Health Protection in a Shrinking World

David J. SencerDirector, National Communicable Disease Center, Atlanta, Georgia 30333

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Not long ago, I received a telephone call from a physician in Cleveland, Ohio, who had been referred to NCDC by his local health department. He thought he had a patient who had South African tick typhus fever. I replied that I would not know the difference between South African tick typhus fever and tsutsugamushi fever. He promptly told me that they were very similar. The physician had been in the Navy in the South Pacific during World War II and had had opportunity to observe and manage tsutsugamushi fever. His patient had returned 10 days previously from a safari in Kenya and had developed lymphadenopathy, eschar, and fever.

If the Presidential Address of last year did not indicate to this group the shrinking nature of this world, certainly this story should. With today's transportation, with today's dispersion of people—military, Peace Corps, technicians, travelers—the “fortress mentality” that perpetuates stringent quarantine activities can no longer exist.