,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #bbj  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,janu>y #c1 #bjai,mr4 
,smi? ( ,new ,j]sey 7= himself1 ,mr4    
,pet]son1 ,mr4 ,posey1 ,ms4 ,/efanik1   
,mr4 ,fitzpatrick1 ,mr4 ,sires1 ,ms4    
,p+ree1 & ,mrs4 ,h>tzl]7 introduc$ !    
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce  ,a     
,,bill  ,to provide = a national /rategy
 to address & ov]come ,lyme disease &   
o!r tick-borne diseases1 & = o!r        
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,national ,lyme &          
,tick-,borne ,diseases ,control &       
,acc\ntability ,act ( #bjai4  #b4 ,(fice
 ( ,ov]sight & ,coord9ation =           
,tick-,borne ,diseases  7a7 ,e/abli%m5t 
,! ,secret>y ( ,heal? & ,human ,s]vices 
%all e/abli% 9 ! ,(fice ( ! ,secret>y ! 
,(fice ( ,ov]sight & ,coord9ation =     
,tick-,borne ,diseases1 to be head$ by a
 director appo9t$ by ! ,secret>y--  7#a7
 to ov]see ! creation & updat+ ( an     
integrat$ national /rategy to ov]come   

,lyme disease & o!r tick-borne diseases2
 &  7#b7 to ov]see & coord9ate ,lyme    
disease & o!r tick-borne disease        
programs & activities across ! ag5cies &
 (fices ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices4  7b7 ,objective ( (fice ,9    
c>ry+ out subsection 7a71 ! ,director ( 
! ,(fice %all facilitate & "w to ensure 
accompli%m5t ( ! foll[+ activities3     
7#a7 ,expansion & enhancem5t (          
epidemiological rese>* & basic1         
translational1 & cl9ical biological &   
biom$ical rese>*4  7#b7 ,expansion &    
improvem5t ( ! surveillance & report+ ( 
,lyme disease & o!r tick-borne disease1 
includ+ co9fections ) ag5ts ( m ?an "o  
tick-borne disease4  7#c7 ,developm5t ( 
effective diagno/ic te/s to accurately &
 timely diagnose ,lyme disease & o!r    
tick-borne disease1 includ+ direct      
det5tion te/s4  7#d7 ,developm5t (      
treatm5ts to cure or improve ! lives (  
^? :o are infect$ ) ,lyme disease or o!r
 tick-borne disease or :o suff] f a     
tick-induc$ disord]4  7#e7 ,design &    

conduct ( cl9ical trials ( suffici5t    
size & duration to support cl9ical      
recomm5dations4  7#f7 ,developm5t &     
ma9t5ance ( "o or m regi/ries ( pati5ts 
& _! exp]i5ces relat+ to exposure to1   
diagnosis =1 & treatm5t ( tick-borne    
disease1 includ+ outcomes1 :i* regi/ries
 %all protect ! confid5tiality & safety 
( pati5t data4  7#g7 ,sy/ematic         
docum5tation ( ! exp]i5ces ( heal? c>e  
pr(essionals 9 diagnos+ & treat+        
tick-borne disease1 includ+ diagno/ic & 
treatm5t outcomes4  7#h7 ,inclusion (   
individuals ) *ronic ,lyme disease 9    
cl9ical1 rese>*1 & s]vice ef=ts4  7#i7  
,coord9ation ) int]national bodies to   
integrate & in=m ! fight aga9/ ,lyme    
disease & tick-borne disease globally4  
7c7 ,integration ( ,tick-,borne ,disease
 ,work+ ,gr\p f9d+s & recomm5dations ,9 
c>ry+ out ?is section1 ! ,director ( !  
,(fice %all1 z direct$ by ! ,secret>y1 )
 any modifications made by & z o!rwise  
det]m9$ appropriate by ! ,secret>y1     
ov]see & coord9ate integration &        

implem5tation1 into ! activities ( !    
,(fice & ! activities & programs ( !    
ag5cies & (fices ( ! ,dep>tm5t ( ,heal? 
& ,human ,s]vices1 ( ! recomm5dations to
 ! ,secret>y & ! f9d+s & conclusions 9 !
 late/ report ( ! ,tick-,borne ,disease 
,work+ ,gr\p submitt$ to ! ,secret>y &  
congressional committees4  7d7 ,priority
 bas$ on disease burd5 ,9 c>ry+ out ?is 
section1 ! ,director ( ! ,(fice %all    
give priority to ,lyme disease & o!r    
tick-borne disease bas$ on assessm5ts ( 
disease burd5 9 ! ,unit$ ,/ates4  #c4   
,national /rategy  7a7 ,9 g5]al ,!      
,secret>y1 9 coord9ation ) ! ,director (
 ! ,(fice1 & 9 consultation ) !         
,tick-,borne ,disease ,work+ ,gr\p1 !   
ag5cies & (fices ( ! ,dep>tm5t ( ,heal? 
& ,human ,s]vices1 & o!r ,f$]al ag5cies 
outside ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices z appropriate1 %all--  7#a7 n  
lat] ?an #b ye>s aft] ! date ( enactm5t 
( ?is ,act1 develop & submit to !       
,congress a national /rategy = ! conduct
 & support ( ,lyme disease & o!r        

tick-borne disease or disord] programs &
 activities2 &  7#b7 n less ?an e #b    
ye>s !reaft]1 update su* /rategy4  7b7  
,cont5ts ,! /rategy "u subsection 7a7   
%all include--  7#a7 propos$ budget>y   
requirem5ts2  7#b7 an assessm5t ( all   
f$]ally fund$ programs & activities     
relat$ to surveillance1 diagnosis1      
treatm5t1 education1 or prev5tion )     
respect to ,lyme disease or o!r         
tick-borne disease1 an evaluation (     
progress & p]=mance bas$ on mission &   
purpose1 & a description ( significant  
*all5ges or b>ri]s to p]=mance1 includ+ 
an assessm5t ( ,f$]al grants aw>d$2     
7#c7 a /rategy = improv+ diagnosis1     
treatm5t1 & prev5tion1 includ+ increas+ 
! impact ( grants aw>d$ by ! ,national  
,in/itutes ( ,heal?1 ! ,c5t]s = ,disease
 ,control & ,prev5tion1 & o!r ag5cies & 
(fices ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices2  7#d7 a /rategy = improv+     
outcomes ( individuals ) ,lyme disease  
or ano!r tick-borne disease or disord]1 
includ+ progress relat$ to *ronic or    

p]si/5t symptoms & *ronic or p]si/5t    
infection & co9fections1 includ+ plans =
 evaluat+ ! pot5tial value ( & support+ 
! conduct ( obs]vational /udies1        
comp>ative effectiv5ess rese>*1         
pati5t-c5t]$ outcomes rese>*1 or o!r    
real _w evid5ce2  7#e7 ! appropriate    
b5*m>ks to measure progress 9 a*iev+ !  
improvem5ts describ$ 9 p>agraphs 7#c7 & 
7#d72  7#f7 a /rategy = improv+         
int]actions1 coord9ation1 & p>tn]%ips ) 
o!r ,f$]al ag5cies1 ,/ate & local       
gov]nm5ts1 & global entities2 &  7#g7 ! 
late/ recomm5dations ( ! ,tick-,borne   
,disease ,work+ ,gr\p & ! /eps tak5 by !
 ag5cies & (fices ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices to implem5t ^?       
recomm5dations4  #d4 ,f$]al activities  
relat$ to ! diagnosis1 surveillance1 &  
prev5tion (1 & rese>* on1 ,lyme disease 
& o!r tick-borne diseases & disord]s    
7a7 ,9 g5]al ,! ,secret>y1 9 coord9ation
 ) ! ,director ( ! ,(fice1 act+ z !     
,secret>y det]m9es appropriate ?r\gh !  
,director ( ! ,c5t]s = ,disease ,control

 & ,prev5tion1 ! ,director ( ! ,national
 ,in/itutes ( ,heal?1 ! ,commission] (  
,food & ,drugs1 ! ,director ( ! ,ag5cy =
 ,heal?c>e ,rese>* & ,quality1 !        
,adm9i/rator ( ! ,heal? ,res\rces &     
,s]vices ,adm9i/ration1 ! ,director ( ! 
,indian ,heal? ,s]vice1 & ! heads ( o!r 
,f$]al ag5cies1 & 9 consultation ) !    
,tick-,borne ,disease ,work+ ,gr\p1 %all
 provide =--  7#a7 ! conduct or support 
( ! activities describ$ 9 p>agraphs 7#a7
 ?r\gh 7#h7 ( subsection 7b72 &  7#b7 ! 
coord9ation ( all programs & activities 
( ! ,dep>tm5t ( ,heal? & ,human ,s]vices
 relat$ to ,lyme disease & o!r          
tick-borne diseases & disord]s &        
,b>tonella4  7b7 ,activities ,!         
activities to be conduct$ or support$ "u
 subsection 7a77#a7 consi/ ( ! foll[+3  
7#a7 ,expansion & enhancem5t ( rese>*   
7,a7 ,9 g5]al ,! ,secret>y %all exp& &  
int5sify epidemiological1 basic1        
translational1 & cl9ical rese>* reg>d+  
,lyme disease & o!r tick-borne disease &
 disord]s & b>tonellosis to bett]       

und]/&--  7i7 ! pa?ophysiology (        
,borrelia burgdorf]i & o!r tick-borne   
microorganisms t are human pa?og5s & (  
,b>tonella2  7ii7 pa?ophysiological     
*anges ov] "t1 includ+ pa?og5 p]si/5ce  
pr(iles = pati5ts ) diff]+ treatm5t     
hi/ories2  7iii7 activation &           
deactivation ( immune sy/em processes2 &
  7iv7 :e!r1 & :at species (1 ,b>tonella
 are transmitt$ by ticks4  7,b7 ,cl9ical
 outcomes rese>* ,! ,secret>y %all      
conduct or support cl9ical outcomes     
rese>* to-- 7i7 e/abli% epidemiological 
rese>* objectives to det]m9e ! long-t]m 
c\rse ( illness = ,lyme disease & o!r   
tick-borne diseases & disord]s2  7ii7   
e/abli% pati5t-c5t]$ treatm5t outcome   
objectives to all[ = ! comp>ative       
effectiv5ess ( diff]5t treatm5t         
modalities2 &  7iii7 e/abli%            
pati5t-c5t]$ rese>* objectives to help  
elucidate promis+ treatm5t protocols =  
individuals suspect$ ( h>bor+           
co9fections ) m ?an "o tick-transmitt$  
pa?og54  7,c7 ,collaborative1           

multidiscipl9>y rese>* ,! ,secret>y %all
 enc\rage ! solicitation ( proposals =  
collaborative1 multidiscipl9>y rese>* t 
w\ld--  7i7 result 9 innovative         
approa*es to /udy em]g+ sci5tific       
opportunities or elim9ate gaps 9 rese>* 
to improve ! rese>* portfolio1 includ+  
application ( successful & promis+      
advances 9 ! /udy ( o!r types (         
diseases1 su* z upregulat+ or           
d[nregulat+ immune sy/em cells or       
processes2  7ii7 outl9e key rese>*      
que/ions1 me?odologies1 & k gaps2  7iii7
 exp& ! numb] ( rese>* proposals t      
involve collaboration betwe5 #b or m    
national rese>* in/itutes or national   
c5t]s ( ! ,national ,in/itutes ( ,heal?1
 includ+ proposals = rese>* ?r\gh !     
,common ,fund pursuant to section       
#djb7;b77#g7 ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bhb7;b77#g77 to    
improve ! rese>* portfolio2  7iv7 exp& !
 numb] ( collaborative                  
multi-in/itutional rese>* grants relat$ 
to tick-borne disease2 &  7v7 involve   

additional national rese>* in/itutes &  
national c5t]s ( ! ,national ,in/itutes 
( ,heal? 9 intramural & extramural      
rese>* on tick-borne disease1 su* z !   
,national ,in/itute ( ,neurological     
,disord]s & ,/roke conduct+ or sponsor+ 
rese>* on neurologic ,lyme disease4     
7,d7 ,evaluation ,n lat] ?an #b ye>s    
aft] ! date ( enactm5t ( ?is ,act1 !    
,secret>y %all evaluate & make f9d+s    
on--  7i7 ! feasibility & pot5tial value
 to ! rese>* community ( e/abli%+ a     
deid5tifi$ human subjects database =    
,lyme disease & o!r tick-borne diseases 
& disord]s2  7ii7 exi/+ gov]nm5t or     
private biorepositories = ,lyme disease 
& o!r tick-borne diseases & disord]s &  
:e!r--  7,i7 specim5s & samples are     
adequate & available to meet rese>*]    
ne$s2 or  7,,ii7 !re are problems or    
*all5ges = rese>*] acquisition ( samples
 & specim5s2 &  7iii7 ! scope & use (   
specim5s & samples f cadav]s1 ! que/ions
 & answ]s su* rese>* may provide1 & !   
ne$ = additional support ( rese>*]s us+ 

cadav] specim5s4  7,e7 ,priority ,9     
c>ry+ out ?is p>agraph1 ! ,secret>y %all
 make x a priority to det]m9e ! ext5t ( 
po/treatm5t p]si/5ce ( ,borrelia        
burgdorf]i & ! cl9ical significance (   
su* p]si/5ce4  7#b7 ,developm5t ( new & 
improv$ diagno/ic te/s  7,a7 ,9 g5]al ,!
 ,secret>y1 9 coop]ation ) ! ,director (
 ! ,(fice1 & act+ ?r\gh ! ,directors ( !
 ,c5t]s = ,disease ,control & ,prev5tion
 & ! ,director ( ! ,national ,in/itutes 
( ,heal?1 %all conduct & support rese>* 
to--  7i7 provide = ! timely evaluation 
( promis+ new & improv$ diagno/ic       
me?ods1 includ+ direct-detection te/s1  
antibody-bas$ te/s1 & te/s bas$ on      
biosignature & biom>k] pr(iles to make a
 specific diagnosis or aid 9 diff]5tial 
diagnoses2  7ii7 improve ! s5sitivity ( 
,lyme disease te/s at all /ages (       
disease progression2  7iii7 develop a   
,lyme disease te/ capable ( di/+ui%+    
betwe5 pa/ & active infections2  7iv7   
improve timely1 s5sitive1 & specific    
diagno/ic tools & te/s = ,rocky ,m\nta9 

spott$ fev]2 &  7v7 improve ! p]=mance  
7timel9ess & accuracy7 ( tools & te/s = 
o!r tick-borne diseases f\nd 9 ! ,unit$ 
,/ates4  7,b7 ,/rategies = exp$it+      
cle>ance ,! ,secret>y %all direct !     
,commission] ( ,food & ,drugs to design 
& propose or implem5t1 z appropriate )9 
! au?orities & public heal? priorities  
ve/$ 9 ! ,secret>y by o!r provisions (  
law1 /rategies = facilitat+ & exp$it+ ! 
cle>ance or approval ( improv$ diagno/ic
 te/s = ,lyme disease & o!r tick-borne  
disease1 p>ticul>ly :]e--  7i7 !re are  
no cle>$ diagno/ic te/s2 or  7ii7 cle>$ 
diagno/ic te/s lack a high level (      
specificity or s5sitivity or are unable 
to confirm ! pres5ce or abs5ce ( active 
infection4  7#c7 ,ensur+ safety &       
efficacy ( vacc9es ,! ,secret>y %all--  
7,a7 ensure ! safety & efficacy ( any   
new1 r5ew$1 or modifi$ human vacc9e =   
,lyme disease1 o!r tick-borne disease1  
or a comb9ation ( su* diseases2 &  7,b7 
require ! ,commission] ( ,food & ,drugs 
to submit to ! ,secret>y prior to f9al  

approval ( ! vacc9e be+ review$1 a      
report1 ) appropriate provisions =      
comm]cial confid5tiality1 detail+ !     
safety ( ! vacc9e & contra/+ its safety 
pr(ile bas$ on its me*anisms ( action to
 safety conc]ns express$ to ! ,food &   
,drug ,adm9i/ration reg>d+ ! human      
vacc9e )drawn f ! m>ket 9 #bjjb & h[ ^? 
conc]ns ) ! )drawn vacc9e h be5 address$
 or :y !y are n relevant4  7#d7         
,monitor+ & und]/&+ human cases ( ,lyme 
disease & o!r tick-borne diseases  7,a7 
,9 g5]al ,! ,secret>y %all-- 7i7 e/abli%
 & ma9ta9 a /ati/ically s\nd1           
sci5tifically cr$ible surveillance sy/em
 to be kn[n z ! ,national ,tick-,borne  
,disease ,surveillance ,sy/em2  7ii7    
enhance & exp& infra/ructure &          
activities to track ! epidemiology (    
,lyme disease & o!r tick-borne diseases 
& disord]s2 &  7iii7 incorporate        
in=mation obta9$ ?r\gh su* activities   
into ! ,national ,tick-,borne ,disease  
,surveillance ,sy/em4  7,b7 ,rese>* ,!  
,secret>y %all ensure t ! ,national     

,tick-,borne ,disease ,surveillance     
,sy/em is design$ 9 a mann] t           
facilitates fur!r rese>* on ,lyme       
disease & o!r tick-borne diseases &     
disord]s4  7,c7 ,cont5t ,9 c>ry+ out    
subp>agraph 7,a71 ! ,secret>y-- 7i7 %all
 provide = ! collection & /orage (      
in=mation on ! incid5ce & preval5ce (   
tick-borne disease 9 ! ,unit$ ,/ates--  
7,i7 :ile cont9u+ to support activities 
9 ! #ad ,/ates ) ! highe/ numb] (       
report$ cases ( ,lyme disease1 &        
int5sify+ ef=ts 9 o!r ,/ates :]e ,lyme  
disease has be5 report$ & :]e all       
report$ cases _c be affirmatively       
associat$ ) out-(-,/ate travel 9 ord] to
 bett] det]m9e :]e ! disease is em]g+2  
7,,ii7 work+ ) ! ,/ates & treat+        
physicians1 9 consultation ) ! ,c\ncil (
 ,/ate & ,t]ritorial ,epidemiologi/s 79 
?is clause ref]r$ to z ! ,,c/e71 to     
improve evaluation ( ! feasibility (    
captur+ data on cases t d n meet        
surveillance crit]ia ( ! ,,c/e & !      
,c5t]s = ,disease ,control & ,prev5tion2

  7,,iii7 9 consultation ) ! ,,c/e1     
work+ ) ,/ates t are us+ av]ag+ or      
simil> te*niques to e/imate case reports
 to ensure t data produc$ by t process  
are able to be report$ out by ! ,c5t]s =
 ,disease ,control & ,prev5tion2  7,,iv7
 9 consultation ) ! ,,c/e1 work+ ) !    
,/ates to enc\rage & improve laboratory 
report+ ( ,lyme disease & o!r tick-borne
 diseases1 & evaluate ! feasibility (   
creat+ a national uni=m report+ sy/em   
includ+ m&atory report+ by ,/ates &     
physicians & laboratories 9 ea* ,/ate2  
7,v7 includ+ 9 ! surveillance sy/em     
b>tonellosis transmitt$ by any vector &1
 if x is kn[n1 by ! vector (            
transmission2 &  7,,vi7 track+ incid5ce 
& preval5ce data = tick-borne disord]s2 
&  7ii7 to ! ext5t practicable1 %all    
provide = ! collection & /orage ( o!r   
available in=mation on ,lyme disease &  
o!r tick-borne diseases & disord]s1     
includ+ in=mation relat$ to p]sons :o h 
be5 diagnos$ ) & treat$ = tick-borne    
disease :o *oose to p>ticipate1 su* z-- 

7,i7 demographics1 su* z age1 race1 sex1
 geographic location1 & o!r in=mation1 z
 appropriate2  7,,ii7 family hi/ory &   
exp]i5ce ) tick-borne disease or tick   
induc$ disord]2  7,,iii7 hi/ory (       
exposure & kn[n tick bites2  7,,iv7     
progression ( signs & symptoms2  7,v7   
diagno/ic & treatm5t hi/ory & outcomes2 
&  7,,vi7 additional scre5+ conduct$ &  
relat$ data1 su* z biological m>k]s4    
7,d7 ,consultation ,9 c>ry+ out ?is     
p>agraph1 ! ,secret>y %all consult )    
individuals ) appropriate exp]tise1 :i* 
may include--  7i7 epidemiologi/s )     
exp]i5ce 9 disease surveillance or      
regi/ries2  7ii7 repres5tatives (       
national pati5t advocacy & rese>*       
organizations t focus on tick-borne     
disease & h demon/rat$ exp]i5ce 9       
rese>*1 data collection1 or pati5t      
access to c>e2  7iii7 heal? in=mation   
te*nology exp]ts or o!r in=mation       
managem5t speciali/s2  7iv7 cl9icians ) 
exp]tise 9 ,lyme disease or o!r         
tick-borne diseases or disord]s2 &  7v7 

rese>* sci5ti/s ) exp]i5ce conduct+     
translational rese>* or utiliz+         
surveillance sy/ems = sci5tific rese>*  
purposes4  7,e7 ,grants ,! ,secret>y may
 aw>d grants to1 or ent] into contracts 
or coop]ative agreem5ts )1 public or    
private nonpr(it entities to c>ry out   
activities "u ?is p>agraph4  7,f7       
,coord9ation ) ,f$]al1 ,/ate1 & local   
ag5cies ,subject to subp>agraph 7,h71 ! 
,secret>y %all-- 7i7 e/abli% agreem5ts &
 me*anisms1 z appropriate1 = improv$    
collect+ & report+ ( tick-borne disease 
surveillance data "u subp>agraphs 7,a71 
7,b71 & clause 7i7 ( subp>agraph 7,c7 & 
o!r available in=mation "u clause 7ii7 (
 subp>agraph 7,c7 f community heal?     
c5t]s fund$ by ! ,heal? ,res\rces &     
,s]vices ,adm9i/ration & m$ical         
facilities ( ! ,indian ,heal? ,s]vice2  
7ii7 e/abli% =mal agreem5ts1 z          
appropriate & may be work$ out1 to      
provide = improv$ collection & report+ (
 surveillance data "u subp>agraphs 7,a71
 7,b7 or clause 7i7 ( subp>agraph 7,c7 &

 o!r available in=mation "u clause 7ii7 
( subp>agraph 7,c71 obta9$ f hospitals &
 m$ical cl9ics run by o!r ,f$]al        
dep>tm5ts & ag5cies2  7iii7 make        
in=mation & analysis 9 ! ,national      
,tick-,borne ,disease ,surveillance     
,sy/em available1 z appropriate1 to all 
compon5ts ( ! ,dep>tm5t ( ,heal? &      
,human ,s]vices1 to o!r ,f$]al ag5cies1 
& to ,/ate & local ag5cies2 &  7iv7     
id5tify1 build ^u1 lev]age1 & coord9ate 
among exi/+ data & surveillance sy/ems1 
surveys1 regi/ries1 & o!r ,f$]al public 
heal? infra/ructure1 :]ev] practicable4 
7,g7 ,public access ,subject to         
subp>agraph 7,h71 ! ,secret>y %all      
ensure t in=mation & analysis 9 !       
,national ,tick-,borne ,disease         
,surveillance ,sy/em are available1 z   
appropriate1 to ! public & o!r int]e/$  
p>ties on ! website ( ! ,dep>tm5t (     
,heal? & ,human ,s]vices4  7,h7 ,privacy
 ,! ,secret>y %all ensure t in=mation & 
analysis 9 ! ,national ,tick-,borne     
,disease ,surveillance ,sy/em are made  

available only to ! ext5t p]mitt$ by    
applicable ,f$]al & ,/ate law1 & 9 a    
mann] t protects p]sonal privacy1 to !  
ext5t requir$ by applicable ,f$]al &    
,/ate privacy law1 at a m9imum4  7#e7   
,education & prev5tion  7,a7 ,consum] & 
community education ,! ,secret>y %all   
increase public education relat$ to     
,lyme disease & o!r tick-borne diseases 
& disord]s ?r\gh ! expansion ( !        
community-bas$ education programs ( !   
,c5t]s = ,disease ,control & ,prev5tion 
to include developm5t & publication ( a 
consum] tick disease pamphlet1 available
 onl9e & by h>d copy1 address+--  7i7   
ticks & tick-borne diseases common to ! 
geographic area1 tick-borne disease t   
c\ld be acquir$ :ile on dome/ic or      
int]national travel1 & ticks t1 :ile n  
common to ! geographic area1 c\ld       
migrate to ! area2  7ii7 signs &        
symptoms ( su* tick-borne disease2      
7iii7 tick removal in/ructions2  7iv7 ! 
mo/ effective actions individuals c take
 to r$uce risk ( exposure to ticks &    

risk ( disease transmission2 &  7v7     
additional community-bas$ actions to    
r$uce risk ( exposure to ticks4  7,b7   
,coord9ation ,9 c>ry+ out subp>agraph   
7,a71 ! ,secret>y1 act+ ?r\gh !         
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion1 %all coord9ate ) legally 
incorporat$ ,lyme disease or o!r        
tick-borne disease organizations4  7,c7 
,dissem9ation ,! ,adm9i/rator ( ! ,heal?
 ,res\rces & ,s]vices ,adm9i/ration & ! 
,director ( ! ,indian ,heal? ,s]vice    
%all make available 9 rural heal? c5t]s 
& cl9ics :i* !y op]ate or fund--  7i7 ! 
consum] tick disease pamphlets develop$ 
"u subp>agraph 7,a72 or  7ii7 su* o!r   
appropriate consum] tick disease        
pamphlets z ! ,adm9i/ration or ,s]vice  
may develop or acquire4  7,d7 ,physician
 education ,! ,secret>y %all c>ry out a 
physician education program t addresses 
! full spectrum ( sci5tific rese>*      
relat$ to ,lyme disease & o!r tick-borne
 diseases & disord]s1 includ+--  7i7 !  
role ( cl9ical diagnosis2  7ii7 !       

limitations ( s]ological diagno/ic te/s2
  7iii7 enhanc$1 validat$ diagno/ics    
available f laboratories c]tifi$ "u     
section #cec ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bfc;a7 t may aid ! 
physician2  7iv7 guidel9es available on 
! ,national ,guidel9e ,cle>+h\se2  7v7 !
 volunt>y nature ( cl9ical practice     
guidel9es2  7vi7 ! complexities pres5t$ 
by co9fections relat+ to symptomology1  
diagnosis1 & treatm5t1 includ+ prud5tly 
act+ 9 ! pati5t's int]e/ 9 non- or      
l[-incid5ce ,/ates2 &  7vii7 !          
id5tification ( significant rese>* gaps 
mo/ impact+ diagnosis & treatm5t1 &     
significant rese>* be+ conduct$ to      
address ^? gaps4  7,e7 ,process =       
develop+ physician education program ,! 
,secret>y ( ,heal? & ,human ,s]vices    
%all-- 7i7 conduct a public meet+ to    
solicit input = ! design ( ! physician  
education program "u subp>agraph 7,d72  
7ii7 give ! public notice ( su* meet+ at
 lea/ #de days 9 advance2  7iii7 also   
solicit input on ! design ( ! physician 

education program f ! ,tick-,borne      
,disease ,work+ ,gr\p2  7iv7 publi% a   
propos$ syllabus = ! physician education
 program n m ?an #abj days aft] ! public
 meet+2  7v7 all[ = a #fj-;day public   
comm5t p]iod be=e publi%+ su* syllabus 9
 f9al =m2 &  7vi7 publi% on ! public    
website ( ! ,dep>tm5t ( ,heal? & ,human 
,s]vices a summ>y ( ! comm5ts receiv$ f 
! public "u ?is subp>agraph be=e        
conduct+ ! fir/ tra9+ program "u        
subp>agraph 7,d74  7#f7 ,monitor+1      
und]/&+1 & controll+ vectors & animal   
res]voirs ( ,lyme disease & o!r         
tick-borne disease  7,a7 ,tick          
,surveillance & ,te/+ ,! ,secret>y1 9   
coord9ation ) ! ,director ( ! ,(fice1   
act+ ?r\gh ! ,director ( ! ,c5t]s =     
,disease ,control & ,prev5tion & o!r    
ag5cies & (fices ( ! ,dep>tm5t ( ,heal? 
& ,human ,s]vices z appropriate1 %all-- 
7i7 n lat] ?an #ahj days aft] ! date (  
enactm5t ( ?is ,act1 provide a report to
 ! ,congress describ+ ! tick            
surveillance & pa?og5 te/+ activities ( 

! ,dep>tm5t & entities fund$ by !       
,dep>tm5t1 includ+--  7,i7 a detail$    
description ( ! tick surveillance & tick
 pa?og5 te/+ activities & plann$        
activities ( ! ,vector-,borne ,disease  
,regional ,c5t]s ( ,excell5ce z e/abli%$
 "u ,fund+ ,opportunity ,ann\ncem5t     
,,rfa-,,ck-#ag-jje1 ,catalog ( ,f$]al   
,dome/ic ,assi/ance ,numb] #ic4jhd2 &   
7,,ii7 )9 su* description1 ! roles (    
p>ticipat+ academic1 gov]nm5tal1 &      
private in/itutions2  7ii7 n lat] ?an #b
 ye>s aft] ! date ( enactm5t ( ?is ,act1
 9 consultation & coord9ation ) o!r     
,f$]al ag5cies & ,/ate & local gov]nm5t 
ag5cies1 z appropriate1 & e/abli%$      
academic or nonpr(it tick-te/+ c5t]s1   
develop a framework & an implem5tation  
plan = a compreh5sive nationwide /rategy
 = ! surveillance & te/+ ( ticks = human
 pa?og5s & microorganisms ) unkn[n      
pa?og5icity1 includ+ a plan = a network 
( tick id5tification & te/+             
laboratories2  7iii7 n lat] ?an #b ye>s 
aft] ! date ( enactm5t ( ?is ,act1      

e/abli% agreem5ts & proc$ures = %>+ data
 on surveillance & te/+ ( ticks ) o!r   
,f$]al dep>tm5ts & ag5cies engag$ 9 su* 
activities2 &  7iv7 consult & coord9ate 
) ! ,am]ican ,vet]9>y ,m$ical           
,association & ! ,companion ,animal     
,p>asite ,c\ncil on obta9+ & %>+ data on
 ! surveillance & te/+ ( ticks &        
tick-borne pa?og5s1 includ+ geographic  
in=mation f vet]9>y enc\nt]s4  7,b7     
,inve/igation ,9 c>ry+ out subp>agraph  
7,a71 ! ,secret>y1 9 coord9ation ) !    
,director ( ! ,(fice1 act+ ?r\gh !      
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion1 9 consultation &         
coord9ation ) o!r ,f$]al ag5cies t      
conduct or support tick surveillance or 
te/+ activities1 z appropriate1 & public
 & private laboratories1 %all--  7i7    
inve/igate &1 :]e appropriate1 promote !
 use ( advanc$ new te*nologies1 su* z   
tools to discov] all kn[n & all         
previ\sly unid5tifi$ microorganisms 9 a 
vector2 &  7ii7 :ile be+ in=m$ by       
previ\s surveillance /udies1 all[ = !   

possibility ( rapid geographic migration
 ( tick vectors & pa?og5s & unexpect$   
f9d+s4  7,c7 ,tick control & prev5tion  
,! ,secret>y1 9 coord9ation ) !         
,director ( ! ,(fice1 act+ ?r\gh !      
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion & ! ,director ( !         
,national ,in/itutes ( ,heal?1 %all1 z  
appropriate & pursuant to au?orities    
ve/$ 9 ! ,secret>y by o!r provisions (  
law1 support activities ( & coord9ate & 
%>e1 in=mation ) o!r ,f$]al1 ,/ate1 &   
local gov]nm5t ag5cies1 involv$ or      
int]e/$ 9 tick prev5tion & control      
activities on--  7i7 ! developm5t ( saf]
 & m effective tick repell5ts1 bo?      
natural & *emical2  7ii7 ! use (        
ac>icides or o!r *emical int]v5tions2   
7iii7 non*emical environm5tal measures  
to less5 human exposure to ticks2  7iv7 
g5etic !rapies = vectors or animal ho/s 
to int]f]e ) ! life cycle ( pa?og5s2 &  
7v7 ! developm5t ( vector or res]voir   
ho/ vacc9es4  7,d7 ,lev]ag+ exi/+ tick  
managem5t res\rces ,9 c>ry+ out ?is     

p>agraph1 ! ,secret>y1 9 coord9ation ) !
 ,director ( ! ,(fice1 act+ ?r\gh !     
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion1 %all id5tify1 build ^u1  
lev]age1 & coord9ate among exi/+ tick   
surveillance1 te/+1 & managem5t res\rces
 & infra/ructure :]ev] practicable4     
7,e7 ,public access to data ,9 c>ry+ out
 ?is p>agraph1 ! ,secret>y1 9           
coord9ation ) ! ,director ( ! ,(fice1   
act+ ?r\gh ! ,director ( ! ,c5t]s =     
,disease ,control & ,prev5tion1 9       
coord9ation & consultation ) o!r ,f$]al 
ag5cies & ,/ate & local ag5cies z       
appropriate1 make data on tick          
surveillance1 te/+1 control & prev5tion 
available to ! public on ! website ( !  
,dep>tm5t ( ,heal? & ,human ,s]vices4   
7#g7 ,conf]5ces1 symposia1 sem9>s1 & o!r
 public meet+s  7,a7 ,s5se ( ,congress  
,x is ! s5se ( ! ,congress t public     
meet+s1 conf]5ces1 symposia1 & sem9>s   
7includ+ web9>s7 sponsor$ by ! ,f$]al   
,gov]nm5t are a valuable input to       
/rategic & op]ational programmatic      

plann+ )9 ,f$]al ag5cies & to ! "w ( !  
,tick-,borne ,disease ,work+ ,gr\p4     
7,b7 ,requirem5ts ,! ,secret>y & !      
,director ( ! ,(fice1 9 coop]ation ) !  
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion1 ! ,director ( ! ,national
 ,in/itutes ( ,heal?1 & ! ,tick-,borne  
,disease ,work+ ,gr\p1 %all--  7i7 no   
lat] ?an #bd mon?s aft] ! date (        
enactm5t ( ?is ,act1 sponsor a          
/ate-(-!-sci5ce conf]5ce on ,lyme       
disease & o!r tick-borne disease includ+
 id5tification ( rese>* gaps & top      
rese>* priorities2  7ii7 = any sci5tific
 or m$ical conf]5ce on ,lyme disease or 
o!r tick-borne disease t is organiz$1   
sponsor$1 or paid = by ! ,dep>tm5t (    
,heal? & ,human ,s]vices1 ensure t a    
controll+ /atem5t ( "w & significant    
modifications !reto1 :e!r 9 ! contract  
or z a sep>ate docum5t1 issu$ to ! v5dor
 organiz+ or conduct+ ! conf]5ce are 9  
writ+ & made available to ! public prior
 to ! conf]5ce2  7iii7 n lat] ?an #abj  
days aft] ! conclusion ( ! conf]5ce "u  

clause 7i71 make available a f9al report
 on ! conf]5ce to ! ,tick-,borne        
,disease ,work+ ,gr\p & to ! public2    
7iv7 n lat] ?an #ah mon?s aft] ! date ( 
enactm5t ( ?is ,act1 work+ ?r\gh !      
,director ( ! ,ag5cy = ,heal?c>e ,rese>*
 & ,quality1 sponsor a symposium on !   
use ( real-_w evid5ce 7mean+ data f     
s\rces o!r ?an r&omiz$ cl9ical trials1  
su* z obs]vational /udies1 comp>ative   
effectiv5ess & pati5t-c5t]$ outcomes    
rese>*1 & pati5t cl9ical data or human  
subject data71 includ+ ! /&>ds &        
me?odologies = collection & analysis (  
real-_w evid5ce 9 manag+ ,lyme disease &
 o!r tick-borne disease2  7v7 include 9 
su* symposium id5tification & analysis (
 exi/+ data s\rces1 su* z pati5t        
regi/ries & human subjects' databases2  
7vi7 sponsor a rese>*] work%op on       
*all5ges & solutions = cl9ical trial    
design & implem5tation = ,lyme disease  
to be held no lat] ?an #bd mon?s aft] ! 
date ( enactm5t ( ?is ,act1 :i* work%op 
may consid] o!r tick-borne disease or   

co9fections ) m ?an "o tick-borne pa?og5
 z may be feasible & practicable2  7vii7
 n lat] ?an #i mon?s aft] ! date (      
enactm5t ( ?is ,act1 9 consultation ) ! 
,tick-,borne ,disease ,work+ ,gr\p1     
design a survey in/rum5t or in/rum5ts   
t>get$ to pati5ts & pati5t advocates1   
physicians & heal? c>e provid]s1 &      
rese>*]s reg>d+ recomm5d$ subjects &    
ag5das = f$]ally sponsor$ meet+s1       
conf]5ces1 & sem9>s1 includ+ web9>s1 on 
,lyme disease & o!r tick-borne disease2 
7viii7 n lat] ?an #f mon?s aft] !       
conduct ( ! survey1 provide an analysis 
( ! results ( ! survey to ! ,tick-,borne
 ,disease ,work+ ,gr\p & publi% su*     
results 9 ! ,f$]al ,regi/] = a #fj-;day 
public comm5t p]iod2 &  7ix7 provide a  
f9al analysis & a propos$ s*$ule & ag5da
 = public meet+s1 conf]5ces1 & sem9>s1  
includ+ web9>s1 = incorporation into !  
national /rategy "u section #c z        
appropriate & to ! ,tick-,borne ,disease
 ,work+ ,gr\p4  7#h7 ,common rese>*     
bibliography ,! ,secret>y1 9 coord9ation

 ) ! ,director ( ! ,(fice1 %all direct !
 ,director ( ! ,ag5cy = ,heal?c>e       
,rese>* & ,quality to assemble a        
bibliography ( pe]-review$ lit]ature (  
tick-borne diseases & disord]s 9 !      
,unit$ ,/ates1 z well z = b>tonellosis f
 :atev] cause1 appropriately organiz$ = 
use by ! sci5tific community1 treat+    
physicians1 & ! public4 ,! bibliography 
%\ld include lit]ature relat+ to        
possible me*anisms ( p]si/5t infection )
 ,borrelia burgdorf]i or o!r types (    
,borrelia4  7c7 ,priority bas$ on       
disease burd5 ,9 conduct+ & support+    
activities "u ?is section1 ! ,secret>y  
%all give priority to ,lyme disease &   
o!r tick-borne diseases bas$ on         
assessm5ts ( disease burd5 9 ! ,unit$   
,/ates4  #e4 ,bi5nial reports  7a7 ,9   
g5]al ,n lat] ?an #bd mon?s aft] ! date 
( ! enactm5t ( ?is ,act1 & bi5nially    
!reaft]1 ! ,secret>y %all submit to !   
,congress a report on ! activities c>ri$
 out "u ?is ,act & ! activities ( !     
,tick-,borne ,disease ,work+ ,gr\p4  7b7

 ,cont5t ,reports "u subsection 7a7 %all
 conta9-- 7#a7 a sci5tifically qualifi$ 
assessm5t ( ,lyme disease & o!r         
tick-borne disease1 includ+ a summ>y (  
preval5ce1 geography1 important exposure
 *>act]i/ics1 disease /ages &           
manife/ations or symptoms ( ^? /ages1   
bas$ on a syn!sis ( ! broad spectrum (  
empirical evid5ce ( treat+ physicians1 z
 well z publi%$ pe]-review$ data1 to    
include = ea* tick-borne disease a      
/ate-(-!-sci5ce diagnosis & treatm5t2   
7#b7 a description ( all programs &     
activities fund$ by ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices t are relat$ to !    
surveillance1 diagnosis1 treatm5t1      
education1 or prev5tion ( ,lyme disease 
or o!r tick-borne disease1 & an         
evaluation ( progress & p]=mance bas$ on
 mission & purpose1 & discussion (      
significant *all5ges or b>ri]s to       
p]=mance1 to include--  7,a7 = ! initial
 report "u ?is section1 a description ( 
! intramural & extramural rese>*        
portfolios ( ! ,c5t]s = ,disease        

,control & ,prev5tion1 ! ,national      
,in/itutes ( ,heal?1 & o!r ag5cies &    
(fices ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices :i* conduct$ or contract$ =    
rese>* projects relat$ to ,lyme disease 
or on o!r tick-borne disease or disord]1
 includ+ in=mation on--  7i7 ! aw>d     
am\nt1 in/itution1 prim>y inve/igator1  
pr9cipal inve/igative "q or que/ions1 & 
significant conclusions2 &  7ii7 /udies 
t receiv$ ,f$]al funds & 7 t]m9at$1 9   
progress1 or initiat$ 9 ! fiscal ye>    
includ+ ! date ( enactm5t ( ?is ,act & !
 #e prior fiscal ye>s2  7,b7 = reports 9
 subsequ5t ye>s1 all ( ! in=mation      
describ$ 9 subp>agraph 7,a71 except !   
ref]5ce 9 subp>agraph 7,a77ii7 to ,f$]al
 funds t]m9at$1 9 progress1 or aw>d$ 9 !
 #f prior fiscal ye>s %all be treat$ z  
ref]5ce to su* funds 9 ! #b prior fiscal
 ye>s2  7,c7 a /atus & summ>y report on 
! ,national ,tick-,borne ,disease       
,surveillance ,sy/em1 includ+-- 7i7 !   
type ( in=mation collect$ & /or$ 9 !    
,sy/em2  7ii7 ! use1 di/ribution1 &     

availability ( su* in=mation1 includ+   
guidel9es = su* use2 &  7iii7 ! use &   
coord9ation ( surveillance & pati5t     
in=mation databases2 &  7,d7 in=mation  
on agreem5ts1 p>tn]%ips1 coop]ation1    
coord9ation1 & data %>+ ) ext]nal       
entities1 su* z ,/ate & local gov]nm5ts1
 o!r ,f$]al ag5cies1 work+ gr\ps1 &     
global entities2  7#c7 a description (  
major ext]nally fund$ rese>*1           
surveillance1 education1 or o!r programs
 & initiatives impact+ ! managem5t or   
sci5ce ( tick-borne disease2  7#d7      
recomm5dations = address+ rese>* gaps 9 
sci5tific und]/&+ ( ,lyme disease & o!r 
tick-borne diseases & disord]s &        
relevant to developm5t ( effective      
diagno/ic tools & treatm5t protocols =  
,lyme disease & o!r tick-borne diseases 
& disord]s2  7#e7 a description (       
cl9ical practice guidel9es = any        
tick-borne disease publi%$ on !         
,national ,guidel9e ,cle>+h\se2  7#f7   
recomm5dations = address+ rese>* gaps 9 
tick biology & tick managem5t2  7#g7 a  

description ( activities = ! promotion (
 public aw>5ess & physician education   
initiatives to improve ! k ( heal? c>e  
provid]s & ! public 9 support ( cl9ical 
& behavioral decision mak+ 9 relation%ip
 to ,lyme disease & o!r tick-borne      
disease2 &  7#h7 a copy ( ! mo/ rec5t   
annual report issu$ by ! ,tick-,borne   
,disease ,work+ ,gr\p & an assessm5t (  
progress 9 a*iev+ recomm5dations ( t    
,work+ ,gr\p4  7c7 ,bi5nial reports (   
,,nih ,! ,secret>y %all ensure t ea*    
bi5nial report "u title ,,iii ( !       
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bda et seq47 or ea* tri5nial 
report "u section #djc ( su* ,act 7#db  
,u4,s4,c4 #bhc7 includes in=mation on   
actions und]tak5 by ! ,national         
,in/itutes ( ,heal? to c>ry out rese>* )
 respect to ,lyme disease & o!r         
tick-borne disease4  #f4 ,def9itions ,9 
?is ,act3 7#a7 ,b>tonellosis ,! t]m     
b>tonellosis means disease caus$ by     
,b>tonella infection f any vector or    
s\rce1 unless o!rwise specifi$4  7#b7   

,disord] ,! t]m disord] means a disord] 
caus$ by ticks1 b n induc+ human        
infection1 su* z tick p>alysis &        
,alpha-,gal meat all]gy4  7#c7 ,(fice ,!
 t]m ,(fice means ! ,(fice ( ,ov]sight &
 ,coord9ation = ,tick-,borne ,diseases  
e/abli%$ "u section #b4  7#d7 ,o!r f$]al
 ag5cy ,o!r ,f$]al ag5cy means a ,f$]al 
,dep>tm5t1 ag5cy or (fice outside ( !   
,u4,s4 ,dep>tm5t ( ,heal? & ,human      
,s]vices4  7#e7 ,secret>y ,! t]m        
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  7#f7 ,tick-borne      
disease ,! t]m tick-borne disease means 
a disease t is kn[n to be transmitt$ by 
ticks 9 ! ,unit$ ,/ates1 unless o!rwise 
specifi$1 or t may be discov]$ to be    
transmitt$ by ticks 9 ! ,unit$ ,/ates4  
7#g7 ,tick-,borne ,disease ,work+ ,gr\p 
,! t]m ,tick-,borne ,disease ,work+     
,gr\p means ! ,tick-,borne ,disease     
,work+ ,gr\p e/abli%$ "u section #bjfb (
 ! #ba/ ,c5tury ,cures ,act 7#db        
,u4,s4,c4 #bhds74