11/08/2023 CS328127-E 1

12 Years of Age and Older 

Updated (2023–24 Formula)

Novavax COVID-19 Vaccine

Standing Orders for Administering Vaccine

2023–24 Formula Vaccine Presentation Age Dose/Injection 

Amount Route

Multidose vial with blue cap and blue label 12 years 

and older 

0.5 mL/5 μg rS and 50 μg 

of Matrix-MTM adjuvant

Intramuscular 

(IM) injection 

Purpose

To reduce morbidity and mortality from coronavirus 

disease 2019 (COVID-19) by vaccinating persons who 

meet the criteria established by the Centers for Disease 

Control and Prevention’s Advisory Committee on 

Immunization Practices (ACIP). 

Policy

Where authorized under state law, standing orders enable 

eligible nurses and other health care professionals (e.g., 

pharmacists) to assess and vaccinate persons who meet 

the criteria in the "Procedure" section below without the 

need for clinician examination or direct order from the 

attending provider at the time of the interaction.

Procedure

Assess persons 12 years of age and older for vaccination with the 2023–24 Novavax COVID-19 Vaccine based on the 

following criteria:

People who are NOT moderately or severely immunocompromised*

COVID-19 vaccination history†

(regardless of COVID-19 vaccine formula)

Schedule for administration of 2023-24 Novavax COVID-19 

Vaccine 

Unvaccinated Give a 2-dose initial series

 Dose 1 now. 

 Dose 2 at least 3–8 weeks‡ after Dose 1§

1 previous dose of the original Novavax COVID-19 

Vaccine (Dose 1) 

Give Dose 2 at least 8 weeks (2 months) after the previous dose

1 previous dose of 2023-24 Novavax COVID-19 

Vaccine (Dose1) 

Give Dose 2 at least 3-8‡ weeks after the previous dose§

Any number of previous doses COVID-19 

vaccine, NOT including at least 1 dose of 2023-

24 COVID-19 vaccine 

Give 1 dose at least 8 weeks (2 months) after the previous dose 

Any number of previous doses COVID-19 

vaccine, INCLUDING at least 1 dose of 2023-24 

COVID-19 vaccine 

No further doses are indicated 

* Persons with a recent SARS-CoV-2 infection may consider delaying vaccination by 3 months from symptom onset or positive test (if infection was asymptomatic).

† COVID-19 vaccination history refers to previous receipt of dose(s) of Original monovalent mRNA, bivalent mRNA vaccine, Updated (2023–2024 Formula), or a combination of the three, 

unless otherwise specified.

‡ An 8-week interval between the first and second COVID-19 vaccine (Novavax) doses might be optimal for some people as it might reduce the small risk of myocarditis and pericarditis 

associated with these vaccines.

§ People who are recommended to receive a multidose series for initial vaccination should receive all doses from the same manufacturer. However, in the following circumstances a different 

age-appropriate COVID-19 vaccine product may be administered when: the same vaccine is not available at the vaccination site at the time of the clinic visit, the previous dose is unknown, the 

person would otherwise not receive a recommended vaccine dose , or the person starts but is unable to complete a vaccination series with the same vaccine due to a contraindication.
11/08/2023 CS328127-E 2

12 Years of Age and Older 

Updated (2023–24 Formula)

Novavax COVID-19 Vaccine

Standing Orders for Administering Vaccine

People who ARE moderately or severely immunocompromised 

COVID-19 vaccination history*

(regardless of COVID-19 vaccine formula)

Schedule for administration of 2023-24 Novavax COVID-19 

Vaccine 

Unvaccinated Give a 2-dose initial series

 Dose 1 now. 

 Dose 2 at least 3 weeks after Dose 1

1 previous dose of the original Novavax 

COVID-19 vaccine (Dose 1)†

Give Dose 2 at least 8 weeks (2 months) after the previous dose

1 previous dose of 2023-24 Novavax COVID-19 

Vaccine (Dose1)†

Give Dose 2 at least 3 weeks after the previous dose

2 previous doses of Novavax COVID-19 vaccine, 

NOT including 2023-24 COVID-19 vaccine† 

Give 1 dose at least 8 weeks (2 months) after the previous dose 

2 or more doses of Novavax COVID-19 vaccine, 

INCLUDING 2023-24 COVID-19 vaccine†

 People who are moderately or severely immunocompromised have the 

option to receive 1 additional dose at least 8 weeks (2 months) following 

the last recommended dose. 

 Further additional dose(s) may be administered, informed by the clinical 

judgement of a health care provider and personal preference and 

circumstances. 

 Any further additional doses should be administered at least 8 weeks (2 

months) after the last COVID-19 vaccine dose.

* COVID-19 vaccination history refers to previous receipt of dose(s) of Original monovalent mRNA, bivalent mRNA vaccine, Updated (2023–2024 Formula), or a combination of the 

three, unless otherwise specified.

† People who are recommended to receive a multidose series for initial vaccination should receive all doses from the same manufacturer. However, in the following circumstances a different 

age-appropriate COVID-19 vaccine product may be administered when: the same vaccine is not available at the vaccination site at the time of the clinic visit, the previous dose is unknown, 

the person would otherwise not receive a recommended vaccine dose , or the person starts but is unable to complete a vaccination series with the same vaccine due to a contraindication.

Additional clinical considerations

 2023–24 Novavax COVID-19 Vaccine may be 

simultaneously administered with other routinely 

recommended vaccines. There are additional 

considerations for simultaneous administration of an 

orthopoxvirus vaccine and COVID-19 vaccine. 

 Persons who have received HCT or CAR-T-cell therapy 

○ Revaccinate persons who received 1 or more doses 

of COVID-19 vaccine prior to or during HCT or 

CAR-T-cell therapy, following the current COVID-19 

vaccination schedule. 

○ Revaccination should start at least 3 months (12 weeks) 

after transplant or CAR-T-cell therapy. 

○ For additional details and all clinical considerations, 

see Interim Clinical Considerations for Use of 

COVID-19 Vaccines.

‡ See FDA fact sheet for a full list of vaccine ingredients.

Contraindications: 

A severe allergic reaction (e.g., anaphylaxis) after a previous 

dose or to a component of Novavax COVID-19 vaccine‡

Precautions: 

 Moderate to severe acute illness, with or without fever

 History of: 

○ A diagnosed non-severe allergy to a component of 

Novavax COVID-19 vaccine‡ 

○ Non-severe, immediate (onset less than 4 hours) allergic 

reaction after administration of a previous dose of 

Novavax COVID-19 vaccine 

○ Multisystem inflammatory syndrome in children (MIS-C) 

or adults (MIS-A) 

○ Myocarditis or pericarditis within 3 weeks after a dose 

of any COVID-19 vaccine
11/08/2023 CS328127-E 3

12 Years of Age and Older 

Updated (2023–24 Formula)

Novavax COVID-19 Vaccine

Standing Orders for Administering Vaccine

Administration:

* A 5/8-inch needle can be used if the skin is stretched tightly, and subcutaneous tissues are not bunched.

† Alternately, the anterolateral thigh can be used. A 1- or 1.5-inch needle may be used if administering vaccine in this site, depending on the age of the patient.

‡ Some experts recommend a 5/8-inch needle for men and women who weigh less than 130 pounds. If used, skin must be stretched tightly (do not bunch subcutaneous tissue).

 Provide all recipients and/or parents/legal guardians with a 

copy of the current Fact Sheet for Recipients and Caregivers.

 Prepare to administer the vaccine following the 

manufacturer's guidance. Choose the correct needle 

gauge, needle length, and injection site for persons: 

○ 12 through 18 years of age: 

» Needle gauge/length: 22–25 gauge, 5/8* -1-inch 

» Site: Deltoid muscle of arm†

○ 19 years of age and older: See chart below. 

 Administer Novavax COVID-19 Vaccine by intramuscular 

(IM) injection 0.5 mL/5 μg.

Sex and Weight of Patient Needle Gauge Needle Length Injection Site†

Female or male less than 130 lbs 22–25 5/8‡–1" Deltoid muscle of arm

Female or male 130–152 lbs 22–25 1" Deltoid muscle of arm

Female 152–200 lbs 22–25 1–1.5" Deltoid muscle of arm

Male 152–260 lbs 22–25 1–1.5" Deltoid muscle of arm

Female 200+ lbs 22–25 1.5" Deltoid muscle of arm

Male 260+ lbs 22–25 1.5" Deltoid muscle of arm

Document Vaccination 

Document each recipient's vaccine administration 

information: 

 Medical record: The vaccine and the date it was 

administered, manufacturer, lot number, vaccination site 

and route, name and title of the person administering 

the vaccine. 

 Vaccination record for recipient: Date of vaccination, 

product name/manufacturer, lot number, and name/

location of the administering clinic or health care 

professional. 

 Immunization information system (IIS): Report the 

vaccination to the appropriate state/local IIS. 

Be Prepared to Manage Medical Emergencies 

Consider observing persons after vaccination to monitor 

for allergic reactions and syncope: 

 30 minutes for persons with: 

○ A history of a non-severe, immediate (onset within 4 

hours) allergic reaction after a previous dose of Novavax 

COVID-19 vaccine 

○ A history of a diagnosed non-severe allergy to a 

component of Novavax COVID-19 vaccine 

 15 minutes: All other persons 

Syncope may occur in association with injectable vaccines. 

Procedures should be in place to avoid falling injuries and 

manage syncopal reactions. 

Have a written protocol to manage medical emergencies 

following vaccination. 

Health care personnel who are trained and qualified to 

recognize the signs and symptoms of anaphylaxis as 

well as administer intramuscular epinephrine should be 

available at the vaccination location at all times. 
11/08/2023 CS328127-E 4

12 Years of Age and Older 

Updated (2023–24 Formula)

Novavax COVID-19 Vaccine

Standing Orders for Administering Vaccine

This policy and procedure shall remain in effect for all patients of the 

effective until rescinded or until 

 . 

Medical director (or other authorized practitioner)

 / / . 

Adapted with appreciation from the Immunization Action Coalition (IAC) standing orders

Standing Orders Authorization

Note: For more information/guidance, please contact the immunization program at your state or local health 

department or the appropriate state body (e.g., state board of medical/nursing/pharmacy practice).

Report Adverse Events to the Vaccine Adverse 

Event Reporting System (VAERS) 

Adverse events that occur in a recipient following 

administration of any licensed or authorized COVID-19 

vaccine should be reported to VAERS, including: 

 Vaccine administration errors, whether or not associated 

with an adverse event

 Serious adverse events, irrespective of attribution to 

vaccination 

 Cases of Multisystem Inflammatory Syndrome (MIS) in 

adults and children 

 Cases of myocarditis 

 Cases of pericarditis 

 Cases of COVID-19 that result in hospitalization or death 

Reporting is also encouraged for any other clinically 

significant adverse event, even if it is uncertain whether 

the vaccine caused the event. Information on how to 

submit a report to VAERS is available at Vaccine Adverse 

Event Reporting System (VAERS) (hhs.gov) or by calling 

1-800-822-7967. 

For More Information, Please See: 

 Interim Considerations: Preparing for the Potential 

Management of Anaphylaxis after COVID-19 Vaccination

 CDC’s General Best Practice Guidelines for Immunization, 

“Preventing and Managing Adverse Reactions” 

 Medical Management of Vaccine Reactions in Children 

and Teens in a Community Setting 

 Medical Management of Vaccine Reactions in Adults in a 

Community Setting