Emerging reports of rare neurological complications associated with COVID-19 infection and vaccinations are leading to regulatory, clinical and public health concerns. We undertook a self-controlled case series study to investigate hospital admissions from neurological complications in the 28 days after a first dose of ChAdOx1nCoV-19 (n = 20,417,752) or BNT162b2 (n = 12,134,782), and after a SARS-CoV-2-positive test (n = 2,005,280). There was an increased risk of Guillain–Barré syndrome (incidence rate ratio (IRR), 2.90; 95% confidence interval (CI): 2.15–3.92 at 15–21 days after vaccination) and Bell’s palsy (IRR, 1.29; 95% CI: 1.08–1.56 at 15–21 days) with ChAdOx1nCoV-19. There was an increased risk of hemorrhagic stroke (IRR, 1.38; 95% CI: 1.12–1.71 at 15–21 days) with BNT162b2. An independent Scottish cohort provided further support for the association between ChAdOx1nCoV and Guillain–Barré syndrome (IRR, 2.32; 95% CI: 1.08–5.02 at 1–28 days). There was a substantially higher risk of all neurological outcomes in the 28 days after a positive SARS-CoV-2 test including Guillain–Barré syndrome (IRR, 5.25; 95% CI: 3.00–9.18). Overall, we estimated 38 excess cases of Guillain–Barré syndrome per 10 million people receiving ChAdOx1nCoV-19 and 145 excess cases per 10 million people after a positive SARS-CoV-2 test. In summary, although we find an increased risk of neurological complications in those who received COVID-19 vaccines, the risk of these complications is greater following a positive SARS-CoV-2 test.

与 COVID-19 感染和疫苗接种相关的罕见神经系统并发症的新报告正在引起监管、临床和公共卫生方面的担忧。我们进行了一项自我对照病例系列研究，调查首次注射 ChAdOx1nCoV-19 ( n = 20,417,752) 或 BNT162b2 ( n = 12,134,782) 后 28 天内以及 SARS-CoV-2- 后 28 天内因神经系统并发症入院的情况。阳性测试（ n = 2,005,280）。格林-巴利综合征（接种后 15-21 天的发病率比 (IRR)，2.90；95% 置信区间 (CI)：2.15-3.92）和贝尔氏麻痹症（IRR，1.29；95% CI）的风险增加：15-21 天时为 1.08-1.56），ChAdOx1nCoV-19。 BNT162b2 会增加出血性中风的风险（IRR，1.38；95% CI：15-21 天时 1.12-1.71）。一个独立的苏格兰队列进一步支持 ChAdOx1nCoV 与吉兰-巴利综合征之间的关联（IRR，2.32；95% CI：1-28 天时 1.08-5.02）。 SARS-CoV-2 检测呈阳性后 28 天内，所有神经系统结果的风险均显着升高，包括格林-巴利综合征（IRR，5.25；95% CI：3.00-9.18）。总体而言，我们估计每 1000 万人接受 ChAdOx1nCoV-19 治疗后，每 1000 万人中会出现 38 例格林-巴利综合征病例，而在 SARS-CoV-2 检测呈阳性后，每 1000 万人中会出现 145 例过量病例。总之，尽管我们发现接受 COVID-19 疫苗的人出现神经系统并发症的风险增加，但在 SARS-CoV-2 检测呈阳性后，这些并发症的风险更大。