GARDASIL™ Study in Healthy Females Between 9 and 26 Years of Age in Sub-Saharan Africa (V501-046)

In Phase A of the study, healthy females between 9 and 12 years of age will be randomized (4:1) to receive the 3-dose regimen of GARDASIL™ or placebo, and those between 13 and 26 years old will receive GARDASIL™. In Phase B of the study, participants who received placebo in Phase A will have the option to receive the 3-dose regimen of GARDASIL™.

• Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine (GARDASIL™) (Biological)
• Placebo (Biological)

Primary outcomes

• Number of Participants Who Seroconvert to Human Papillomavirus (HPV) Type 6 [Month 7 (1 month postdose 3 in study Phase A)]: Seroconversion was defined as achieving an anti-HPV Type 6 competitive Luminex Immunoassay (cLIA) level of >=20 milli Merck U/mL. The dilution-corrected limit of detection for the Type 6 cLIA was 4.2 milli Merck U/mL.
• Number of Participants Who Seroconvert to HPV Type 11 [Month 7 (1 month postdose 3 in study Phase A)]: Seroconversion was defined as achieving an anti-HPV Type 11 cLIA level of >=16 milli Merck U/mL. The dilution-corrected limit of detection for the Type 11 cLIA was 3.9 milli Merck U/mL.
• Number of Participants Who Seroconvert to HPV Type 16 [Month 7 (1 month postdose 3 in study Phase A)]: Seroconversion was defined as achieving an anti-HPV Type 16 cLIA level of >=20 milli Merck U/mL. The dilution-corrected limit of detection for the Type 16 cLIA was 9.7 milli Merck U/mL.
• Number of Participants Who Seroconvert to HPV Type 18 [Month 7 (1 month postdose 3 in study Phase A)]: Seroconversion was defined as achieving an anti-HPV Type 18 cLIA level of >=24 milli Merck U/mL. The dilution-corrected limit of detection for the Type 18 cLIA was 5.8 milli Merck U/mL.
• Number of Participants With Injection-site Adverse Experiences [Up to Day 5 after any vaccination in study Phase A]: Participants were prompted to report injection-site experiences of pain, erythema, or swelling and were also asked to report any other injection-site adverse experiences
• Number of Participants With Elevated Temperature (Oral Temperature >=100 °F) [Up to Day 5 after any vaccination in study Phase A]
• Number of Participants With Serious Adverse Experiences [From the time of informed consent is signed through the last study visit (up to 19 months)]: A serious adverse experience is any adverse experience that results in death, is life threatening, results in persistent or significant disability/incapacity, results in or prolongs existing inpatient hospitalization, is a congenital anomaly/birth defect, is a cancer, is an overdose, or is another important medical event that may jeopardize the participant and may require medical or surgical intervention

Secondary outcomes

• Geometric Mean Titer (GMT) of Anti-HPV Type 6 Antibody [Month 7 (1 month postdose 3 in study Phase A)]: Anti-HPV Type 6 antibodies were measured by cLIA. The seropositive cut-off threshold for this assay is defined as 20 milli Merck U/mL.
• GMT of Anti-HPV Type 11 Antibody [Month 7 (1 month postdose 3 in study Phase A)]: Anti-HPV Type 11 antibodies were measured by cLIA. The seropositive cut-off threshold for this assay is defined as 16 milli Merck U/mL.
• GMT of Anti-HPV Type 16 Antibody [Month 7 (1 month postdose 3 in study Phase A)]: Anti-HPV Type 16 antibodies were measured by cLIA. The seropositive cut-off threshold for this assay is defined as 20 milli Merck U/mL.
• GMT of Anti-HPV Type 18 Antibody [Month 7 (1 month postdose 3 in study Phase A)]: Anti-HPV Type 18 antibodies were measured by cLIA. The seropositive cut-off threshold for this assay is defined as 24 milli Merck U/mL.

Sex: Female, ages: 9 Years to 26 Years, accepts healthy volunteers

Inclusion Criteria :

* Healthy subjects who are native to and living in a participating Sub-Saharan African country.
* Subject agrees to provide study personnel with a primary telephone number as well as an alternate telephone number for follow-up purposes. If potential subject does not have a telephone number, the subject must provide an address at which he or she may be contacted.
* Post-pubertal female subjects must not be pregnant
* Subjects who are sexually active must agree to use effective contraception or remain abstinent through Month 7 of the study.
* Subjects who have not yet had sexual intercourse must either agree to remain abstinent through Month 7 of the study, or if they become sexually active during the vaccination phase of the study, to use effective contraception through Month 7.
* Subjects who have had sexual intercourse in the two weeks prior to enrollment must have been using effective contraception as defined above. (Emergency contraception is not considered effective contraception for enrollment in the study.)

Exclusion Criteria :

* Subject is pregnant as determined by a positive pregnancy test
* Subject has had a temperature ≥ 37.8 °C or ≥ 100 °F within 24 hours prior to the first injection.
* Subject is currently enrolled in another clinical study of an investigational agent or agents.
* Subject has a history of known prior vaccination with a HPV vaccine, or was previously enrolled in an HPV vaccine study and received either active agent or placebo.
* Subject has received any inactivated vaccine within 14 days prior to enrollment or any live vaccine within 21 days prior to enrollment.
* Subject has a history of severe allergic reaction to any agent (e.g., swelling of the mouth and throat, difficulty breathing, hypotension, or shock) that required medical intervention.
* Subject has known allergy to any vaccine component, including aluminum, yeast or BENZONASE™ (nuclease, Nycomed™ \[used to remove residual nucleic acids from this and other vaccines\]).
* Subject has received any immune globulin preparation or blood-derived products within the 6 months prior to the first injection, or plans to receive any such products during the course of the study.
* Subject has a history of splenectomy, known autoimmune disorder (e.g., systemic lupus erythematosus, rheumatoid arthritis), or is receiving immunosuppressives (e.g., substances or treatments known to diminish immune response such as radiation therapy, administration of antimetabolites, antilymphocytic sera, systemic corticosteroids). Individuals who have received periodic treatments with immunosuppressives, defined as at least 3 courses of systemic corticosteroids each lasting at least 1 week in duration for the year prior to enrollment, will be excluded. Subjects using topical steroids (i.e., inhaled or nasal) will be eligible for vaccination.
* Subject is immunocompromised or has been diagnosed as having Human Immunodeficiency Virus (HIV) infection
* Subject has known thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injections.
* Subject has known sickle cell anemia disease, active malaria or active tuberculosis.
* Subject has any condition which in the opinion of the investigator might interfere with the evaluation of the study objectives.
* Subject has a history of recent or ongoing alcohol or other drug abuse.
* Female subject has a prior history of abnormal Pap test showing squamous intraepithelial lesion (SIL), atypical squamous cells of undetermined significance (ASC-US), atypical squamous cells, cannot rule out a high grade lesion (ASC-H), or biopsy showing cervical intraepithelial neoplasia (CIN) or worse.
* Subject has any prior history (or at Day 1) of genital warts or treatment for genital warts.
* Subject with >4 lifetime sexual partners.
* Subject has undergone hysterectomy with removal of the cervix.
* Subject plans to permanently relocate from the area prior to the completion of the study or to leave for an extended period of time when study visits would need to be scheduled.

Participant flow

Outcome results

• Number of Participants Who Seroconvert to Human Papillomavirus (HPV) Type 6 (Primary), Number, Participants: GARDASIL 9 to 26 Years Old 147; Placebo 9 to 12 Years Old 1
• Number of Participants Who Seroconvert to HPV Type 11 (Primary), Number, Participants: GARDASIL 9 to 26 Years Old 147; Placebo 9 to 12 Years Old 1
• Number of Participants Who Seroconvert to HPV Type 16 (Primary), Number, Participants: GARDASIL 9 to 26 Years Old 160; Placebo 9 to 12 Years Old 0
• Number of Participants Who Seroconvert to HPV Type 18 (Primary), Number, Participants: GARDASIL 9 to 26 Years Old 156; Placebo 9 to 12 Years Old 0
• Number of Participants With Injection-site Adverse Experiences (Primary), Number, Participants: GARDASIL 9 to 12 Years Old 54; Placebo 13 to 15 Years Old 21; GARDASIL 16 to 26 Years Old 88; Placebo 9 to 12 Years Old 9
• Number of Participants With Elevated Temperature (Oral Temperature >=100 °F) (Primary), Number, Participants: GARDASIL 9 to 12 Years Old 9; Placebo 13 to 15 Years Old 6; GARDASIL 16 to 26 Years Old 7; Placebo 9 to 12 Years Old 5
• Number of Participants With Serious Adverse Experiences (Primary), Number, Participants: GARDASIL 9 to 12 Years Old 0; Placebo 13 to 15 Years Old 0; GARDASIL 16 to 26 Years Old 1; Placebo 9 to 12 Years Old 0
• Geometric Mean Titer (GMT) of Anti-HPV Type 6 Antibody (Secondary), Geometric mean, milli Merck U/mL: GARDASIL 9 to 26 Years Old 602 (526 to 689); Placebo 9 to 12 Years Old NA (NA to NA)
• GMT of Anti-HPV Type 11 Antibody (Secondary), Geometric mean, milli Merck U/mL: GARDASIL 9 to 26 Years Old 626 (545 to 718); Placebo 9 to 12 Years Old NA (NA to NA)
• GMT of Anti-HPV Type 16 Antibody (Secondary), Geometric mean, milli Merck U/mL: GARDASIL 9 to 26 Years Old 3786 (3360 to 4265); Placebo 9 to 12 Years Old NA (NA to NA)
• GMT of Anti-HPV Type 18 Antibody (Secondary), Geometric mean, milli Merck U/mL: GARDASIL 9 to 26 Years Old 811 (708 to 928); Placebo 9 to 12 Years Old NA (NA to NA)

Adverse events

Time frame: Serious adverse events were assessed up to 19 months from study start. Other adverse events were assessed up to 15 days after each vaccination in study Phase A.

Serious adverse events by term

Other adverse events by term

• Results publication: Mugo N, Ansah NA, Marino D, Saah A, Garner EI. Evaluation of safety and immunogenicity of a quadrivalent human papillomavirus vaccine in healthy females between 9 and 26 years of age in Sub-Saharan Africa. Hum Vaccin Immunother. 2015;11(6):1323-30. doi: 10.1080/21645515.2015.1008877. PMID 25912475