What is the most appropriate action when a 15‑year‑old male patient desires human papillomavirus (HPV) vaccination and his mother consents, but his father objects? a) Administer the vaccine during the visit b) Contact the father before administering the vaccine c) Refer the patient to the county health department for vaccination d) Refuse to administer the vaccine due to the father's disapproval

Administer the HPV Vaccine During This Visit

The most appropriate action is to administer the HPV vaccine during the visit (option a), as consent from one parent together with the 15-year-old's assent is legally and ethically sufficient; the father's objection does not constitute a legal barrier to vaccination.

Legal Framework for Adolescent Consent

• At age 15, adolescents possess sufficient maturity to meaningfully participate in healthcare decisions, particularly for preventive services like vaccination. 1

• In most jurisdictions, consent from one parent combined with the adolescent's assent is legally adequate for HPV vaccination; a second parent's objection does not override this valid consent. 1

• The mother has provided informed consent and the patient desires vaccination—these two elements together satisfy legal requirements for proceeding. 1

Clinical Urgency Driving Immediate Action

• HPV vaccination is most effective before sexual exposure, and approximately 24% of adolescents report sexual activity by ninth grade, making timely vaccination critical. 1

• The cumulative incidence of HPV infection reaches roughly 40% within the first two years after initial sexual intercourse, creating a narrow window for optimal protection. 1

• At age 15, this patient requires the three-dose schedule (0,1-2, and 6 months) rather than the two-dose schedule available to younger adolescents, making prompt initiation essential. 1

• Follow-up compliance in adolescents is notoriously poor; providers should adopt a "now or never" approach to avoid missed vaccination opportunities. 1

Why Other Options Are Inappropriate

Option b (Contacting the Father First)

• Delaying vaccination to seek unanimous parental agreement compromises the adolescent's health and increases the risk of HPV exposure during the delay. 1

• The father's objection, while noted, does not constitute a legal requirement for additional consent when one parent and the mature adolescent have already provided informed consent. 1

• Such delays often result in missed vaccination entirely, as the patient may not return or may become sexually active in the interim. 1

Option c (Referring to Health Department)

• Referral creates unnecessary barriers to vaccination and reduces the likelihood of series completion. 1

• A provider's recommendation is the single most influential factor driving HPV vaccine uptake; transferring care to another venue abandons this critical relationship. 1, 2

• The patient is already present, consented, and ready—referral wastes this opportunity. 1

Option d (Refusing Due to Father's Disapproval)

• Refusal based on one parent's objection when legal consent exists prioritizes parental conflict over the adolescent's best medical interest. 1

• This approach directly contradicts evidence-based practice and may constitute a failure to provide standard preventive care. 1

Practical Implementation Steps

• Document thoroughly: Record that benefits and risks were discussed with both the adolescent and the consenting mother, note the mother's consent and the patient's assent, and document that the father's objection does not constitute a legal barrier. 1

• Provide educational materials to the mother for sharing with the father, helping address his concerns and facilitate informed family decision-making. 1

• Emphasize cancer prevention when discussing the vaccine, as this is the most powerful messaging strategy to increase acceptance. 1, 2

• Normalize the vaccination by framing it as routine preventive care alongside other adolescent vaccines (Tdap, meningococcal). 1

Common Pitfalls to Avoid

• Do not underestimate the 15-year-old's role in consent; at this age, the adolescent's informed assent carries significant legal and ethical weight. 1

• Do not attempt to time vaccination based on predicted sexual debut, as this is impractical and frequently results in delayed or missed immunization. 1

• Never postpone vaccination while seeking unanimous parental agreement when legal consent already exists; such delays compromise the adolescent's health. 1

• Do not dismiss the father's concerns entirely—acknowledge them respectfully while proceeding with medically indicated care, and offer to discuss his specific worries at a future visit. 2, 3

Supporting Evidence for HPV Vaccination

• HPV vaccines demonstrate high efficacy against HPV types 16/18, which account for approximately 70% of cervical cancers, with additional protection from nonavalent formulations. 4, 5

• The vaccines have an excellent safety profile, with the most common adverse effects being transient injection site reactions; serious adverse events like anaphylaxis occur in fewer than 1 per 1,000 doses. 6

• High-risk HPV types are strongly associated with cervical, anal, oropharyngeal, penile, vulvar, and vaginal cancers, making prevention through vaccination a major public health priority. 4, 5