Excerpt

It was obvious to participants at the workshop that a significant impasse has developed in the world of Lyme disease. There are conflicts within and among the science; policy; politics; medicine; and professional, public, and patient views pertaining to the subject, which have created significant misunderstandings, strong emotions, mistrust, and a game of blaming others who are not aligned with one’s views. Lines in the sand have been drawn, sides have been taken, and frustration prevails. The “walk in the woods” process of conflict resolution or a similar process seems necessary for creating a new environment of trust and a better environment for more constructive dialogue to help focus research needs and achieve better outcomes. Such a process does not imply a compromise of the science but rather is needed to shift to a more positive and productive environment to optimize critical research and promote new collaborations.

Contents

• The National Academies
• Committee on Lyme Disease and other Tick-borne Diseases: The State of the Science
• Reviewers
• Preface: A Walk in the Woods
• Acronyms
• Overview
  • EMERGING INFECTIONS, TICK BIOLOGY, AND HOST–VECTOR INTERACTIONS
  • SURVEILLANCE, SPECTRUM, AND BURDEN OF TICK-BORNE DISEASE, AND AT-RISK POPULATIONS
  • PATHOGENESIS
  • DIAGNOSTICS AND DIAGNOSIS
  • PREVENTION
  • SUMMATION
• 1. Introduction
  • THE GENESIS OF THE WORKSHOP
  • THE COMMITTEE APPROACH
• 2. An Overview of Tick-Borne Diseases
  • A SYSTEMS APPROACH TO UNDERSTANDING TICK-BORNE DISEASES: PEOPLE, ANIMALS, AND ECOSYSTEMS
  • DISCUSSION
• 3. The Social Construction and Human Face of Tick-Borne Disease
  • THE SOCIAL CONSTRUCTION OF LYME DISEASE
  • THE HUMAN FACE OF TICK-BORNE DISEASE INFECTIONS
  • DISCUSSION
• 4. Emerging Infections, Tick Biology, and Host–Vector Interactions
  • EMERGING AND REEMERGING TICK-BORNE INFECTIONS: GENETIC MANIPULATION OF INTRACELLULAR TICK-BORNE PATHOGENS
  • NATURAL HISTORY OF TICKS: EVOLUTION, ADAPTATION, AND BIOLOGY
  • WILDLIFE AND DOMESTIC HOSTS: THEIR IMPORTANT ROLES IN MAINTAINING AND AMPLIFYING PATHOGENS AND THEIR CHANGING DYNAMICS
  • DISCUSSION
  • COMPARATIVE MEDICAL IMPORTANCE OF A ONE-HEALTH APPROACH TO EMERGING TICK-BORNE DISEASES
  • VARIATION OF BORRELIA SUBSPECIES: IMPLICATIONS FOR HUMAN DISEASE
  • DISCUSSION
  • CONCLUDING THOUGHTS ON EMERGING INFECTIONS, TICK BIOLOGY, AND HOST–VECTOR INTERACTIONS
• 5. Surveillance, Spectrum, and Burden of Tick-Borne Disease, and At-Risk Populations
  • LANDSCAPE OF LYME DISEASE: CURRENT KNOWLEDGE, GAPS, AND RESEARCH NEEDS
  • LYME DISEASE: APPROACHES TO UNDERSTANDING A MULTIDIMENSIONAL DISEASE
  • DISCUSSION SESSION
  • THE INCREASING HEALTH BURDEN OF HUMAN BABESIOSIS: CLINICAL MANIFESTATIONS, COINFECTION, AND RESEARCH NEEDS
  • EHRLICHIA AND ANAPLASMA: SURVEILLANCE, COINFECTION, AND RESEARCH NEEDS
  • RICKETTSIA DISEASES: SPECTRUM OF DISEASE, SPATIAL CLUSTERING, AT-RISK POPULATIONS, AND RESEARCH NEEDS
  • DISCUSSION SESSION
  • PANEL DISCUSSION SESSION
  • GENETIC AND ACQUIRED DETERMINANTS OF HOST SUSCEPTIBILITY AND VULNERABLE POPULATIONS
  • AT-RISK POPULATIONS FOR BABESIA
  • DISCUSSION
• 6. Pathogenesis
  • PATHOGENESIS OF BORRELIA BURGDORFERI INFECTION AND DISEASE
  • DURATION OF SPIROCHETE INFECTION FOLLOWING ANTIBIOTIC TREATMENT IN ANIMALS
  • DISCUSSION
  • ANTIGENIC VARIATION AS A MECHANISM FOR PERSISTENT BORRELIA INFECTION
  • COLLAGEN SEQUESTRATION AS A MECHANISM FOR PERSISTENCE OF BORRELIA BURGDORFERI
  • DISCUSSION
  • PATHOGENESIS OF EHRLICHIA AND ANAPLASMA INFECTION AND DISEASE
  • PATHOGENESIS OF RICKETTSIAL INFECTIONS
  • DISCUSSION
  • CONCLUDING THOUGHTS ON PATHOGENESIS
• 7. Diagnostics and Diagnosis
  • DIAGNOSTICS FOR LYME DISEASE: KNOWLEDGE GAPS AND NEEDS
  • IMPROVED DIAGNOSTICS AND NOVEL APPROACHES TO TICK-BORNE DISEASES
  • POTENTIAL BIOMARKER APPLICATIONS FOR LYME DISEASE: ALIGNING MULTIPLE SYMPTOMS WITH BIOLOGICAL MEASURES
  • DISCUSSION
  • PANEL: CHALLENGES FOR CLINICIANS IN DIAGNOSIS AND MANAGEMENT OF CHRONIC ILLNESS MANIFESTATIONS: KNOWLEDGE GAPS
  • DISCUSSION
  • CONCLUDING THOUGHTS ON DIAGNOSIS AND DIAGNOSTICS
• 8. Prevention
  • CURRENT VACCINES FOR TICK-BORNE DISEASES AND VACCINE DEVELOPMENT
  • DEVELOPING OPPORTUNITIES FOR FUTURE VACCINES
  • DISCUSSION
  • EDUCATION, BEHAVIOR CHANGE, AND OTHER NON-PHARMACEUTICAL MEASURES AGAINST LYME AND OTHER TICK-BORNE DISEASES
  • VECTOR- AND HOST-TARGETED STRATEGIES FOR PREVENTION OF TICK-BORNE DISEASES
  • DISCUSSION
  • CONCLUDING THOUGHTS ON PREVENTION
• 9. Closing Panels
  • CRITICAL NEEDS AND GAPS IN UNDERSTANDING TICK-BORNE DISEASES: PRACTICING PHYSICIAN PERSPECTIVE
  • CRITICAL NEEDS AND GAPS IN UNDERSTANDING TICK-BORNE DISEASES: PATHOGENESIS PERSPECTIVE
  • CRITICAL NEEDS AND GAPS IN UNDERSTANDING TICK-BORNE DISEASES: RESEARCHER SPECIALIZING IN EHRLICHIA AND ANAPLASMA
  • CRITICAL NEEDS AND GAPS IN UNDERSTANDING TICK-BORNE DISEASES: THE GLOBAL PERSPECTIVE
  • CRITICAL NEEDS AND GAPS IN UNDERSTANDING TICK-BORNE DISEASES: THE PATIENT PERSPECTIVE
  • PANEL DISCUSSION
  • FINAL SUMMATION AND CLOSING REMARKS
• References
• Appendixes
  • A Commissioned Papers
  • B Federal Funding of Tick-Borne Diseases
  • C Summary of Public Comment on Agenda
  • D Workshop Agenda
  • E Public Comment Summary
  • F Speaker Biosketches

This project was supported by Contract No. N01-OD-4-2139 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.