Before the book was published, there was an extract published in The New Yorker, October 26, 1992, "Crisis in the Hot Zone." It covered all the main points that the book does. I would say that article had more of an impact than the book did. It was widely read, and inspired several Hollywood movie projects--one starring Jodie Foster, that ended up not happening, and the other starring Dustin Hoffman, which became Outbreak. The Jodie Foster one was a straight up adaptation of the story--they bought the rights to it. The Hoffman one was inspired by it, but had a quite different story, and the creators didn't have the rights to The Hot Zone so they were free to write their own story. Because of the article and these film projects, there ended up being a whole array of similar plague-themed projects that came out. There was an X-Files episode, for example, but there were also a number of others that I don't remember off the top of my head. Basically, I feel that The New Yorker article captured the public's imagination, in a way that actual plagues like AIDS did not. This in turn inspired a boom in international pandemic fiction that previously had only seen occasional books published, like Stephen King's The Stand and Crichton's Andromeda Strain in the 1970s. Though I wouldn't be surprised if the decision to adapt The Stand into a tv miniseries was partially fueled by the vogue for plague stories. It feels like since that time, international pandemic stories have become a staple of fiction. Even with plots that existed earlier, like zombie stories, many gained an emphasis on the contagious, plague-like nature of it. Besides Outbreak and the X-Files episode, there were video games about plagues, 28 Days Later, 12 Monkeys, the new Planet of the Apes got a plague backstory, Carriers, The Doomsday Book, even World War Z and Contagion.