Vaccinating Youth

The COVID-19 vaccine is available to people 6 months of age and older.

October 3, 2023 – the U.S. Food and Drug Administration amended the emergency use authorization (EUA) of the Novavax COVID-19 Vaccine, Adjuvanted for use in individuals 12 years of age and older to include the 2023-2024 formula that target omicron subvariant XBB. 1.5. Bivalent mRNA and Original Novavax COVID-19 vaccines are no longer authorized or available in the United States.

The current COVID-19 vaccine recommendations are as follows:

Pfizer or Moderna:

  • Children 6 months – 4 years old who are unvaccinated are recommended to receive 2 doses of updated 2023-2024 Moderna COVID-19 vaccine or 3 doses of updated 2023-2024 Pfizer COVID-19 vaccine.
  • Children 6 months – 4 years old who were previously vaccinated are recommended to receive 1 or 2 doses of an updated 2023-2024 Moderna or Pfizer COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine[s] received).
  • Anyone 5 years old and older regardless of previous vaccination is recommended to receive 1 dose of an updated mRNA 2023-2024 Moderna or Pfizer COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.
  • Individuals 6 months and older who are moderately or severely immunocompromised should complete a 3-dose initial series and may receive 1 or more additional updated 2023-2024 COVID-19 vaccine doses at least 2 months after their last dose.

Novavax:

  • Individuals 12 years old and older previously vaccinated with any COVID-19 vaccine: one dose of Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula), administered at least 2 months after receipt of the last dose of a COVID-19 vaccine.
  • Individuals 12 years old and older not previously vaccinated with any COVID-19 vaccine: two doses of Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula), administered three weeks apart.
  • Immunocompromised individuals 12 years old and older: an additional dose of Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula) may be administered at least 2 months following the last dose of a COVID-19 vaccine (2023-2024 Formula).  Additional doses of Novavax COVID-19 Vaccine, Adjuvanted (2023-2024 Formula) may be administered at the discretion of the healthcare provider, taking into consideration the individual’s clinical circumstances. The timing of the additional doses may be based on the individual’s clinical circumstances. 

The Washington State Department of Health is currently reviewing and updating our webpages and supporting resources to reflect these new recommendations.

Below are resources and information for providers who are interested in vaccinating people under 18 years old.

Education Materials

Printable Resources

Web Resources

Communication Toolkits

Clinical Resources

Provider Trainings

Frequently Asked Questions

Why should minors get vaccinated against COVID-19?

Since the beginning of the pandemic, over 15 million children in the United States have gotten COVID-19. New COVID-19 variants are more dangerous and infectious to children than the original strains and led to peak COVID-19 hospitalizations among youth.

While COVID-19 is often milder in children than adults, children can still get very sick and spread it to friends and family who are immunocompromised or vulnerable in other ways.

Children who are infected with COVID-19 can develop “long COVID-19” or persistent symptoms that often include brain fog, fatigue, headaches, dizziness and shortness of breath. Vaccination is the best way to keep kids healthy and safe.

Children who get infected with COVID-19 may be at greater risk for Multisystem inflammatory syndrome (MIS-C). MIS-C is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. While it is still unknown what causes MIS-C, many children with MIS-C had COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children diagnosed with this condition have gotten better with medical care.

What can I do as a provider to support COVID-19 vaccinations for youth?

COVID-19 vaccine providers can help youth get their COVID-19 vaccine by:

  • Listening to your patient's concerns and answering their questions with empathy. You can use the COVID-19 mRNA vaccine discussion guide (PDF) and the provider discussion guide: building parental/guardian confidence in COVID- 19 vaccine (PDF) for tips.
  • Clearly stating your available vaccine types during the scheduling process, on the registration form, and at the clinic site. The current vaccines available for youth are:
    • Three doses of 2023-2024 Pfizer-BioNTech - 6 months- 4 years
    • One dose of 2023-2024 Pfizer-BioNTech - 5 years and older
    • Two doses of 2023-2024 Moderna - 6 months- 4 years
    • One dose of 2023-2024 Moderna - 5 years and older
    • Two doses of 2023-2024 Novavax - 12 years and older and unvaccinated
    • One dose of 2023-2024 Novavax – 12 years and older and previously vaccinated
  • Making your consent process clear during the scheduling process. Provide any necessary forms and let youth know what they need to bring to confirm consent. You should include if your organization:
    • Requires an authorized adult to provide consent in person for the vaccine
    • Applies the Mature Minor Doctrine
    • Accepts consent from school nurses and school counselors for minors who are unhoused through the McKinney-Vento Homeless Assistance Act
  • Offering incentives to compensate youth for their time.
  • Asking youth to outreach to other youth. They'll be more likely to trust and listen to their peers. You can also get their input on how your clinic could better serve youth. If youth have a good experience with a provider, they are more likely to come back and more likely to tell their friends about it.
Which vaccine can I administer to someone under 18 years of age?
  • The Pfizer-BioNTech (Pfizer) 2023-2024 COVID-19 vaccine is currently authorized under EUA for individuals 6 months-11 years old. The Corminaty (Pfizer) 2023-2024 COVID-19 vaccine is approved for individuals aged 12 and older.
  • The Moderna 2023-2024 COVID-19 vaccine is currently authorized under EUA for individuals 6 months-11 years old. The Spikevax (Moderna) 2023-2024 COVID-19 vaccine is approved for those aged 12 and older.
  • The Novavax 2023-2024 COVID-19 vaccine is authorized for individuals aged 12 and older.
Do youth need a 2023-2024 dose?

CDC recommends everyone 6 months and older get at least one dose of updated 2023-2024 COVID-19 vaccine. The updated vaccine should be given at least two months after last dose if previously vaccinated. Children 6 months-4 years may need multiple doses depending on previous number of doses received. 

What should I do if I accidentally give a child between ages 5 and 11 the adult dose of COVID-19 vaccine?

If a child receives adult COVID-19 vaccine, do not repeat dose. See the Center for Disease Control and Prevention's clinical considerations for more information.

What should I do if I accidentally mix and match the series for children ages 6 months-4 years?

Children ages 6 months-4 years who receive different mRNA products for the first 2 doses of an mRNA COVID-19 vaccine series should receive a third dose of either mRNA vaccine 8 weeks after the second dose to complete the 3-dose primary series.

What should I do if I accidentally administer an incorrect formulation for children?
  • If the incorrect formulation is administered, resulting in a higher than authorized dose, do NOT repeat dose. A subsequent dose may still be administered at the recommended interval.
  • If the incorrect formulation is administered, resulting in a lower than authorized dose, repeat dose immediately (no minimum interval) with the age-appropriate formulation. If there are concerns of the patient being at risk of myocarditis, you can delay the repeated dose for 8 weeks after the invalid dose.
Do I need to get consent from an authorized adult to vaccinate people under age 18?

Yes. People under age 18 may need consent from an authorized adult to get the vaccine, unless they are legally emancipated. You can treat consent for COVID-19 vaccination the same as you would for other recommended vaccinations for adolescents, such as Tdap or the meningococcal vaccine.

If you have questions about what you can accept as consent, please consult your legal counsel. You can use this sample consent for minor vaccination as a starting point.

Who can give consent for a minor?

The following adults are authorized to consent for a minor:

  • The parents of the minor
  • An appointed guardian or authorized legal custodian
  • A person authorized by the court to consent to medical care for a child in out-of-home placement (see chapter 13.32A or 13.34 of the Revised Code of Washington)
  • An individual to whom the minor's parent has given a signed authorization to make health care decisions for the minor patient
  • A competent adult relative who is responsible for the health care of the minor patient, or a competent adult who has signed and dated a declaration (see RCW 9A.72.085) stating this
  • A school nurse, school counselor, or homeless student liaison for a homeless youth or young adult who is not under the supervision or control of a parent, custodian, or legal guardian, and is not in the care and custody of the Department of Children, Youth and Families
What can I accept for consent?

Your organization must determine what it accepts as consent. For instance, is verbal consent enough or will you require written consent? Check whether your organization already has policies in place for minor consent. If they do, follow the guidelines. If there are not existing guidelines in place, discuss with your legal counsel to draft guidelines. DOH cannot offer legal advice in this matter. For written consent, you can refer to this sample consent for minor vaccination as a starting point.

Who doesn't need consent from an authorized adult?

Mature minors, emancipated minors, and married minors are exempted from this rule and do not need parent or guardian consent. If a minor is exempt, be sure to document the reason for the exemption for each dose.

What is the Mature Minor Doctrine?

The Mature Minor Doctrine was established by Smith v. Seibly in the Washington Supreme Court in 1967. This doctrine allows some providers to determine whether a minor has the capacity to understand the proposed health care service or treatment and is sufficiently mature to make their own health care decisions.

Health care providers are responsible for determining whether the Mature Minor Doctrine applies in each situation. Criteria that may be used in this determination include age, intelligence, maturity, training, experience, economic independence, general conduct as an adult, and freedom from the control of parents/guardians.

Only some providers may be able to make a Mature Minor determination. Discuss with your legal counsel to determine whether you are one of these providers.

Examples of applying the Mature Minor Doctrine:

Note: These are only examples of what other organizations have done. This is not a direction from DOH that you must follow any of these specifically.

Who is an emancipated minor?

An emancipated minor is someone who is 16 or 17 years old who has been legally declared an adult by the court system. An emancipated minor can give informed consent for all health care services, including immunization, without the need for parent or guardian approval.

Emancipated minors can show you their status with one of the following:

  • Certified Decree of Emancipation
  • Washington State driver license that says they are emancipated
  • Washington State ID card that says they are emancipated

Your organization should have a policy on what to do regarding proof of emancipation.

Do married minors need consent from an authorized adult?

A minor who is married to an adult or to an emancipated minor is considered an adult and can give informed consent for all health care services, including immunization, without the need for parent or guardian approval.

Can patients receive both COVID-19 and other routine vaccines at the same time on the same day?

Yes. The Advisory Committee on Immunization Practices (ACIP) changed their recommendation on May 12, 2021. You can now administer COVID-19 vaccines and other vaccines to patients without regard to timing of most other vaccines. Please see the following link for specifics: