

Total

22375
Participants

Age, Continuous

15.8
years (Mean)
Standard Deviation: 4.9

Enrolment

22375
Participants

Race and Ethnicity Not Collected

0
Participants

Sex: Female, Male

Overall Study

3-dose

2-dose

2 Doses by Default

Single-dose

Unvaccinated

Drop/Withdrawal Reasons

Unvaccinated