In the Journals: HPV Vaccine and Recurrent Respiratory Papillomatosis

In 2006, the human papillomavirus (HPV) vaccine was recommended for routine use in all girls 11 to 13 years of age in the United States. The following year, the Australian National Immunisation Program launched the same program for girls in Australia. Currently, about 78 percent of girls in Australia are fully vaccinated with the HPV vaccine (as compared with about 45 percent in the United States). Both countries also now recommend the HPV vaccine for routine use in adolescent boys.

The HPV immunization program in Australia has resulted in a significant decline in the prevalence of vaccine-targeted HPV types among young women as well as a decline in high-grade cervical (i.e., pre-cancerous) lesions in women up to 30 years of age, and in genital warts.

One disease, however, has attracted little attention. Until now.

Babies who travel through a birth canal containing HPV types 6, 8, and 11 occasionally suffer a disease called recurrent respiratory papillomatosis (RRP), which first appears when the child is between 3 and 4 years of age. In order to maintain voice function and airway patency, frequent surgical procedures are required. Occasionally the recurrent lesions spread to the lower respiratory tract, causing a disease similar to cystic fibrosis. Deaths have been reported.

Because the HPV vaccine contains serotypes 6 and 11, which account for about 85 percent of cases of RRP, a team of clinicians from several hospitals in Australia examined the incidence of RRP during the past five years. They found rates of RRP declined from 0.16 per 100,000 in 2012 to 0.02 per 100,000 in 2016 (p<0.5) (Novakovic D, Cheng ATL, Zyrynksi Y, et al. A Prospective Study of the Incidence of Juvenile-Onset Recurrent Respiratory Papillomatosis After Implementation of a National HPV Vaccination Program. J. Infect. Dis. (2017) doi: 10.1093/infids/jix498).

This is the first reported evidence that the HPV vaccine has caused a clear reduction in the incidence of this relatively rare but severe and occasionally fatal infection of children.