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 EA 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: atlcheng@bigpond.com
Sexual Health 7(3) 253-261 https://doi.org/10.1071/SH09142
Submitted: 10 December 2009 Accepted: 13 April 2010 Published: 19 August 2010
Abstract
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.
Acknowledgements
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.
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