[Recurrent respiratory papillomatosis: indication for HPV vaccination?]

Recurrent respiratory papillomatosis (RRP) is a rare disease in children and adults. It is characterized by proliferation of benign squamous cell papillomas within the respiratory-digestive tract, predominantly the larynx. RRP is caused by oral infection with human papilloma virus (HPV) types 6 or 11. In aggressive disease, which within few months or even weeks requires multiple surgical interventions to remove papillomas, residual impairment of voice and breathing is almost inevitable. Nowadays immune stimulation with interferon alpha or topic application of Cidofovir are recommended to lower the recurrence rate in aggressive disease but vaccination against mumps virus and photodynamic therapies has also been administered. The recently developed tetravalent HPV vaccine Gardasil induces neutralizing antibodies against capsid antigens of the HPV types 16 and 18, which are associated with cervical cancer, as well as against types 6 and 11, which are associated with condylomata acuminata und respiratory papillomatosis. The vaccine has been shown to be safe and highly immunogenic. It can efficaciously prevent new genital infections by one of the four vaccine types as well as the epithelial lesions induced by them. However, the vaccine had no effect against pre-existing genital infections or lesions. Here we propose the hypothesis that HPV vaccination could have a therapeutic effect in RRP by preventing new papilloma formation at additional sites. First case reports on Gardasil vaccination in juvenile as well as adult onset RRP have become available and their serological findings are presented here. In view of the low risk of this adjuvant immunotherapy a larger controlled multicentric trial is proposed to verify this hypothesis.