What vaccinations are due at a 19-year-old's wellness check?

Vaccinations Due at 19-Year-Old Wellness Check

At a 19-year-old wellness visit, prioritize catch-up HPV vaccination (if not previously completed), annual influenza vaccine, and assess meningococcal vaccination status—particularly MenACWY booster if the last dose was before age 16, and consider MenB vaccination based on risk factors or shared clinical decision-making.

Core Vaccination Assessment

HPV Vaccination (High Priority)

• Complete the HPV vaccine series if not already done, as males aged 13-21 years should receive the full series if not previously vaccinated 1
• Males aged 22-26 years may still be vaccinated, making 19 years an optimal time to catch up 1
• The complete series consists of 3 doses: second dose 4-8 weeks after the first, third dose 24 weeks after the first and 16 weeks after the second 1
• Either 4vHPV or 9vHPV can be used for males 1

Annual Influenza Vaccine

• Administer annual influenza vaccination as recommended for all adults aged ≥19 years 1
• This should be given yearly, ideally before flu season begins 2

Meningococcal Vaccination Review

• Verify MenACWY booster status: If the patient received their first MenACWY dose at age 11-12 but did not receive the booster at age 16, administer it now 1
• First-year college students aged ≤21 years living in residence halls need a single dose of MenACWY if they haven't received one on or after their 16th birthday 1
• Consider MenB vaccination: Young adults aged 16-23 years may receive either a 2-dose series of MenB-4C or 3-dose series of MenB-FHbp based on shared clinical decision-making 1
• The preferred age range for MenB is 16-18 years, but 19 years still falls within the acceptable window 1

Additional Vaccines to Assess

Tdap/Td Status

• Verify completion of Tdap dose (should have been given at age 11-12 years) 2, 3
• If Tdap was never received, administer it now 2

Hepatitis B Series

• Confirm completion of the 3-dose HepB series, typically completed in infancy 2
• If incomplete, finish the series with appropriate intervals 2

MMR and Varicella

• Verify 2-dose MMR series completion (typically given at 12-15 months and 4-6 years) 2
• Confirm 2-dose varicella series if not previously completed 2

Hepatitis A

• Ensure completion of 2-dose HepA series (first dose at 12-23 months, second dose 6 months later) 2
• All adolescents aged 2-18 years who haven't received HepA should complete the series 2

Risk-Based Vaccinations

High-Risk Conditions Requiring MenB

• Administer MenB vaccine series immediately if the patient has:
  • Anatomical or functional asplenia 1
  • Persistent complement component deficiencies 1
  • Use of complement inhibitors 4
  • Occupational exposure (microbiologists working with N. meningitidis) 1
• These patients should receive either 2 doses of MenB-4C or 3 doses of MenB-FHbp 1

Special Populations

• Men who have sex with men should complete HPV series through age 26 if not previously vaccinated 1
• Immunocompromised persons should complete HPV series through age 26 1

Common Pitfalls to Avoid

• Don't miss the MenACWY booster: Many 19-year-olds received their first dose at age 11-12 but never got the critical booster at age 16 2, 3
• Don't assume HPV vaccination is complete: Coverage with HPV series remains suboptimal, with only 58.6% of adolescents being up-to-date as of 2020 3
• Don't overlook catch-up vaccinations: Review the entire vaccination history systematically, as many young adults have incomplete childhood series 2, 3
• Don't forget annual influenza: This must be administered every year, not just once 2

Practical Implementation

Step 1: Review complete vaccination records from childhood and adolescence 2

Step 2: Prioritize HPV series completion if any doses are missing 1

Step 3: Verify MenACWY booster was given at or after age 16; if not, administer now 1

Step 4: Discuss MenB vaccination using shared clinical decision-making, emphasizing that age 19 is still within the acceptable window 1

Step 5: Administer annual influenza vaccine 1

Step 6: Complete any missing doses of routine childhood vaccines (HepB, MMR, varicella, HepA) 2