Which vaccines are indicated today for an 11-year-old male at his annual wellness visit given his up-to-date childhood immunizations?

Vaccines Needed Today for an 11-Year-Old Male

This 11-year-old should receive Tdap (tetanus-diphtheria-acellular pertussis), meningococcal conjugate vaccine (MenACWY), and HPV (human papillomavirus) vaccine today, along with the current year's influenza vaccine. 1

Rationale for Each Vaccine

Tdap Vaccine (Required)

• Adolescents aged 11-18 years should receive a single dose of Tdap instead of Td for booster immunization if they have completed the recommended childhood DTaP vaccination series and have not received Td or Tdap. 1
• The preferred age for Tdap vaccination is 11-12 years, which directly applies to this patient. 1
• This patient completed his DTaP series with the last dose at age 4 years 2 months, making him due for the adolescent booster. 1
• Critical timing consideration: Data show that 15-36% of children aged 9-13 years lack protective tetanus antibody levels despite previous vaccination, and among children vaccinated 6-10 years before testing, 28% lack protective immunity. 2
• Since this patient's last tetanus-containing vaccine was approximately 7 years ago, he is at risk for waning immunity and needs this booster promptly. 2

Meningococcal Conjugate Vaccine (Required)

• Adolescents should be routinely immunized at 11 to 12 years of age with meningococcal conjugate vaccine, with a booster dose at age 16 to 18 years. 1
• This patient has no documented meningococcal vaccination, making him due for his first dose. 1
• The vaccine can be administered simultaneously with Tdap during the same visit if both vaccines are indicated and available. 1

HPV Vaccine (Required)

• Adolescents aged 11-12 years should receive HPV vaccine as part of routine vaccination. 3, 4, 5
• The 2-dose HPV vaccine series is recommended for immunocompetent adolescents initiating the vaccination series before their 15th birthday. 3
• This patient has no documented HPV vaccination and is at the ideal age to begin the series. 3
• The second dose should be scheduled 6-12 months after the first dose. 3

Influenza Vaccine (Required Annually)

• Annual influenza vaccine is recommended for all children and adolescents. 1
• This patient's last documented influenza vaccine date is not specified as current year, so he should receive this year's formulation. 1

Administration Strategy

Simultaneous Vaccination Protocol

• All indicated vaccines should be administered during the same visit to increase the likelihood that adolescents will receive each vaccine on schedule. 1
• Each vaccine should be administered using a separate syringe at a different anatomic site. 1
• The dose of Tdap is 0.5 mL, administered intramuscularly, preferably into the deltoid muscle. 1
• Some experts recommend administering no more than two injections per muscle, separated by at least one inch. 1

Important Safety Consideration

• Syncope can occur after vaccination and may be more common among adolescents than other age groups. 1
• A 15-20 minute observation period following vaccination is suggested. 1

Follow-Up Scheduling

Second HPV Dose

• Schedule the second HPV dose for 6-12 months from today. 3

Meningococcal Booster

• Schedule the meningococcal booster dose for age 16-18 years (at least 8 weeks or up to 5 years after the first dose). 1
• Since this patient is receiving his first dose at age 11, he will need the booster at age 16. 1

Future Tetanus Boosters

• All subsequent routine Td boosters should be administered at 10-year intervals after the Tdap dose given today. 1

Verification of Completed Series

This patient's immunization record confirms completion of:

• DTaP series (5 doses completed) 1
• Hepatitis B series (4 documented doses) 1
• MMR series (2 doses via MMRV and MMR) 1
• Varicella series (2 doses via MMRV and varicella) 1
• Polio series (4 doses completed) 1
• Pneumococcal conjugate series (5 doses of PCV13) 1

No catch-up vaccinations are needed for these series. 1