Study Finds HPV-Related Respiratory Disease Prevented by Vaccine

Researchers in Australia have found encouraging evidence to support that in addition to preventing human papillomavirus (HPV), the HPV vaccine may also protect against recurrent respiratory papillomatosis (RRP), a rare, but incurable childhood respiratory disease. The findings were recently published in The Journal of Infectious Diseases (JID).

According to the Centers for Disease Control and Prevention (CDC), “RRP is a rare condition characterized by recurrent warts or papillomas in the upper respiratory tract, particularly the larynx. The juvenile onset form (JORRP) is believed to result from HPV infection transmitted perinatally from a mother to her baby during delivery. Estimates of the incidence of JORRP are relatively imprecise but range from 0.12 to 2.1 cases per 100,000 children aged <18 years [in the United States].” The life-threatening condition requires repeated surgeries to clear the airway and can lead to upwards of $123 million in annual medical costs, according to a press release.

In the Australian study, the investigators reported the results of a nationwide surveillance program for JORRP in which they enrolled pediatric otorhinolaryngologists and offered HPV typing on suspected cases. According to the study, a total of 7 cases of JORRP were reported in 2012, the first full year of the program, and then, from 2012 to 2016, the number of reported cases continued to decline with just 1 case reported in 2016.

“Among the 15 incident cases (60% male),” the study authors write, “no mothers were vaccinated prepregnancy, 20% had maternal history of genital warts, and 60% were first born; 13 of the 15 were born vaginally, and the genotyped cases were HPV-6 (n = 4) or HPV-11 (n = 3).”

The investigators contend that the decline in cases is related to high HPV vaccination rates in Australia, citing, too, that the country had deployed a broad-ranging HPV vaccination program in females ages 12 through 26 from 2007 to 2009. Australia boasts a publicly-funded HPV immunization program which provides the quadrivalent vaccine through school-based programs. “Nationwide, 86% of girls and 79% of boys 14 to 15 years of age have received the first dose of the vaccine, according to current estimates,” according to the press release. In comparison, in the United States, only 63% of girls aged 13 to 17 years have received at least 1 dose of the HPV vaccine, and 42% had received all recommended doses in the series (as of 2015 statistics from the CDC). These data are a far cry from the Healthy People 2020 goal of 80% coverage of 3 doses of HPV vaccines for females by age 13 to 15 years.

Because of the positive results seen in the Australia study, Basil Donovan, MD, and Denton Callander, PhD, of the Kirby Institute at the University of New South Wales in Sydney, Australia, who were not involved in the study are urging high-income countries with equally good HPV immunization rates “to fully evaluate similar population-level impacts of their vaccination programs.” In an accompanying commentary on the study, they are quoted as saying, “National and individual vaccine hesitancy remains common, and, unless these hesitant countries are persuaded by the ever-expanding benefits of quadrivalent HPV vaccination, millions of dollars in health spending along with countless unnecessary episodes of disease and death will occur in the coming decades.”