Researchers in Australia have found that the HPV vaccine prevents juvenile-onset recurrent respiratory papillomatosis (JORRP) in that nation's children.
Their findings, published online Nov. 9 in The Journal of Infectious Diseases,(academic.oup.com) suggested the country's successful HPV vaccination program led to the disappearance of the rare chronic and difficult-to-treat condition in Australian youth.
"This is a world-first finding of evidence that the HPV vaccine has actually prevented recurrent respiratory papillomatosis cases," said study author Julia Brotherton, M.D., Ph.D., M.P.H., of the Victorian Cytology Service in Melbourne, Australia, in a news release.(www.idsociety.org) "It's really exciting that we finally have a way to prevent this terrible disease. It adds to the list of strong reasons why you as a parent should choose to vaccinate your child."
Research has shown infants acquire recurrent respiratory papillomatosis during birth when HPV type 6 or 11 is spread from mother to child. The juvenile-onset form of the disease typically develops in early childhood, with a mean age of diagnosis between ages 3 and 4.
- Researchers in Australia have found that the HPV vaccine prevents juvenile-onset recurrent respiratory papillomatosis in that nation's children.
- The study noted that nine years after Australia introduced its national HPV vaccination program in 2007, the country reported that 86 percent of girls and 79 percent of boys ages 14-15 had received at least the first dose of the quadrivalent HPV vaccine.
- Starting in 2017, the CDC's Advisory Committee on Immunization Practices recommended patients ages 11-12 receive two doses of the nine-valent HPV vaccine at least six months apart; adolescents ages 13-14 also can receive the two-dose series.
In some cases, the virus causes benign exophytic papillomata to develop in the larynx, making it difficult to breathe. The condition can be life-threatening and may require multiple surgeries to clear the airway.
The study noted that Australia introduced its national HPV vaccination program in 2007 as part of the broader Australian National Immunization Program. The quadrivalent HPV vaccine (HPV4; Gardasil) was administered to girls and boys ages 12-13 through their school systems.
Nine years later, the country reported that the program had resulted in 86 percent of girls and 79 percent of boys ages 14-15 having received at least the first dose of the vaccine.
Researchers analyzed 2012-2016 results from the Australian Pediatric Surveillance Unit, which monitors rare pediatric diseases in the country based on clinician reporting. They found that during the surveillance program's first full year in 2012, seven cases of JORRP were reported. The number of cases declined during the next four years, with clinicians reporting only one case in all of Australia in 2016.
None of the mothers of the children who were diagnosed with the disease from 2012-2016 had been vaccinated against HPV prior to their pregnancies.
"We have documented a significantly declining rate of new diagnoses of JORRP in Australia in the 5- to 10-year period following the implementation of the National HPV Vaccination Program," the authors said.
"Our data strongly suggest that the previously documented impact of quadrivalent HPV vaccination in dramatically reducing the prevalence of HPV-6 and HPV-11 genital infection in the Australian population is translating to a reduction in the risk of transmission to infants intrapartum and subsequent development in some of these children of JORRP."
It should be noted that this study was funded in part by Gardasil manufacturer Merck & Co. Inc.'s Investigator Initiated Studies Program.
In a related editorial,(academic.oup.com) Basil Donovan, M.D., and Denton Callander, Ph.D., both of the Kirby Institute at the University of New South Wales in Sydney -- neither of whom was involved in the study -- urged high-income countries with good HPV immunization rates to evaluate how their vaccination programs might have similar population effects.
"National and individual vaccine hesitancy remains common," they said in the editorial, "and unless these hesitant countries are persuaded by the ever-expanding benefits of … HPV vaccination, millions of dollars in health spending along with countless unnecessary episodes of disease and death will occur in the coming decades."
Family Physician's Perspective
According to the CDC, although HPV vaccination rates have improved in the United States since the vaccine was introduced in 2006, only 60 percent of patients ages 13-17 received one or more doses of HPV vaccine in 2016.
Starting in 2017, the CDC's Advisory Committee on Immunization Practices recommended patients ages 11-12 receive two doses of the nine-valent HPV vaccine (HPV9; Gardasil 9) at least six months apart. Children can receive the vaccine starting at age 9, with a two-dose series recommended through age 14.
Patients who start the HPV9 vaccine at ages 15-26 should receive the previously recommended three-dose series.
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that although JORRP is extremely rare in the United States (occurring in about 4.5 per 100,000 children), the study's finding that the HPV vaccine prevents the disease represents another likely benefit that family physicians can promote.
"Family physicians should make a strong recommendation for HPV vaccination, informing patients of the potential benefits," she said. "This is another benefit that physicians could add to that list."
Frost said she thinks widespread HPV vaccination in the United States would likely produce results similar to those seen in Australia.
However, vaccine hesitancy in America, which can be traced to misinformation and mistrust, continues to be a challenge, she said. Overall, HPV vaccination rates are lower than those for other childhood vaccines.
"One reason is that clinicians discuss the HPV vaccine differently than other vaccines, expressing their own hesitancy," Frost said.
"The HPV vaccine protects individuals from cancer, as well as genital warts and likely JORRP," she stated. "It should receive a strong recommendation, along with the other vaccines on the CDC's immunization schedule."
Related AAFP News Coverage
CDC: HPV Infection Rates Remain High in Both Men, Women