Novavax COVID-19 Vaccine
by David Freedman
last updated
2023-04-29 16:44:40
© Antimicrobial Therapy, Inc.
Nuvaxovid, Covovax, NVX-CoV2373
Introduction
- CDC vaccination recommendations updated as of April 19, 2023
- Persons >12 yrs who previously received 1 or more doses of Novavax are recommended to receive 1 bivalent mRNA vaccine dose
- Any bivalent mRNA vaccine may be used at 2 months to boost a primary series with Novavax, monovalent
- See COVID-19, Vaccines for general vaccine indications, efficacy, duration of protection, choice an
Vaccine
- Type: recombinant protein subunit vaccine, adjuvanted
- Novavax COVID-19 Vaccine, Adjuvanted, monovalent (Nuvaxovid; Indian version branded as Covovax)
- Contains same original strain spike protein that is coded for by mRNA vaccines
Dose and Schedule
- Novavax remains authorized to provide:
- A 2-dose primary series to people ages >12 years and older. The primary series doses are separated by 3–8 weeks. An 8-week interval between the first and second primary series doses might be optimal for some people ages 6 months–64 years, especially for males ages 12–39 years, as it might reduce the small risk of myocarditis and pericarditis associated with this vaccine.
- A booster dose in limited situations to people ages 18 years and older who previously completed primary vaccination using any FDA-approved or FDA-authorized COVID-19 vaccine; have not received any previous booster dose(s); and are unable (i.e., mRNA vaccine contraindicated or not available) or unwilling to receive an mRNA vaccine and would otherwise not receive a booster dose. The monovalent Novavax booster dose is administered at least 6 months after completion of any primary series.
COVID-19 vaccination history | Bivalent vaccine | # of bivalent doses indicated | Dosage (mL/ug) | Interval between doses |
1 or more doses of Novavax vaccine (5 µg rS and 50 µg of Matrix-M™ adjuvant) | Moderna | 1 | 0.5 mL/50 ug | At least 8 weeks after last monovalent dose |
Pfizer BioNTech | 1 | 0.3 mL/30 ug | At least 8 weeks after last monovalent dose |
- Additional bivalent dose. Persons >65 yrs have the option to receive 1 additional bivalent mRNA vaccine dose >4 mos after the first dose of a bivalent mRNA vaccine. If Moderna is used, administer 0.5 mL/50 ug (dark blue cap and label with a gray border); if Pfizer-BioNTech is used, administer 0.3 mL/30 ug (gray cap and label with a gray border).
Toxicities
Contraindications
- Anaphylaxis or immediate allergic reaction (within 4h) to a previous dose of an mRNA vaccine or separately to a vaccine constituent including polyethylene glycol (PEG) or polysorbate.
- Do not vaccinate with any mRNA vaccine
- History of a known diagnosed allergy to a vaccine component
Precautions
- Immediate allergic reaction (within 4h) to any other vaccine or injectable therapy not related to a component of mRNA-COVID-19 vaccines or polysorbate.
- Persons with a reaction to a vaccine or injectable therapy that contains PEG
- History of myocarditis or pericarditis after a dose of an mRNA or Novavax COVID-19 vaccine, avoid future doses of any COVID-19 vaccine
- Allergy-related contraindication to one type of COVID-19 vaccine is a precaution to the other types of COVID-19 vaccines
- Defer vaccination until resolution of a moderate or severe acute illness, with or without fever
Not Contraindications
- Food (including egg and gelatin), pet, insect, venom, environmental, latex, oral medications; any other history of anaphylaxis not related to vaccine or injectables.
- History of GBS in proximity to another vaccine.
Adverse Effects
- Pain at the injection site, sometimes severe, occurs frequently
- Fatigue, headache, and myalgia common but are mild to moderate, occurring within 1–3 days of vaccination, and resolving within 1–3 days of onset.
- More frequent following dose 2 and among ages 12–64 years compared to >65 years
- Myocarditis: cases identified in clinical trials and post-authorization. risk low but as yet unquantified.
- Reactions more frequentand after dose 2 than dose 1.
- 8-week interval between the first and second primary series doses of Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines may be optimal for some people to reduce myocarditis.
Special Populations
Pregnancy
- Vaccinate according to standard recommendations if pregnant, breastfeeding, attempting or contemplating conception
- Pregnant and recently pregnant persons at increased risk for severe illness and the fetus is at increased risk
- Benefits outweighs risks of vaccination
- Antibodies are transferred to the newborn
- No contraindications to breastfeeding
Immunocompromised / HIV
- An updated vaccine schedule table for immunocompromised person will be published shortly by CDC
Serologic Testing
- Antibody testing is not recommended to assess for immunity following COVID-19 vaccination or to assess the need for vaccination in an unvaccinated person.
- No correlates of protection are available and assays vary widely.
- +ve IgG only minimally reassuring, -ve IgG unhelpful in patients whose ability to mount a B-cell response is uncertain.
- If antibody testing is done, vaccination should be completed as recommended regardless of the antibody test result.
- Prior receipt of a COVID-19 vaccine will not affect the results of SARS-CoV-2 viral tests (nucleic acid amplification or antigen tests).