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Children prenatally exposed to anesthesia for maternal surgery during pregnancy were significantly more likely than unexposed children to receive a diagnosis of a disruptive or internalizing behavioral disorder including attention deficit hyperactivity disorder, behavioral disorders, developmental speech or language disorders and autism, according to a new study at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center (CUIMC). Until now associations between prenatal exposure to general anesthesia for maternal surgery during pregnancy and subsequent risk of behavioral disorders in children was unclear. The findings are published online in the British Journal of Anesthesia.
Prenatal exposure to general anesthesia was associated with a 31 percent increased risk for a subsequent disruptive or internalizing behavioral disorder (DIBD) diagnosis in children, with higher risk when the exposure occurred in the second or third trimester of pregnancy. The probabilities of DIBD diagnosis between exposed and unexposed children were similar in the first three years of life, but diverged thereafter.
“For several years there have been concerns about the long-term neurodevelopmental effects of anesthetic exposure in children, with the FDA in 2016 releasing a Drug Safety Communication warning against repeated or lengthy use of anesthesia in young children and pregnant women,” said Caleb Ing, MD, MS, associate professor of Anesthesiology and Epidemiology at Columbia Public Health and CUIMC and first author. “Studies evaluating exposures in children however have been limited because children needing surgery and anesthesia may have more underlying health problems which may predispose them to neurodevelopmental disorders.
Prenatal exposures are particularly relevant because general anesthetic drugs cross the placenta, and since the need for anesthesia is related to maternal medical problems, the risk of bias due to underlying health problems in children is reduced, according to the authors. “However, caution is advised, as many procedures in pregnant women may be necessary, and avoidance of necessary procedures can have detrimental effects on mothers and their children,” advises Ing.
The study population was drawn from Medicaid Analytic eXPrenatal eXtract for general anesthetic exposure and was identified using maternal claims with International Classification of Disease for either an appendectomy or cholecystectomy which are the two most common non-obstetric procedures performed during pregnancy. Exposures were classified as occurring in the first, second, or third trimester of pregnancy. The researchers also controlled for a variety of factors including age, race, ethnicity, state of residence, income based on zipcode, and Medicaid enrollment for disability vs. poverty.
Each prenatally exposed child was matched with five unexposed children. The population consisted of 16,778,231 deliveries linked to an infant born between 1999 and 2013 with known sex. Of those, 34,271 children were exposed to general anesthesia due to maternal appendectomy or cholecystectomy during pregnancy.
“This study provides compelling evidence that prenatal exposure to surgery and general anesthesia may have adverse effects on children’s neurobehavioral development ,” said Guohua Li, MD, DrPH, professor of Epidemiology and Anesthesiology at Columbia Mailman School and Vagelos College of Physicians and Surgeons, and senior author. “Our findings could help inform preoperative risk assessment in pregnant women, especially when the surgical procedure is elective or when viable treatment is available. Results of this study also give added impetus to research on safer anesthetic drugs and techniques.”
Co-authors are Jeffrey H. Silber,,Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine; Deven Lackraj, Stanford Chihuri, and Ling Guo , Columbia University Vagelos College of Physicians and Surgeons; Mark Olfson and Melanie Wall, Columbia Mailman School of Public Health and Vagelos College of Physicians and Surgeons; Caleb Miles, Columbia Mailman School of Public Health; Joseph G. Reiter and Siddharth Jain, Children’s Hospital of Philadelphia; and Cynthia Gyamfi-Bannerman, University of California San Diego.
The study was supported by the Agency for Healthcare Research and Quality (AHRQ), grant R01HS026493.

U.S. flu vaccines are likely to move from quadrivalent to trivalent due to a change in circulating influenza viruses, says a University of Michigan researcher.
Currently, all influenza vaccines in the United States are quadrivalent, meaning that they protect against four different flu viruses.
In a new paper published in the New England Journal of Medicine, researchers detail the spread of influenza B/Yamagata virus, which has not been in circulation since early 2020; the regulatory discussions and recommendations on updating vaccines; and the manufacturing considerations for new vaccine formulations for the U.S. and abroad.
“The removal of B/Yamagata virus is logical as we do not want to include a virus in vaccine formulation that is no longer in circulation,” said Arnold Monto, professor emeritus of epidemiology and global public health at the U-M School of Public Health.
“It also gives us the space to replace B/Yamagata virus with a component that will give improved protection against the circulating influenza viruses. That will take additional studies to accomplish.”
Monto has dedicated his career to researching the occurrence, prevention and control of respiratory infections. He also serves as a member of the U.S. Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee.
Co-authors include Maria Zambon of the U.K. Health Security Agency and Jerry Weir of the Division of Viral Products, Center for Biologics Evaluation and Research at the U.S. Food and Drug Administration.

Researchers at the University of Michigan Health Rogel Cancer Center are exploiting a unique biological feature of glioblastoma to gain a better understanding of how this puzzling brain cancer develops and how to target new treatments against it.
The team, led by senior author Pedro Lowenstein, M.D., Ph.D., Richard Schneider Collegiate Professor of Neurosurgery at Michigan Medicine, had previously identified oncostreams as a key feature in glioblastoma development and in more aggressive disease. These highly active, elongated, spindle-like cells move throughout tissue in complicated patterns. The accumulation of oncostreams found throughout a tumor serve as the basis for cancerous cells’ behavior, determining how tumors grow and invade normal tissue.
In this new study, published in Advanced Science, the team developed human and mouse models of glioblastoma oncostreams and examined multiple factors in the tumor microenvironment that could impact how oncostreams develop and how to reverse them.
Utilizing this model, they also identified a potential inhibitor, DDR1-IN-1, which appears to dismantle oncostreams. Preliminary studies in a mouse model of glioma showed the DDR1 inhibitor led to better survival. This suggests a potential pathway for additional research.
Glioblastoma is an aggressive cancer, with only a 5% survival rate beyond two years. In large part, it’s because even when surgery is possible, it’s often difficult to remove all the cancerous cells. Radiation and chemotherapy have limited effectiveness, and no other treatment options have been developed in decades. This work will hopefully lead to new clinical trials, like the phase I trial of dual vector gene therapy, supported in part by the Rogel Cancer Center, which was published recently in The Lancet Oncology.
“This model has deepened our understanding of how glioblastoma cells grow and invade and has led to the identification of a potential new therapeutic target,” said Syed M. Faisal, Ph.D., a postdoctoral fellow in Lowenstein’s lab and the first author of the study.
“Understanding the mechanism of how glioblastoma grows and migrates is essential to developing new and better treatments,” Lowenstein said. “Our oncostream model will be a valuable tool for gaining new insights into how glioma invades. It will allow us to test potential new therapeutic strategies that undermine the cellular and molecular foundations of glioblastoma malignancy.”
Additional authors: Jarred E. Clewner, Brooklyn Stack, Maria L. Varela, Andrea Comba, Grace Abbud, Sebastien Motsch, Maria G. Castro
Funding for this work is from National Institutes of Health grants: R37-NS094804, R01-NS105556, R01-NS122536, R01-NS124167, R01-NS122165, R21-NS123879-01, R01-NS076991, R01-NS096756, R01-NS082311, R01-NS122234, R01-NS127378, R01-EB022563, U01-CA224160, R01-CA243916; RNA Biomedicine; Rogel Cancer Center; Ian’s Friends Foundation; Leah’s Happy Hearts Foundation; Pediatric Brain Tumor Foundation; Smiles for Sophie Forever Foundation; ChadTough Foundation.

Lockdowns imposed during the COVID-19 pandemic had an impact on the gut microbiome development of babies born during these periods according to new research from RCSI University of Medicine and Health Sciences, Children’s Health Ireland and APC Microbiome Ireland (APC), a world leading SFI Research Centre, based in University College Cork.
Our gut microbiome, an ecosystem of microbes that live in our digestive tract, plays an essential role in human health. The study published in Allergy is the first to specifically explore the gut health of newborns in the pandemic. It revealed significant differences in the microbiome development of babies born during lockdown periods when compared to pre-pandemic babies. Babies born during lockdown also had lower than expected rates of allergic conditions, such as food allergies.
The findings highlighted gut health benefits for ‘pandemic babies’ arising from the unique environment of lockdown including lower rates of infection and consequent antibiotic use, and increased duration of breastfeeding. The newborns were found to have more of the beneficial microbes acquired after birth from their mothers. These maternal microbes could be playing a protective role against allergic diseases.
Professor Jonathan Hourihane, Head of the Department of Paediatrics at RCSI, Consultant Paediatrician at Children’s Health Ireland Temple Street, who is joint senior author of the study, commented on the research’s implications: “This study offers a new perspective on the impact of social isolation in early life on the gut microbiome. Notably, the lower allergy rates among newborns during the lockdown could highlight the impact of lifestyle and environmental factors, such as frequent antibiotic use, on the rise of allergic diseases.
“We hope to re-examine these children when they are 5 years old to see if there are longer term impacts of these interesting changes in early gut microbiome.”
Professor Liam O’Mahony, Principal Investigator at APC Microbiome Ireland and Professor of Immunology, at University College Cork is joint senior author. He added: “While we all start life sterile, communities of beneficial microbes that inhabit our gut develop over the first years of life. We took the opportunity to study microbiome development in infants raised during the early COVID-19 era when strict social distancing restrictions were in place, as the complexity of early life exposures was reduced and this facilitated a more accurate identification of the key early life exposures. Prior to this study it has been difficult to fully determine the relative contribution of these multiple environmental exposures and dietary factors on early life microbiome development.
“One fascinating outcome is that due to reduced human exposures and protection from infection, only 17% of infants required an antibiotic by one year of age, which correlated with higher levels of beneficial bacteria such as bifidobacteria. The study has provided a rich repository of data, which we will continue to analyse and investigate in the future.”
The researchers from RCSI, CHI and APC Microbiome Ireland analysed fecal samples from 351 babies born in the first three months of the pandemic, comparing these with pre-pandemic cohorts. The former were part of the CORAL (Impact of CoronaVirus Pandemic on Allergic and Autoimmune Dysregulation in Infants Born During Lockdown) project. Online questionnaires were used to collect information on diet, home environment and health. Stool samples were collected at 6,12 and 24 months and allergy testing was performed at 12 and 24 months.
‘Association between Gut Microbiota Development and Allergy in Infants Born during Pandemic-Related Social Distancing Restrictions’ was carried out in collaboration with University College Cork, University of Helsinki, University of Colorado, Karolinska Institute Stockholm, Children’s Health Ireland, Rotunda Hospital and The Coombe Hospital.
The CORAL study was supported by the Temple Street Hospital Foundation in Dublin, Ireland and the Clemens von Pirquet Foundation in Geneva, Switzerland.

His willingness to remove kidneys from brain-dead patients increased the organs’ viability while challenging the line between living and dead.Guy Alexandre, a Belgian transplant surgeon who in the 1960s risked professional censure by removing kidneys from brain-dead patients whose hearts were still beating — a procedure that greatly improved organ viability while challenging the medical definition of death itself — died on Feb. 14 at his home in Brussels. He was 89.His son, Xavier, confirmed the death.Dr. Alexandre was just 29 and fresh off a yearlong fellowship at Harvard Medical School when, in June 1963, a young patient was wheeled into the hospital where he worked in Louvain, Belgium. She had sustained a traumatic head injury in a traffic accident, and despite extensive neurosurgery, doctors pronounced her brain dead, though her heart continued to beat.He knew that in another part of the hospital, a patient was suffering from renal failure. He had assisted on kidney transplants at Harvard, and he understood that the organs began to lose viability soon after the heart stops beating.Dr. Alexandre pulled the chief surgeon, Jean Morelle, aside and made his case. Brain death, he said, is death. Machines can keep a heart beating for a long time with no hope of reviving a patient.His argument went against centuries of assumptions about the line between life and death, but Dr. Morelle was persuaded.They removed a kidney from the young patient, shut off her ventilator and completed the transplant within a few minutes. The recipient lived another 87 days — a significant accomplishment in its own right, given that the science of organ transplants was still evolving at the time.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Behavior change among gay and bisexual men was more important than shots in curbing the spread, researchers concluded.The NewsThe 2022 outbreak of mpox, previously known as monkeypox, was curbed in large part by drastic changes in behavior among gay and bisexual men, and not by vaccination, according to a new analysis published on Thursday in the journal Cell.Mpox vaccinations in a mobile clinic outside a Manhattan club in 2022.Kholood Eid for The New York TimesWhy It Matters: Vaccines often arrive too late to stamp out outbreaks.Public health response to outbreaks often relies heavily on vaccines and treatments, but that underestimates the importance of other measures, said Miguel Paredes, lead author of the new study and an epidemiologist at the Fred Hutchinson Cancer Center in Seattle.Although the Food and Drug Administration approved a vaccine for mpox in 2019, getting enough doses produced and into arms proved challenging for many months after the outbreak began. Vaccines for new pathogens are likely to take even longer.The new analysis suggests an alternative. Alerting high-risk communities allowed individuals to alter their behavior and led to a sharp decrease in transmission, Mr. Paredes said. In North America, the outbreak began petering out in August 2022, when less than 8 percent of high-risk individuals had been vaccinated.Public health messaging can “be really powerful to control epidemics, even as we’re waiting for things like vaccines to come,” he said.The Long View: Vaccines are still important.Some experts unrelated to the work were not convinced that behavioral change was largely responsible for stemming the outbreak.“If the national numbers are driven by large outbreaks in a few places, then the folks at the highest risk in those places would get infected pretty quickly, and their immunity would be especially valuable in limiting the outbreak size,” said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.“Add in some vaccine-induced immunity in this group and a bit of behavior change, and it will be even more effective,” he said.The Centers for Disease Control and Prevention worked closely with the L.G.B.T.Q. community to raise awareness about the importance of behavior modification, said Thomas Skinner, a spokesman for the agency.While behavioral change can curtail outbreaks in the short term, vaccinations prevent the outbreak from resurging once people return to their normal routines, said Virginia Pitzer, an epidemiologist at the Yale School of Public Health.“As we’ve seen with Covid, the behavioral change only lasts so long,” she said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Infection control lapses, severe staffing shortages and lowering vaccination rates have continued to plague many facilities beyond the pandemic.Many Americans prefer to believe the Covid pandemic is a thing of the past. But for the nation’s nursing homes, the effects have yet to fully fade, with staffing shortages and employee burnout still at crisis levels and many facilities struggling to stay afloat, according to a new report published Thursday by federal investigators.The report, by the inspector general’s office at the U.S. Department of Health and Human Services, found that the flawed infection-control procedures that contributed to the 170,000 deaths at nursing homes during the pandemic were still inadequate at many facilities. And while the uptake of Covid vaccines was initially robust when they first became available, investigators found that vaccination booster rates among staff workers and residents have been badly lagging.The findings were directed at the Centers for Medicare & Medicaid Services, the agency under the department’s jurisdiction that oversees 1.2 million nursing home residents whose care is provided mainly by the federal government. The inspector general’s report described the staffing problems as “monumental,” noting high levels of burnout, frequent employee turnover and the burdens of constantly training new employees, some of whom fail to show up for their first day of work. For nursing homes, the inability to attract and retain certified nurse aides, dietary services staff and housekeeping workers is tied to federal and state reimbursements that do not cover the full cost of care.Rachel Bryan, a social science analyst with the inspector general’s office, said the report sought to ensure that key lessons from the pandemic were not lost, especially now that the acute sense of urgency has faded.“Just as airplanes cannot be repaired while in flight, nursing home challenges could not be fully repaired during the pandemic,” she said. “We feel very strongly that as we come out of emergency mode, we take the time to reflect, learn and take real steps toward meaningful change.”The Centers for Medicare & Medicaid Services declined to discuss the recommendations, and instead directed a reporter to comments the agency provided for the report. Those comments were largely noncommittal, neither agreeing or disagreeing with the recommendations, but agency officials asked that some of the proposed recommendations be removed from the report, saying improvements were already in the works.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Published2 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesMPs should have the chance to vote on assisted dying after the findings of a new report, according to campaigner Dame Esther Rantzen. There was some evidence it has led to better end-of-life care in places where it is allowed, the Health and Social Care Committee found.A number of countries have legalised assisted dying, assisted suicide or euthanasia, which are all different. What is assisted dying?There is some debate over exactly what the various terms mean.But assisted dying is generally used to describe a situation where someone who is terminally ill seeks medical help to obtain lethal drugs which they administer themselves.What is assisted suicide?Assisted suicide is intentionally helping another person to end their life. It can involve people who are not terminally ill.Providing someone with a lethal dose of sedatives, or helping them go to Switzerland (where assisted suicide is legal), could both be considered assisted suicide.What is euthanasia?Euthanasia is the act of deliberately ending a person’s life to relieve suffering, in which a lethal drug is administered by a physician.It is legal in fewer places than assisted dying or assisted suicide, and patients do not necessarily have to be terminal. There are two types: voluntary euthanasia, where a patient has given consent, and non-voluntary, where they have not been able to, for example if they are in a coma. Are euthanasia, assisted dying or assisted suicide legal in the UK?The laws throughout the UK prevent people from asking for medical help to die. More specifically, euthanasia is illegal under English law and is considered manslaughter or murder. The maximum penalty is life imprisonment. The Suicide Act 1961 also makes it illegal to encourage or assist a suicide in England and Wales. Those found guilty could face up to 14 years in prison. Similar laws also exist in Northern Ireland. There is no specific crime of assisting a suicide in Scotland, but it is possible that helping a person to die could lead to prosecution for culpable homicide.The Health and Social Care Committee highlighted confusion about what the current system means for doctors. It said it was not clear whether they could provide medical evidence for people who wanted to go abroad to die.The British Medical Association (BMA) advises doctors against producing medical reports to facilitate assisted suicide abroad.Who is calling for a change in the law in the UK?Campaigners have made numerous attempts to alter the law over many years.Broadcaster Dame Esther Rantzen, who has stage four lung cancer, launched a petition in support of assisted dying. It recently passed the 100,000-signature threshold needed to trigger a debate in Parliament. She welcomed the committee’s findings, but said she was “disappointed” that it had not backed her calls for a vote.Image source, PA MediaThe government says any change is a matter for Parliament. Proposals on assisted dying were last rejected in July 2022, but the government said it would provide time to debate the subject again. It indicated that MPs would be free to vote as they wished.The current law has also been challenged in the courts, with a number of people with terminal and life-limiting illnesses arguing for their right to die.Assisted suicide campaigner dies aged 65Ex-England cricketer backs calls for assisted dyingWho opposes euthanasia or assisted dying? Both the BMA and Royal College of Nursing have neutral positions on assisted dying.Others argue the current legal position around all forms of assisted death should remain the same. Baroness Grey-Thompson is concerned that vulnerable people could be coerced into pursuing assisted dying, and that it is hard to put adequate safeguards in place. “We need to make sure people are protected,” she told BBC Breakfast, arguing that medical complications can arise once lethal drugs enter the body.Dr Gordon Macdonald, of anti-assisted dying campaign group Care Not Killing, said he believed there were “many problems” with changing the law.He is worried that criteria for assisted dying could in time be extended beyond terminally-ill people to include those with disabilities, and conditions such as dementia and depression.Where is euthanasia or assisted dying legal around the world?Dignity in Dying says more than 200 million people around the world have legal access to some form of assisted dying. Switzerland has allowed assisted suicide since 1942. It is perhaps best known for its Dignitas facility. However all forms of euthanasia are against the law.Assisted suicide is also legal in neighbouring Austria.In the US,11 states allow assisted dying. Known as “physician-assisted dying”, it permits doctors to prescribe lethal drugs for self-administration. Physician-assisted dying is legal in Oregon, California, New Mexico, Colorado, Washington, Hawaii, New Jersey, Vermont, Maine and Washington DC. In Montana, court rulings allow doctors to defend themselves if they assist in a person’s suicide. Voluntary euthanasia is legal in Canada, where it is called medical assistance in dying. It can be provided by a doctor or nurse practitioner, either in in person, or through the prescription of drugs for self-administration.It is also legal in Spain and Colombia, both of which also permit assisted suicide.Assisted dying is legal in some parts of Australia, but the law differs across states. It is not permitted in either the Northern or Australian Capital territories, which have separate legal systems.New Zealand’s End of Life Choice Act legalises assisted dying and allows adults in their final months of life to request assistance from a medical professional. Three countries have laws that allow people who are not terminally ill to receive assistance to die: The Netherlands, Belgium and Luxembourg.If you’ve been affected by issues in this article, help and support is available via the BBC Action Line.

A study suggests that humans often misinterpret a pet’s signals; even purring doesn’t guarantee a contented cat.What is the meaning of a cat’s meow that grows louder and louder? Or your pet’s sudden flip from softly purring as you stroke its back to biting your hand?It turns out these misunderstood moments with your cat may be more common than not. A new study by French researchers, published last month in the journal Applied Animal Behaviour Science, found that people were significantly worse at reading the cues of an unhappy cat (nearly one third got it wrong) than those of a contented cat (closer to 10 percent).The study also suggested that a cat’s meows and other vocalizations are greatly misinterpreted and that people should consider both vocal and visual cues to try to determine what’s going on with their pets.The researchers drew these findings from the answers of 630 online participants; respondents were volunteers recruited through advertisements on social media. Each watched 24 videos of differing cat behaviors. One third depicted only vocal communication, another third just visual cues, and the remainder involved both.“Some studies have focused on how humans understand cat vocalizations,” said Charlotte de Mouzon, lead author of the study and a cat behavior expert at the Université Paris Nanterre. “Other studies studied how people understand cats’ visual cues. But studying both has never before been studied in human-cat communication.”Cats display a wide range of visual signals: tails swishing side to side, or raised high in the air; rubbing and curling around our legs; crouching; flattening ears or widening eyes.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Published5 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, UKHSAA multimedia campaign featuring the voices of children will remind parents in England of the serious risks of diseases like measles if vaccinations are missed.Health officials said they wanted to target busy parents with a message that “stops them scrolling”. Measles cases have been rising since late last year with clusters in a number of regions, including London.A steady fall in uptake of childhood jabs since the pandemic is to blame.Measles is one of the most infectious diseases known to humans and when vaccination rates go down, it is most likely to spread quickly. Although it normally clears up with within 10 days, complications can be nasty and include blindness, seizures and meningitis. In some cases it can also kill.In the campaign by the UK Health Security Agency (UKHSA), which launches on Monday, parents are being urged to make sure their children have had two doses of the MMR vaccine, which protects against measles, mumps and rubella, and check they are up to date with all other jabs.In a video which will run on TV, radio and online, children tell their parents and carers: “If we’re not vaccinated, we’re not protected.” The campaign will be supported by trusted community leaders engaging with parents in inner-city areas, which are a particular concern, and have information leaflets in different languages. Why are measles cases rising and what is the MMR vaccine?Parents of baby with measles in vaccination pleaAdult dies in Ireland after contracting measlesThe MMR vaccine is very effective at protecting against measles, but only 85% of children starting primary school in the UK have had both jabs – well below the target of 95% needed to stop it spreading.Other vaccines, including whooping cough, measles, mumps and rubella, polio, meningitis and diphtheria, have also seen declines in uptake, meaning levels of population immunity are no longer high enough to prevent outbreaks, UKHSA said.Prof Dame Jenny Harries, head of UKHSA, said: “While the majority of the country is protected, there are still high numbers of children in some areas that continue to be unprotected from preventable diseases. “It is not just their own health that can suffer, but other unvaccinated people around them such as school friends, family and those in their community could also experience serious infections.”Dane Jenny warned that unless uptake improves, diseases that the vaccines protect against could start to re-emerge and cause more serious illness.Many other countries have also seen the same fall-off in vaccinations among children, and the World Health Organization recently warned of the growing threat of measles.Incident Room: Measles Outbreak: Why now?Health experts examine why the virus is back and what can be done to get rid of it?Watch now on iPlayerHealth officials in England have already started contacting more than four million parents, carers and young adults to tell them they or their children have missed out on one or both doses of MMR jab. Anyone under the age of 25 can now have one by contacting their GP surgery.There have been 650 confirmed measles cases in England since the start of October – nearly twice the total for the whole of 2023. In the four weeks since 29 January, there have been 183 cases – with 69 of those reported in the most recent week, latest figures show.The West Midlands accounted for 43% of cases during the last month, with most occurring in Birmingham, although health officials say cases in that region now appear to be stabilising. Measles has affected other regions of England in February:19% of cases have been in the North West14% have been in London10% have been in the East Midlands8% have been in Yorkshire and The Humber Many of the infections have been in children and young people. What is measles and what are the symptoms?Measles is caused by a virus that is spread by coughs and sneezes.Common symptoms include:high feversore, red and watery eyescoughingsneezingSmall white spots may appear inside the mouth. A blotchy red or brown rash usually appears after a few days, typically on the face and behind the ears, before spreading to the rest of the body. It can be harder to see on brown and black skin. You can catch it at any age if you have not been vaccinated. The measles, mumps and rubella (MMR) vaccine is given in two doses – the first around the age of one and the second when a child is about three years and four months old.More on this storyWhy are measles cases rising and what is the MMR vaccine?Published15 FebruaryNHS launches pop-up MMR vaccine clinicsPublished2 days agoAlarming 45-fold rise in measles in Europe – WHOPublished23 JanuaryMeasles jab campaign targets unprotected millionsPublished22 JanuaryMeasles cases highest since 1990sPublished11 January