CDC Urges Awareness of Measles in Americans Returning from Germany

As American travelers go to and return from Germany for the World Cup soccer championship games, the Centers for Disease Control and Prevention advises travelers and doctors to be aware that some travelers may have been exposed to the measles virus.

Since Jan. 1, nearly 1,200 cases of measles have been reported in the North Rhine-Westphalia region of Germany. Three of the 12 cities hosting the games - Cologne, Dortmund and Gelsenkirchen - are in the affected region. CDC is particularly concerned about the risk posed by the World Cup because the event is expected to draw more than one million tourists, people will be in close proximity and the measles virus is extremely contagious.

Outbreaks like this can also cause greater concern because travelers may not take as many precautions when traveling to western Europe as they would to other parts of the world. There is a possibility that Americans traveling to Germany could be exposed to measles while there.

CDC recommends that:

• Travelers who plan to go to Germany should check their immunization status and visit their doctors if they are not immune to measles or are not sure they are.

• People returning from the World Cup in Germany should see a healthcare provider if they develop signs or symptoms of measles -- a fever and a raised rash that begins on the face and spreads to the arms and legs, cough, red eyes or a runny nose.

• People with these symptoms should also limit their contact with others as much as possible to prevent the spread of the disease.

• Clinicians seeing a patient with fever should ask about vaccination history and any recent international travel.

Measles is a highly contagious viral respiratory illness transmitted through coughing and sneezing.

The disease can lead to inflammation of the brain, resulting in death in approximately 2 of every 1,000 cases in developed countries, and can be an especially severe disease in people who are malnourished or with weak immune systems. In the United States, most people born before 1957 -- or those who have had a documented case of measles or received 2 doses of MMR vaccine -- are considered immune.

Live virus measles vaccine given within 72 hours of exposure may prevent disease. Immune globulin given up to six days after exposure may prevent disease among people at high risk for complications of measles (such as pregnant women, people with weak immune systems, and children).

For more information about the measles outbreak and travel precautions, please visit www.cdc.gov/travel

Outpatient U.S. Medical Care Exceeds 1 Billion Visits

New reports from the Centers for Disease Control and Prevention examine ambulatory health care in America. They report on the more than 1 billion visits a year Americans make to doctors' offices, emergency rooms and hospital outpatient departments. The latest in an annual series, these reports provide a comprehensive analysis of visits to ambulatory health care settings in 2004.

• Ambulatory care visits have increased at three times the rate of population growth over the past decade.

• Infants under the 1 year of age had the highest rate of visits to primary care offices and hospital outpatient and emergency departments, compared to other age groups.

• Hospital settings as opposed to physician offices were used morefrequently for ambulatory care by Medicaid recipients and by patients with self-pay, no charge, or charity indicated as the expected source of payment.

• The amount of time a patient waits before seeing a physician in the emergency department increased from 38 minutes in 1997 to 47 minutes in 2004. There was no change in the average time--about 16 minutes--a patient spends face-to-face with a doctor in an office visit.

• For the first time, seasonal estimates are available and show that overall, office visits decreased from spring through the summer.

Visits for mental disorders increased during the fall. Emergency injury visits were more likely to occur in the spring than other seasons.