Laryngeal papillomatosis (recurrent respiratory papillomatosis) is a rare but devastating disease which is caused by the Human Papillomavirus (HPV). The virus causes crops of warts to grow on the vocal cords and elsewhere in the respiratory tract, resulting in hoarseness and even respiratory compromise if the disease narrows the airway. Current treatment involves surgical removal of the warts, but they always recur, meaning that multiple operations are required. Some patients have had hundreds of operations over their lifetimes.
Some recent studies have suggested that administering the Gardasil vaccine results in increasing the length of time between operations or, occasionally, eliminating the disease altogether. Gardasil is now in widespread use in the UK – girls have received the inoculation for several years, and from September 2019 it will be offered to all boys as well. The Global Advisory Committee on Vaccine Safety report that it is a safe vaccine with an excellent track record.
The cost to the NHS of a course of Gardasil is £207.60. The NHS tariff for surgical treatment for laryngeal papillomatosis (microlaryngoscopy and laser and/or microdebrider) is between £1,143 and £1,466 – so it can be seen that any intervention that reduces the frequency of operations would be beneficial not only for the patient, but also from a financial point of view.
The British Laryngological Association strongly supports the use of Gardasil HPV vaccination in all patients above the age of 9 years with laryngeal papillomatosis. Below 9 years of age the BLA advise that individual cases are presented to the host Trusts Medicines Evaluation Committee which will undoubtedly require evidence of HPV disease status of the patient to be identified.
