Tick-Borne Disease Working Group Meeting #3 – Breakout Session 1

Operator: And welcome to the breakout session
topic: “Disease Vectors, Surveillance, and Prevention.” As a reminder, subcommittee members please
press star six to mute and un-mute your lines. I will now turn the conference over to Pat
Smith and Ben Beard. Go ahead. (Silence.) Ben Beard: Hello, Pat. Are you there yet? Pat Smith: Yep. I’m here. Sorry. I had to get un-muted. Okay. We’d like to welcome you to our subcommittee
meeting today and we certainly, Ben and I, want to thank you for agreeing to serve on
our committee. And at this time — because we have a very
ambitious agenda — we are going to just quickly introduce ourselves very briefly if we can,
and I will call your name and ask you then to give your brief introduction. I’ll start with myself, Pat Smith. I’m President of the Lyme Disease Association. Uh, prevention, research, and patient support
is our mission and I also… I’m on the Congressionally Directed Medical
Research Programmatic Panel. And additionally, I work with Columbia University
on their advisory committee to their research center. Also, two of my children – in the ’80s – developed
Lyme disease and I have been involved now for 34 years. And Ben, would you go next, please. Ben Beard: Thanks, Pat. This is Ben Beard. I’m Deputy Director of CDC’s Division
of Vector-Borne Diseases and you know, I’ve been here at CDC for approximately 28 years. And before that, I had worked previously in
the area of vector-borne diseases, both nationally and internationally. Thank you. Pat Smith: Uh, Jill. Jill Auerbach: Hello, my name is Jill Auerbach
and, um, I originally had Lyme disease – undiagnosed for about a decade. And finally, in the early ’90s, um, leave
my job as assistance programmer at IBM because I was so sick. And within a year, I really thought that my
life was over. And finally, somebody turned me to a physician
that could help and indeed I did have Lyme disease and I had that validated down at Stony
Brook, because I’m one of those people that says like Missouri, “Show me.” So, finding that, I was like delighted. I thought, “Two aspirins and I’ll be better
in the morning.” So, it was a big surprise to find out that
wasn’t the case, and that’s when I dug in. So, the first association I have is with Hudson
Valley Lyme Disease Association, of which I’m chairperson; um, then with the Dutchess
County Legislative Tick Force, of which I’m a member; Stop Ticks On People, which I’m
a board member; Federal Coalition on Lyme and Tick-Borne Diseases, New York State Coalition,
New York State Senator Serino’s advisory board, I’m a co-chair; and started Tick
Research to Eliminate Diseases. I’m a coordinator of the scientific coalition
and also, not to say the least, but Public Integrative Test Management Workgroup. So, I’ve been buried in this, and I strongly
believe that we’ve got to do something about preventing disease. We’ve got to protect our future generations. Thank you. Pat Smith: Okay, Jill. Neeta. Neeta Connally: So this is Neeta Connally. I’m a professor of biology at Western Connecticut
State University. My educational background is in medical entomology
and also in public health. So, the work that I do here at Western is
specifically related to research surrounding prevention and vector ecology as it relates
to the prevention of Lyme disease and other tick-associated illnesses, those specifically
associated with the black-legged tick in the Northeastern United States. And most of the studies that we work on are
focused in the peri-domestic or backyard environment. Thank you. Pat Smith: Thank you. Katherine. Katherine Feldman: Yeah, hi. Thank you, Pat. Um, Katherine Feldman. I am a senior epidemiologist at the MITRE
Corporation, which is a corporation that runs, uh, federally funded research and development
centers to help federal agencies think through problems. But that’s really new to me. I’ve only been here a month or two. Um, prior to that I was at Maryland Department
of Health for over 10 years, and prior to that, um, spent a few years with the CDC and
with the California Department of Health. Um, at the Maryland Department of Health I
was the Chief of the Center for the Zoonotic and Vector-Borne Diseases, and in that role
was responsible for vector-borne disease surveillance and investigation. I also had the privilege of being the part
of the TickNET, um, program with CDC and other state health departments. So, I’ve been involved in both bread-and-butter
public health surveillance of tick-borne diseases, as well as participating in applied research
for tick-borne diseases. I’m a veterinarian by training, and also
have degrees in epidemiology with a master of public health and other certifications
in epidemiology, and I’m delighted to be part of this subcommittee and part of the
federal effort. Pat Smith: Thank you. Tom. Thomas Mather: I’m Tom Mather. I’m a PhD and professor of public health
entomology at the University of Rhode Island. I’ve been involved in black-legged tick
research, ecology, and control since 1983, and I currently serve as the director of the
URI Center for Vector-Borne Disease and its TickEncounter Resource Center. Pat Smith: Thank you. Phyllis. (Silence.) Is Phyllis Mervine here? Phyllis Mervine: Yeah. Hi. I was on mute. Uh, my name is Phyllis Mervine, and I’m
the founder and president of the patient advocacy nonprofit LymeDisease.org. Um, I was infected with Lyme in northern California
in 1977. I was finally diagnosed and treated in 1987. So, I thought my life was over, too, but it
wasn’t. Luckily I met a doctor who treated me long-term
and I got better, but it took a long time. And I am currently, um, Editor in Chief of
the Lyme Times, which is now a digital, but for many years was a paper magazine that went
out across the country and I’ve worked a lot with epidemiology — no, I’m sorry — entomologist
Bob Lane from UC Berkeley, who’s done a lot of tick studies in my area, and so I’ve
learned a lot from him. And I’m happy to be on this committee, and
I don’t know what else to say, but if you have any questions, I’ll take them. Pat Smith: Thank you. Robin. Robin Nadolny: Hi everybody. My name is Robin Nadolny, and I work for the
Tick-Borne Disease Laboratory at the Army Public Health Center, where I’m the program
coordinator of the Tick-Borne Disease Lab. I’ve been working in this position for almost
2 years, and I took over from Ellen Stromdahl, who many of you will know, uh, who ran this
program for the last 20-some-odd years before me. We run the DOD Human Tick Test Kit Program,
where we basically have a passive surveillance program. Anybody that’s affiliated with the Department
of Defense that gets a tick bite can submit that tick to us for identification and testing,
and they use that information that we provide as actionable evidence when they go to their
physicians and try to determine what to do about a tick bite. Um, we also use that information for surveillance,
and we have a lot of information from a lot of installations throughout the United States,
going back 20-plus years just seeing where…what the distributions of ticks and tick-borne
pathogens are throughout the United States. I’ve been working in the arena of ticks
and tick-borne diseases for about eight years now. I started in 2010, working with Dr. Holly
Gaff at Old Dominion University, and I worked with her for a number of years before completing
my PhD in tick ecology, focusing on the tick range expansions in 2016. And after that, I’ve been here at the Army
Public Health Center in Maryland. Pat Smith: Thank you very much. Adalberto. Adalberto Perez De Leon: Hello. Was that Adalberto Perez De Leon? Pat Smith: Yes. Adalberto Perez De Leon: Ah, thank you. Hello everybody. Excuse me. My name is Adalberto Perez De Leon. I am a veterinarian and an entomologist by
training. And currently I serve as Director of the U.S.
Department of Agriculture, Agricultural Research Service, Knipling–Bushland U.S. Livestock
Insects Research Laboratory. And the laboratory has a rich history of doing
research to control or eradicate ticks that are also vectors of diseases that affect normally
animal populations, but humans as well. Interesting note here on the history, uh,
the U.S. Department of Agriculture in the late 1800s discovered and documented for the
first time that ticks were able to carry microbes that cause diseases. So, there’s a rich history of this type
of tick control and/or eradication research that translates into technologies that can
deal with the diseases themselves. So, we’re very honored to be part of this
effort and more recently we have also contributed to diagnostic tests for tick and tick-borne
diseases and in particular, to the thing that we are addressing. It’s important to note that the situation
has global implications. Of course, we are dealing with Lyme disease
here in the U.S. It’s a major pandemic, but ticks and tick-borne
diseases are a huge problem around the world. Thank you. Pat Smith: Thank you. Daniel. Daniel Sonenshine: Hi, this is Dan Sonenshine. Um, I hardly know where to begin. I’ve been actively studying ticks since
the late 1950s. I’m a retired professor from Old Dominion
University, now a guest researcher at the LMVR, Laboratory for Malaria and Vector Research
at the NIAID, NIH, in Rockville, Maryland now, and also the author of the book Biology
of Ticks and several hundred articles on the subject. Thanks. Pat Smith: Thank you. Uh, Jean. Jean Tsao: I just got in. Pat Smith: Perfect timing. Jean Tsao: Hello everyone. Okay. I didn’t hear you. So, I’m Jean Tsao, um, Michigan State University,
Department of Fisheries and Wildlife, and Large Animal Clinical Sciences. Pat Smith: Thank you. Uh, Monica. Monica White: Hi, I’m Monica White. I’m President and Co-Founder of Colorado
Tick-Borne Disease Awareness Association, focused on education, prevention, research,
advocacy, including patient support. I’m also a member of the Public Tick IPM
Working Group. I am a former wildlife biologist and wildland
fire fighter for the U.S. Forest Service. I had to leave my job due to my infection
with Lyme disease. And most importantly, I am a mother and wife
of family impacted by Lyme. Pat Smith: Thank you. Stephen. Stephen Wikel: I’m Stephen Wikel. I’m Professor and Chair Emeritus of the
Department of Medical Sciences at the School of Medicine at Quinnipiac University. Previously, I was Professor of Pathology at
The University of Texas Medical Branch and Senior Scientist in Biodefense and Emerging
Infectious Diseases, the national laboratory there. I have 45 years of experience working on the
immunology and other aspects of the tick-host pathogen interface, and have extensive experience
broadly across ticks, tick-borne diseases, particularly in terms of things such as the
tick genome, of which I was one of the co-authors of the white paper that was successful on
finding…funding for the Ixodes scapularis Project. Thank you. Pat Smith: Thank you. Have I missed anyone on this call? (Silence.) Okay. I’m seeing none. The slides, uh, the purposes of the subcommittees
and the purposes to support the working group by providing, assessing, and synthesizing
evidence; identifying, assessing, and summarizing the data; identifying the gaps; prevent new
cases; improve diagnoses; and improve the care and treatment of people living with tick-borne
disease. Now, there are some things that we need to
say that will not be listed on this slide. Um, the working group will write the report
to Congress and the HHS Secretary, but the subcommittees will provide them with most
of the… Phyllis Mervine: Are we supposed to be seeing
a slide? Pat Smith: No. I think… I’m sorry. You must not have heard me. This is not on this slide, but they asked
us to address this. Phyllis Mervine: I don’t have any slides. Okay. Jill Auerbach: I don’t either. Pat Smith: You don’t have any slides? Male: If you’re connected to the web link,
you should be seeing a slide if you logged into the webinar itself. I’m seeing one right now that says, “Purpose
of Subcommittees” and it’s got four green boxes, which is what Pat is talking through
right now. Male: Yeah, we see it. Pat Smith: Right. Male: It’s available on the screen. Jill Auerbach: I don’t have that. Phyllis Mervine: Yeah. I have a complete blank. So maybe I should click again on the link
to join the subcommittee. That’s what I did and I got a blank. Pat Smith: I would click a box, Phyllis. Is that you, Phyllis? I would go into the box, the chat box, for
help. Phyllis Mervine: The chat box? (Echo sound recurring.) Pat Smith: Okay. There’s a chat box on the lower right-hand
part of your screen. Phyllis Mervine: Yeah, no. I don’t have a chat box. I don’t have anything. It just says, “Check for our troubleshooting
page.” There’s a link. I had this problem before, and I communicated
back-channel with Jennifer, so, and she…suddenly it came on. So, I don’t know what’s the problem. Pat Smith: But this is Phyllis, right? Phyllis Mervine: Yeah, Phyllis. Now how many other people are having this
problem? Maybe it’s just me and Jill. Jill Auerbach: Okay, Phyllis. Phyllis, log out and come back in. I got it by doing that. Phyllis Mervine: Okay. Katherine Feldman: This is Katherine. Um, I… They just sent out a new email with links
to all the subcommittee groups. And so, my first time in I couldn’t get
in, but when I clicked on the link that was in the email, it got me in. Phyllis Mervine: Okay. Oh, here we go. Okay. Pat Smith: Okay, I think we’re going to
have to move along while you’re getting… Phyllis Mervine: Yeah. Go ahead. Go ahead. I’ll just listen. Pat Smith: Okay. So this will… This verbiage will not appear on this slide,
but it’s a part of this section of the purpose. The working group will write the report to
Congress and the HHS Secretary, but the subcommittees will provide them with most of the information
that is used to develop the report. We’ll also highlight a number of opportunities
that may inform the recommendations the working group develops. The subcommittee is responsible for completing
an overview of the issues, describing and identifying gaps in the federal response that
will be presented in writing and verbally to the working group members in May. Interim milestones include lists of potential
topics, priorities. Each group will address topics in priority
order, focusing in on about five to complete the full in-depth assessment. They will also provide a copy of their full
report at that time. Now, this portion was in the discussion this
morning if you were on the working group. We will talk about how we do this in a little
bit, but we could… This could involve looking at existing systematic
reviews; scientific articles published in the peer-reviewed literature; other articles
and conference presentations; reports and other documents published by agencies, organizations,
and programs; presentations from subject matter experts, patients, family members, and their
providers; input from public comment; town hall sessions, as well as the verbal and written
remarks; the inventories of HHS and DOD programs and activities — which of course we did discuss
this morning — um, the process of the report. Subcommittees will work on presentations and
reports to the working group for the meeting in May. When a document is ready to move forward,
the subcommittee members will be asked to review and vote on the document. The outcomes of votes will be determined by
a simple majority. The report and presentation to the working
group in May will make this info available to the public in draft format for written
public comment. The working group will then use the information
we provide to make decisions about what will be included in the report to Congress. Confidentiality: all information presented
during a closed meeting should be treated as confidential and, just to clarify this,
today’s meeting is an open meeting for the subcommittees. But as we go forward, those are not included
under FACA and will…in all likelihood not be, uh, will be subject to confidentiality. Due to the evolution of the report, all the
work done in the subcommittees is confidential until it has been released for public comment. Although it is not required for subcommittees,
one-page summaries will be produced for the subcommittee meeting showing names of all
persons who attended, presenters, and topics discussed. Purpose of this breakout session: we’re
here to review the work we’ll be doing together over the next 12 weeks. We’ll review the inventory of HHS and DOD
programs and discuss the National Town Hall and touch on next steps. Timeline — the initial major milestones to
get us started: on February 15, we’ll send the final inventory tool to HHS and DOD for
completion and, of course, we’ll be discussing that shortly. February 23rd: develop a set of issues, questions,
and priorities. March 9: background section of report to the
Tick-Borne Disease Working Group. A full timeline with all major milestones
will be provided to the subcommittees of the Tick-Borne Disease Working Group so that final
products are produced in time for the meeting in May. And May 4: there’ll be a full report and
slides. Inventory: at the end of this breakout session,
this subcommittee should be able to provide feedback to the working group about additional
information they need to capture in the inventory, and that is the inventory that we’ll be
providing to the government. The purpose of the inventory of HHS tick-borne
disease projects and activities is to provide a summary of HHS activities related to tick-borne
diseases, including what the agencies are doing and spending each year with regard to
TBD; epidemiological activities related to the *** (unclear due to background noise-
00:22:03); basic clinical and translational TBD research related to the parthenogenesis
prevention, diagnosis, and treatment of TBDs; and gaps in TBD research described above. So, at this point in time, we are looking
to see in Category A, of the inventory review, are there any other relevant things that should
be included from the perspective of our subcommittee? So, the current listing of categories are:
“Prevention,” “Vector Control Education,” “Basic Research,” “Research Diagnostics”
(plural), “Research Vaccine,” “Research Treatment,” “Research Vector Control,”
“Epidemiology,” and “Surveillance,” “Research-Human Translational Research Involving
Human Beings,” “Medical Care and Treatment,” “Testing Programs,” “Mental Health Services,”
“Mental Health Support Groups,” “Other Supportive Services,” “Capacity Building
and Technical Assistance,” and “Policy Development.” So, at this time what I’m going to ask is:
before you speak, if you would please identify yourself, and I would ask Ben if he could
basically take over the comments that are coming in from this. Okay. Does anyone have any questions? Jill Auerbach: I’d love to speak. It’s Jill Auerbach. Um, I’m not quite certain where beneficial
animals would come in there, uh, you know natural ones in nature, such as opossums,
wolf spiders, red fox versus coyotes, etc. And of course, the “Vector Control,” I
guess, would cover the mice, chipmunks, shrews, deer, and in California, the squirrels and
wood rats, but another thing that I have a key interest in is…and I find it very disturbing
that – and the CDC had no choice with this – but I’m just going to talk about, um,
the natural nootkatone, which is food-grade to humans. It kills mosquitoes and ticks but not honeybees. It’s currently being used in food and fragrance
products. CDC testing demonstrated that the soap wash
caused infected ticks to drop off mice, killing 85% of them. No mice were infected. Since most tick pathogens transmit in over
12 hours, a nightly shower or a bath with the nootkatone soap could prevent many, if
not most, diseases. Simple, safe, inexpensive, no new habits to
establish. It would be used by the public. Compliance would be much better than tick
checks and would remove minuscule ticks that we don’t find on ourselves. The CDC has had a patent for 14 years but
has not had funding to move it forward. There’s something terribly wrong with this
picture when funding and profitability by companies prevent effective preventions coming
to market. And I think that as a group, there’s something
wrong here, and we must consider how we can rush a stopgap measure for this as a personal
care product to the public. So, that’s what I have to say. Pat Smith: Jill, this is too specific, I think,
Jill, at this point. I don’t think we’re going that specific. We’re looking at categories. So, I would ask that we just stick to what
additional categories are necessary. We’re not going into the specifics at this
point in time and I ask that please keep your comments, you know, on that issue. So, did you have a specific category that
needed to be listed in addition to the ones that were here? Jill Auerbach: Uh, I’m just trying to think
of what that might fit in, but “overlooked research” or “problems with funding.” I don’t know. Ben Beard: I think… This is Ben. I think maybe… Stephen Wikel: ***.
Ben Beard: Go ahead, Steve. Stephen Wikel: Oh, sorry. I would think one area that we might want
to look at is whether, you know, the various agencies, what they’re doing in terms of
integrated tick management strategies. Another category that I think might be relevant
is what’s actually being put together, and I know that CDC has been the main source and
has done a really excellent job. But in terms of educating physicians about
the changing patterns of where tick distributions are occurring, as well as things that should
have been — newer diseases — that are being developed, what kind of information is out
there or is being used in those areas? Ben Beard: So, maybe I can comment on those. This is Ben, and I would just say, with regard
to Jill’s comment, that I think maybe this category of research… and to vec… “Research Vector Control,” that’s on
the list here on… “Novel Vector Control” would give us a
chance to address that in our subcommittee. And Steve, with regard to your comment, I
think that the whole idea of the agency inventory that’s being done should pick up a lot of
that. And there was a report, a white paper, on
tick-borne disease integrative test management that we published a few years ago. Dan Strickman and I were the editors on that,
and there’s an update up until about like 2014, maybe on that, and I think we will build
on that as we query and inventory federal agencies and activities, but I agree. All of that is really important information,
and I think we’ll get into the granularity of that when we meet as a subcommittee and
get into more detail. But those are both really good comments, and
I think we’ll have those covered. Over. Stephen Wikel: Thank you, Ben. Katherine Feldman: This is Katherine. Pat Smith: Do you have any other indications
of any places that we are missing a category here? Katherine Feldman: Yes. So, it’s Katherine. You have epidemiology and surveillance. Those are two different things. So, you might want to separate them out. And then I’d also suggest that surveillance
— I don’t know if it’s just mentioned — there could be vector surveillance versus
surveillance of a human disease. So, I don’t know if those are worth distinguishing,
so that later on we know what folks are looking at: vector versus human surveillance. And then the other comment I was going to
make on the categories is that I… It is not clear to me what research…human
translational…research involving human beings…means and so, if I were completing this, um, I would
be confused by that. Pat Smith: Well, I think that that is really
what we’re looking for, ones for our subcommittee, I think, at this moment in time. And so, Ben, I’m not sure that that applies
to us in this particular category? Ben Beard: Yeah. I would think that… Uh, this is Ben. And I think that probably that this is going
to relate more to one of the other, like the vaccines and therapeutics or one of the other
committee’s treatment or something like that, more than in ours. But Katherine, just to reiterate your comment,
again, we’ll get into this when we get into the granularity of our task, but… Um, and so I don’t want to jump ahead, but
Pat and I have kind of broken down our committee into, you know, the disease vectors, surveillance,
and prevention. And we thought that maybe the whole thing
of human surveillance, we want to keep that apart from vector surveillance, but …. And
we have some talks and presentations – to bring people all up to speed – that we’re
going to be talking about as we move forward. So, I think that those comments will be gathered,
and I think the translational research will probably be more relevant to one of the other
subcommittees than to ours. Katherine Feldman: Right. My comment was just with the parenthetical
involving human beings. If I were, uh, completing this and I was doing
a TickNet project that wasn’t on therapeutics or vaccines, but I saw the category, it involved
human beings, I would feel compelled to check it. So, just pointing that out after a lot of
survey design experience, just… Um, and then at some point — maybe now is
not the time — but your comment about vector surveillance versus human surveillance, that
would be good to clarify and to distinguish that this subcommittee is not focused on human
surveillance. Um, I would appreciate that clarification
at some point. So, thank you. Ben Beard: Actually, it will be focused on
both. So, I think that there are… In this part of the… When the working group was put together, there
were concerns in both of these, and there’s a sense in which, you know, I see these probably
as you — as being two completely different areas, but they did get linked together here. But we will definitely draw the distinction
between the two. And surveillance has its own issues, and it
will be covered in our group, but it will be covered separately from vector surveillance,
if that makes sense. Katherine Feldman: Okay. Great. Thank you. Thank you for that clarification. Jill Auerbach: I have one suggestion on prevention,
that it be split into two parts: personal prevention and landscape or environmental. Ben Beard: Thanks, Jill, and I think we’ll
probably wait to get into the granularity of all this until a little bit later, but
yeah, I certainly agree with your thoughts there. Jill Auerbach: And one other question is,
where would, as far as Eisen’s recent findings that most people contract Lyme disease on
their own property… Ben Beard: I think that that’s also covered
under this issue of prevention and vector control. It’s covered… What we want to do right now is just make
sure these current listings of categories are going to be really, um, they cover all
the issues that we’re dealing with. We’re going to get into the granularity
of this a great deal as we move forward, if that’s okay with all. Phyllis Mervine: Um, this is Phyllis. I have a question. Can I ask a question? Okay, I don’t… I’ve been looking up stuff while we were
talking and so I’m not clear that the *** (indistinct – 00:33:02) column really belongs under our
subcommittee, but I’m not… I don’t know. To me, that seems a little bit broad. But I wanted to ask Ben about the mapping,
the risk mapping, and whether that would, um, be under one of the topics that’s down
there referring to papers like Lars Eisen’s “High Acarologic Risk Site Model,” um, and
I thought that was a really important study because it showed that people that lived close
to any of those high-risk habitats that they modeled on their map were much more likely
to contract Lyme disease, including in southern California where it’s not really known to
be common. Ben Beard: Yeah. Hi, Phyllis. This is Ben. Thanks for that comment. And yes, I think that that’s really important
work to the purview of our subcommittee and I would see that fitting under “Prevention”
and also kind of “Vector Control Education” knowing…and “Research Vector Control;”
several of these different categories and so yes. I think that’s a really important area of
research to summarize in our group. Pat Smith: Yeah, and could I just make a clarification? This is Pat. Um, the clarification is: all of these categories
are not under our group. Okay? These are the categories that are in the inventory
review document that’s going to go out to the government, and they’re going to have
to check off which of these categories their particular agency or whatever does. So, these are not all ours. What we’re looking for is under the ones
that would fit under ours; have we missed any? We have “Prevention,” “Vector Control,”
um, you know, things like that. We don’t have, necessarily, all of these. So, if you see something for our committee
that is not addressed in a general category, that’s what we’re trying to ascertain,
and I know it’s confusing, but this is how they put the slides up. So, thank you. Jill Auerbach: So, is there one for, um, for…
funding for tick research? Pat Smith: I’m sorry. Repeat that Jill. Jill Auerbach: Well, there’s acute funding
for tick research, and right now what happens is these talented scientists retire and because
there’s no real funding, there’s nobody to replace them. The new scientists, the new graduates go into
other fields. So, we have a loss of knowledge. There’s a knowledge base loss and a period
of training where somebody who’s leaving a position can train somebody and hand things
over. That gets lost. That happened at IBM. So, I’m very keen on that. Monica White: Hi. This is Monica. I’m sorry. I was just wondering if… Jill, that might fit under, like, “Vector
Research Period.” Pat Smith: Well, I think that — and Ben,
correct me, if you think it’s something different — but I think that what’s going
to happen here is that we are asking the agencies for information on the resources that they
provide and resources would certainly include financial, and the questions that are asked
in the document are based also on financial. So, I think that’s already covered. Jill Auerbach: Where do you see that, Pat? I don’t see that listed here. Pat Smith: Well, that’s on the document,
which it was my understanding you got, but maybe you did not. The inventory of HHS tick-borne disease project
***… (indistinct – 00:37:15.) Jill Auerbach: You mean the ***? (Indistinct
– 00:37:18.) Pat Smith: …provide information on the resources
provided by your agency or office that support improvement and stability response. That is on the actual document. This is just the category section of the document
that you’re looking at. Ben Beard: Yeah and just to be certain… On Section D it says, “Complete information
in the table below. Be as descriptive as possible. Total funding may apply. 17 total funding for FY18.” So, it gets into a lot of granularity, numbers
of FTEs, numbers of fellows and contractors. You know, we’re working on these areas of
activities. So, I think that that will come out in the
inventory. Thomas Mather: Ben and… Jill Auerbach: Okay. Thank you. Stephen Wikel: Ben and Pat, this is Steve
Wikel. Thomas Mather: Um, it might be appropriate,
though, under the “other” just to include training. Pat Smith: I’m sorry. Who’s speaking, please? Thomas Mather: This Tom Mather. Pat Smith: Oh, Tom. Thank you. We need that for the person taking the record. Thomas Mather: I was just suggesting that
maybe to capture all of this in a very clear way from an inventory box kind of thing. If you just put under “training,” because
you would be able to know what allocations you’ve made for training, like your new
vector biology training centers, for instance. Pat Smith: Ben, what’s your thought on that? Ben Beard: Yeah, I think that that will… I’m sure that will get captured. I’m just trying to see if it falls out anywhere
here. There’s one for “Capacity Building and
Technical Assistance,” and “Other.” So, yeah, we’ll make a point of that to
make sure that training gets addressed in here. Thanks, Tom. Thomas Mather: Uh huh. Daniel Sonenshine: This is Dan… Stephen Wikel: Uh, Ben and Pat. This is Steve Wikel. I have a question about where this inventory
will go. I noticed that the email this morning, it
said, “HHS and DOD.” Will the USDA also be seeing this? I’m thinking about the implications that
we’re going to probably be asked about One Health type issues dealing with tick and tick-borne
diseases and given the USDA’s research agenda. Ben Beard: Yeah. Thanks, Steve. That’s a good question, and I would definitely
like to see that go both to USDA and EPA, as well. And, for that matter, there’s USGS and several
other stakeholders that are doing this type of work, so. But for starters — and you know this whole
effort has been kind of fast and furious, and a lot of it occurred over the weekend,
getting all this organized, and I think people were thinking in very broad brush strokes. Obviously, it had to be HHS because of the
nature of the bill, “The 21st Century Cures Act” and… Stephen Wikel: Absolutely. Ben Beard: …then I think people thought
DOD because it was very obvious with the CDMRP program that’s dedicated, you know the Tick-Borne
Research Program, but I think it should be expanded and I’m sure Adalberto and others
can help us with USDA and we’ll have to reach out to the other agencies. So, I agree with that. Adalberto Perez De Leon: Yeah. This is Adalberto. Daniel Sonenshine: Why is… This is Dan. Adalberto Perez De Leon: I’m sorry. Daniel Sonenshine: Is there an update? Can anybody hear me? Adalberto Perez De Leon: Yeah. Dan, go ahead, please. Daniel Sonenshine: Yeah, I was just curious
if there was a place where there could be tick-borne disease training programs; where
universities could compete for, especially an inter-institutional type of tick-borne
training program, that would train people at the master’s and PhD levels. Ben Beard: I think… Yeah, thanks for that comment, Dan, and I
think that can be… you know, something that could be recognized as a gap and can be a
recommendation to have something more formal like that. You may be aware of the Centers of Excellence
Programs that were stood up by CDC. It’s a $50-million program with 10 Centers
of Excellence. They are not specifically in tick-borne diseases,
but all of the different centers have tick-borne disease efforts, and they have a number of
training opportunities that really address public health entomology, in general. But if this is seen as a gap, it’s a recommendation
that the subcommittee can make in the report. Daniel Sonenshine: Yeah, that’s why I bring
it up as a gap. Adalberto Perez De Leon: Hey, um, this is
Adalberto. Thank you, Ben and Steve, for your comments
before and yeah, certainly we welcome having the USDA there at the table, because as some
of you may remember, in 2010 the National Academy of Sciences actually had an exercise
of this type on the state of the research on Lyme disease and, as many of you will know,
I heard from the extraordinary group that we have here together, most of these tick-borne
diseases are stenotic. So, I think it was Steve that mentioned the
one health aspect that’s crucial to address. And so, with the more that…the USDA will
be more than happy to share with you an update on our research portfolio and some of the
technologies that we have been innovating recently in this research field. And also, in that regard, and to address the
comment made before, uh, maybe… I mean, I don’t know if it is separate from
translational research, but to me, it’s an aspect of it is… this aspect of finding
innovative ways to enable public/private partnerships. Because from the… I’m a researcher and most of the time we
come to a wall where we keep hitting…where we do a lot of research and it looks really
interesting. We may even patent the technology, but then
we come to this so-called “valley of death” in the research and development of new technologies
where we don’t find a way, because — for the most part, I think — and I guess, in
this case, speaking for myself, I am a federal research entity. I do not have the authority to be seeking
approval or registration of a certain technology of the product to commercialize it, and we
have to find private concerns that we can partner with to commercialize the technology
and then put it in the hands of the end user. So, for example, with the USDA we have the
small business research initiative where private concerns, especially small biotechs or small
companies, will compete for resources to enable and commercialize…go through the development
process and commercialize technologies, you know. So, I think that that would be an important
aspect to consider and then, more recently, working again with industry, especially the
animal health industry. We were able to bring a vaccine…the vaccine
technology for the Cattle Fever Tick Eradication Program and believe me, that takes time and
a lot of effort, but it can be done. And that’s an example of a public/private
partnership and then just to the chairman or chairwoman, as well, what is the product? Because we are supposed to report, right? At the end of our session we need to report
back and just a question on what that is, please? Pat Smith: Okay. Can I just ask at this time — I thank you
for all those comments — but we are actually running very short of time and we have deliverables
that need to be done. And so, the kind of input that you have is
wonderful. And I think that we certainly — uh, Ben and
I –we’re sure to include the USDA in on this committee, and we will be discussing
those issues in the future, but right now we really have to move along. If we don’t have any other categories, we
still have another section of this review that we have to go over. So, I would ask, unless there’s somebody
that has an absolute distinct category that needs to be included on here, um, I think
we’ll have to move along. And I would also ask that due to the nature
of this surveillance and how much, you know, dialogue has been spent on that, perhaps we
can ask them to put after the word “surveillance” in parens “human and vector,” and that
would clarify that for us, but it’s not necessarily a separate category. And other than that, what I think I heard
and someone can please correct me here, Ben or someone else, um, that we needed to somewhere
put “in training” and we can certainly mention to them about reports to the USDA. I believe those will be covered. I don’t think that they’re necessarily
a separate category here. Ben, do you have a quick comment on that before
we… Ben Beard: No. I’m fine with that. Thanks, Pat. Pat Smith: All right. Phyllis Mervine: Hey, Pat. Pat Smith: Yes. Who is this? Phyllis Mervine: Um, this is Phyllis. I put some stuff in the Q&A just for my own… I don’t know if other people can see it
too. Just for my own clarification. That little box on my screen that’s down
on the right side. Pat Smith: Yeah. I don’t know. Monica White: I cannot see anything Phyllis. This is Monica. Pat Smith: Phyllis, we have to really move
along. Do have a category or that you suggest? Phyllis Mervine: No. I just made a list, a cleaner list for my
own purposes of what actually applied to us from this big list so that I could see if
something was missing. So, I have down: “Prevention,” “Vector
Control Education,” “Basic research,” “Research Vector Control,” “Epidemiology,”
and “Surveillance Training Programs,” and “R&D Partnerships with Private Industry. Pat Smith: I like the last… Male: I see the comments there, Phyllis. Thank you. Pat Smith: Okay. I don’t know where you wrote that. So, I don’t see it. Robin Nadolny: Hi, this is Robin, also. I just wanted to jump in real quick before
we move along and say an additional category that we could add would be “Research Tick
Ecology,” and that would sort of be an umbrella that would capture a lot of what people like
Jill were saying about the way ticks interact with various hosts, also the way hosts interact
with various diseases in nature, with tick range expansions and tick spread; all that
sort of thing might be lumped in there. I could see that also going under a number
of other categories. So, it’s up to folks whether they think
that’s going to be valuable or not. Katherine Feldman: Katherine here. And I would say just “ecology,” which
would capture all of that. Robin Nadolny: Exactly. Phyllis Mervine: I like that. Jill Auerbach: Tick and vector ecology. Robin Nadolny: Yes, tick as well. Katherine Feldman: Well, just ecology. I mean if you want to study white-tailed deer,
that might not be ticks, so, but could be relevant to tick-borne disease. Robin Nadolny: Yeah, tick ecology, or I don’t
know, tick-host vector ecology or ecology. Ben Beard: I think… Jill Auerbach: You know, much of this has
caused a huge environmental problem. So, I really like the…your putting ecology
there because that kind of covers it. How do we fix the ecology? What can be done? What’s affecting it? What’s simple? What are some of the things that naturally
can prevent and what… We have to get information to people so that
they can protect themselves. And some of these things are really just knowledge
and simple and the other thing that we have to do is team up with, for instance… Um, I know there’s going to be a suggestion
made that mosquito control be linked with tick control. So, are there methodologies that we can use? Pat Smith: Jill, excuse me. We’re going to be cut off in five minutes,
and we have other deliverables. Ben, are we going to… Can we put in that tick ecology or not? Ben Beard: Yeah. This is a really, really general list here,
and I think that these are great comments. And I think it’s just unfortunate we’ve
not given good instructions on this, but when we get into the meat of the subcommittee,
I think all of these things are going to be addressed and we’ll work through this on
our next…you know when we have a subcommittee meeting, the next meeting. But let’s move on, or we’re not going
to get done at all. So, yeah, Pat, why don’t you take this slide. Pat Smith: Yes. Thank you very much. And remember, we only got this information
ourselves, actually, in the last few hours. Um, okay. Next slide is the inventory review. So, are there categories missing from Section
C that are relative to our subcommittee and should be included? Well, I know that there are, and I’m sure
that you know. So, if someone wants to go down the list of
what’s missing or I can go down a list of what’s missing or… Does anyone… Robin Nadolny: This is Robin. Uh, they do have a different category for
other tick-borne diseases. So, I mean this covers a lot, you know, a
lot of different things in the United States. There’s obviously, you know, more that could
be included, but do we need to…do we need to actually have a list of every single tick-borne
disease that we’re concerned about or does that “other” category kind of grab it? Pat Smith: Yes. But we have to… They want us to specify “other tick-borne
diseases specify.” So, I think that we do need to probably specify
just to make sure that the tick-borne diseases are not left out. Ben, what’s your thinking on that? Ben Beard: Yeah, again, I don’t know if
we have to give all the details right now, but we have… You know, there’s things like Heartland
virus and Bourbon virus that are missing here or there, the broader range of Lyme Borrelia
mayonii, and then the relapsing fever spirochetes. Those are generally listed here, but I think
for now, you know, unless someone just has their all-star agent that they want to put
on here. Of course, I’m sure a lot of people are
thinking Bartonella and I think our report will, you know, will have to address, you
know, “What do we currently know about tick-borne transmission of Bartonella? What has been… What in terms of Koch Postulates have been,
for vector-borne diseases, have been satisfied?” We don’t need to talk about that now, but
I think that we can… That’s something that the report will need
to address. What are the state of the science and what
needs to be done? So, I don’t know. I think, unless there’s some really burning
comments, we should move on. Jill Auerbach: Okay. Let’s move on. Yeah, if we need to, AGF is another one. Ben Beard: Right. Pat Smith: Well, we… We can move on and then when we report, when
we go back in and report, I’ll ask, if they want, that we do have other specific diseases
for other tick-borne diseases and if they want them there, we will provide those. Adalberto Perez De Leon: Hey, this is Adalberto. Really quick, could it be emerging and reemerging
tick-borne diseases as a big umbrella? Pat Smith: Ah. I don’t… I don’t know. What is everyone think about that? Stephen Wikel: I think that’s a very important
point, because I was just about to comment, there are number of unspecified agents that
may emerge as pathogenic in future years such as various rickettsias that are frequently
found in Ixodes scapularis and nobody knows what they’re there for, what they do, things
of that sort. Jill Auerbach: And we’ve got things like
Crimean-Congo hemorrhagic fever that haven’t made it to our shores yet, and Garth Ehrlich
also found about 50 different pathogens in the deer tick and separately in the lone star
tick, but that’s all preliminary. He hasn’t published it yet, and many of
those or a number of those were pathogenic to humans. So… Phyllis Mervine: So, what we need is stuff
to say “emerging.” Ben Beard: Yeah. Phyllis Mervine: Emerging. Adalberto Perez De Leon: And reemerging. Ben Beard: Emerging would be good. Jill Auerbach: Emerging and reemerging. Ben Beard: Emerging and reemerging. Jill Auerbach: Saying reemerging, what are
you thinking about in specific for reemerging? Pat Smith: Okay. I think “emerging and reemerging” is good
and we’re going to be cut off any second. So, about section… The next… I’m sorry. We have to move on. Section D: this is the current list of information
requested and…on these documents and total funding for FY17, 18 is available, 10 to 16
is available, uh, number of full-time employees, supported with funds; additional full-time
employees dedicated to TBD; number of fellows, contractors, or other support staff supported
with these funds. Which organizational units in your agency
or office have responsibility for TBDs? Which one of these, if any, has primary responsibility
for TBDs — name of director or chief of primary unit;
agency/person of contact for tick-borne disease? Does your agency or office have a strategic
plan for addressing TBDs, or are they included in your agency’s strategic plan or other
priority setting documents that guide your work? If yes, include a link to the documents or
attach a file. What are the strengths of your agency or office’s
response to TBDs? What are the future opportunities for improving
efficiency, effectiveness, and/or impact of your activities for TBDs? What do you see as the weaknesses of your
agency or office’s response to TBDs? What do you see as threats to the future of
your agency or office’s response to TBDs? What unmet needs have been identified through
your agency or office’s work on TBDs? What educational or training tools, tool kits,
products, or resources have been developed by your agency or office for TBDs? For 2017, the sole publications the agency’s
staff authored or co-authored about TBDs include surveillance or agency author’s reports;
provide links where possible. How does your agency or office engage in public
and other stakeholders in planning activities and obtaining feedback on activities? And I think that’s… That’s that list. (Chuckle.) Jill Auerbach: Who do they refer to as agency? Pat Smith: Go ahead, Ben. Do you want to address that? Ben Beard: Yeah. So, Jill, these are the queries that are going
out to HHS and DOD and whoever else. So, within HHS, you know we… It’s prob… You know the operating divisions. So, it would be CDC and IHFDA, etc. Jill Auerbach: Oh, okay. Thank you. Pat Smith: Okay. Is there any other thoughts on this? Phyllis Mervine: Can you show the second slide
of that list? Pat Smith: Yes. It’s on… It’s currently on the second slide right
now – 11 through 20. Are you looking for something different? Phyllis Mervine: Oh, no. Wait. Sorry. I had a screen shot up. So it was just… Okay. I see it. Adalberto Perez De Leon: Hey, guys. This is Adalberto. I was never able to access the slides. Could you share them via email? Is that possible, please? Pat Smith: Uh, I don’t know that we can. I don’t have a way to do that. They didn’t… Unfortunately, we’ve got limited training
as to how this was coming down the pike in a short period of time. Adalberto Perez De Leon: Okay. Thank you. Monica White: This is Monica and these… All of these listings are on the handouts
that were provided in attachments with our information for the meeting, if people want
to print them off that way. Pat Smith: Thank you. That’s what I thought they had done, but
you know… Operator: Excuse me. This is the operator. You have two minutes remaining before we join
you back to the main call. Pat Smith: Okay. Well, we need to… Unfortunately, we are supposed to have some
topics, which I think we’re going to have to skip to for the National Town Hall Meeting. We’re supposed to have several topics from
our working group — about one or two questions or issues we’d like to pose at the Town
Hall so we can receive input from the community. Do we quickly have some suggestions on those? (Pause.) Jill Auerbach: Other than giving them a list
and letting them vote. Phyllis Mervine: I have written down just
a few things. Um, reservoir ticks, environmental and personal
protection, funding, and tick research – including genomic research. Pat Smith: Okay. Does anyone else have anything? Monica White: This is Monica. I was just thinking… You know, if we’re asking for input from
the community, do… Does the community think we have adequate
prevention education in place? Does the community think we have the resources
that they need available for… Whether you’re a member of the public, a
patient, a physician? Is that the kind of thing you’re looking
for? Pat Smith: Uh, yes. I think that’s exactly what we’re looking
for and I think that’s… You know, these are all good suggestions,
because I think especially with the… you know, this one and also we might ask them
why — related to what Jill said, maybe — why they’re not using or are they using protection
methods and, if not, why? That’s something that… Jill Auerbach: Pat, I don’t mean to squelch
you, but, you know, people just don’t do everything all the time, especially when it
takes so much effort. It just doesn’t happen, and that’s why
we’ve got to provide them with something that works and is easy to do. I think if you speak to people and you say,
“How do you feel about being able to protect yourself against ticks?” They’re going to say they don’t feel very
confident about it. So, that’s why I have been pushing so hard
on… It’s going to take years and years before
we get to develop everything, but something simple like a soap to wash themselves with,
or I believe Tom said he used… He had at one time had a patent on permethrin
in a soap. Well, nootkatone’s a lot safer. I think we have to get away from the fact
that there isn’t funding for it right now and away from the fact that the company who
now has a license on it may not make enough money from it, but it will help the public
immensely. So, do they feel that they have easy protective
measures? And you know they’re going to say “no.” Pat Smith: We’ve just gotten… We have less than one minute, and we have
to get these recommendations in. So, what we’re looking at right now, maybe,
is, why using or not using protection, adequate prevention, and education. And I also felt that we need to hear what
about surveillance and how the current surveillance is impacting access to care for patients? Robin Nadolny: I agree. This is Robin. I would also like to add on to that that,
“How are they receiving information about tick range expansions and the changing risks?” Jill Auerbach: Right. Pat Smith: Okay. Are there anything else real quick before
we’re shut down? (Chuckle.) Anyone else have anything? Jill Auerbach: I have something to complain
about is that they throw this at us and don’t give anybody time to look at it ahead of time. Pat Smith: Jill, believe me. You’re speaking to the choir here, please,
and we need to stay on target. I just want to add, and we may get cut off,
that Ben and I have been discussing about how to do these meetings down the road and
we were thinking about the possibility — I don’t know if it will work — but we were
talking about the possibility of Friday. But there’s going to be a Doodle Poll that
will be put out, but I think that if there are people who have a commitment every week
at a certain date, we would certainly want to know about that and we would try to go
away from that. Um, but that’s what we were talking about
at this point in time with the idea of maybe — I don’t know if this will come about
— but maybe we could even get in a meeting late next week so that we could perhaps move
forward. I don’t know that that’s going to happen,
but does anybody have a particular day that they know that, uh… Male: Monday… Jill Auerbach: I don’t think they’re good
because there are a lot of conferences and things that start on Fri…uh, that you have
to be away Thursday, Friday, Saturday, Sunday. I would suggest a Monday would be a better
day. Pat Smith: Well, we can certainly… You know, we can vary it and we don’t have
to stick to a specific schedule. We can, you know, maybe do it, you know, perhaps… You know, we can book them up in uh, you know,
a month or two in advance, but we were trying to get some idea about days that were good
for people and so, I don’t know. Does anyone else have any other thoughts? Katherine Feldman: Katherine. I actually liked Friday. So, if you’re going to do a Doodle Poll,
be sure to include it. Pat Smith: Okay. Thank you. We’ll try. (Chuckle.) Female: Yeah. Well, Monday. We’re all here today. Pat Smith: Yeah. I hear you. Okay. Anyone else have any input on that? Ben, did we cover everything, other than what… Operator: And pardon me. We’re now transferring you back to the main
conference. Pat Smith: That… Well, we did. (Chuckle.)

local_offerevent_note February 21, 2020

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