What vaccines does a 13-year-old need?

Vaccines Recommended for a 13-Year-Old

A 13-year-old needs three core vaccines: Tdap (tetanus-diphtheria-pertussis), MenACWY (meningococcal conjugate), and HPV (human papillomavirus), plus annual influenza vaccine and any catch-up doses for incomplete childhood series. 1

Core Adolescent Vaccines

Tdap (Tetanus-Diphtheria-Pertussis)

• One dose of Tdap is required at age 11-12 years for adolescents who completed the childhood DTaP series 1, 2
• If not received at age 11-12, it should be given as catch-up at age 13 3, 4
• This vaccine protects against tetanus, diphtheria, and pertussis (whooping cough) 1
• National coverage for Tdap reached 86% in 2015, though this represents a slight decrease from prior years 5

MenACWY (Meningococcal Conjugate Vaccine)

• One dose of MenACWY is recommended at age 11-12 years, with a booster required at age 16 1, 6
• If the first dose was not given at age 11-12, it should be administered at age 13 as catch-up 4
• This vaccine protects against meningococcal disease caused by serogroups A, C, W, and Y 1, 6
• Meningococcal disease has increased incidence in late adolescence, with serious complications including neurologic sequelae, limb amputation, and death 5
• National coverage reached 81% for at least one dose in 2015 5

HPV (Human Papillomavirus) Vaccine

• For a 13-year-old starting the HPV series now, three doses are required (0,1-2 months, 6 months) 7
• The three-dose schedule is necessary because vaccination started after age 15 requires three doses for adequate immune response 7
• If the 13-year-old had started the series before age 15, only two doses would be needed 1, 8
• HPV vaccine prevents multiple types of cancer, with HPV types 16 and 18 responsible for approximately 70% of cervical cancers 5, 7
• The 9-valent HPV vaccine (Gardasil-9) is the only HPV vaccine available in the United States as of 2017, protecting against nine HPV types 7
• HPV vaccination is most effective when given before sexual debut, as approximately 24% of adolescents report sexual intercourse by 9th grade 8
• National coverage lags significantly behind other adolescent vaccines, with only 42% of girls and 28% of boys completing the series in 2015 5

Annual Vaccine

Influenza Vaccine

• Annual influenza vaccination is recommended for all adolescents every fall/winter season 1
• Adolescents with chronic conditions (asthma, diabetes, heart disease, immunosuppression) are at particularly high risk and should be prioritized 5
• Coverage for influenza vaccine among adolescents was only 46.8% in the 2015-2016 season 5

Catch-Up Vaccines (If Incomplete)

Hepatitis B Series

• Three-dose series should be completed if not done in childhood 1, 4
• The Healthy People 2010 objective of 90% coverage was met for hepatitis B among adolescents 4

MMR (Measles-Mumps-Rubella)

• Two-dose series should be completed if not done in childhood 5, 4, 2
• This is particularly important given recent measles outbreaks in multiple states 5

Varicella (Chickenpox)

• Two-dose series is required for adolescents without reliable history of chickenpox 5, 4
• For those under 13 years, a single dose historically provided >95% protection, but current recommendations call for two doses 5
• National coverage reached 83% for two doses among susceptible adolescents in 2015 5

Critical Implementation Points

Simultaneous Administration

• All three core adolescent vaccines (Tdap, MenACWY, HPV) can and should be administered during the same visit 5
• Concurrent administration yields similar immune responses compared to individual administration with no increase in adverse effects 5
• Missing opportunities to co-administer these vaccines is a major barrier to achieving adequate coverage 5, 8

Provider Recommendation

• Strong, unambiguous provider recommendation is the single most important factor in vaccine acceptance 5, 1, 8
• Lack of consistent provider recommendation is a major reason for non-receipt of adolescent vaccines 5
• Frame HPV vaccine as cancer prevention rather than an STI vaccine to improve acceptance 1

Common Pitfalls to Avoid

• Do not delay HPV vaccination waiting for a "better time" - vaccination before age 15 allows for the more convenient two-dose schedule 7, 8
• Do not assume sexually active adolescents won't benefit from HPV vaccine - they are unlikely to have been exposed to all vaccine types 5
• Do not require separate visits for different vaccines - this creates unnecessary barriers and reduces completion rates 5, 8
• Do not skip vaccination at non-comprehensive visits (sports physicals, minor illness visits) - these are opportunities to catch up 8

Special Considerations

• Immunocompromised adolescents require three doses of HPV vaccine regardless of age at initiation 7
• Adolescents with chronic medical conditions may require additional vaccines (pneumococcal, hepatitis A) based on specific risk factors 5
• Pregnancy is a contraindication to varicella vaccine; assess pregnancy status and counsel about avoiding pregnancy for one month after vaccination 5