Human Papillomavirus 6/11 in the Lower Airway of Neonates
Condition: Papillomavirus Infections
MeSH terms: Papillomavirus Infections
Study type: Observational

Summary: 
      Vertical transmission of human papillomavirus (HPV) 6/11 leads to infection in the lower
      airway of neonates. The presence of HPV 6/11 may later cause juvenile onset recurrent
      respiratory papillomatosis (JORRP).
    

Detailed description: 
      Juvenile onset recurrent respiratory papillomatosis (JORRP) is caused by human papillomavirus
      (HPV), almost exclusively type 6 and 11. The disease is well-known for its recurrence and
      difficulty in management. The peak incidence is around 2-3 year of age. Since HPV infection
      has always been considered a sexual transmitted disease, the rate of vertical or perinatal
      transmission had been studied extensively. However, few studies focused on HPV 6 and 11.

      To the best of our knowledge, in the several large-scale studies available for HPV infection
      in the newborn, no case of HPV 6/11 infection had been identified. Most of these studies had
      specimens taken from the oral cavity of newborn. In contrast to the occurrence of JORRP in
      the larynx, trachea and lower respiratory tract, if vertical transmission of HPV 6/11 does
      exist, specimens from lower respiratory tract of newborn is mandatory to detect any possible
      infection.

      There is no study available about HPV 6/11 infection in the lower airway of healthy
      neonate/children. In some studies of adults, the prevalence of HPV 6/11 in larynx or vocal
      cord of patients without recurrent respiratory papillomatosis ranged between 19~25%. In
      contrast, several studies had specimen taken from the non-disease lower airway (trachea,
      vocal cord) and/or larynx of patients with JORRP. Except for the almost 100% presence of HPV
      6/11 DNA in the diseased site, 38~60% of specimens taken from non-disease site were also
      positive for the viral DNA, showing that latent infection is not infrequent in normal airway,
      and may later cause active disease by mechanism still unknown to date.

      The largest national registry of JORRP to date was conducted in the US and had 603 cases. The
      study showed that there was a significant association between younger age at diagnosis and
      papillomas occurring below the larynx (mean age 4.6 VS 2.1 years, p=0.009). This finding
      further emphasizes the importance of getting specimen at the laryngeal level, especially in
      neonates.

      The aim of our study is to examine the presence of HPV 6/11 DNA in lower respiratory tract
      specimens from newborn. To get the lower respiratory tract specimen without unnecessary
      medical intervention, only those needed intubation will be included in this study. Specimens
      from bronchial lavage (or scraping?) will be obtained after getting informed consent from the
      parents, and undergo PCR to identify the presence of HPV 6/11 DNA.
    

Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All intubated neonates younger than 1 month-old admitted to our neonatal intensive care
        unit.
      
Biospecimen description: 
      Bronchial lavage fluid
    
Keywords: Human papillomavirus 6/11; Neonates; Human papillomavirus 6 or 11 infection