This paper reports the results of a follow-up study investigating the possible role of adjuvant Gardasil vaccination in patients with recurrent laryngeal papillomatosis. The preceding study – also published in the Journal of Voice (2017) – reported the changes in HPV antibody titres in adult men with recurrent laryngeal papillomatosis following Gardasil vaccination. In this latest study, the same cohort of patients (excluding one who had developed laryngeal cancer) were assessed at one-year post-vaccination for the presence of HPV-DNA in laryngeal mucosa, as well as for the presence or absence of laryngeal papillomata.

Of the 11 patients in the cohort, eight showed no evidence of HPV-DNA on laryngeal secretion testing (all 11 were positive for HPV-DNA before vaccination). Of the three who still had evidence of HPV-DNA in their secretions, all were found to have laryngeal papillomata present. An additional two patients who were negative for HPV-DNA also had evidence of laryngeal papillomata.

In some ways these results are encouraging, insofar as they suggest that Gardasil vaccination may facilitate HPV clearance even after infection and reduce papilloma recurrence. Nevertheless the absence of a control group who were not vaccinated means that the HPV clearance cannot conclusively be attributed to the effects of the vaccination alone. Moreover, the persistence of HPV-DNA in 27% of vaccinated subjects and the recurrence of papillomata in 45% of the group clearly demonstrates that adjuvant Gardasil vaccination is unlikely to be the magic bullet that will solve the issue of established, recurrent laryngeal RRP. As such, the results of this trial reinforce the need for a national vaccination programme for both girls and boys that will hopefully serve to prevent HPV infection of the respiratory tract in the first place.

Gardasil Vaccination for Recurrent Laryngeal Papillomatosis in Adult Men Second Report: Negative Conversion of HPV in Laryngeal Secretions.
Hirai R, Makiyama K, Matsuzaki H, Oshima T.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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