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An adverse reaction or vaccine effect is an untoward vaccine effect that is extraneous to immunization inducing effects of the vaccine. While vaccines are generally both effective and safe, no vaccine is totally safe for all recipients. Vaccination may sometimes cause certain mild side-effects: local reaction, slight fever and other systemic symptoms, which may develop as part of the normal immune response. In addition, certain components of the vaccine (e.g. aluminium adjuvant, antibiotics or preservatives) occasionally cause reactions. A successful vaccine reduces these reactions to a minimum while inducing maximum immunity. Serious reactions are rare. Local or systemic reaction can also result from the too frequent administration of a vaccine such as Td or rabies vaccine.

A known contraindication should be clearly marked on the vaccination card, so that the vaccine may be avoided in future. In exceptional circumstances, the medical adviser may consider the risk of a particular disease to be greater than the theoretical risk of administering the vaccine and will advise vaccination.

Common mild vaccine reactions
Most vaccines produce some mild local and/or systemic reactions relatively frequently. These reactions generally occur within a day or two of immunization. However, the systemic symptoms that may arise with measles or MMR vaccine occur 5–12 days after vaccination. Fever and/or rash occur in 5–15% of measles/MMR vaccine recipients during this time, but only 3% are attributable to the vaccine; the rest may be classed as background events, i.e. normal events of child

Uncommon, severe adverse reactions
Most of the rare vaccine reactions are self-limiting and do not lead to long-term problems. Anaphylaxis, for example, although potentially fatal, can be treated and has no long-term effects.
All serious reactions should be reported immediately to the relevant national health authority and marked on the vaccination card. In addition, the patient and relatives should be instructed to avoid the vaccination in the future.

Vaccine Possible adverse reactions Expected rate of reactions per million doses *
BCG suppurative lymphadenitis


Disseminated BCG infection
100–1 000 (mostly in immunodeficient individuals)

1–700 (rarely with current vaccines)
Cholera NR  ---

Persistent crying
Hypotonic–hyporesponsive episode Anaphylaxis

1 000–60 000
Haemophilus influenza NR
Hepatitis A NR
Hepatitis B**  Anaphylaxis 1–2
Influenza     Guillain–Barré syndrome <1
Japanese encephalitis     Mouse-brain only – neurological eventHypersensitivity Rare 1800–6400
Measles     Febrile seizure
Thrombocytopenic purpura


Meningococcal disease    Anaphylaxis 1
Mumps Depends on strain – aseptic meningitis 0–500
Pneumococcal Anaphylaxis Very rare
Poliomyelitis (OPV) Vaccine-associated paralytic poliomyelitis (Extremely Rare). 1.4–3.4
Poliomyelitis (IPV) NR
Rabies Cell-derived – allergic reactions Rare
Rubella Arthralgia/arthritis/arthropathy very rare
Tetanus Brachial neuritis
Tick-borne encephalitis NR
Typhoid fever Parenteral vaccine
various Oral vaccines – NR
Very rare
Yellow fever Encephalitis (<6 months)
Viscerotropic disease
20 for vaccinees
above 60 years of age
  • * Precise rate may vary with survey method.
  • **Although there have been anecdotal reports of demyelinating disease following hepatitis B vaccine, there is no scientific evidence for a causal relationship
  • NR = None Reported.

Contraindications to vaccines

Vaccine Contraindications
All An anaphylactic reaction*following a previous dose of a particular vaccine is a true contraindication to further immunization with the antigen concerned and a subsequent dose should not be given.
MMR, BCG, live JE, varicella                           

Severe immunodeficiency

Yellow fever**

Severe egg allergy Severe immune deficiency (from medication, disease or symptomatic) Pregnancy, HIV infection

BCG HIV infection
Influenza  Severe egg allergy
Pertusis-containing  vaccines Anaphylactic reaction to a previous dose
Delay vaccination in case of evolving neurological
disease (e.g. uncontrolled epilepsy or progressive encephalopathy).
  • * Generalized urticaria, difficulty in breathing, swelling of the mouth and throat, hypotension or shock.
  • ** In many industrialized countries, yellow fever vaccine is administered to individuals with symptomatic HIV infection or who are suffering from other immunodeficiency diseases, provided that their CD4 count is at least 200 cells/mm and if they plan to visit areas where epidemic or endemic yellow fever actually occurs.
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