Impact of HPV infection of the airway measured for the first time

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For the first time, the scope and devastating impact of the human papilloma virus (HPV) infection of the airway in children has been measured, according to a new population study from the University of Toronto and The Hospital for Sick Children (SickKids).

For some time, the impact of HPV infection on the cervical and anogenital tract (anus and genital tract) has been widely recognized; less well documented is the impact of the same affliction in the airway. The disease, which can be passed from infected mother to child during pregnancy or childbirth, can cause wart-like lesions of the nose, pharynx, trachea and bronchi. These lesions interfere with breathing and require frequent surgical removal. In children, the affliction is known as juvenile onset recurrent respiratory papillomatosis, or JoRRP.

For a relatively rare disease, JoRRP extracts a significant toll on patients, families and the health-care system, according to a study by Paolo Campisi, Associate Professor in the University of Toronto Faculty of Medicine’s Department of Otolaryngology – Head & Neck Surgery and Staff Otolaryngologist and Project Investigator at SickKids. The study, published in the June advance online edition of the peer-reviewed journal Laryngoscopy, was presented by Campisi at the 26th International Papilloma Virus & Clinical and Public Health Workshops conference in Montreal last week.

“While the overall incidence of JoRRP is low, the implication for the afflicted children is significant and knowing the scope of the problem is critical. There is an enormous physical, psychological and financial burden for these young patients and their families,” said Dr. Campisi, who is also Director of SickKids’ Centre for Paediatric Voice and Laryngeal Function.

Dr. Campisi and his team collected data from colleagues across Canada and found that between 1994 and 2007, the overall incidence rate of JoRRP in children aged 14 and younger was only 0.24 cases per 100,000, or 243 reported cases (the prevalence rate was 1.11 per 100,000). But that modest number of cases required a substantial 3,021 surgical procedures performed on affected children. The data revealed that the median age at time of diagnosis was 4.4 years, and children with JoRRP underwent a median of seven surgical procedures each.

Patients were nearly equally split between male and female. The database also showed regional variations within Canada. Over the course of the study period, the disease prevalence rose in Atlantic Canada and Quebec, decreased in Ontario and British Columbia and held steady in the Prairies.

“Genital HPV infection is the most common sexually transmitted disease among young, sexually active people. Widespread vaccination against HPV within the female population may affect the incidence of JoRRP and spare children from the harsh consequences of the disease,” Dr. Campisi said.

Despite being a rare condition, estimates have put the cost of treatment in the U.S. at $100 million annually. While the incidence and prevalence of JoRRP has been examined in some parts of the world, the majority of the reported epidemiological rates are derived from limited populations or from estimates and extrapolations. Dr. Campisi’s database is the first well-defined population study of JoRRP. Canada’s public health-care system and population size made it an ideal subject for a study of this kind, he said. The national database will also be used as the basis for future surveillance studies and to facilitate recruitment for interventional trials.

This study was funded, in part, by an unrestricted research grant from Merck Frosst Canada Ltd. and by SickKids Foundation.