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Estimating the prevalence of and treatment patterns for juvenile onset recurrent respiratory papillomatosis in Australia pre-vaccination: a pilot study

Daniel Novakovic A , Alan T. L. Cheng B F , Daron H. Cope C and Julia M. L. Brotherton D E
+ Author Affiliations
- Author Affiliations

A St Luke’s Roosevelt Hospital, 1000 10th Avenue, New York, NY 10019, USA.

B Department of Paediatric Otolaryngology, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.

C Gosford Hospital, Holden Street, Gosford, NSW 2250, Australia.

D Registries, Victorian Cytology Service, PO Box 310, East Melbourne, Vic. 8002, Australia.

E National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Discipline of Paediatrics and Child Health, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.

F Corresponding author. Email:

Sexual Health 7(3) 253-261
Submitted: 10 December 2009  Accepted: 13 April 2010   Published: 19 August 2010


Background: Recurrent respiratory papillomatosis (RRP) causes serious morbidity. RRP in Australia may be eliminated in the near future following the implementation of a national vaccination program using a human papillomavirus (HPV) vaccine that protects against infection with HPV types 6 and 11, those responsible for RRP. Baseline data on RRP prevalence and disease burden in Australia are lacking. Methods: Three study methods were used to estimate the burden of juvenile onset RRP in Australia. We conducted a retrospective chart review of RRP cases treated at The Children’s Hospital at Westmead over 10 years, examined the coding of these cases, and then calculated and applied the positive predictive value of the codes to national data to estimate the prevalence of RRP in Australia. We also conducted an online survey of otolaryngologists in Australia who manage RRP. Results: Nineteen patients were treated at the hospital over 10 years, involving 359 admissions. We estimate that between 33 and 56 RRP cases aged <20 are being treated nationally per year (0.6–1.1 per 100 000 persons), with children 5–9 years having a higher estimated rate of 1.2–1.8 per 100 000. Among 39 otolaryngologists treating juvenile onset RRP, the majority (73%) treated RRP in a paediatric tertiary hospital, and used the microdebrider for ablation of lesions. Conclusions: Our estimates of RRP disease burden agree with international estimates. As a small number of clinicians treat RRP nationally, we believe that establishment of a national RRP register is both feasible and necessary to monitor the impact of vaccination.

Additional keywords: genital warts, HPV, juvenile onset recurrent respiratory papillomatosis, lesions, paediatrics.


Thank you to Silvia Hope, who assisted with the national hospital separations data extraction, and to Mark Carmichael and Carole Gridley from the Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) for supporting and facilitating the survey. We thank Paolo Campisi for conceptual advice about the utility of the on-line survey. We also thank all the doctors who participated in the survey and the clinicians at CHW who gave permission to review their patient data.


[1] Buchinsky FJ,  Donfack J,  Derkay CS,  Choi SS,  Conley SF,  Meyer III CM, et al. Age of child, more than HPV type, is associated with clinical course in recurrent respiratory papillomatosis. PLoS One 2008; 3 e2263.
CrossRef |

[2] Wiatrak BJ,  Wiatrak DW,  Broker TR,  Lewis L. Recurrent respiratory papillomatosis: a longitudinal study comparing severity associated with human papilloma viral types 6 and 11 and other risk factors in a large pediatric population. Laryngoscope 2004; 114((Suppl 104)): 1–23.
CrossRef |

[3] Reeves WC,  Ruparelia SS,  Swanson KI,  Derkay CS,  Marcus A,  Unger ER,  RRP Task Force National registry for juvenile-onset recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg 2003; 129 976–82.
CrossRef |

[4] Lindeberg H,  Oster S,  Oxlund I,  Elbrond O. Laryngeal papillomas: classification and course. Clin Otolaryngol Allied Sci 1986; 11 423–9.
CrossRef |

[5] Johnson K,  Derkay C. Palliative aspects of recurrent respiratory papillomatosis. Otolaryngol Clin North Am 2009; 42 57–70.
CrossRef |

[6] Kashima HK,  Shah F,  Lyles A,  Glackin R,  Muhammad N,  Turner L, et al. A comparison of risk factors in juvenile-onset and adult-onset recurrent respiratory papillomatosis. Laryngoscope 1992; 102 9–13.
CrossRef |

[7] Wiatrak BJ . Recurrent respiratory papillomatosis. In Graham JM, Scadding GK, Bull PD, editors. Pediatric ENT. Berlin: Springer-Verlag; 2007. pp. 256–65.

[8] Cheng ATL,  Backer CL,  Holinger LD,  Dunham ME,  Mavroudis C,  Gonzalez-Crussi F. Histopathologic changes after pericardial patch tracheoplasty. Arch Otolaryngol Head Neck Surg 1997; 123 1069–72.

[9] Maran A,  Amella CA,  DiLorenzo TP,  Auborn KJ,  Taichman LB,  Steinberg BM. Human papillomavirus type 11 transcripts are present at low abundance in latently infected respiratory tissues. Virology 1995; 212 285–94.
CrossRef |

[10] Derkay CS,  Wiatrak B. Recurrent respiratory papillomatosis: a review. Laryngoscope 2008; 118 1236–47.
CrossRef |

[11] Hawkes M,  Campisi P,  Zafar R,  Punthakee X,  Dupuis A,  Forte V, et al. Time course of juvenile onset recurrent respiratory papillomatosis caused by human papillomavirus. Pediatr Infect Dis J 2008; 27 149–54.

[12] Rady PL,  Schnadig VJ,  Weiss RL,  Hughes TK,  Tyring SK. Malignant transformation of recurrent respiratory papillomatosis associated with integrated human papillomavirus type 11 DNA and mutation of p53. Laryngoscope 1998; 108 735–40.
CrossRef |

[13] Gelinas JF,  Manoukian J,  Cote A. Lung involvement in juvenile onset recurrent respiratory papillomatosis: a systematic review of the literature. Int J Pediatr Otorhinolaryngol 2008; 72 433–52.
CrossRef |

[14] Stamataki S,  Nikolopoulos TP,  Korres S,  Felekis D,  Tzangaroulakis A,  Ferekidis E. Juvenile recurrent respiratory papillomatosis: still a mystery disease with difficult management. Head Neck 2007; 29 155–62.
CrossRef |

[15] Derkay CS. Recurrent respiratory papillomatosis. Laryngoscope 2001; 111 57–69.
CrossRef |

[16] Wu R,  Coniglio SJ,  Chan A,  Symons MH,  Steinberg BM. Up-regulation of Rac1 by epidermal growth factor mediates COX-2 expression in recurrent respiratory papillomas. Mol Med 2007; 13 1–50.
CrossRef |

[17] Zeitels SM,  Lopez-Guerra G,  Burns JA,  Lutch M,  Friedman AM,  Hillman RE. Microlaryngoscopic and office-based injection of bevacizumab (Avastin) to enhance 532-nm pulsed KTP laser treatment of glottal papillomatosis. Ann Otol Rhinol Laryngol 2009; 118(Suppl 201) 1–24.

[18] Haleden C,  Majmudar B. The relationship between juvenile laryngeal papillomatosis and maternal condylomata acuminata. J Reprod Med 1986; 318 804–7.

[19] Tenti P. Perinatal transmission of human papillomavirus from gravidas with latent infections. Obstet Gynecol 1999; 93 475–9.
CrossRef |

[20] DeVoti JA,  Rosenthal DW,  Wu R,  Abramson AL,  Steinberg BM,  Bonagura VR. Immune dysregulation and tumor-associated gene changes in recurrent respiratory papillomatosis: a paired microarray analysis. Mol Med 2008; 14 1–17.
CrossRef |

[21] Stern Y,  Felipovich A,  Cotton RT,  Segal K. Immunocompetency in children with recurrent respiratory papillomatosis: prospective study. Ann Otol Rhinol Laryngol 2007; 116 169–71.

[22] Shah K,  Kashima H,  Polk BF,  Shah F,  Abbey H,  Abramson A, et al. Rarity of cesearean delivery in cases of juvenile-onset respiratory papillomatosis. Obstet Gynecol 1986; 68 795–9.

[23] Garland SM,  Hernandez-Avila M,  Wheeler CM,  Perez G,  Harper DM,  Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 2007; 356 1928–43.
CrossRef |

[24] Schaffer A,  Brotherton J,  Booy R. Do human papillomavirus vaccines have any role in newborns and the prevention of recurrent respiratory papillomatosis in children? J Paediatr Child Health 2007; 43 579–80.
CrossRef |

[25] Matys K , Hood S , Bautista O , Esser M , Saah A . Maternal transfer of anti-HPV antibodies following vaccination with Gardasil. [conference abstract] P-03.51. Presented at the 25th International Papillomavirus Conference, Malmo, Sweden, 8–14 May, 2009.

[26] Somers GR,  Tabrizi SN,  Borg AJ,  Garland SM,  Chow CW. Juvenile laryngeal papillomatosis in a pediatric population: a clinicopathologic study. Pediatr Pathol Lab Med 1997; 17 53–64.
CrossRef |

[27] Benjamin B,  Parsons DS. Recurrent respiratory papillomatosis: a 10 year study. J Laryngol Otol 1988; 102 1022–8.
CrossRef |

[28] Gabbott M,  Cossart YE,  Kan A,  Konopka M,  Chan R,  Rose BR. Human papillomavirus and host variables as predictors of clinical course in patients with juvenile-onset recurrent respiratory papillomatosis. J Clin Microbiol 1997; 35 3098–103.

[29] Schraff S,  Derkay CS,  Burke B,  Lawson L. American Society of Pediatric Otolaryngology members’ experience with recurrent respiratory papillomatosis and the use of adjuvant therapy. Arch Otolaryngol Head Neck Surg 2004; 130 1039–42.
CrossRef |

[30] Australian Institute of Health and Welfare. Interactive national hospital data (datacubes). Available online at: [verified 7 June 2010].

[31] Silverberg MJ,  Thorsen P,  Lindeberg H,  Ahdieh-Grant L,  Shah KV. Clinical course of recurrent respiratory papillomatosis in Danish children. Arch Otolaryngol Head Neck Surg 2004; 130 711–6.
CrossRef |

[32] Australian Institute of Health and Welfare. Indigenous identification in hospital separations data-quality report. Health Services Series no.35. HSE 85. Canberra: AIHW; 2010.

[33] Campisi P,  Canadian JORRP Working Group The epidemiology of juvenile onset recurrent respiratory papillomatosis derived from a population level national database. Laryngoscope 2010; 120 1233–45.

[34] Carvalho CM,  Huot L,  Charlois A-L,  Khalfallah SA,  Chapuis F,  Froehlich P. Prognostic factors of recurrent respiratory papillomatosis from a registry of 72 patients. Acta Otolaryngol 2009; 129 462–70.
CrossRef |

[35] Nunez DA. Update on human papilloma virus vaccination and the European recurrent respiratory papillomatosis registry. Clin Otolaryngol 2009; 34 12.

[36] He S,  Zurynski YA,  Elliott EJ. Evaluation of a national resource to identify and study rare diseases: the Australian Paediatric Surveillance Unit. J Paediatr Child Health 2009; 45 498–504.
CrossRef |

[37] Mouadeb DA,  Belafsky PC. In-office laryngeal surgery with the 585 nm pulsed dye laser (PDL). Otolaryngol Head Neck Surg 2007; 137 477–81.
CrossRef |

[38] Rees CJ,  Postma GN,  Koufman JA. Cost savings of unsedated office-based laser surgery for laryngeal papillomas. Ann Otol Rhinol Laryngol 2007; 116 45–8.

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