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Standing Orders

Note: The booklet Standing Orders for Immunizations 2023-24 is currently being updated. It will be posted again once that update is complete. Meanwhile, individual standing orders can be found below.

Immunization standing orders are approved protocols that authorize appropriately trained health care personnel to assess patient immunization status and administer vaccinations without a written provider order or examination. Strong evidence demonstrates standing orders are an effective strategy for decreasing vaccine-preventable disease burdens while allowing for the safe delegation of the immunization process. Based upon such evidence, the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices, the Community Preventive Services Task Force, the American Academy of Pediatrics and the National Vaccine Advisory Committee all recommend the use of standing orders to increase access to quality immunization health care and to reduce missed opportunities for immunizations in both children and adults. Similarly, the Defense Health Agency Immunization Healthcare Division strongly recommends the use of standing orders for vaccinations in children and adults within the Department of Defense.

The use of standing orders in the DOD is a requirement under Army Regulation 40–562; BUMEDINST 6230.15B; AFI 48–110_IP; CG COMDTINST M6230.4G (Immunizations and Chemoprophylaxis for the Prevention of Infectious Diseases). Standing orders allow eligible nurses and other health care professionals working within their scope of practice (as determined by their license and each service and/or the Defense Health Agency), to provide safe and efficient vaccine delivery in the absence of a privileged provider. All standing orders must be locally approved by a physician. A privileged provider must still be available to respond to a medical emergency when immunizations are given.

Please see below for examples of various standing orders; these are updated as needed. DHA Immunization Healthcare Division standing orders detail recommended practices for administering vaccines within the DOD; there will not be standing orders developed for every vaccine licensed for use in the United States.

*Standing orders will have to be downloaded and saved locally in order to add a digital signature. 

Medical Management of Vaccine Reactions Date
Medical Management of Vaccine Reactions in Children and Teens
May 8, 2023
Medical Management of Vaccine Reactions in Adults
October 2022
How to Use Standing Orders
Information Paper: Standing Orders for Vaccine Delivery in the Department of Defense
March 21, 2022
2022 updates
Recent Changes to Standing Orders (adult and pediatric)
June 2022
Anthrax Date
Anthrax Vaccine Adsorbed (Adult)
March 11, 2024
Chickenpox Date
Varicella (Chickenpox) Vaccine (Pediatric)
May 15, 2023
Measles Mumps Rubella Varicella (MMRV) Vaccine (Pediatric)
May 15, 2023
Varicella (Chickenpox) Vaccine (Adult) Jan. 23, 2024
COVID-19 Date
Standing Orders for Administering COVID-19 Vaccine (Pediatric)
Oct. 20, 2023
Standing Orders for Administering COVID-19 Vaccine (Adult)
Oct. 20, 2023
Haemophilus Influenzae type b
Date
Haemophilus influenzae type b Vaccine (Pediatric)
May 15, 2023
Haemophilus influenzae type b Vaccine (Adult)
May 15, 2023
Hepatitis A Date
Hepatitis A Vaccine (Pediatric)
May 18, 2023
Hepatitis A Vaccine (Adult)
May 26, 2023
Hepatitis B Date
Hepatitis B Vaccine (Pediatric)
April 6, 2023
Hepatitis B Vaccine (Adult)
May 17, 2023
Human Papillomavirus Date
Human Papillomavirus Vaccine (Pediatric)
June 2022
Human Papillomavirus Vaccine (Adult)
June 2022
Influenza Seasonal Date
Influenza Vaccine for Children and Adolescents
Pending update anticipated late August 2024
Influenza Vaccine for Adults
Pending update anticipated late August 2024
Japanese Encephalitis Date
Japanese Encephalitis Vaccine (Pediatric)
June 2022
Japanese Encephalitis Vaccine (Adult)
June 2022
Meningococcal Date
Meningococcal ACWY Vaccine (Pediatric)
Nov. 3, 2023
Meningococcal ACWY Vaccine (Adult)
May 24, 2024
Meningococcal B Vaccine (Adult)
May 24, 2024
Meningococcal B Vaccine (Pediatric) May 24, 2024
Measles-Mumps-Rubella Date
Measles Mumps Rubella Vaccine (Pediatric)
May 15, 2023
Measles Mumps Rubella Varicella (MMRV) Vaccine (Pediatric)
May 15, 2023
Measles Mumps Rubella Vaccine (Adult)
May 17, 2023
Mpox Date
Mpox Vaccine (Adult)
May 30, 2024
Pneumococcal Date
Pneumococcal Vaccines (Pediatric)
Oct. 12, 2023
Pneumococcal Vaccines (Adult)
Oct. 12, 2023
Polio Date
Inactivated Polio Vaccine (Pediatric)
June 2022
Inactivated Polio Vaccine (Adult)
June 2022
Rabies Date
Pre-Exposure Rabies Vaccine (Adult and Pediatric)
June 2022
Respiratory Syncytial Virus Date

RSV Vaccine (Abrysvo) During Pregnancy

Dec. 22, 2023
Rotavirus Date
Rotavirus Vaccine (Pediatric)
March 11, 2024
Shingles Date
Zoster (Shingles) Vaccine (Adult)
June 2022
Tetanus-Diphtheria-Pertussis Date
Diphtheria, Tetanus and Acellular Pertussis (DTaP) Vaccine (Pediatric)
June 2022
Tetanus, Diphtheria and Pertussis (Tdap-Td) Vaccines (Pediatric)
June 2022
Tetanus, Diphtheria and Pertussis (Tdap-Td) Vaccines (Adult)
April 9, 2024
Tick-Borne Encephalitis Date
Tick-Borne Encephalitis Vaccine (ages 1 and older) June 2022
Typhoid Date
Typhoid Vaccine (Pediatric)
June 2022
Typhoid Vaccine (Adult)
June 2022
Yellow Fever Date
Yellow Fever Vaccine (Pediatric)
June 2022
Yellow Fever Vaccine (Adult)
June 2022
Last Updated: July 11, 2024
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