Promise for Recurrent Respiratory Papillomatosis: Pediatric otolaryngologists have high hopes for the HPV vaccine

Optimism is growing that a new HPV vaccine will drastically decrease the number of cases of pediatric recurrent respiratory papillomatosis (RRP), a rare but devastating disease.

Regulators have proclaimed the vaccine safe, but experts on the disease and the vaccine say that more widespread use is needed to wipe out the disease. In addition, experts say, the medical culture in the U.S., traditionally hesitant with regard to adolescent vaccinations that are not mandated, might be a stumbling block.

RRP afflicts about four of every 100,000 children. Interferon and other drugs help to slow the spread of the lesions, but patients usually have to undergo multiple surgeries, sometimes dozens, to remove the lesions.

About 2,000 cases of pediatric RRP are reported each year in the U.S., almost all of them caused by the HPV 6 and HPV 11 strains.

The children at greatest risk are the firstborn children of young women who have genital warts during delivery. Still, the disease occurs in only about 0.5 percent of children whose mothers have condylomata during their pregnancies.

Two HPV vaccines, one developed by Merck and one by GlaxoSmithKline, have been approved for prevention of cervical cancer.

Use of the vaccine to prevent the spread of new lesions in those already afflicted has sparked interest among researchers, but otolaryngologists say controlled trials must be done to ground such treatment in solid science. There is growing hope, however, that preventive use of the Merck vaccine, Gardasil, can profoundly decrease the number of pediatric RRP cases. Gardasil is the only vaccine that targets HPV 6 and 11. It also protects against HPV 16 and 18, while the GlaxoSmithKline product, Cervarix, only protects against strains 16 and 18.

Beginning of the End

Michael Zacharisen, MD, a professor of pediatrics at the Medical College of Wisconsin who specializes in immunology and has studied RRP, said he hopes the vaccine is the beginning of the end for the affliction. “My impression would be that, with widespread immunization, RRP might become of historical interest only,” he said. “It’s not very common to begin with, but to those kids who have it it’s a huge problem, a chronic problem and a life-threatening problem.”

Craig Derkay, MD, professor of otolaryngology and pediatrics at Eastern Virginia Medical School and chair of the RRP Task Force, which is sponsored by the American Society of Pediatric Otolaryngology, said the vaccine should have a big effect. “If we get some herd immunity and vaccinate a large portion of the population before they become sexually active, then when their babies are born they will not be passing through birth canals that have been infected with the human papillomavirus,” he said.