Recurrent respiratory papillomatosis (RRP) is well known to be caused by infection with the human papilloma virus (types 6 and 11). Recurrence after surgical removal is common and potentially frequent and severe. Previous research has established that many patients with RRP do not produce antibodies against HPV that are detectable in the serum. Patients with non-recurrent disease have also been found to have a significantly higher HPV antibody titre than recurrent cases. As such, there is increasing interest in the use of the quadrivalent HPV vaccine Gardasil to stimulate an immune response in cases of established RRP to reduce or prevent disease recurrence. The long-term aims of the case series study reported in this paper are to examine whether Gardasil injection effectively inhibits recurrence of RRP in adult men. Twelve male patients aged 32-74 with HPV-positive laryngeal papillomatosis received a full Gardasil vaccination course following laser resection of their disease. In this preliminary report, HPV antibody titres pre- and post-vaccination are reported. Consistent with previous data, pre-vaccination antibody titres in all patients were extremely low (undetectable in 10/12). Seven months after the first vaccination, all patients exhibited a significant rise in antibody titres, similar in degree to that reported previously with vaccination in younger subjects (aged 16-26). The results presented in this paper are an important first step in assessing the potential efficacy of HPV vaccination in older male subjects. Until now, there have been no reported investigations of antibody titre responses to HPV vaccination in older men, and it is encouraging that the immune response in older patients appears similar to younger subjects. Clearly, the most important outcome to be assessed is whether Gardasil vaccination does indeed reduce or prevent recurrence of established disease, and the longer term results of this study are awaited with interest.

Gardasil vaccination for recurrent laryngeal papillomatosis in adult men - first report: changes in HPV antibody titer.
Makiyama K, Hirai R, Matsuzaki H.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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