Paul A. Offit
For the first time, researchers have found evidence that the HPV vaccine prevents an incurable respiratory infection in children.
According to findings from an ongoing study in Australia, the incidence of juvenile-onset recurrent respiratory papillomatosis (JORRP) declined over the past 5 years following the implementation of a national quadrivalent HPV vaccination program that immunized at least half of the country’s female population aged between 12 and 26 years.
A rare but potentially life-threatening disease, JORRP is caused by HPV — most often type 6 or 11 — and is thought to be transmitted from mother to child around the time of birth, according to the Infectious Diseases Society of America. Usually diagnosed around age 3 or 4 years, the disease is difficult to treat, often requiring repeated surgeries to clear the airway of wart-like benign growths.
Around 800 children each year develop JORRP in the United States, where yearly medical costs related to the disease total $123 million, according to the IDSA. Paul A. Offit, MD, director of the Vaccine Education Center and attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia, said the impact that HPV vaccination is having on new cases of JORRP in Australia is an unsurprising, but significant, finding.
Researchers in Australia reported for the first time that the HPV vaccine can prevent an incurable and potentially deadly respiratory infection in children.
“Following vaccination, as the incidence of HPV infection in women declines, the chance that they will pass the virus to their babies during the birth process also declines,” Offit told Infectious Disease News. “Because recurrent respiratory papillomatosis is essentially untreatable, the only way to deal with the disease is to prevent it. These authors provide the first evidence that the HPV vaccine can finally put an end to this devastating disease of infants and young children.”
Australia implemented its national vaccination program in 2007, using the quadrivalent HPV vaccine Gardasil (Merck). The vaccine protects against HPV types 6 and 11, which cause the majority of genital warts, and high-risk types 16 and 18, which cause around 70% of cervical cancer cases worldwide.
“Given the virtual disappearance of genital warts in young women and that no HPV-6 or 11 infections were detected in a recent study of 431 sexually active women in Victoria, Australia, it is likely that the maternal source of exposure to HPV-6 and 11 in infants is being eliminated in Australia,” Julia M.L. Brotherton, MD, PhD, MPH, of the Victorian Cytology Service in Melbourne, Australia, and colleagues wrote.
To measure the incidence of JORRP in patients aged younger than 15 years, Brotherton and colleagues enrolled 28 pediatric specialized ear, nose and throat surgeons who treat most JORRP cases in Australia in an already established national surveillance program that monitors rare pediatric diseases using reports from clinicians. There were 15 newly diagnosed cases of JORRP between September 2011 and December 2016, including 11 confirmed cases, according to Brotherton and colleagues. In each case, the mother was unvaccinated before pregnancy, and 20% had a history of genital warts.
Almost half of the total number of cases were diagnosed in the first year of the study. The surveillance program showed a decline in the annual incidence each year from 2012 through 2016, from 0.16 per 100,000 people to 0.02 per 100,000.
Basil Donovan, MD, and Denton Callander, PhD, both from the Kirby Institute at the University of New South Wales in Sydney, were encouraged by the downward trend noted in the study. They said high-income countries like Australia with excellent vaccination coverage are obligated to study the impact of their immunization programs.
“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,” they wrote in an accompanying editorial – by Gerard Gallagher
Novakovic D, et al. J Infect Dis. 2017;doi:10.1093/infdis/jix498.
Donovan B and Callander D. J Infect Dis. 2017;doi:10.1093/infdis/jix499.
Disclosures: Brotherton reports receiving partial, unrestricted research funding for epidemiological studies of HPV from Merck and Seqirus but has never received any personal financial benefits. Please see the study for all other authors’ relevant financial disclosures. Callander reports receiving HPV research funding from the Australian Department of Health and Seqirus. Donovan reports receiving occasional speaker’s honoraria from Merck. Offit reports no relevant financial disclosures.