A Prospective Study of the Incidence of Juvenile-Onset Recurrent Respiratory Papillomatosis After Implementation of a National HPV Vaccination Program

Daniel Novakovic; Alan T L Cheng; Yvonne Zurynski; Robert Booy; Paul J Walker; Robert Berkowitz; Henley Harrison; Robert Black; Christopher Perry; Shyan Vijayasekaran; David Wabnitz; Hannah Burns; Sepehr N Tabrizi; Suzanne M Garland; Elizabeth Elliott; Julia M L Brotherton

doi:10.1093/infdis/jix498

A Prospective Study of the Incidence of Juvenile-Onset Recurrent Respiratory Papillomatosis After Implementation of a National HPV Vaccination Program

J Infect Dis. 2018 Jan 4;217(2):208-212. doi: 10.1093/infdis/jix498.

Authors

Daniel Novakovic¹, Alan T L Cheng^{1

2}, Yvonne Zurynski^{1

3}, Robert Booy⁴, Paul J Walker⁵, Robert Berkowitz⁶, Henley Harrison⁷, Robert Black⁸, Christopher Perry⁸, Shyan Vijayasekaran⁹, David Wabnitz¹⁰, Hannah Burns⁸, Sepehr N Tabrizi^{11

12}, Suzanne M Garland^{11

12}, Elizabeth Elliott³, Julia M L Brotherton^{13

14}

Affiliations

¹ University of Sydney Medical School, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead).
² ENT Department, Children's Hospital Westmead, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead).
³ Australian Paediatric Surveillance Unit, University of Sydney and Kids Research Institute, Sydney Children's Hospitals Network (Westmead).
⁴ National Centre for Immunisation Research and Surveillance, Children's Hospital Westmead.
⁵ Otolaryngology Department, John Hunter Children's Hospital, Newcastle, New South Wales.
⁶ Otolaryngology Department, Royal Children's Hospital, Melbourne, Victoria.
⁷ ENT Department, Sydney Children's Hospital, Randwick, New South Wales.
⁸ Paediatric Otolaryngology Head and Neck Surgery Department, Lady Cilento Children's Hospital, Brisbane, Queensland.
⁹ Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Hospital for Children, Perth, Western Australia.
¹⁰ Department of Otolaryngology - Head and Neck Surgery, Women's and Children's Hospital, Adelaide, South Australia.
¹¹ Royal Women's Hospital, Department of Microbiology and Infectious Diseases, and Murdoch Children's Research Institute, Infection and Immunity Theme, Parkville.
¹² Department of Obstetrics and Gynaecology, University of Melbourne, Parkville.
¹³ National HPV Vaccination Program Register, VCS, East Melbourne.
¹⁴ School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.

PMID: 29136168
DOI: 10.1093/infdis/jix498

Abstract

Background: Recurrent respiratory papillomatosis is a rare but morbid disease caused by human papillomavirus (HPV) types 6 and 11. Infection is preventable through HPV vaccination. Following an extensive quadrivalent HPV vaccination program (females 12-26 years in 2007-2009) in Australia, we established a method to monitor incidence and demographics of juvenile-onset recurrent respiratory papillomatosis (JORRP) cases.

Methods: The Australian Paediatric Surveillance Unit undertakes surveillance of rare pediatric diseases by contacting practitioners monthly. We enrolled pediatric otorhinolaryngologists and offered HPV typing. We report findings for 5 years to end 2016.

Results: The average annual incidence rate was 0.07 per 100000. The largest number of cases was reported in the first year, with decreasing annual frequency thereafter. Rates declined from 0.16 per 100000 in 2012 to 0.02 per 100000 in 2016 (P = .034). Among the 15 incident cases (60% male), no mothers were vaccinated prepregnancy, 20% had maternal history of genital warts, and 60% were first born; 13/15 were born vaginally. Genotyped cases were HPV-6 (n = 4) or HPV-11 (n = 3).

Conclusion: To our knowledge, this is the first report internationally documenting decline in JORRP incidence in children following a quadrivalent HPV vaccination program.

Keywords: human papillomavirus; pediatric otolaryngology; recurrent respiratory papillomatosis; surveillance; vaccination.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Australia / epidemiology
Child
Demography
Female
Genotype*
Humans
Immunization Programs*
Incidence
Papillomaviridae / classification
Papillomaviridae / genetics
Papillomaviridae / isolation & purification*
Papillomavirus Infections / epidemiology*
Papillomavirus Infections / prevention & control*
Papillomavirus Vaccines / administration & dosage*
Prospective Studies
Respiratory Tract Infections / epidemiology*
Respiratory Tract Infections / prevention & control*
Young Adult

Substances

Papillomavirus Vaccines

Supplementary concepts

Recurrent respiratory papillomatosis