What is the assessment and plan for a 14-year-old female with a history of human papillomavirus (HPV) vaccination, menarche at age 13, and a family history of hypothyroidism and type 2 diabetes mellitus, presenting with normal vital signs, including normotension and bradycardia, and a physical examination revealing Tanner stage 4 sexual maturity rating?

From the Guidelines

The 14-year-old girl should receive her third dose of the HPV vaccine series, but since she is now 14, she only needs one more dose >6 months later to complete the series, as per the revised recommendation of the Advisory Committee on Immunization Practices (ACIP) for persons initiating the vaccine series from 9 through 14 years of age with a 2-dose series 1. The ACIP recommends a 2-dose series for persons initiating the vaccine series from 9 through 14 years of age, with doses given at 0 and 6-12 months 1. Given that the patient received her first dose at age 12 and a second dose 6 months later, she is now due for her final dose to complete the series, but the ACIP revised its recommended HPV schedule to be a 2-dose series for persons initiating the vaccine series from 9 through 14 years of age 1. Completing the full HPV vaccination series is important as it provides optimal protection against HPV infections that can lead to cervical cancer and other HPV-related cancers and diseases. The vaccine is most effective when given before potential exposure to HPV through sexual activity, making this the ideal time for completion as the patient has not yet become sexually active. Additionally, routine adolescent care should include screening for depression, substance use, and providing anticipatory guidance about healthy behaviors, though her current sleep patterns, limited screen time, and physical activity through volleyball suggest good health habits. It is also important to note that the 9-valent HPV vaccine (9vHPV) is the only available HPV vaccine in the United States as of January 2017, and it provides protection against the original 4 HPV types (6,11,16, and 18) in the quadrivalent vaccine and for the high-risk HPV types 31,33,45,52, and 58 1. Health care provider recommendation and physician attitude play a major role in the decision to vaccinate against HPV, and a strong endorsement is more influential than a weak one 1. The American Cancer Society (ACS) has partnered with the CDC on initiatives aimed at increasing HPV vaccination rates and ultimately reducing the incidence of and mortality from HPV-associated cancers and precancerous lesions 1. The ACS recommends routine HPV vaccination principally for girls aged 11 to 12 years, but also for females aged 13 to 18 years to “catch up” those who missed the opportunity to be vaccinated, or who need to complete the vaccination series 1. The ACIP recommends vaccination of men who have sex with men and immunocompromised persons through age 26 years if not vaccinated previously 1. Overall, completing the HPV vaccination series is crucial for the patient's health and well-being, and health care providers should strongly recommend the vaccine to parents and patients.

From the Research

Patient Profile

• The patient is a 14-year-old girl who is doing well in school and plays on the volleyball team.
• She has a healthy lifestyle, sleeping 9 hours every night, drinking 2 glasses of 2% milk daily, and limiting her screen time to 2 hours a day.
• She has no chronic medical conditions and takes no medications.
• She received her first dose of human papillomavirus (HPV) vaccination at age 12, with another dose administered 6 months later.

Family Medical History

• The patient's mother has hypothyroidism.
• Her maternal grandmother recently died from complications of type 2 diabetes mellitus.

HPV Vaccination

• The patient has received two doses of HPV vaccination, which is consistent with the recommended schedule for individuals who initiate vaccination before their 15th birthday 2.
• The HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients 3.
• Vaccination is the primary method of prevention for HPV-related cancers, and the nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients 4.

Diabetes and HPV

• There is no significant association between HPV infection and diabetes mellitus, according to a nationwide population-based cohort study 5.
• A retrospective cohort study found no increased risk of developing type 1 diabetes after HPV vaccination in males and females 6.

Health Status

• The patient's height and weight are at the 60th percentile, and her blood pressure and pulse are within normal ranges.
• Her physical examination reveals an alert and engaged adolescent, with a sexual maturity rating (Tanner) stage of 4.
• Her cardiopulmonary examination is unremarkable, and her abdomen is soft and nontender.