Original Research

Gardasil® as adjunctive therapy for respiratory papillomatosis at Red Cross Children’s Hospital, Cape Town

Shavina Frank, Jessica K. McGuire, Fiona Kabagenyi, Vincent Pretorius, Shazia Peer
Journal of the Colleges of Medicine of South Africa | Vol 2, No 1 | a33 | DOI: https://doi.org/10.4102/jcmsa.v2i1.33 | © 2024 Shavina Frank, Jessica K. McGuire, Fiona Kabagenyi, Vincent Pretorius, Shazia Peer | This work is licensed under CC Attribution 4.0
Submitted: 21 September 2023 | Published: 24 May 2024

About the author(s)

Shavina Frank, Division of Otorhinolaryngology, Department of Surgery, Faculty of Health Sciences, University of Cape Town (Red Cross War Memorial Children’s Hospital), Cape Town, South Africa
Jessica K. McGuire, Division of Otorhinolaryngology, Department of Surgery, Faculty of Health Sciences, University of Cape Town (Red Cross War Memorial Children’s Hospital), Cape Town, South Africa
Fiona Kabagenyi, Department of Ear Nose and Throat, Faculty of Medicine, Makerere University, Kampala, Uganda
Vincent Pretorius, Division of Otorhinolaryngology, Department of Surgery, Faculty of Health Sciences, University of Cape Town (Red Cross War Memorial Children’s Hospital), Cape Town, South Africa
Shazia Peer, Division of Otorhinolaryngology, Department of Surgery, Faculty of Health Sciences, University of Cape Town (Red Cross War Memorial Children’s Hospital), Cape Town, South Africa

Abstract

Background: Juvenile onset recurrent respiratory papillomatosis (JoRRP) is an incurable condition caused by human papilloma virus (HPV) types 6 and 11, often requiring repeated surgeries and in severe cases, tracheostomy. This imposes a significant socioeconomic burden on patients and families. Gardasil®, a proven prophylactic HPV vaccine, is emerging as a potential adjuvant therapy. We studied its response on JoRRP patients at our center.

Methods: We conducted a retrospective review at Red Cross War Memorial Children’s Hospital from January 2015 to June 2022 on histologically confirmed JoRRP cases. Age at diagnosis, baseline and post-dosing Derkay-Coltrera (DC) scores (disease severity measure), inter-surgical intervals and tracheostomy, were collected.

Results: Twenty-five of 30 confirmed cases were included. Average age at diagnosis was 60 months (about 5 years old), with HPV Type 6 in 40% and Type 11 in 48% of patients. All patients received at least one Gardasil® dose, 84% received a second dose and 64% a third dose. Total population DC score decreased from an average of 17 (range: 4-34) pre-first dose to 8 (range: 0-16) after three doses, indicating a 50% reduction. Surgical intervals modestly increased. More significant improvements were seen in patients with aggressive forms of the disease.

Conclusion: This is the first study in Southern Africa highlighting Gardasil® as adjuvant therapy. Despite our limited sample size, new cases observed a linear reduction in DC scores and tracheostomy rates.

Contribution: This suggests that Gardasil® as adjuvant therapy has the potential to reduce disease severity and extend surgical intervals.


Keywords

Gardasil-4; Gardasil-4®; juvenile-onset recurrent respiratory papilloma; vaccine; upper airway obstruction; tracheostomy; Derkay-Coltrera score; human papilloma virus

Sustainable Development Goal

Goal 3: Good health and well-being

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