A 13-year-old is seen for a well-child visit. Which vaccine should be initiated at this visit if not previously given?

Hpv vaccine recommendations: Routine: age 11-12 (can start at age 9); Catch-up: 13-26 for females; 13-26 for males; 27-45: shared clinical decision-making (less benefit as likely prior exposure).

Dosing schedule: Age 9-14 at initiation: 2 doses (0, 6-12 months); Age 15+ at initiation: 3 doses (0, 1-2, 6 months).

Vaccine: Gardasil 9 (9vHPV) — protects against HPV types 6, 11 (warts) and 16, 18, 31, 33, 45, 52, 58 (cancer).

Cancer prevention: HPV causes 90% of cervical cancer, 70-85% of oropharyngeal cancer, anal cancer, penile cancer; vaccine most effective before HPV exposure (before sexual activity initiation).

Nursing role: Destigmatise the vaccine (it's a cancer prevention vaccine); address parental concerns about sexual activity encouragement (no evidence of this effect); 13-year-old visit: ensure HPV series is initiated if not already; also give Tdap if not given at 11-12.