Vaccines protect against many infectious diseases, including some that can directly or indirectly cause nervous system damage. Serious neurological consequences of immunization are typically extremely rare, although they have the potential to jeopardize vaccination programmes, as demonstrated most recently during the COVID-19 pandemic. Neurologists have an important role in identifying safety signals at population and individual patient levels, as well as providing advice on the benefit–risk profile of vaccination in cohorts of patients with diverse neurological conditions. This article reviews the links between vaccination and neurological disease and considers how emerging signals can be evaluated and their mechanistic basis identified. We review examples of neurotropic infections with live attenuated vaccines, as well as neuroimmunological and neurovascular sequelae of other types of vaccines. We emphasize that such risks are typically dwarfed by neurological complications associated with natural infection and discuss how the risks can be further mitigated. The COVID-19 pandemic has highlighted the need to rapidly identify and minimize neurological risks of vaccination, and we review the structures that need to be developed to protect public health against these risks in the future.

疫苗可以预防许多传染病，包括一些可以直接或间接导致神经系统损伤的疾病。免疫接种造成的严重神经系统后果通常极为罕见，尽管它们有可能危及疫苗接种计划，正如最近在 COVID-19 大流行期间所证明的那样。神经科医生在识别人群和个体患者水平的安全信号方面发挥着重要作用，并就患有不同神经系统疾病的患者群体中疫苗接种的利益-风险状况提供建议。本文回顾了疫苗接种与神经系统疾病之间的联系，并考虑了如何评估新出现的信号及其确定其机制基础。我们回顾了减毒活疫苗引起的神经性感染的例子，以及其他类型疫苗的神经免疫学和神经血管后遗症。我们强调，与自然感染相关的神经系统并发症相比，此类风险通常相形见绌，并讨论如何进一步降低风险。 COVID-19 大流行凸显了快速识别和尽量减少疫苗接种的神经系统风险的必要性，我们审查了未来需要制定的结构，以保护公众健康免受这些风险的影响。