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

OBJECTIVE: To evaluate 19-year trends in juvenile-onset recurrent respiratory papillomatosis incidence and treatment utilization in the context of increasing human papillomavirus vaccine uptake. STUDY DESIGN: Retrospective cohort study. SETTING: TriNetX United States Collaborative Network. METHODS: 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. RESULTS: 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. CONCLUSION: 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.