Is Human Papillomavirus (HPV) vaccination effective for preventing recurrent laryngeal papillomatosis in adults?

HPV Vaccination for Recurrent Laryngeal Papillomatosis in Adults

HPV vaccination is strongly recommended for adults with recurrent laryngeal papillomatosis (RLP) aged 9-26 years to prevent disease recurrence, with the quadrivalent or nonavalent vaccine preferred due to their coverage of HPV types 6 and 11, which cause 90-95% of RLP cases. 1

Background and Rationale

• Recurrent laryngeal papillomatosis (RLP) is characterized by multiple papillomas in the airway causing obstructive symptoms including shortness of breath, hoarseness, and stridor 1
• The disease affects both children (juvenile onset) and adults, with an estimated incidence of 3-7 per 100,000 individuals 1
• Human papillomavirus (HPV) types 6 and 11 are responsible for 90-95% of RLP cases 1, 2

Evidence for Vaccination in RLP

Guideline Recommendations

• The Spanish multidisciplinary evidence-based consensus guidelines (2019) strongly recommend HPV vaccination for patients with RRP aged 9-26 years despite the low quality of evidence 1
• The guidelines specifically recommend quadrivalent or nonavalent vaccines due to their coverage of HPV types 6 and 11 1
• This recommendation is based on several studies showing that vaccination induced partial or complete remission in a substantial proportion of RRP patients 1

Clinical Evidence Supporting Vaccination

• A 22-year retrospective clinical analysis found that only 15.4% of vaccinated RRP patients developed disease recurrence (after mean 54.9 months), compared to 100% of unvaccinated patients who relapsed (after mean 12.3 months) 3
• A case series study of adult men with RLP demonstrated that HPV vaccination led to negative conversion of HPV-DNA in laryngeal secretions in 72.7% of patients after vaccination 4
• Current evidence suggests the vaccine may have both preventive and therapeutic effects in RRP by preventing new papilloma formation at additional sites 5, 3

Vaccination Approach for Adults with RLP

Recommended Vaccines

• Quadrivalent vaccine (Gardasil) or nonavalent vaccine (Gardasil 9) are preferred as they contain virus-like particles (VLPs) of HPV types 6 and 11, which are the predominant types causing RRP 1, 2
• The nonavalent vaccine provides broader coverage, protecting against HPV types 6,11,16,18,31,33,45,52, and 58 1, 2

Dosing Schedule

• A 3-dose schedule is recommended for all adults with RLP 1
• This recommendation is based on the original licensing of HPV vaccines, which were initially tested in adult populations 1

Important Considerations and Caveats

• While evidence supports vaccination for RRP patients aged 9-26 years, compassionate use may be considered for juvenile patients who are under the age indicated in the summary of product characteristics 1
• The vaccine appears to be safe and well-tolerated in RRP patients, with no remarkable adverse effects reported 1
• Current management of RRP still includes surgical debulking of papillomatous lesions, with vaccination serving as an adjuvant therapy 2, 6
• Although randomized clinical trials specifically for RRP are lacking, observational studies consistently show benefits of vaccination 1, 3
• For adults over 26 years, the evidence is more limited, but Taiwan's 2025 guidelines suggest HPV vaccination may be considered for adults through age 45 for prevention of HPV-related conditions 1

Conclusion for Clinical Practice

• HPV vaccination should be incorporated into the management plan for adult patients with RRP, particularly those aged 9-26 years 1
• The potential benefit of vaccination in preventing recurrences outweighs the minimal risks associated with vaccination 1
• The quadrivalent or nonavalent vaccines are specifically recommended due to their coverage of the causative HPV types 6 and 11 1, 2