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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.