Background and objective

Recurrent respiratory papillomatosis (RRP) can be categorized into two diagnoses based on the mode of transmission and disease onset. We differentiate between infection occurring in adulthood primarily due to sexual activity (Adult onset Recurrent Respiratory Papillomatosis - AoRRP) and infection in children transmitted from the mother during vaginal childbirth (Juvenile onset Recurrent Respiratory Papillomatosis - JoRRP).

RRP is a rare disease caused by human papillomavirus (HPV), resulting in infections and papilloma lesions (warts) in the respiratory tract [1]. The burden of the disease can be substantial for individuals with RRP, leading to frequent hospitalizations and potential surgeries [2]. Previous research has estimated that over 90% of all RRP cases are caused by HPV types 6 & 11 [3]. The vaccine Gardasil provides protection against both of these HPV types and was previously utilized in school vaccination programs from 2009 to 2016.

We are now investigating the vaccine effectiveness and incidence rate of RRP in both adults and children. This is being done through two parallel projects:

In the project "Effect of the HPV vaccine Gardasil against Laryngeal papillomatosis (AoRRP)," the primary objective is to examine whether vaccination with GARDASIL/GARDSIL9 before the age of 17 reduces the risk of RRP diagnosed in adulthood (after the age of 15). The secondary objective is to investigate the incidence rate of RRP in both genders (ages 0-31) in Norway from 2008 to 2021.

In the project "Effect of GARDASIL/GARDASIL9 against juvenile onset laryngeal papillomatosis in Sweden, Denmark, and Norway (JoRRP)," we aim to investigate whether the risk of JoRRP is lower for children whose mothers are fully vaccinated with GARDASIL/GARDASIL 9 at least one year before the age of 17, compared to children with unvaccinated mothers. The JoRRP project is conducted in collaboration with the Danish Cancer Society and the Karolinska Institute in Sweden.

Status: The project is awaiting data access from

1. Larson DA, Derkay CS. Epidemiology of recurrent respiratory papillomatosis. APMIS. 2010 Jun;118(6-7):450-4. doi: 10.1111/j.1600-0463.2010.02619.x. PMID: 20553527.

2. Taliercio S, Cespedes M, Born H, Ruiz R, Roof S, Amin MR, Branski RC. Adult-onset recurrent respiratory papillomatosis: a review of disease pathogenesis and implications for patient counseling. JAMA Otolaryngol Head Neck Surg. 2015 Jan;141(1):78-83. doi: 10.1001/jamaoto.2014.2826. PMID: 25393901.

3. Fortes HR, von Ranke FM, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, Souza CA, Marchiori E. Recurrent respiratory papillomatosis: A state-of-the-art review. Respir Med. 2017 May;126:116-121. doi: 10.1016/j.rmed.2017.03.030. Epub 2017 Apr 1. PMID: 28427542.