What vaccines are recommended for an 18-year-old male with no significant medical history?

Recommended Vaccines for an 18-Year-Old Male

An 18-year-old male with no significant medical history should receive annual influenza vaccine, Tdap if not previously given in adolescence (then Td boosters every 10 years), HPV vaccine series (3 doses at 0,1-2, and 6 months), hepatitis B series if not previously vaccinated, and MenACWY vaccine if not received after age 16. 1, 2, 3

Core Routine Vaccinations

Influenza Vaccine

• Administer annually using standard-dose quadrivalent inactivated vaccine. 1
• This is recommended for all adults regardless of age or health status. 3

Tdap/Td Vaccination

• Give one dose of Tdap if not previously received in adulthood, then Td booster every 10 years thereafter. 1, 3
• If vaccination history is unknown or incomplete, begin or complete a 3-dose primary series including one Tdap dose, with remaining doses given at least 4 weeks apart for the first two doses and 6-12 months after the second dose for the third. 3

HPV Vaccination

• Administer 3-dose series of HPV vaccine (9vHPV or 4vHPV) at 0,1-2, and 6 months for males through age 21 years as routine catch-up vaccination. 2, 3
• Males aged 22-26 years may be vaccinated (permissive recommendation rather than routine). 2, 3
• The second dose should be given 1-2 months after the first, and the third dose 6 months after the first (minimum 24 weeks after first dose and 12 weeks after second dose). 4, 3
• Vaccination is especially important for men who have sex with men through age 26 years, as they may particularly benefit from protection against condyloma and anal cancer. 2, 4
• Prior sexual activity does not preclude vaccination, as the individual may not have been infected with all vaccine HPV types. 2, 4

Hepatitis B Vaccination

• Administer universal vaccination for all adults aged 19-59 years with hepatitis B if not previously vaccinated. 1
• Use HEPLISAV-B (2-dose series at 0 and 1 month) or traditional 3-dose series (0,1, and 6 months). 1
• Do not assume immunity without documentation; many adults lack adequate vaccination records. 1

Meningococcal Vaccination

MenACWY Vaccine

• Administer a single dose of MenACWY vaccine if not received on or after the 16th birthday. 3
• This is particularly important for first-year college students aged ≤21 years who live in residence halls. 3
• Revaccinate every 5 years only if the individual remains at increased risk (e.g., persistent complement deficiency, asplenia, travel to hyperendemic areas, military recruits). 3

MenB Vaccine

• Young adults aged 16-23 years (preferred age 16-18 years) may be vaccinated with either a 2-dose series of MenB-4C or a 3-dose series of MenB-FHbp vaccine based on shared clinical decision-making. 3
• This provides short-term protection against most strains of serogroup B meningococcal disease. 3
• The 2024 guidelines note that a newly licensed pentavalent meningococcal vaccine (Penbraya) is now available, which covers serogroups A, B, C, W, and Y. 3
• MenB vaccination is subject to shared clinical decision-making rather than routine recommendation, which has resulted in lower uptake compared to MenACWY. 5

Catch-Up Vaccinations to Verify

MMR (Measles, Mumps, Rubella)

• Verify 2-dose series completion; if not documented, administer catch-up doses. 3
• Evidence of immunity includes documentation of 2 doses at least 4 weeks apart or U.S. birth before 1980 (though this does not apply to healthcare personnel). 3

Varicella

• Verify 2-dose series completion for those without evidence of immunity. 3
• Evidence of immunity includes documentation of 2 doses at least 4 weeks apart, U.S. birth before 1980 (except healthcare personnel), or laboratory evidence of immunity. 3

Poliovirus

• Most adolescents aged 18 years born and raised in the United States can be assumed to be vaccinated against poliovirus as children. 3
• Administer a one-time, lifetime IPV booster only to those who have completed the primary series and are at increased risk for exposure to poliovirus (e.g., laboratory workers, travelers to endemic areas). 3

Special Considerations for COVID-19

• Follow current COVID-19 vaccination recommendations, which vary based on previous vaccination history and immunocompromised status. 3
• Consult current CDC guidance as recommendations are updated regularly. 3

Important Clinical Pitfalls to Avoid

• Do not delay vaccination until a "complete" preventive visit; administer vaccines at any healthcare encounter. 1
• Multiple vaccines can and should be given during the same visit at different anatomic sites to maximize completion rates. 1, 3
• Do not assume vaccination history is complete without documentation; verify all vaccines. 1
• For HPV vaccination, do not withhold vaccine based on sexual activity status; protection is still beneficial even after sexual debut. 2, 4
• If vaccine series is interrupted, do not restart; simply continue from where the series was stopped. 4