We report on the clinical, epidemiologic, and laboratory characteristics of the first case of human ehrlichiosis acquired outside the United States caused by an Ehrlichia sp. other than E. sennetsu. The patient, a 24-year-old woman, presumably acquired the infection in Mali in northern Africa; the diagnosis was made when she returned to North America. The patient reported a fever and diarrhea a week before she left Mali; the diarrhea resolved, but the fever and chills continued. She also reported intermittent tingling in both hands and feet and muscle discomfort. Her temperature was 37.8 degrees C and her pulse rate was 100 per minute. She had two erythematous maculopapules (0.5 x 0.7 mm) on her thigh and ankle that resembled infected insect bites. Her hemoglobin level was 148 g/l with normal indices, and her white blood cell count was 10, 500/mm3 with many atypical lymphocytes and platelets. This report is intended to increase physicians' awareness of ehrlichiosis in foreign travelers and other patients, and suggests the need for further research to determine the prevalence and distribution of this disease.

Reported concern and commitment to recommendations decreased rapidly. Initial university messaging and response was critical in shaping participants' later perceptions.

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To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the child's parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.