A nurse in a family practice office routinely reviews clients' immunization status at their annual physical examination visits. For which of the following clients should the nurse recommend a human papillomavirus immunization?

Rationale: A. A middle adult man: Although some adults up to age 45 can receive the HPV vaccine based on shared decision-making, routine vaccination is not typically initiated in middle adulthood. The vaccine is most effective when given prior to exposure to HPV, ideally during adolescence. B. A teenage boy: The HPV vaccine is routinely recommended for all adolescents, including boys, starting at ages 11 to 12, with catch-up vaccination through age 26 if not previously vaccinated. It helps prevent various HPV-related cancers and is most effective when administered before sexual activity begins. C. An older adult woman: HPV vaccination is not routinely recommended for individuals older than 26. While it may be considered up to age 45 in certain situations, it is less beneficial after potential HPV exposure, and routine administration in this age group is not advised. D. A preschool-age girl: The HPV vaccine is not recommended for children under 9 years old. Initiating the vaccine too early is not effective or necessary, as the immune system response and timing related to potential HPV exposure are best addressed in early adolescence.