title: Risk factors for the development and severity of juvenile-onset recurrent respiratory papillomatosis: a systematic review.
abstract: OBJECTIVE
  Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a rare yet aggressive disease caused by human papillomavirus (HPV). Although many newborns are likely exposed to HPV, few develop JoRRP and the clinical course of the disease varies from one child to another. This systematic review seeks to provide an up-to-date understanding of the risk factors for acquisition and severity.
  
  
  METHODS
  We conducted a comprehensive literature search in EMBASE, MEDLINE and EBMR databases using various combinations of keywords related to JoRRP etiology, risk factors and severity. We also searched Google Scholar and the reference lists of eligible studies. Our search was limited to original studies published in French or English between 1995 and July 2012 and to patients under 20 years of age.
  
  
  RESULTS
  Of 1362 citations, we retrieved 102 articles and found 14 additional studies. We retained 32 studies meeting inclusion criteria. All were observational and together included 2296 JoRRP cases. Risk factors could be classified mainly as maternal and birth history, viral genotype, and host factors. A history of genital warts during pregnancy and delivery was strongly linked to the development of JoRRP. Depending on ethnicity, specific human leukocyte antigen class II alleles and immune response factors were important determinants of JoRRP acquisition and severity. HPV-11 genotype and younger age at onset of JoRRP were important predictors of severity.
  
  
  CONCLUSIONS
  Genetic and immunological profiles underlying the acquisition and clinical course are not readily modifiable. Thus, preventing condylomas in women of childbearing age could reduce the burden of this life-threatening disease.
authors.affiliation: Department of Social and Preventive Medicine, University of Montreal, Public Health School 7101, Avenue du Parc, 3rd Floor, Montreal, Quebec H3N 1X9, Canada; Sainte Justine Hospital (CHU Sainte-Justine), 3175 Chemin de la Côte Ste-Catherine, Room A-830, Montreal, Quebec H3T 1C5, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Niyibizi
authors.affiliation: Department of Social and Preventive Medicine, University of Montreal, Public Health School 7101, Avenue du Parc, 3rd Floor, Montreal, Quebec H3N 1X9, Canada; Merck Canada Inc., 16711 Route Transcanadienne, Kirkland, Quebec H9H 3L1, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rodier
authors.affiliation: Sainte Justine Hospital (CHU Sainte-Justine), 3175 Chemin de la Côte Ste-Catherine, Room A-830, Montreal, Quebec H3T 1C5, Canada.
authors.forename: Maggy
authors.initials: M
authors.lastname: Wassef
authors.affiliation: Department of Social and Preventive Medicine, University of Montreal, Public Health School 7101, Avenue du Parc, 3rd Floor, Montreal, Quebec H3N 1X9, Canada; Sainte Justine Hospital (CHU Sainte-Justine), 3175 Chemin de la Côte Ste-Catherine, Room A-830, Montreal, Quebec H3T 1C5, Canada. Electronic address: helen.trottier@umontreal.ca.
authors.forename: Helen
authors.initials: H
authors.lastname: Trottier
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D011247:Pregnancy; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D012307:Risk Factors
keywords: Acquisition; Human papillomavirus; Recurrent respiratory papillomatosis; Review; Severity