Family Medicine

8 yoF & 13 yoM siblings present for HPV vaccination counseling

Ashley Schinske on Jan 26, 2017

Mrs. Lang arrives in your primary care office with her children-- Melissa, 8 and Ryan, 13. She brings them in today regarding information on the HPV vaccines. Both children are up-to-date in all vaccines, but Mrs. Lang decided to wait on the HPV series due to its recent release and her unfamiliarity. She is now interested in learning more about the vaccines after hearing her neice and nephew were vaccinated per a school enrollment mandate.

Melissa is a third grader and in good health. With the exception of a broken arm in a failed Superman attempt, Ryan is also in good health and in the 7th grade. Neither have any allergies or take any medications.

At this point, which of Mrs. Lang's children are eligible to begin the HPV vaccine series?

Expand all answers
Melissa and Ryan.
Incorrect. Ryan is eligible at 13 years of age. Melissa is only 8 years old. It is recommended that females are vaccinated at 11-12 through 26 years of age, although the vaccines are approved to begin as early as 9 years of age.


Ryan.
Correct. Ryan is the right age to begin vaccination. The recommendation for males is to begin at 11-12 years through 21 years of age. Additionally, completing the series prior to initiation of sexual activity is best for both males and females.


Melissa.
Incorrect. Melissa is only 8 years old. It is recommended that females are vaccinated at 11-12 through 26 years of age, although the vaccine are approved to begin as early as 9 years of age.


Neither child.
Incorrect. See above answer choices for explanation.


Mrs. Lang now understands that only Ryan will be able to start the series today. Although a budding adolescent with minimal fear, the idea of a shot has him shaking like a leaf. Mrs. Lang's neice only received a 2-shot series, but her older nephew received a 3-shot series. She wonders about the difference between the children and how many times she will need to vaccinate Ryan?

You explain that prior to late 2016, the Centers for Disease Control recommended HPV vaccines in both males and females beginning around 11-12 years of age. The 3-shot series was to be completed over six months. As of October 2016, the recommendations have been updated.

Regarding Ryan, you tell Mrs. Lang that he will need a...

Expand all answers
2-shot series with doses at 0 and 6-12 months.
Correct. These are the new recommendations for males and females ages 9-14 (with the exception of some special populations).


3-shot series with a 0, 1-2 and 6 month dosing schedule
Incorrect. This is the old recommendation for all persons. It is now the current recommendation for males and females 15 years of age and older (with the exception of special populations).


3-shot series with two years between shots
Incorrect. Select another answer.


2-shot series with at least a year between shots
Incorrect. Select another answer.


Ryan is relieved he will only require the 2-shot series!

Early in the visit, Mrs. Lang reported that her niece and nephew were vaccinated due to a mandate for school enrollment. She is curious if this is the case for all schools and whether she will need to provide paperwork to Ryan's school after his vaccinations?

 

Bonus Question: Which of the following U.S. states mandate HPV vaccinations for secondary school enrollment?

Expand all answers
Michigan, Ohio & Texas
No. In 2006, Michigan became the first state to introduce legislation requiring all female students be vaccinated prior to starting 6th grade. Later in 2007, Ohio introduced similar legislation. Neither were enacted. In February 2007, Texas enacted a mandate-by executive order from the governor-that all females entering the sixth grade receive the vaccine. Legislators later passed a bill to override the executive order prior to implementation.


California, Colorado & Oregon
No. Although these states typically rank high in overall health outcomes, they do not require vaccination for school enrollment.


Virginia, Rhode Island & Washington D.C.
Yes, in 2008 Virginia implemented a mandate for HPV vaccination in all female students prior to starting 6th grade. In 2009, Washington D.C. implemented an identical mandate for female students starting 6th grade. In 2015, Rhode Island implemented a far reaching mandate for both male and female students: 1st vaccine by 7th grade, 2 vaccine by 8th grade and series completion upon entering 9th grade.


Hawaii & New York
No, Hawaii and New York both have purposed legislation in the works for mandating both male and female students to complete the HPV series for school enrollment.


  1. Colgrove, J., Abiola, S., & Mello, M. M. (2010). HPV Vaccination Mandates — Lawmaking amid Political and Scientific Controversy. New England Journal of Medicine, 363(8), 785-791. doi:10.1056/nejmsr1003547
  2. HPV VACCINE: STATE LEGISLATION AND STATUTES. (2017, January 20). Retrieved from http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx
  3. Stewart, A. (2008). CHILDHOOD VACCINE AND SCHOOL ENTRY LAWS: THE CASE OF HPV VACCINE. Public Health Reports, 123(6), 801–803.
  4. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–1408. DOI: http://dx.doi.org/10.15585/mmwr.mm6549a5

Mrs. Lang arrives in your primary care office with her children-- Melissa, 8 and Ryan, 13. She brings them in today regarding information on the HPV vaccines. Both children are up-to-date in all vaccines, but Mrs. Lang decided to wait on the HPV series due to its recent release and her unfamiliarity. She is now interested in learning more about the vaccines after hearing her neice and nephew were vaccinated per a school enrollment mandate.

Melissa is a third grader and in good health. With the exception of a broken arm in a failed Superman attempt, Ryan is also in good health and in the 7th grade. Neither have any allergies or take any medications.

At this point, which of Mrs. Lang's children are eligible to begin the HPV vaccine series?

Expand all answers
Melissa and Ryan.
Incorrect. Ryan is eligible at 13 years of age. Melissa is only 8 years old. It is recommended that females are vaccinated at 11-12 through 26 years of age, although the vaccines are approved to begin as early as 9 years of age.


Ryan.
Correct. Ryan is the right age to begin vaccination. The recommendation for males is to begin at 11-12 years through 21 years of age. Additionally, completing the series prior to initiation of sexual activity is best for both males and females.


Melissa.
Incorrect. Melissa is only 8 years old. It is recommended that females are vaccinated at 11-12 through 26 years of age, although the vaccine are approved to begin as early as 9 years of age.


Neither child.
Incorrect. See above answer choices for explanation.


Mrs. Lang now understands that only Ryan will be able to start the series today. Although a budding adolescent with minimal fear, the idea of a shot has him shaking like a leaf. Mrs. Lang's neice only received a 2-shot series, but her older nephew received a 3-shot series. She wonders about the difference between the children and how many times she will need to vaccinate Ryan?

You explain that prior to late 2016, the Centers for Disease Control recommended HPV vaccines in both males and females beginning around 11-12 years of age. The 3-shot series was to be completed over six months. As of October 2016, the recommendations have been updated.

Regarding Ryan, you tell Mrs. Lang that he will need a...

Expand all answers
2-shot series with doses at 0 and 6-12 months.
Correct. These are the new recommendations for males and females ages 9-14 (with the exception of some special populations).


3-shot series with a 0, 1-2 and 6 month dosing schedule
Incorrect. This is the old recommendation for all persons. It is now the current recommendation for males and females 15 years of age and older (with the exception of special populations).


3-shot series with two years between shots
Incorrect. Select another answer.


2-shot series with at least a year between shots
Incorrect. Select another answer.


Ryan is relieved he will only require the 2-shot series!

Early in the visit, Mrs. Lang reported that her niece and nephew were vaccinated due to a mandate for school enrollment. She is curious if this is the case for all schools and whether she will need to provide paperwork to Ryan's school after his vaccinations?

 

Bonus Question: Which of the following U.S. states mandate HPV vaccinations for secondary school enrollment?

Expand all answers
Michigan, Ohio & Texas
No. In 2006, Michigan became the first state to introduce legislation requiring all female students be vaccinated prior to starting 6th grade. Later in 2007, Ohio introduced similar legislation. Neither were enacted. In February 2007, Texas enacted a mandate-by executive order from the governor-that all females entering the sixth grade receive the vaccine. Legislators later passed a bill to override the executive order prior to implementation.


California, Colorado & Oregon
No. Although these states typically rank high in overall health outcomes, they do not require vaccination for school enrollment.


Virginia, Rhode Island & Washington D.C.
Yes, in 2008 Virginia implemented a mandate for HPV vaccination in all female students prior to starting 6th grade. In 2009, Washington D.C. implemented an identical mandate for female students starting 6th grade. In 2015, Rhode Island implemented a far reaching mandate for both male and female students: 1st vaccine by 7th grade, 2 vaccine by 8th grade and series completion upon entering 9th grade.


Hawaii & New York
No, Hawaii and New York both have purposed legislation in the works for mandating both male and female students to complete the HPV series for school enrollment.


  1. Colgrove, J., Abiola, S., & Mello, M. M. (2010). HPV Vaccination Mandates — Lawmaking amid Political and Scientific Controversy. New England Journal of Medicine, 363(8), 785-791. doi:10.1056/nejmsr1003547
  2. HPV VACCINE: STATE LEGISLATION AND STATUTES. (2017, January 20). Retrieved from http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx
  3. Stewart, A. (2008). CHILDHOOD VACCINE AND SCHOOL ENTRY LAWS: THE CASE OF HPV VACCINE. Public Health Reports, 123(6), 801–803.
  4. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–1408. DOI: http://dx.doi.org/10.15585/mmwr.mm6549a5