The presentations summarized in this document represent the views of the individual speakers and should not be interpreted as a consensus or an endorsement by the Institute of Medicine, the committee, or its sponsors. Furthermore, the committee recognizes that the language and terminology used to describe various facets and manifestations of Lyme disease and coinfecting conditions are not uniform throughout the report—this reflects differences in scientific perspective among speakers and authors. As highlighted by many presenters, a standard lexicon that is consistently applied and understood would improve and advance research efforts related to Lyme disease and other tick-borne diseases. Furthermore, addressing the major knowledge gaps identified in this report is likely to lead to standardization of terminology as the unknown becomes the known.

The following sections of the overview summarize the committee’s highlights of presentations and discussions from the scientific portion of the agenda. The committee appreciates the time and efforts of the presenters and commissioned paper authors and the many participants who shared their stories to provide a context for these discussions. The interactions with patients and advocates were useful and constructive and served as an effective reminder of why scientific observations and gaps in knowledge need to be filled. Science is lagging behind as the burden of these diseases increases. The reader is directed to Chapter 3 for the rich presentation of participant views.

EMERGING INFECTIONS, TICK BIOLOGY, AND HOST–VECTOR INTERACTIONS

The recognized number of serious diseases transmitted by ticks has increased over the past 30 years. The emergence and increased incidence of several major TBDs has been attributed to specific human activities and behaviors that disrupt ecosystems. Increases in human population and demographic shifts have brought dramatic changes in the distribution and composition of natural habitats, as people modify the land for living spaces, agriculture, or recreation. These changes mean that people and animals interact at many more interfaces, creating new opportunities for the transmission of zoonotic pathogens, including those responsible for TBDs. This session examined the natural history of ticks and their wildlife and domestic hosts; outlined the contributions of animal health experts to understanding human TBD; explored genetic diversity among pathogens, vectors, and hosts; and showed how scientists are investigating the microbial community found within the ticks themselves. During the session, the individual speakers highlighted a number of research gaps and opportunities for studying TBDs. Some of these gaps and opportunities cut across individual presentations and comments from the audience. A few of the themes discussed included



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