Silent Threat of Relapsing Respiratory Papillomatosis for Children

In the busy corridors of the Kenyatta National Hospital (KNH), ear, nose and throat (ENT) disorder expert Dr Reul Maina Kageni witnessed a worrying trend.

A rare but potentially fatal disease, known as recurrent respiratory papillomatosis (RRP), is affecting an increasing number of patients, particularly children.

RRP is a viral disease characterized by the growth of cauliflower-like tumors in the airways, primarily affecting the voice box (larynx).

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“It starts with hoarseness of the voice, then progresses to difficulty breathing,” says Dr. Maina. “It is often confused with asthma, which can delay diagnosis and treatment.”

According to the doctor, the disease is caused by human papillomavirus (HPV) types 6 and 11, the same viruses that cause genital warts.

The World Health Organization explains that RRP affects four in 100,000 children and one to two in 100,000 adults worldwide. However, these statistics may not accurately reflect the situation in Kenya.

The National Library of Medicine reports that RRP is more prevalent in developing countries, with several African countries significantly affected.

Although exact statistics for the continent are limited, countries such as South Africa, Nigeria and Kenya have reported higher incidence rates than global averages.

Dr. Maina notes, “At KNH, we have treated approximately 350 patients with RRP, with children accounting for more than 300 of these cases. We think this is just the tip of the iceberg. Many cases go undiagnosed, particularly in rural areas where access to specialized care is limited.

Studies have shown that children born to mothers younger than 20 are at higher risk of developing RRP. This is of particular concern in Kenya, where teenage pregnancies remain a significant problem.

The report on human papillomavirus and associated diseases in Kenya highlights that the high prevalence of HPV among young women contributes to the risk of vertical transmission to infants during childbirth.

The patients that Dr. Maina sees are primarily children from low socioeconomic backgrounds. This demographic trend aligns with global trends, as studies have shown that RRP is more prevalent in populations with limited access to healthcare and lower HPV vaccination rates. Diagnosing RRP requires specialized equipment and expertise. “We use laryngoscopy in the clinic for diagnosis,” says Dr. Maina.

“However, many patients come to us urgently, unable to breathe, and are taken directly to the operating room. »

The main treatment is surgical removal of papillomas. “On average, patients require surgery three times a year,” notes Dr. Maina. This frequent need for intervention has a significant impact on patients’ quality of life and represents a significant financial burden for families and the health system.

To improve care, Dr. Maina and his team advocate for advanced equipment like flexible laryngoscopes and intraoperative techniques like microdebriders and lasers. These tools could improve accuracy and potentially reduce the frequency of surgical procedures.

The link between RRP and HPV opens up possibilities for prevention and management, the doctor says.

The Gardasil vaccine, which protects against HPV types 6 and 11, has shown promise in reducing RRP recurrence rates.

“Our goal is to provide the vaccine to all patients,” he said. “Ideally, it should be affordable, or even free, to ensure widespread access. »

This approach aligns with recommendations from the National Institutes of Health (NIH) in the United States, which supports the use of HPV vaccines in the management of RRP.

However, implementing such strategies in Kenya faces challenges due to limited resources and competing health priorities.

Dr. Maina and his colleagues have established a patient support group and are undertaking a national outreach program to educate health care providers and the public about this disease.

“Early detection leads to early intervention and a good prognosis,” says Dr. Maina. “We are working to ensure that more healthcare providers can recognize the signs of RRP and refer patients appropriately. »