Juvenile-Onset Recurrent Respiratory Papillomatosis and Human Papillomavirus Vaccine Uptake: A 19-Year Retrospective Cohort Study.

Abstract

To evaluate 19-year trends in juvenile-onset recurrent respiratory papillomatosis incidence and treatment utilization in the context of increasing human papillomavirus vaccine uptake. Retrospective cohort study. TriNetX United States Collaborative Network. Children 18 years of age or younger with juvenile-onset recurrent respiratory papillomatosis diagnosed between January 1, 2006, and December 31, 2024, were identified using International Classification of Diseases codes. Annual encounter-based incidence per 100,000 patients was calculated for both juvenile-onset recurrent respiratory papillomatosis and human papillomavirus vaccination. Within the pediatric juvenile-onset recurrent respiratory papillomatosis cohort, annual utilization of major treatment modalities, including bevacizumab, cidofovir, lesion excision, and tracheostomy, was assessed. A total of 1854 children met inclusion criteria (mean age 7.9 ± 5.7 years). Juvenile-onset recurrent respiratory papillomatosis incidence declined by 65.2%, from 3.1 cases per 100,000 in 2006 to 1.1 cases per 100,000 in 2024 (P < .001). Human papillomavirus vaccine incidence increased by 1448.1%, from 45.5 to 704.4 cases per 100,000 patients over the same period (P < .001). Annual juvenile-onset recurrent respiratory papillomatosis incidence was inversely correlated with human papillomavirus vaccine incidence (r = -0.892; P < .001). Within the pediatric juvenile-onset recurrent respiratory papillomatosis cohort, use of bevacizumab and cidofovir increased significantly, whereas lesion excision and tracheostomy incidence remained stable. Rising human papillomavirus vaccine uptake is associated with a significant reduction in encounter-based juvenile-onset recurrent respiratory papillomatosis incidence at the population level. Surgical excision remains the predominant management approach, with limited adoption of adjuvant therapies despite recent increases.