ProMED has proven over the years that if an epidemic breaks out anywhere in the world, you’re likely to hear about it first there, from dengue in Malaysia to a 1996 ebola outbreak in Gabon. If the information does not come from government health agencies, it is likely to come from a physician or missionary working in the middle of nowhere, which was the case with the Gabon ebola outbreak. “We had information from the Central African Republic before anybody else had it,” says Charlie Callisher, a ProMED moderator at Colorado State University. “Not that we go out necessarily looking for it, but there are missionaries out there who read ProMED. They’re thrilled they have it. It keeps them in touch with the outside world, and if they see something funny, they tell us first.”

The story of the Swiss tourist who succumbed to yellow fever is a classic case of ProMED’s impact. The Swiss physician who reported the case got to ProMED only after Woodall noticed a submission the doctor had made to a Web site known as Outbreak (see sidebar: “Epidemiology at the Web Cafe”), for which Woodall serves as chief of the scientific review team. When the physician mentioned he had seen a case of yellow fever, Woodall promptly asked him to post a case report on ProMED, which led to the WHO and Pan American Health Organizations (PAHO) learning of the situation. PAHO informed the Brazilian government, which initiated a vaccination campaign in Manaus to avoid a possible outbreak. “It’s a damn good thing they did,” says Woodall. “Six months later the same thing happened to an American tourist. He had been told to get vaccinated, but couldn’t be bothered. He went to the same area, went fishing on the Amazon, got sick, went through Manaus, waited overnight for a plane, and got back to Tennessee to die.”