U.S. Environmental 

Protection Agency’s

Promoting 

Community 

IPM to 

Prevent TickBorne 

Diseases 

Conference 

Meeting Notes

Arlington, Virginia 

March 30-31, 2011
Promoting Community Integrated Pest Management (IPM) for Reducing 

Tick-Borne Diseases 

Conference Goals

1. Identify successful strategies for community IPM programs

2. Identify research priorities and knowledge gaps

3. Strengthen partnerships amongst participants

Day 1 Introduction 

Keith Matthews (EPA)

Thank you for joining us today for our community IPM tick conference. Very pleased to see such a large 

crowd. I am the director of OPP BPPD. BPPD registers reduced-risk biopesticides and pesticides. It is one 

of the registering programs in OPP. They also have a mandate for pollution prevention. In the pollution 

prevention aspect of the role is where IPM falls. IPM has a long history in the Environmental 

Stewardship Branch (ESB) and is something that we have been involved with for many years. Initially we 

planned this conference for 80 to 100 participants. The level of interest has continued to grow. We now

have over 150 attendees and 100 people who have registered for the webinar portion. 

Tick-borne diseases are a very important and significant public health issue. Ticks are vectors for 

anaplasmosis, babesiosis, ehrlichiosis, Rocky Mountain spotted fever and Lyme disease as well as other 

pathogens. This conference will focus on IPM as a prevention strategy. Prevention is smart and cost 

effective, we want to stop problems before they happen and grow out of control. Session 1 will focus on 

community IPM. Session 2 will focus on protecting children and outdoor environments. Lisa Jackson’s 

priority- protecting children- this is a huge problem for children and they will be impacted by tick-borne 

diseases. We will address this in session 2. In session 4, we will look at school age children and older 

Americans as highest risk groups. This session will recommend and suggest ways to best communicate 

to at risk populations. We will also talk about protecting outdoor workers, measuring the impact, 

research strategies, and the cost effectiveness of prevention. We will do a case study for public health 

protection and a summary of research needs and knowledge gaps. It is a very full and useful agenda. I 

look forward to the next few days. 

Charles “Ben” Beard (CDC)

I want to begin by applauding EPA for the effort in pulling together such a distinguished group for this 

meeting. When Candy had mentioned this meeting, I felt like she had stolen our thunder- CDC was 

discussing having a meeting with stakeholders for prevention. We are eager to collaborate with all 

stakeholders for Lyme disease prevention. We see this as a huge mission for us at CDC. Lyme disease is 

7th on the list of 70-80 diseases reported to CDC each year. Our number 1 priority is to secure the 

necessary information, methods, and collaborative relationships required to launch a national Lyme 

disease prevention program. We have a goal to reduce the prevalence of Lyme disease in the US. 

Christopher Zarba (EPA)

Associate Director for the Office of Research and Development - I was looking at the attendance list and

was impressed by the number and diversity of people attending. There are over 5,000 years of advanced 

education in this room right now. Thank you for coming, particularly those who have traveled significant 

lengths to get here. EPA’s Office of Research and Development has 1,800 employees. We are a mission 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

2

agency that does research to meet our customer’s needs. We do a lot of this work in house. However,

there are instances when we do not have enough resources and need to go outside to obtain the 

expertise and equipment we need. We frequently see the newest issues facing the agency such as 

hydrofracking, biofuels, and nano-technology. We determined that having a consistent strategy with all 

the right people that is broadly accepted as a path forward was very important. Marketing this strategy 

is also very important. Given the difficult budgets we need to be aggressive, and target our approaches 

as well as to embrace collaboration. We are here to identify success areas, identify research priorities, 

and strengthen our partnerships. With the ultimate goal of developing a plan- we hope to take forward 

(this will be available for comment). We can look at this plan and determine what is relevant to our 

organization, develop the plan, and move forward. Hopefully we will have a follow on meeting in a few 

years after this to discuss the progress of our plan. 

A few years ago, the agency was faced with recreational water use as an issue. There were 4,000 or 

5,000 beach closings each year and each state has different rules and regulations for closing beaches. 

We came up with an action plan for beach and recreational waters, based on science, for people. About 

a year after sending this document up to the hill and making it available- Congress passed the Beach Act. 

Congress took our action plan, products, deliverables, timelines etc. and put them into the Beach Act. I 

am looking forward to getting the funding and momentum needed for this issue to move forward so we 

can get resources where they are so desperately needed.

Michael McDavitt (EPA)

I would like to officially thank the organizers for this meeting. Everyone contributed to the development 

of this meeting so we will have a very organic meeting. A couple details- at break there is lunch- fill out 

the provided paper if you plan to eat here. We are convening this meeting under the auspices of the 

Pesticide Program Dialogue Committee (PPDC) this gives us our grounding. Be mindful of this. We are 

creating advice to the agency that will be considered. The speaker’s bios are in the packet in the back. 

This session is interactive, if you would like to formally provide public comment, please sign up. The 

focus of this meeting is PREVENTION, not on DIAGNOSIS OR TREATMENT. Everyone has been touched by 

these diseases, my mother-in-law has a disease from a tick. My father developed a disease from a tick 

bite that has been treated as well. They cannot be avoided, and they touch our lives everyday very 

personally. Each session will be in this room. There will be a panel, each will have a moderator or two. 

They will be chairing and organizing each session. It may be a little awkward at time, but we were 

looking for a maximum participation. Close with a quote: “Far and away the best prize that life offers is 

the chance to work hard at work worth doing” Teddy Roosevelt. Hopefully we will have great progress 

for two days.
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Session I: Creating Institutional Structures for Community Level IPM

Moderators Karl Malamud-Roam, IR-4, Rutgers University

John Carroll, USDA

Panelists Sean Healy, Monmouth County (NJ) Mosquito Extermination Commission

Thomas Mather, University of Rhode Island

Peter Jesson, Chadds Ford Township, PA

Brooke Bissinger, TyraTech, Inc.

Karl Malamud Roam (IR-4, Rutgers University)

Thank you for being here. I could use your help. The IR 4 program is a partnership between USDA and

land-grant schools. The economics of public health pesticides are very similar to those for minor crops , 

there is not enough incentive to develop without funding. The IR-4 program also works with the 

communities that have need—families, and organized local gov’t programs. Moving into ticks is 

relatively new, as is thinking about what communities can do together to control tick disease. Minor 

crops have been our bread and butter for the IR-4 program. There is not enough profit for companies to 

innovate and develop and register the best pest control technologies without some investment. I am 

trying to identify tools for public health and work with people who have need for vector control 

materials. I have been working closely with families and also organized vector control programs. Who 

will do IPM for tick-borne diseases? This session will discuss this. What is the paradigm for vector 

control? What are tools that have been suggested for community based mosquito and tick control over 

the years?

Integrated pest management is a huge buzz word, there is a subset called integrated vector 

management (IVM). Vectors are a type of pest, but are different than agricultural pests. We are trying to 

protect human health. IVM is based on the principles that reducing contact with vectors reduces human 

disease and that vector control can work to reduce vector borne disease. Individual actions are also 

effective. However, these can be inadequate. Community coordinated response is necessary. 

Eradication of a vector is rarely possible but control can reduce the disease. Eradication is not the goal 

usually. Reducing contact with the vector, reduces diseases. Surveillance- you have an active program. 

Biological control can help, pesticides are useful tools as long as they are public health pesticides. 100 

years of publically funded mosquito control – interested in malaria, arboviruses, and West Nile virus. 

The question that is key to me is can we learn from mosquito control programs to help us develop 

programs for tick control and IPM? Public education can be broad- it usually means that someone is 

doing the educating, but who should educate and to whom? Land-use planning- make provisions to 

reduce contact between people and disease. Deer population management? This is contentious- we will 

not see it solely to protect human health. However, we will consider it. These may have ancillary 

benefits for human health protection. Biological control- there are a lot of exciting ideas about using 

fungi for reducing tick-borne diseases. We need to know what good ideas are out there. There is a suite 

of chemical prevention strategies. Using barriers is important, tick control on deer (4-poster idea), tick 

control on rodents (tick control on nesting materials and baited food with acaricides so rodents receive a 

systemic load of the chemical to reduce the tick load on the rodents). 

Area wide control of ticks with pesticides is the least likely to be promoted here today. This is a big 

difference for mosquitos where area wide control is supported. We need to know what your ideas are. 

We have been asked to develop discussion pieces- I suggest: Do we know enough to recommend that 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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local governments spend money on vector control of tick-borne diseases? What do we need to do to 

develop recommendations? Who will make recommendations? What research needs to be done and by 

whom to determine what works where? Should we measure effectiveness?

John Carroll (USDA)

Where do we go from here? Where implies a plan, we need to know where we are going and how to get 

there. Who will initiate dialogue with existing institutions or create new institutions? We- the people in 

this room- should start this off and other people can get involved. There have been meetings and great 

ideas have come out but these have died out. We need a plan. This session is about institutions. There 

are institutions at various levels. Large long established institutions are the hardest to change. In smaller 

institutions it is easier to promote change. Large institutions however have the infrastructure and 

resources for change. We need to make difficult choices. It is difficult to start new programs, whether it 

is within an existing program or starting a new one. We have economic constraints. Desired and 

realizable goals: surveillance, tick population management, and reduction of Lyme disease cases. We 

need to make decisions on priorities. We want to see reduction but how will we do it? Areas with 

emerging problems and areas with an entrenched problem both need attention. Existing problem- this 

will receive attention. However, this is a spreading problem. The range of the tick is expanding into new 

areas. We have seen it move westward in Maryland for instance. The local population may not be aware 

of it yet. These people need to be involved. Not just the ones where there have been problems with 

Lyme disease for the past 20 years. In summary, vectors cross property lines and create a community 

level problem. At some levels we will need to deal with institutions. We need to define our goals, make 

plans, and initiate actions. 

Sean Healy (Monmouth County (NJ) Mosquito Extermination Commission)

Genesis of the mosquito control in Monmouth County. Mosquito control district was founded in 1914. It 

began looking at the salt marsh mosquito. In 1990- started looking at some tick related initiatives. In 

1992 the commission looked into a larger initiative for ticks- large scale field trials to control Ixodes 

scapularis. We used aerial applications of granules. This was the first area wide project for tick control in 

New Jersey. What drove the commission to actively implement a tick control program into the mosquito 

control problem? The director at the time, Martin Chomskey, felt that the best way to control ticks in 

these areas was through mosquito control districts that were already established. Lyme disease was the 

number 1 reported arthropod borne disease in NJ and the current level of funding was insufficient. 

Mosquito control is mandated by law in New Jersey at the county level. It is very specific and narrowly 

defined- it did not include a provision for these institutions to undertake tick related activities. 

In 1994- Monmouth County spearheaded changes to this provision to enable mosquito control agencies 

to undertake tick control. In 1997- the governor signed this into law Public Law. The commission 

followed this by adopting a resolution to designate the mosquito commission as the commission to 

undertake tick related activities. From the onset of the program- commissioners said that tick control 

needed to be budgeted separately from funding to control mosquitos. At that time they instituted the 

tick program at Monmouth County with a separate budget than the mosquito control districts. Funds for 

the tick program do not impact the mosquito control program. We have continued to collaborate and 

look at projects that can be implemented at the county level. The only ongoing tick control project is 

county wide and uses the 4-poster program. We also have a tick identification program and testing 

program. We research ticks in the county. 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Q&A

Question Karl Malamud-Roam: Do we have the knowledge needed for tick control? Where does the 

county go next? 

Response Sean Healy- I think that is the real question we are trying to address, do we have the tools 

we need to move forward in this type of program. This has been an overwhelming and 

daunting task- how do you get to all the people at risk. Can you do this fairly and 

adequately? There are ways of approaching this and it is possible. We look at peridomestic 

mosquito problems that are backyard containing breeding mosquitos. We had to convert 

our strategies to get the most bang for our buck. We have to do control in peoples yards to 

try to address the problem and in communities.

Thomas Mather (University of Rhode Island)

We have a peridomestic problem. We have potential for help at higher levels of government. We need 

people to make individual homeowner level decisions to make a large difference. Homeowners can 

make control inconsistent because people can opt out. How do we facilitate translation of training and 

information about control? Who are the people developing programs? What is their background and 

credibility? This should be a bottom up approach. We need to think about getting people (homeowners) 

to ask for assistance. We need to develop decision support tools to help people make decisions. One 

way is to incentivize them. If I offer you 100 dollars, you would be more likely to do what I ask. At the 

University of Rhode Island, we have a small EPA grant to develop a decision support tool for the 

peridomestic environment. We need trained tick controllers to help meet the demand for control tools 

adequately- for instance, five sprays may not be necessary but rather a single timed spray. 

In Rhode Island, we held the first deer tick management certification program for Pest Control 

Operators (PCOs). This will be the first group of people to be certified for deer tick management in 

people’s backyards- we had the first 15 graduates last week. They do not get their certification unless 

they provide for us their new tick bite protection/tick bite prevention plan so we can assess whether or 

not they have used science to address the issue. It is not good enough to say that I will do 4 sprays 

because the label on the control agent says so. Tick risk calculator- the early phases focus on 

surveillance, without surveillance you do not know the level of risk. This calculator provides risk 

appropriate recommendations necessary to make good decisions. Even in a highly deer tick endemic 

community, there will be landscapes in peoples backyard that do not have ticks. As a result, 

understanding the level of control needed varies by location, risk, etc. By understanding risk, it is easier 

to make decisions and tools to make these decisions are necessary. We need to motivate people in PCO 

industries to have tools to access town level, and individual risk parameters in yards to create action 

plans. 

Peter Jesson (Chadds Ford Township, Pennsylvania)

The level of Lyme disease is currently unacceptable. We need to document the need for initiatives. We 

have worked towards establishing a tick reduction program in a 4,000 resident rural township. We 

surveyed the township by letter- it told us we had an unacceptable problem and we should go forward 

with tick control initiatives. More recently, I uploaded an online survey which we are trying to get every 

resident in the township to fill out. It is quick and easy for people who have not had Lyme disease. It also 

has branching to allow for people affected by Lyme disease to put in as much information as they would 

like. The data is instantly put into a spreadsheet so it can be manipulated. I have added local wildlife 

management unit columns so I can identify which unit residents are in. The survey shows that so far 150 

households have responded with about 400 individuals. About 130 people have had Lyme disease and 

there were 225 Lyme disease incidents. The systematic approach- we chose the northern section of the 

township and we will institute a systematic drive with volunteers to contact the residents in this block of 
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the town and get them to fill out the survey. We will then move onto other sections. Involving 

appropriate organizations- we have the township administration, the civic association, Pennsylvania 

Game Commission, USDA, LDASEPA (Lyme Disease Association of Southeastern Pennsylvania), and 

universities in the area committed to the issue. We are doing bow hunting for the deer part of our 

program. We put in place a research effort- I have scoured the literature to determine the elements we 

need to put into place for our program. The research effort determined the following efforts for tick 

control: 

• Searching the literature for approaches

• Reduction of deer population through bow-hunting

• Damminix Tick Tubes® (rodent nesting material)

• Personal protection

• Spraying properties with pesticides

• 4-poster deer feeders (expensive)

• Bait Boxes (unavailable)

• Vaccination – contraception (not in PA)

• Fungus (still in research)

• Domesticated fowl (probably not effective)

We are attempting to reduce the deer population through bow hunting. We have a huge deer 

population 140 deer per square mile. This is a huge effort to get it down to any level where it will have 

an impact on the tick levels. We will be stocking Damminix Tick Tubes® and will let people purchase 

them if they would like them for their properties. It would be too expensive to do this on our own 

throughout the county. We are considering spraying. The township wants us to do this program for free. 

We have several task forces to address these issues- Public Information and Survey Task Force, Deer 

Control Task Force, Deer Population Measurement Task Force with USDA, Tick Measurement Task Force. 

Resident Awareness Program- long term, surveys, information distribution, website etc.

Tick Reduction Milestones Program- scoured the literature and published a report.

We have a plan developed and are in the process of implementing the plan. We divided the township 

into 12 management sections. We have all of the things that will allow us to look at one house from 

satellite and look at vegetation and determine how to handle it for deer hunting. 

Long term we will do annual surveys to reduce the deer population to 10 per square mile if possible. We 

need surrounding townships to get on board to maintain this. We would like to fully educate our 

residents with regards to personal protection and spraying property with pesticides. Over all, the long 

term plan is to:

• Annual Lyme surveys

• Keep reducing deer population (10 sq miles)

• Annual tick survey

• Fully educate and inform residents

• Keep track of new approaches

• Encourage surrounding townships to implement similar approaches
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Brooke Bissinger (Tyra Tech)

She has studied a plant-based repellent for her PhD. Many people are afraid of synthetic pesticides but 

people are afraid to use these chemicals. We need better education programs so people are not afraid 

of these materials or we need truly efficacious plant based repellents. 

Q&A

Question Karl Malamud-Roam, IR-4, Rutgers University- Deer control is much more acceptable than 

it was 20 years ago- likely because people are sick of hitting deer with their cars, having 

them eat their gardens etc. I would like to ask, should we be making recommendations 

regarding deer population management?

Response Peter Jesson- There has been interest in townships and surrounding townships for deer 

population management. It will likely spread easily through our area because we have not 

received a lot of negative response to deer population management. Attitudes have 

changed regarding this issue, people are much more on board with this issue. I believe that 

the interest that people are showing in our township will spread. Chadsford Township is on 

the state of Delaware border and is 40 miles west of Philadelphia.

Question Pat Smith, Lyme disease Association- Many of the cases came from the Naval Weapons 

Station. Why do we not have more of a collaborative effort? They have been mapping ticks 

in these bases. How are they controlling the ticks in these controlled setting? Why don’t 

we approach the military because they are an established entity that has had dealing with 

this and try to get help from them on what we should do?

Response Karl Malamud-Roam- the Armed Forces Pest Management Board- is meeting next week. 

They discuss research priorities. This is a topic on their agenda. I will try to get this on their 

agenda.

Question Robert Coney, EPA Region 1- This is in regards to the training program for PCOs- what type 

of training did they receive? Was it public health? What kind of material was taught? 

Changing plantings? Changing composition in your yard?

Response John Carroll- people were getting certification credits in category III- horticulture and 

landscape. They also could have had it in public health. There are several strategies to 

understand. Different strategies can be implemented to control ticks and reduce exposure. 

We talked a little about surveillance, evaluating yards, etc. We want them to be armed 

with what is tick habitat, why it is tick habitat, and move from there. It is important to 

engage people and let them be part of the surveillance in a passive way. If you find a tick, 

put it in a bottle, we can take a look at it. A lot of people do not know a lot of about ticks. 

We need to educate people so they know different types of ticks are out there. All ticks 

come in different sizes- if it is large it still could be an adult deer tick.
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Question David Gaines- There are a fair number of repellents on the market. There are many people 

who do not like DEET. It seems to be the only repellent researched for efficacy for ticks. 

Most of the products on the market have been studies for repellency for mosquitos but not 

ticks. Does the EPA plan to look at these products regarding their repellency for ticks?

Response Karl Malamud-Roam- The military is funding significant research and development on 

repellents to protect them from tick-borne diseases. There is federally funded research on 

repellents- whether it is sufficient that is another question. For many years EPAs focus has 

been on making sure products were safe. Efficacy was the focus for public health. There is 

a good efficacy website.

Response Brooke Bissinger- There has been a lot less research on efficacy for ticks. There are a 

number of studies that are looking at different active ingredients. It concerns me that this 

information is not being provided to the public. People with access to journals can see this 

information. There seems to be a knowledge gap between the research being conducted 

and the public. David Gaines- we have seen very little on repellency to ticks. I wrote a 

review article on tick control strategies, if anyone would like to see it, I would be happy to 

share it.

Response Candy Brassard- We are in the middle of rulemaking for product performance data rule. 

There have been many questions about ticks including the test organism and what should 

be on the label. There are biochemical and conventional products being included in this 

rule.

Response Keith Matthews- we are working a rule that will require efficacy data for public health 

control agents.

Response John Carroll- there is an information disconnect. We have worked with the Army, we have 

done two tests using human volunteers. These have shown these formulations are 

effective for 12 hrs. in these tests on specific repellents. There is information in the 

literature.

Response Joe Piesman- Community Prevention and Training- We at CDC- funded four states to work 

on community prevention of Lyme disease- Massachusetts, New York, Connecticut, and 

New Jersey. The vaccine came out around this time and was quickly taken off the market. 

Outreach was a focus of this. Connecticut was the most effective at moving training 

forward- area wide acaricides are widely effective and can be used against Lyme disease. 

The problem is they are overused on occasion. Pest control operators do not need to spray 

weekly- we need one adequate timed spray before the season starts. By participating in 

the program the PCOs were registered as having taken the course and this information was 

translated throughout the township. Coming out of these programs- there are two 

manuals that are useful- Kirby Stafford’s IPM for the Homeowner and also another manual. 
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Question Question for Peter Jesson from Webinar participant- CDC has funded these unity education 

and management projects in four states. What you are doing in your community is 

interesting. You mentioned you will be following up so you know who does what- will you 

be researching the combinations and factors that are effective for control? Secondly, you 

mentioned that there are fewer deer- sustainability of control methods- what about 

anticipating any decrease in hunter participation or not having enough deer? What might 

you be anticipating to encourage participation in the future?

Response Peter Jesson- As the population decreases the hunters may lose interest. If they want to 

hunt in Chadsford, they may have to make a low count. We have access to the landowners 

that they do not. We also have one of the most attractive deer hunting areas in the state. 

We are expecting those who are dedicated to help solve the Lyme program will continue 

participation. We are hoping by tracking the deer population, tick population, and disease 

incidence that we will have a record year after year to determine if what we are doing is 

effective or not. 

Question Lisa President of National Tick-borne Disease Advocates- With the budget challenges at 

state, local, and federal level- what about the dialogue with the USDA? In Texas we had a 

study come out that Cattle ticks are carrying different pathogens.

Response Mat Pound- Cattle fever ticks carry babesis specific to cattle.

Question Sherry Glick- How is the data from the tick calculator used? I am interested in how this can 

be used for IPM and kids.

Response Thomas Mather- The calculator is specific for homeowners. It walks through 45 questions 

about what your yard looks like, how it is use, current practices for tick bite protection. It 

then calculates a number between 1 and 100. It then lets you try implementing a control 

strategy through the tool and see how the risk number can drop. Web address: it is not 

quite available yet, I have been stalling launching it, I like to get things right. It should be 

available for a few states hopefully sometime this season.

Question Do we know enough to make tentative recommendations?

Response Karl Malamud-Roam: We know enough to make tentative recommendations. There are 

recommendations that can be made to individuals, homeowners, communities, states etc. 

There are actions that are appropriate for individuals and a role for the federal government 

in research and data, reviewing case loads, and looking at long term trends. John Carroll: It 

is interesting to see how this problem has evolved and mechanisms to control have 

evolved. Monmouth County and Chadford Township have both evolved completely 

differently. 
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Session II: Protecting Children in Schools and Outdoor Environments

Moderators Kathy Murray, Maine Department of Agriculture, Food, and Rural Resources

Thomas Green, IPM Institute of North America

Panelists Christine Dunathan, Friends Community School, College Park, MD

Benedict Pagac, U.S. Army Public Health Command- Region North

Shirley Schantz, National Association of School Nurses

Herbert Bolton, U.S. Department of Agriculture

Audrey Moore, U.S. EPA Region 2

Clara Fuentes, U.S. EPA

Kathy Murray (Maine Department of Agriculture)

Why focus on children- they are our future. Schools are at risk. We talked about peridomestic issues. 

Many schools are in suburban and rural areas and are close to tick habitat. I receive calls every year 

from schools seeking help. The goals of this session are to: 

• Discuss IPM practices used effectively at schools and other outdoor environments to reduce 

children’s risks of exposure to tick-borne diseases.

• Identify priority needs and knowledge gaps in research, education, regulation and 

implementation to protect children at schools and other outdoor environments.

• Develop coordinated strategies for community IPM programs and strengthen partnerships 

among organizations, agencies, schools and other public facilities.

We SHOULD focus on children’s health and ensure they are protected from exposure to tick-borne

diseases. Children rely on adults to help check their bodies for ticks after outdoor play, direct activities 

away from tick infested areas, assist with application of repellents, and get necessary medical care when 

needed. Children may be more vulnerable to exposures because of their behaviors (climbing trees for 

instance or building forts in the woods), and perhaps because their immune systems are not fully 

developed.

Tick IPM in schools is a combination of managing people and managing pests. There are a number of 

jobs and different job descriptions of people involved in managing school properties and facilities. 

People who play a role include: coaches, parents, office staff, teachers, maintenance staff, students, 

nurses, and contractors (pest control and landscaping). It takes a lot of effort to facilitate coordination 

between these groups. School nurses and the school board play a huge role.

School nurses can help prevent and identify tick-borne diseases and provide guidance to parents. 

Role of the School Nurse:

 Prevent and identify tick-borne illnesses in schools

 Early detection and referral

• Monitor student’s symptoms to improve outcomes

• Advocate for post-diagnosis accommodations for students with ongoing symptoms

 Provide guidance to parents and guardians

• Prevention, detection and treatment

 Assist with school district policy development

The Friends Community School is located in a very tick infested area. There are many encounters with 

ticks. The school shares land with deer, foxes and other wildlife. There is also a stream along the eastern 

edge of the property which is part of the Chesapeake Bay watershed. The forest starts outside of the 
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door. Once they moved into the building they realized they had a tick problem. One of the parents had a 

contact at USDA and they enrolled in a study run by John Carroll. They created a multiple point IPM 

program which included:

• Field policy and dress code

• Teacher education

• Parent education

• Biannual testing

• Duct tape for each teacher

• Repellent

• Pyrethrins on socks

• Garlic barrier spraying program

• Deer feeder

• Tick tubes spring and fall

• Chickens

The U.S. Army has worked to protect Boy Scouts from ticks during the Jamboree. “Large, outdoor nature 

events held in known tick habitat can be a major public health challenge.” A multitude of protective 

measures ranging from the simple (raising awareness via signs) to the sophisticated (producing GIS 

threat maps and establishing an on-site field lab to identify attached ticks and test them for pathogens 

via PCR) can successfully mitigate disease risk. Successful tick and tick-borne disease management in 

large outdoor public events relies on: advanced planning, early stakeholder communication & 

coordination, systematic sampling, wise IPM decision making, delineation of risk, re-evaluation and 

modification, quick diagnostic turnaround, and on-site/on-call expertise. Events such as scouting 

jamborees are noteworthy in that, in some cases, hundreds of thousands of national and international 

participants interface closely with nature for a two-week period and then return home. Preventive 

measures are the first priority but they should dovetail with on-going diagnostic monitoring and 

documentation so that follow-up actions can take place, if needed, with patients having suspected 

exposures. US Army has worked closely with the Boy Scout Jamboree with almost 100,000 participants 

each year. This area is complex. They created tick risk zone maps, a mobile laboratory to test them for 

Borellia, etc. 

With an increased emphasis on getting kids outdoors (No Child Left Inside initiatives, school gardening, 

experiential learning) environmental education information is needed to protect children from tickborne diseases. 

Charge questions for the panel are: 

1) What is your organization doing to protect children from tick-borne diseases at schools and 

other public spaces, what challenges do you face, and what should EPA do to help you to 

overcome those challenges and support your programs.

2) What guidance can you offer to school administration and staff, or to managers of parks, 

children’s camps and other outdoor spaces frequented by children, in terms of facilities 

management, education, and stable funding sources if needed, to reduce risk of tick-borne 

diseases. 

3) What are the top priority needs for research to reduce children’s risk of exposure to tick-borne 

diseases at schools and other outdoor environments?
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Thomas Green (IPM Institute of North America)

The IPM Institute of North American was started in 1998. The industry was opening up to our needs to 

protect the environment. One of our first jobs was working with the Food Alliance which certifies 

production and IPM is one of their requirements as opposed to organic. Their producers have to use IPM 

to participate in the program. Food Alliance then provides marketing support and an eco-label. EcoApple is another marketing strategy where we embrace IPM. The IPM Institute has been around for 12 

years working in agriculture and communities. The IPM Star program was started using the organic 

model where we go onsite to the school programs and if we approve of what they are doing we certify 

them with the IPM Star. We also work closely with military schools. We have had an impact on cleaning 

up improper use of pesticides. 

This is not rocket science; it is simple things like putting door sweeps in schools and other mechanical 

control mechanisms. We can reduce pest complaints by 60% just by putting door sweeps in schools. We 

want high level IPM in schools by 2015. We are coordinating our efforts- it is the first time we have done 

this. We are infiltrating people already working in schools and getting leaders from these organizations 

on board with the program. This has been going on since 2006. IPM has been recognized as a continuum 

of practices. We are striving to implement IPM in these schools, empower people to create sustainable 

programs and then let them take it from there. We have people using products improperly because of 

resistance and overuse. There are a lot of unknowns with regards to products that we are using now not 

just pesticides but pharmaceuticals etc. We want to minimize our reliance on pesticides. These are 

valuable tools that can be used especially targeted specific chemicals instead of broad spectrum 

pesticides.

Accomplishments to date: Demonstration projects. Pilot schools use proven approaches, such as 

assessments, workshops, targeted newsletters, and pest monitoring to successfully demonstrate IPM in 

their region and state. Each year, our goal is to initiate demonstrations in at least five new states that

have not previously completed a demonstration project. Established 12 school IPM pilot projects 

throughout four regions:

• Ascension Parish, Louisiana

• Brookings, South Dakota 

• Flandreau, South Dakota

• Westville, Illinois

• Lincoln, Nebraska

• Omaha, Nebraska

• Chariho, Rhode Island

• Exeter, New Hampshire

• White River Junction, Vermont

• Salem Keizer, Oregon

• Sterling, Colorado

• Russellville, Arkansas

New demonstrations have been starting across the country, adding to our success in prior years. Over 

300,000 students and 20,000 teachers have been impacted by school IPM demonstrations in recent 

years. New demonstration projects:

• Catlin, Illinois

• Champaign, Illinois

• Vermillion County, Illinois

• Bozeman, Montana

• Dothan Brook, Vermont

• Hartford School District, Vermont

• Indianapolis, Indiana

• Caliche Schools, Colorado

• Albuquerque, New Mexico

• Rio Rancho, New Mexico
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Self-expanding coalitions use professionals already trained and working in demonstration schools to 

recruit and mentor professionals from other school systems in their states. Have established school IPM 

coalitions in 15 different states including:

• Alabama

• Arizona 

• Colorado

• Illinois

• Indiana

• Missouri

• Montana

• Nebraska

• New Hampshire

• New Mexico

• Ohio

• Pennsylvania

• Utah

• Vermont

• Washington

Lessons learned include the need to identify the key decision makers and champions in the districts. 

Asthma affects 6% of our kids. Compelling messages can activate decision makers so they work on things 

we want them to work on. There are many opportunities with new partners. Green schools may put 

planning in place that may increase tick habitats. We need to work together to minimize tick habitats 

and schools. This has been a broad effort with support from a variety of agencies and organizations. 

Would like to leverage the support we are receiving. We would like to learn more on how we can get 

involved. Regions are really doing a lot of work and have working groups. Schools can be used as tools to 

get information out to the community. If we educate students now, they will become better consumers 

in the future and hopefully will support IPM initiatives. 

Christine Dunathan (Friends Community School, College Park, MD)

I became involved in this group because of John Carroll. I represent the microcosm of implementation. 

The Friends Community School has young children. We are a green school located on a forested 17 acre 

site and are adjacent to Greenbelt National Park. We have wetlands and various animals. Our program is 

hands on and we try to integrate experience with classroom learning. We envisioned we would have a 

very active use of our property and we would get the kids outside a lot to do science, math etc. We had 

a rude awakening when we moved in. We did not know we had ticks. We had a camp before we 

officially started school. A lot of the campers were getting ticks so we had to move the camp to an 

emergency location. We are a Quaker school serving 200 kids K-8. The type of site we have is protected, 

we want to be green and be good stewards of the earth and all that goes into this. We immediately 

began researching IPM strategies to look into this problem. 

In addition to deer, fox, and many small mammals we have a creek with frogs, fish etc. We did not want 

to just spray anything that could endanger these species. Didn’t want to just spray randomly.

Immediately brought in pest-management companies and they suggested spraying lots of strong stuff, 

and didn’t appreciate the environmental concerns. We had a problem. We brought in for profit pest 

management companies that suggested spraying pesticides inside and outside the school. I started 

doing research and did not want to spray indoors and outdoors. One key thing they did was study the 

problem, look for experts. We signed up with John Carroll to join his study. We needed to know the kind 

of ticks, the location, etc. We were very grateful to have the information and advice John delivered to 

document our baseline situation and figure out next steps. 

I developed a tick management plant with short medium and long term goals. Immediately when we 

showed it to the faculty people were concerned with what their kids would be exposed to. We had other 

parents saying the kids could not go outside at all. Some parents said we should do everything to get rid 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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of ticks possible. We had three major attitude approaches to deal with. Timing was an issue of course, in 

the fall the second wave of ticks was coming out. We needed to limit exposure to the children. Because 

we are an independent school we adopted the policy and did not have to worry about the school board 

etc. We had children play on the blacktop, insisted children wear shoes, long socks, etc. We had a lot of 

behaviors we had to change. We developed criteria and steps to take to be minimally invasive. We 

wanted to be as effective as possible at the least cost. We did not want to spray anything that would 

impact fish and wildlife. We developed a multiple point plan with a field policy and dress code. We 

started a teacher education program. We had the campus tested twice a year to determine the 

effectiveness of the steps we were taking. We issued rolls of tape to teachers so the students would put 

it around the socks. We trimmed around the trails. We abandoned paths and started taking kids to parks 

with asphalt paths until we could spray. We sprayed with a garlic barrier spray. We had every kid bring 

in socks and we treated the socks with pyrethrin. The kids would wear these socks if they went outside. 

We sprayed nematodes- I cannot say whether this was effective or not. We established a deer feeder 

and put out tick tubes. We took a flock of chickens and had chickens onsite that we would move around 

every few weeks. It was quite a decision piece. 

Herbert Bolton (USDA- National Institute of Food and Agriculture)

We are the branch of the USDA that has extramural programs. We are a grant agency for research, 

education, and extension. We depend on our land-grant partners to do our research through grants, 

education, and outreach. To support IPM- our organization is focusing on research, education, and 

extension. At NIFA we do not have a grant portfolio directed towards ticks or towards IPM. The Farm Bill

was focusing on issues facing agriculture. We do have some special grants however that focus on ticks. 

Check out tick encounter.org which is a very interesting site that we were able to help support through 

our grant. In extension efforts we support the funding of the regional IPM centers. Some of this funding 

has gone towards IPM in schools. Our land-grant partners go into the community a lot. These land-grant

university specialists are a first line of resource. The grants that they receive from us support these 

efforts. New effort by land-grant universities is eXtension- they all cannot be doing the same thing over 

and over in the same states. This is web-based. There are leaders in communities of interest. Go to 

eextension.org they will pop up. These are practices across the land-grant universities. I suggest that this 

is a way to track research and to support these systems independently. Recommendations- encourage 

people to check out what state extension programs have to offer. Tom Mather is right on. What people 

are willing to do is based on their understanding of risk. If risk is low or non-existent- you will burn them 

out. People are already trying to focus on keeping their families healthy. It is important to consider risk. 

Top priorities for research and outreach- we need surveillance at a greater level for ticks. We need an 

inventory of federal outreach materials. We need to see what state agencies have already developed 

collect resources, and do an inventory of what is out there. We can overwhelm people with material, we 

need to see what is out there, what is the best of the best, what is science based etc. There is a great 

need for social scientists to be involved- so we can consider what people are going to do with the 

information received. They can help determine how people set up programs and why. Outreach and 

Materials- let’s look at what we have. You have to ask yourself who is the target audience, how do you 

want people to respond, we need focus groups, surveys, etc. and re-adjust our focus on the user (the 

school, people in the school, parents). What is the information that they want, not the information that 

we think they should get. AMCA is doing this in some parts for communities. We should bring in social 

media. There is a user based website called useability.gov which talks about making websites accessible 

to the user. 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Benedict Pagac (US Army Public Health Command-Region North)

It was mentioned the Army had an involvement with the Scouting Jamboree- it was a special event that 

has applicability to larger scale events. The National Scout Jamboree happens every 4 or 5 years. The 

military has large tracks of land so they were a natural fit to hold events like this. Planning is imperative 

for outdoor events. You need to know the site well. Planning should occur a year in advance. The event 

occurs in the Virginia Piedmont which is tick country. In the early planning process ticks may not be on 

the table. There should be consideration of vectors when planning these events. This is a 

multidisciplinary effort- getting public health officials and pest experts together along with safety people 

to make it a successful event. It is established that you need a lot of good planning. Part of the tick 

approach is delineating the site into different sections. Dragging is effective in finding ticks. People 

should expose themselves to ticks using this method to learn something! 25 years these things still 

amaze me. They are amazing animals that we deal with. You learn something new every day. 

It is important to know your subject. Planning- during an event is not inconceivable to have an onsite 

tick testing lab. You can fit everything you need to have an onsite lab in a standard panel van. You need 

electricity, water, and somewhere to put it. This allows us to provide people with exposure information 

in real time especially given the international nature of the event. There are many materials provided by 

local health departments. Among children there is a desensitization to paper. We explored in 

discussions- social media to get the message out about awareness. We need to exploit social media to 

get information out about protecting yourself. One other lesson learned - jiffy-johns. In an outdoor 

event a major issue is the number and location of your portable toilets. If you do not have them and 

they are not in the right place, there are natural places to do things that will expose you to ticks. Special 

behaviors- you have to go through behaviors of participants to determine exposure- e.g.: hiking, trading 

patches. 

The military is involved in making sure military families have as healthful a living environment as 

possible. Military members are in harm’s way and so are their families. There has been a big push in 

providing better child development centers and youth activity centers. These are often placed in the 

more bucolic areas to provide a good setting. A lot of thought needs to be put into play areas, 

manicured areas, fences, buffer zones, etc. Ticks will be found in unconventional habitat- this needs to 

be considered. Balls go over fences and someone has to go out of these areas. EPA can help by doing 

what they are doing- looking at new repellents, doing good registration, providing good guidance 

material that people can do. They are doing a good job but areas can be offered to target for the future. 

Shirley Schantz (National Association of School Nurses (NASN))

We are located in Silver Spring, Maryland. Before that we were in Colorado. The NASN is a national 

organization and we have chapters in 49 states, D.C., and an overseas chapter. We have over 15,000 

members. There are about 75,000 school nurses in the U.S. There are school nurses in 75% of our 

schools every day. The NASN has been involved with the EPA tools for schools program for the past 8 

years. One thing that we do is IPM. We have a program and bring our nurses to the conference and at 

any rate we have trained school nurses about indoor air quality. We have educated about 5000 school 

nurses about IPM. These nurses then educate parents, staff, children etc. We provide a weekly digest 

and can promote some policies. We also produce articles in our evidence based journal. We have a good 

network of communication to school nurses. We can publish information that you want disseminated 

throughout to nurses. A school nurse is the health authority in the school. If there are children that go to 

the office or the parents see changes in behavior- nurses can identify children having symptoms-we can 

do a health assessment and determine if they need to go to a primary care provided which is outside the 

area of expertise to the teachers. A school nurse can identify illnesses even if it is vague and determine 

the child needs to seek further medical attention. We have great communication with teachers, families, 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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students in the schools. We focus on prevention. If we can identify areas of prevention to recommend to 

schools or school boards, and to the community and we can help promote these. We would be happy to 

promote programs. We want to focus on children’s health, preventing the issues and keeping children 

healthy, in class and ready to learn. The number of children with asthma is increasing- about 10% of all 

children have asthma. The school community and building has to be a safe, clean area that provides a 

healthy environment for everyone who comes into the schools. The EPA- I would like to encourage the 

EPA to provide evidence based information that we can communicate to families and to promote 

evidence based policies. Top research priority- I would like to know the real incidence of tick-borne

diseases in schools. Evidence that IPM actually affects the incidence of tick-borne diseases. We want to 

show that a healthy environment promotes decreased absenteeism and an increase in academic 

success. We want happy and healthy children. 

Audrey Moore (EPA, Region 2)

I have been with EPA for about 20 years now. For the past 10 years I’ve been working for agricultural 

initiatives, school and community IPM. Our region has a well-established outreach program that we 

have been targeting schools and trying to promote IPM. I also am involved in the PESP grant program. 

We funded a grant to the University of Medicine and Dentistry in New Jersey to put together an 

interactive training program for children regarding tick awareness and prevention for 4th and 5th graders. 

The actual program consists of a prevention video and an interactive game. The children can then 

identify what a tick is, how to identify a bite, what to do when bitten. We are hoping to get this material 

out there once it is complete. We need to collaborate on future projects. Starting to lose some of their 

state level partners. Happy to have this opportunity to find other potential collaborators, stakeholders 

etc. to work together.

Q&A

Question Pat Smith- Question to Tom- School districts have a fear of being sued. Districts tend to be 

afraid of having problems and admitting it. Have you run across that and how do you deal 

with it?

Response Tom Green- Yes, I have run across that- most recently there was a bedbug meeting- I made 

some remarks for a colleague about the bedbug problem in their district and the phone 

was ringing off the hook. Larger districts may have a professional manager on staff to deal 

with these issues. In other small districts they may not have these resources. Working with 

people and determining success is a good way to determine how schools can deal with this 

liability. It is easier to find experts and provide support to school districts.

Question Conservation Org- The real need to continue to encourage our children to be exposed to 

outdoor environments- how can we do this given the tick problem? This is a real research 

need.

Response Shirley Schantz- The more we allow children to go outside the more we expose them to 

risk. We need to consider this in cost and benefit analyses. The only way to do this is 

prevention strategies. Prevention needs to be addressed along with encouraging our 

children to go outside.
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Question Karl Malamud Roam- If we do monitoring and decide we did 12 interventions and the rate 

went down- how can we decide what is being effective?

Response Christine Dunathan- We struggled with this. We implemented all of these things over time. 

We started a few, dropped them. Started others, then tested again. We did several at a 

time. The first thing we had to do was promote a change in behavior. We have eliminated 

areas where there were a lot of ticks. I suggest that the federal government reach out with 

groups that deal with kids to not brush this off and take tick-borne disease more seriously. 

Question Question: The tick seasons etc. are very different in different parts of the season. How can 

we move towards regionalizing advice. My concern is use of social media. My point is we 

need to regionalize our efforts.

Response Herb Bolton: There are people planning social media etc. who are mapping by zip code and 

you can receive information by county. Thomas Mather: We need to partner with regions 

to make regionally appropriate information available. We do not receive much feedback. 

We need to incentivize informational sharing. There are mechanisms that are simple. 

Question Sherry Glick- Are there developed and proved school curriculum regarding tick prevention?

Response Kathy Murray- I have a grant to teach kids about IPM in the classroom. We have tick 

lessons that Audrey’s grantee that has developed. There are pest control companies that 

do this as well.

Response Bob Maurais, Mainely Ticks- We have taken an approach to deal with this in Maine. We try 

to model Tom’s website. We create posters, community based form. Everything is 

community based. This is a paradigm shift. Things are not the same as they were before. 

In Summary: Need for better surveillance methods and data- we need to make this information available 

to those who need it. We need to inventory the materials available, find the best of the best, and make

them readily available. We need to involve social scientists. Planning is needed. We need to invite 

partners to reach out and invite others for collaboration such as with the NASN. 

Session III: Landscape Planning and Tick Management

Moderators 

and Speakers

Montira Pongsiri, U.S. EPA 

Howard Ginsberg, U.S. Geological Survey

Kirby Stafford, Connecticut Agricultural Experiment Station

Panelists Wink Hastings, National Park Service

Laura Jackson, U.S. EPA

Terra Rentz, the Wildlife Society

Robert Snieckus, U.S. Department of Agriculture

Kevin Sweeney, U.S. EPA

Kendra Briechle, The Conservation Fund
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Montira Pongsiri (EPA)

We are talking about landscape planning and tick management. The questions for the panel include: 

1. How can we engage the landscape design professions in the prevention of tick-borne diseases?

2. What is the best way to provide information on tick-borne disease prevention to professional 

planners and landscape architects? 

These strategies have been untapped. We want to look at these and take steps towards incorporating 

them into landscape design. 

Howard Ginsberg (USGS)

The genesis of this session is from something a lot of tick biologists have experienced. Looking at layout 

and landscape design- people may be artificially creating habitats for ticks. Minor changes in planning 

for landscape design could change this- this could reduce the number of people getting bit and suffering 

from tick-borne diseases. This strategy does not require people to do a lot on their part. Rather, the 

design is implemented and it is done. Lyme disease is the most important vector disease in temperate 

areas. One tick species is the vector for Lyme disease, one pathogen but various reservoirs. There are 

two populations of ticks living in one place at the say time due to the lifecycle. The nymphal stage is 

what causes a majority of the Lyme disease cases. This stage of tick is usually making people sick and is 

the stage we want to concentrate on.

Approaches to managing ticks and Lyme disease include: 

• Self-protection precautions

• Habitat manipulation

• Manipulation of host populations

• Biological control

• Pesticide applications

o broadcast

o host-targeted

The goal for IPM for tick-borne diseases is to integrate techniques so as to efficiently lower probability of 

exposure to pathogen. Research suggests that .25 percent of nymphs are infected. On average mice are 

bitten by 30 to 2000 ticks each summer. This suggests that it is very difficult to control natural 

reservoirs. Studies demonstrate that prevention is the most cost effective and BEST way to reduce 

people being exposed to the pathogen. Ticks have habitat requirements. Good tick habitat is found in 

thickets, and woody cover. 

You will not find ticks in poor habitat like open fields. Nymphal abundance is related to relative humidity 

in leaf litter. Canopy cover is also related to nymphal abundance. It is not quite that simple however. 

Things are happening on a yearly basis that affects the habitats that ticks are living in. Factors change 

from year to year that affect tick abundance. You can have a very good tick habitat with a lot of ticks 

however if you manage the environment so that people are not encountering the ticks you will reduce 

number of people being bitten. Ixodes scapularis nymphs require:

• moist leaf litter

• typically with forest canopy cover

• appropriate hosts present
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Landscape features that lower tick abundance and number of tick bites include:

• dry at ground level

• open forest canopy 

• appropriate hosts excluded (local? area-wide?)

• people discouraged or excluded from tick habitat

Crushed rock or woodchip barriers can be very uncomfortable environments for ticks. This can make a 

huge amount of difference. Fencing keeps people out of tick environments rather than discouraging 

ticks from the area. Paths to separate people from tick habitat- stone, crushed rock, etc. There will be 

very few on the path because it is poor habitat. They will avoid it. Paths through the woods provide little 

protection from ticks- clearing off the leaf litter can help. Boardwalks- these keep people out of tick 

habitat and ticks will for the most part not go up onto the boardwalk. These are simple ideas that if 

incorporated properly can make a large difference. 

Kirby Stafford, Connecticut Agricultural Experiment Station

There have been a number of approaches to try to manage people’s exposure to ticks and controlling 

the vector to begin with. Tick management includes:

• Personal Protection Measures

• Habitat or landscape modifications 

• Biological and natural control

• Area-wide chemical control

• Host reduction or exclusion

• Host-targeted acaricides

• Host-targeted vaccines

Emergence of Lyme disease has been linked to reforestation and suburbanization that expose humans 

to habitat and hosts that favor Ixodes scapularis. Many studies have linked forest edge (reviewed Killilea 

et al. 2008) and lower host diversity (LoGiudice et al. 2003, etc.) (favoring deer and white-footed mice) 

with the risk of Lyme disease. Authors examined LD incidence and land-cover metrics for 12 counties in 

Maryland. LD (Lyme disease) incidence rate most explained by edge-contrast index, a measure of 

forest-herbaceous edge plus larger percent forest cover. Edge contract index may explain Lyme disease

Incidence.

Lyme disease risk is linked to peridomestic exposure. Distribution of Ixodes scapularis in the home 

environment:

• 67.3% woods, 21.6% ecotone, 2% on the lawn

• 82% nymphs are within 3-m of the lawn edge with woods, stone walls, ecotone, etc.

Risk linked to peridomestic activity: 

• Estimated 75% ticks are picked up outdoors at home

• Indicated activity: Play 47%; Yard work 18%; Gardening 12%; Elsewhere neighborhood 4%

CDC funded a number of studies to declare a war on ticks looking at pesticides and landscape decisions. 

Residential landscape management includes: 

• Mowing, pruning

• Clearing brush
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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• Restrict groundcover

• Leaf litter removal

• Landscape barriers

• Deer fencing

• Deer resistant plantings

Studies indicate that:

• Insecticidal soap and silical gel with pyrethrin & PBO provided 78-100% control nymphal ticks 

Pachysandra, sod, stones or woodchips.

• Alaska yellow cedar sawdust or woodchips and cellulose acted as barriers to nymphal tick 

movement, but only the sawdust impeded crossing up to 1 month.

When you incorporate changes like leaf litter removal and landscape barriers you see big results. 

Essentially, there needs to be a tick zone and a tick safe zone. The tick zone should be cut off using a 

barrier. 

From 1999-2002, three CT health districts initiated intensive community-based intervention programs 

increase awareness Lyme disease and encourage use prevention measures. Brochure came out- get your 

backyard in the zone. A Spanish version was also created. This brochure was targeted towards landscape 

designers. This includes suggestions, methods, etc. Materials are available and need wider circulation.

A study was conducted on knowledge, attitudes, and behaviors regarding Lyme disease prevention in 

Connecticut residents (Gould et al., 2008). This study considered residents in three CT health districts 

who were surveyed in 1999, 2002, and 2004. The survey found that:

• In WWHD (Westport Weston Health District), use of all environmental measures increased 

from 1999 to 2002 and were sustained as of 2004.

• Most respondents willing remove brush or leaf litter (91%) or place wood chip or gravel 

barriers (82%).

• Fewer willing to use deer fences (52%) or spray pesticide (47%).

• 44% willing to spend up to $100, 37% spend more than $100. 

Another study was conducted that considered Peridomestic Lyme disease Prevention based on 

population-based case-control (Connally et al., 2009). This study: Examined personal protection, 

landscape modification, and chemical control in a prospective case-control study in CT.

• Checking for ticks within 36 hours of time in the yard was protective against LD.

• Bathing within 2 hours of time in the yard was protective.

• Fencing of any type was protective, but mechanism unclear.

• No other landscape modifications (mowing, leaf litter clearing, presence of playscapes, mulch or 

gravel barrier) were protective.

• Having stone wall, birdfeeders, vegetable garden, woods adjacent to property made no 

difference between cases and control (sample size also small in some cases).

NOFA Standards for Organic Land Care create standards to follow. This is the heart of the Organic Land 

Care Program which:

• Provides a definition of “organic” in land care

• This definition is used for educational purposes (course, public outreach)
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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• Also specifies materials and practices that professionals pledge to use in providing organic land 

care to their clients

The specific tick (pest) management NOFA standards for Organic Land Care include: 

• Preferred

Tick bite prevention (avoid tick areas, pants in socks, repellents?) 

Tick checks to detect and remove before pathogen transmission

Environmental modifications (landscape practices)

Host management (deer fencing & herbal, soap, human hair as repellents)

• Allowed

Biological agents (parasites & pathogens)

Diatomaceous earth & insecticidal soaps

Botanical insecticides, including plant extracts, such as pyrethrum and minimum-risk or 25b 

insecticides (FIFRA Section 25b), which are exempt federal registration and do not have to 

demonstrate efficacy

• Prohibited

All synthetic insecticides and piperonyl butoxide as an insecticide synergist

Any pesticide formulated with any inert ingredient not allowed by the National Organic 

Program.

This suggests the need for MORE TOOLs.

Invasive plants is a huge issue in and of itself. Lyme disease is very prevalent in areas where barberry is 

invasive. Charles Lubelczyk and colleagues found a close association of Ixodes scapularis with the type 

of habitat and plant species. Ticks are associated with exotic vegetation. This research raised a question: 

can you control ticks by removing barberry? The results of the study conducted by Scott Williams and 

colleagues (2009) demonstrated that:

• Barberry infested 40-70% sites and was reduced from 62% of cover to 3% cover by mechanical 

cutting and burning with propane in controlled areas in 3 sites in CT

• Questing adult blacklegged tick abundance greatest in areas Japanese barberry

• Greater abundance larval ticks on mice in barberry

• Larval ticks sig. fewer in 2008 in controlled areas

• Significance difference in the mean number of larval ticks and the amount of barberry. 

• Barberry provides habitat for the host

• Barberry Management. Questing adult blacklegged tick abundance was greatest in areas with 

Japanese barberry. This invasive plant provides suitable habitat for the tick and rodent hosts. 

Managing Japanese barberry significantly reduced the density of spirochete infected ticks to 

nearly 60% of that of unmanaged infestations.

Measures to reduce tick-borne diseases that fit within an organic or least-toxic tick management 

framework include: 

• Personal prevention measures and tick checks

• Landscape management practices

• Deer fencing, resistant plantings, and accepted repellents
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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• Pyrethrin insecticides (limited effectiveness w/o PBO) with desiccants and insecticidal soap

• Biological (Metarhizium should be an option by 2012)

• Botanical compounds, plant essential oils

• Host-targeted insecticides much better environmentally, but chemicals used are not organic 

(permethrin, fipronil). Limited use to date.

Wink Hastings (National Park Service)

Projects- rivers and trails program of the NPS (National Park Service). We work directly with community 

groups and non-profit groups not directly in the parks. I also work for the Chesapeake Bay Program- we 

are trying to protect and restore the quality of the water resource. The main projects I work on are land 

conservation, watershed management, comprehensive land use plans, and large landscape 

conservation. With land trusts we are helping them prioritize lands within their service area to best 

meet the needs and mission of the organization. There is opportunity to manage pests through land 

conservation. Cacapon and Lost Rivers Land Trust in West Virginia is an example- they are trying to use 

strategic conservation planning. Watershed management is pretty much the same. It is with local 

governments usually. I have been working on projects in New York State and Maryland. There is 

opportunity to add additional objectives, purposes etc. to the work being done to address other pest 

management needs. 

Invasive species are very problematic particularly in the north east. There are a lot of land managers 

focused on eliminating invasive. This is an area of opportunity. With comprehensive planning there is a 

decision making process. Green infrastructure plans are useful in landscape planning. We try to target 

areas where the natural resources are important and vulnerable to future growth. The Idea is to protect 

these areas in the path of growth. Cheverly is developing a green infrastructure plan for the community. 

One of their focuses is invasive species management and the reintroduction of natural species. Storm 

water is a big thing too but we can manage it with vegetation. If we focus on putting in natural cover 

and remove invasives we can make a difference. The BW parkway is another area we are looking at. The 

most beneficial thing in this conference is that organizers pulled in planners and landscape architectsthere is plenty of opportunity to influence the work of landscape designers and landscape planners. I am 

reminded of what Shunryu Suzuki said, “Iin the beginner’s mind, there are many possibilities, in the 

expert’s mind there are few.” I identified a few things I thought would be helpful. Local planning at the 

county level often does not include environmental or public health factors in making land use decisions. 

Very few consider anything beyond the socioeconomic factors with a little bit of the environment when 

planning land use. There is an opportunity to increase awareness of things like tick management into the 

scheme of things. Research is important. It needs to be understandable to practitioners. Messaging is 

absolutely critical. There are 18 million people living in the Chesapeake Bay watershed- a majority of 

these people (98%) do not know that the quality is affected by what they do. Demonstration projects 

are a useful tool to use. Green infrastructure is trying to address a whole slew of things- protecting 

working lands, agriculture, conservation areas, etc. Ecosystem maintenance - NPS does not like to talk 

about controlled burning, but fire management is critical to a lot of invasive species. There is a program 

called crime prevention through landscape design. This may be a good model to use to create trainings 

for land use planners and architects to create landscapes to address ticks. Think outside the box. The 

Farm Bill provides a lot of funding. Partnerships- recreational equipment- have them put a logo on their 

clothing and products to remind people ticks are out there. ESRI- has been designing applications to be 

used by local planners and non-profits. National Geographic- have an article on ticks- free advertising. 
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Panel Discussion

Questions for Consideration:

1. How can we engage the landscape design professions in the prevention of tick-borne diseases?

2. What is the best way to provide information tick-borne disease prevention to professional 

planners and landscape architects?

3. How can landscape design foster both conservation and prevention of tick-borne diseases?

Laura Jackson- We need to consider large areas as well as small areas like lawns. We need to promote 

healthier wildlife to reduce the prevalence of Borellia. Large scale planning is difficult in our culture. 

However this is imperative.

Terra Rentz- I want to encourage the involvement of state wildlife and fishery agencies. Urban and 

suburban hunting programs for deer have been increasing throughout the country. There have been 

numerous studies that have shown huge impacts to deer and tick populations. Bow hunting takes a lot 

longer to take down target populations. Firearm hunting is more effective in taking down deer. 

Prescribed burns are a tool to use - annual burns in habitats where regular fire is appropriate have been 

shown to reduce tick numbers. Without an annual firing, however, tick populations may increase. 

Reducing groundcover and leaf litter through firing. When it comes to exclusion devices for wildlife in 

our environments- they are great for small scale environments. In large scale environments some of 

these tools are not practicable. We need to encourage people to go outside and we do not want people 

to fear going into the woods. The more we can become more tech savvy in how we reach out to people 

the better we can get our message out. 

Robert Snieckus- My eyes have been opened today. We focus on private lands and work on a voluntary 

basis. With the impact we have on private lands- we can put this information into technical standards. 

Professional journals need to start publishing information on landscape planning for ticks. EPA should 

put links up regarding what partners are doing. Public outreach on the Mall. Green roofs on historic 

buildings. Additional construction phases. Disconnecting our downspouts and putting them into rain 

gardens. Public awareness and visibility is important. EPA needs to do this. 

Kendra Briechle- There are a variety of partnerships we could use- developers, urban land institute, 

parks and recreation, trail designers, the Appalachian Trail Conservancy, federal and state agencies. The 

ways to do this vary- we can use online outreach and in person outreach. We need to identify the right 

people and vehicles within organizations to communicate our strategies. It is imperative that we have 

the right message as well. Design guidelines need to be disseminated to professionals as well. Linking to

existing efforts- we talked about invasives, state wildlife action plans- green infrastructure design- we 

need to look at strategic planning and management of open space, working farms and forest, and 

conservation lands- there are a variety of scale efforts and there would be great cross over if we link to 

these efforts- ex) minimizing edge effect. There might even be an opportunity to protect species. This 

may help to prevent other species. Training forum or more specialized look at this issue would be 

beneficial- bring various professions together. 

Kevin Sweeney- We need to decrease exposure. We need to bring this work into government 

contracting. If we force contractors to address this issue when there is money involved this will provide 

incentive. There needs to be something done with regards to communication about use of pesticides. 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Q&A 

Comment Ben Beard (CDC) - I wanted to make a point- the single highest risk group is children from 

5-8 years of age. We think a majority of these cases are occurring in back yards. This 

suggests why mosquito control districts have been less able to tackle this issue. The way 

habitat is fragmented in suburban areas we cannot just target yards- we need to get 

communities together. We need to get the message out and provide recommendations for 

limiting exposure of people to ticks by managing the various reservoirs and behavior. 

Question Tom Mather (URI)- I keep hearing it would be good to have standards- who will be charged 

with actually doing this? I was talking with a major developer in several states and they 

want standards before we reach out to them. We should push towards practical things that 

should be done and developing standards rather than focusing on rhetoric. Planning needs 

to consider moving people away from forests. Look at Europe- their Lyme disease

encounters are primarily recreational not peridomestic. 

Response Howard Ginsberg- Is there a venue for formal dialogue to happen for planning? This would 

make a huge difference.

Response Wink Hastings- We could develop permitted guidelines for developers- If they have 

information and guidelines immediately they are very willing to do things. 

Response Kendra Briechle- There have been some guidelines regarding landscape planning today- we 

should get this information out. We need to connect with the Smart Growth network on 

this issue. There is an EPA office to help manage this and there are a slew of organizations 

involved. 

Response Ellen Stromdahl (U.S. Army) - Developer- if I want to develop my undeveloped land, I have 

to have the landscape engineer and planner to create the plan. I then need to have a 

developer give me a permit. There is a political process that needs to be considered. There 

was a landscape plan developed at a conference with EPA and landscape planners etc.

Question Ellen Stromdahl- Isn’t there a small community in Maine that drew up landscape plans...in 

the meeting last year...East Falmouth, ME? 

Response Montira Pongsiri- Was a planner giving us a primer on land use planning and processes- we 

talked about the politics. He based it all on well-developed science informing where 

species are in corridors. Just to include this science took a huge effort. This gave us 

information on what we need to do and what needs to be communicated to the public in 

order to include this kind of information in the planning process? We have the essential 

science we need to inform the planning process. With regards to scaling things up this will 

require more information. We have a community practice on landscaping and community 

health. We want to make this useful for people to use. We have identified other partners 

we need to include as part of this discussion.

Question Questioner: Landscape recommendations did not seem to have an impact on the people to 

receive ticks given the CDC study. How much more do we need to know with regards to the 

efficacy of these recommendations?

Response Kirby Stafford- Ot is very difficult to take studies one step forward and prove impact on 

human disease. Lyme disease surveillance increased as a result of community based 
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projects. Lyme disease incidence went up due to this- in reality however our surveillance 

became more effective. Trying to demonstrate an impact on Lyme disease itself is VERY 

difficult. 

Response Ben Beard- as you increase awareness for tick-borne diseases- case numbers increase 

because people are more involved. 

Question a Mindy Block - Can someone speak more about the fungi used to reduce ticks?

Response a Kirby Stafford- One potential approach as an alternative to synthetic pesticides is the 

use of biopesticides. There are entomopathogenic fungi being looked at. Novozymes is 

proceeding on developing and marketing a fungi for tick control. They have built a 

formulation plant up in Canada. They are still working out some details. They want to 

have it available this year. It should be available by 2012.

Question b David Brassard- does it work?

Response b Kirby Stafford- it does work. It may not be as effective as a synthetic chemical but it 

does work.

Question How effective are guinea hens at controlling ticks and have you seen homeowners use 

them?

Response Howard Ginsberg- They do eat a lot of ticks, only one study has looked at it. Two study 

sites. In one there was no significant difference, in another site, it did lower somewhat the 

level of ticks. There was no follow-on so hard to know what happened following year. 

Session IV: Public Outreach Strategies to Reach Targeted Populations

Moderators Emily Zielinski-Guiterrez, Centers for Disease Control and Prevention

Patricia Smith, Lyme Disease Association

Panelists Diane Blanchard, Time for Lyme, Inc.

Douglas Fearn, Lyme Disease Association of Southern Pennsylvania, Inc.

Jennifer Reid, Ridgefield (CT) Health Department

Kathy White, Lyme Association of Greater Kansas City

Katie Kuffner, Chester County (PA) Health Department

Anne Kjemtrup, California Department of Public Health

Patricia Smith (Lyme Disease Association)

Session questions:

1. What are obstacles you encounter to getting the public to adopt tick prevention measures 

(especially IPM) and how do you overcome them? 

2. In this era of fiscal constraints, what gives your program “bang for the buck”? 

3. What does your program offer that advances the national fight against tick-borne diseases? 
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Diane Blanchard (Time for Lyme, Inc.) 

I want to give you a synopsis of what we have done. We created an in school curriculum- we began in 

1998- there was not a lot of information targeted towards kids. We were being called into schools to 

explain to kids what ticks look like, where you can get them, and what to do if you receive them. We 

went to the school board and asked to develop an in school curriculum for a more global approach. We 

spent 2 years developing the curriculum for the schools to include in their health classes. We are proud 

of the outcome. We have four individual curriculum books for each grade we targeted (K, 3, 6, 9) we 

want to promote student knowledge and skills regarding tick bite prevention and what to do when a tick 

is found. These kids go home and bring the information back that they learn at school. They ask their 

parents to do nightly tick checks etc. In 6th and 9th grade we step up the learning. We address the 

symptoms, treatment, disease progression etc. We have videos for these programs. We use a CDC video 

that we cut down to a 20 minute segment. In 9th grade we have another video called living the Lyme lifewe watch students go through the disease, talk to doctors etc. We have been successful in getting the 

program out. We have about 450 packets that have been distributed. With each curriculum comes four

binders. They include instructional material, assessments, take home materials. We also provide a 

nurses packet. If they feel a child is at risk for Lyme, they call the parent and discuss the issue with the 

parents. We are partnering with the Red Cross. This has allowed us to target the message to kids. The 

challenges of the program are getting it out there. It is a competitive field to create curriculum for the 

health and safety field. It is important to discuss with children risks of contracting tick-borne pathogens. 

Douglas Fearn (Lyme Disease Association of Southern Pennsylvania, Inc.)

We developed our organization with people who have had Lyme disease or people who had family 

members impacted. We had a very good core group of people with different experiences. We decided to 

focus on public education. I wrote a booklet preceding this group because I became tired telling people 

the same thing over and over. I believe in doing something once and having it continue to work so this is 

why we developed the pamphlet. We partnered with the Chester County Health Dept. and Pennsylvania 

Farm Bureau to form an organization with goals similar to ours. We pooled resources and did a survey 

among Pennsylvania Farm Bureau members (3200 people with a 10% response rate) and we got a lot of 

valuable information. 20 to 30 percent of people had personal experience with Lyme disease. We also 

learned that although people were knowledgeable about how they get Lyme disease they did NOT 

engage in prevention measures. Only about 10% were engaging in prevention. We need to motivate 

people to take prevention measures- how do you do this? In 2010, we did over 200 presentations to:

• Local townships and public meetings, 

• Public and private schools

• Service organizations

• Farming organizations

• Environmental groups

• Parks nature centers, 

• Conservations groups

• Libraries, churches health fairs, boy scouts, community events, 

Almost every event we do, leads to additional invitations. We do not have to ask to speak anymore we 

are invited. We tell people what Lyme disease is, how you get it, prevalence in their area, symptoms, 

diagnosis and treatment, and try to promote prevention. It is important to scare people a little bit to get 

them to listen to your prevention programs. 
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Jennifer Reid (Ridgefield (CT) Health Department)

Community Coordinator for BLAST Tick-Borne Diseases program for the Ridgefield (CT) Health 

Department. This was created in 2008 with the help of a startup grant. The grant allows BLAST to 

develop materials that can be used for outreach anywhere. Collaboration is the hallmark of our 

program. Collaboration needs to occur between researchers and the community. We need to know how 

to avoid tick encounters, remove ticks, and detect ticks quickly. We try to listen carefully to people. Our 

message is short and easy to understand to reach a wide audience. We try to make things fun to attract 

people to our booth at events we go to. Program attendees regularly say that they thought they knew 

about ticks but after the program realize there was a lot that they had not known. We need to 

encourage people that these are diseases that they are worth preventing. BLAST program materials are

available free on the website. The town of Richfield has an active tick task force. We use free marketing 

opportunities. Our community Prevention and Early Symptom Identification Program is:

• Based on science

• Health Belief Model

• Affordable

• Reproducible

• Easy to understand and remember

• Maximize marketing opportunities

• Make it fun

BLAST is an easy to remember acronym:

• B athe or shower soon after coming indoors 

• L ook for ticks and remove with tweezers

• A pply repellents for skin and/or clothing

• S pray the perimeter of your yard for ticks

• T reat your pets 

Our display is consistent with bright lime green coloring allowing us to stand out. The acronym is easy to 

remember. Some people are willing to listen because of their pets. We hold training sessions regularly. 

Volunteers include teachers, nurses, business people, etc. 

Kathy White (Lyme Association of Greater Kansas City)

Lyme disease has been reported in all 50 states. Lyme disease is underreported in southern and central 

states. Many people are dying from this. Children and adults are bed-ridden for years and months 

before dying from the disease. Most people are getting tick-borne diseases in the Central and Southern 

United States from lone star ticks. American Dog ticks also carry some. I work for the Lyme Association 

of Greater Kansas City. There is not a single symptom of Lyme disease you cannot get from lone star tick

bites. We provide education packets to public schools in the Kansas City area. We have done this 

through grants and donations. Our goal now is to give an education packet to every public school in the 

state of Kansas and Missouri. We have quite a few schools to reach with this organization. Our packets 

have a handbook that has information for teachers and nurses. It also contains brochures. It includes the 

LDA ABCs of Lyme Disease. We have the LDAs Lymer Primer. We also include information for doctors, 

nurses etc. We have a tick remover in the packet- it has a narrow v-shaped slot. We include information 

on how to remove the tick, what to do with the tick, personal prevention, how to make your property 

safe from ticks. There is a dvd with four programs for different age levels made by the Lyme Disease

Association with funding and help from CDC. 
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Katie Kuffner (Chester County (PA) Health Department)

Chronic Disease and Injury Prevention Division- We started surveillance of Lyme disease in 1998. Many 

cases are underreported or misdiagnosed. Some of the programs we have a parallel to what Doug Fearn 

mentioned. We have been able to partner together and provide resources. In 2000, we received funding 

from CDC to create signs at our county parks. These are large signs that we put out in parks. We also 

provide presentations, attend fairs, community events for outreach strategies. We are working closely 

with the migrant mushroom farmer’s information on providing education to workers. We have worked 

with the boy scouts for a public health badge. We work with other local organizations and have tried to 

train the trainer. We are working with park staff to disseminate information. We work with camp 

counselors. The PLAC advisory committee- we work with them to address the issue. We did a study in 

2001 to access people’s attitudes and information regarding Lyme disease. We had the same reaction as 

Doug’s survey. People know they are at risk but are not engaging in prevention strategies. 

Anne Kjemptrup (California Department of Public Health)

California represents the west coast tick issues. We do not typically have a lot of peridomestic exposure. 

We have wide based IPM control for mosquitoes. Local control agencies have been able to add tick 

control to our mosquito control districts. Our website has a lot of information available and I was asked 

to showcase this along with our materials available. The principles behind our tick-borne disease 

program- surveillance and science based. We have partnerships with local agencies and legislatively 

mandated advisory committee providing us valuable input on our education component. We try to 

identify target populations- such as physicians, school children, and occupational health program and 

identify the needs for these programs then develop materials. We try to emphasize the importance of 

the evaluation of the materials. We then promote the material and share it with people. The tick 

database is a collection of data on ticks being tested for the Lyme disease pathogen. We tried to add 

context- we have a pdf document with explanation and a map- with counties so you can see county 

specific tick data. We are adding GPS data of where the ticks were found. Risk varies by yardage and 

throughout time. Has this proved useful? It has- we have promoted it through physician newsletters and 

helps to improve decisions- decision support tool. 

Q&A

Comment Katie Kuffner - The park signs have become very weathered. To deal with this we created 

low cost signs for the parks who were concerned people would be too fearful and stop 

visiting. 

Comment Judy Anderson (DEET organization) - We had a webinar that was for medical professionals 

with physicians- we had 500 people login to the webinar. It is online and we have had 

many people to obtain information. So many primary care and emergency room physicians 

do not know the symptoms as they present. I encourage you to use webinars as an 

approach.
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Comment Karen Daughty (Richfield, Connecticut)- It is difficult to recognize the true nature of this 

disease. A lot of people have personal experience with this through a family member and 

these people are willing to do anything to prevent it. On the other hand, we have groups of 

people who have not had contact with this and they are not willing to try to prevent this.

We need to target physicians. 

Response Anne Kjemptrup- We do try to target physicians. We need to recognize that this is an 

ongoing process. There are competing diseases. There is no such thing as a program that 

will answer everything people may need information on.

Response Kathy White (Lyme Association of Kansas City)- We have an information booth at a 

conference of young resident doctors and give them information on Lyme disease. We are 

trying hard to educate doctors. 

Response Pat Smith- We have always thought that one thing Health Departments could do is put out 

material to physicians registered in their states and let them know that not everyone gets 

an EM rash. There are physicians that do not know that many people do not get EM rashes. 

Response Anne Kjemptrup- In - the California health department, the focus is on awareness and 

prevention. What we have on diagnosis and treatment is very minimal. We do not want to 

get in between the patient and physician. 

Question Tom Brennan (EPA) - I am curious to know your perspective on the science and outreachare we getting materials back and forth etc.? 

Response Emily, Zielinski-Guiterrez (CDC) - We do not always put new findings into practice and 

outreach nearly as quickly as we could or we should. Many times we wait for new evidence 

and sometimes we wait too long. There is a need for a variety of methods. In the public 

health sciences we need to balance between things that are new and offer opportunities 

and finding our coalitions to get the information across. 

Response Jennifer Reid (BLAST) - We find that the most simple prevention strategy is bathing or 

showering after outdoor activities. It is easy for people to do and we need to include it in 

our speeches.

Comment Ben Beard- There is a lot of work that needs to be done to educate physicians. On our 

website, you can link to a physician education CME course that can be taken in Lyme

disease. I hear a lot about this physician education issue a lot. Early action is necessary. 

Recognizing Lyme disease and treating it early is the best way to reduce long last impacts 

and reduce impact.

Question Jay, EPA- Is there information about experiences or advice given regarding which tick 

repellents people have experience with and recommend? 

Response Pat Smith- In my talks, one of the biggest bits of feedback from people is that they want a 

natural product that they can use. I used a microencapsulated formula on my lawn and it 

has been effective. 

Response Thomas Mather- I think you were talking about repellents- Brooke said she had a review 

she would be happy to share with people. One problem is a lot of this data has not been 

collected for deer ticks. 
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Comment Misdirected efforts in resources- we should spend more time and money on risk reduction 

rather than diagnosis and treatment because this is a personal issue. 

Pat Smith- organizations like LDA can be the eyes and ears for the government. We hear things, see 

things, etc. and are in contact with people on the ground. We need to bind together to do something. 

Emily Zielinski-Guiterrez- We have a number of differences in what we look at- but we need to continue 

to engage with each other and find common ground to work together. Barriers to IPM- crowded 

environment- lots calling people’s attention. We need to engage people in risk perception, counter 

misperceptions. Low funding is a huge problem. We need to balance the fearfulness that people have. 

We need to help people prioritize the actions they can do. We need to engage in partnerships and find 

funding. We need to find efficiencies. We need to find ways to make things happen. We need to use 

new technological tools. People offer marketing skills- we need to make things attractive to consumers, 

we need to focus on at risk populations, and we need to assess populations through focus groups, needs 

assessments. We need evaluation due to limited resources and time so let’s make sure what we are 

doing has an effect. Need to take new research and turn it into programing. Bringing people together on 

risk reduction and prevention. 

Day 1 Conclusion

Brooke Bissinger (Tyra Tech)

Summation of the Day. What I found as an overarching theme with five components: prevention, 

education (particularly science based), using new technologies for education, surveillance for tick hosts 

and ticks, compliance by the public, and communication between groups. 

Session I: creating institutional structures- people described experience- question do we have enough 

information to make recommendations to individual control units to make recommendations? The 

answer is yes. Do we have data to make recommendations? There is a lot of data available, but more 

data is always useful. There is a need for communication between different partners and we need to 

disseminate information more broadly. What research and by whom? What research is necessary? What 

about the cost? Surveillance is needed. Given the economic climate, funding is an issue. There are some 

funding opportunities available. 

Session II: Children between ages 5 and 9 are at highest risk from tick-borne diseases. We need to focus 

on managing people. Social sciences are very important. IPM in schools- need to work to educate 

students and lead to better educated adult tax payers. We learned about methods employed in schools. 

We heard about direct and indirect funding opportunities. There is a need for an inventory of outreach 

materials that exist. Nurses are a key in detecting infecting children in schools and disseminating 

information in schools. There is a disconnect in older students- we need to remind them these risks are 

out there and vector borne disease is a serious problem.

Session III: Landscape plays a big role in tick control. Fire regimes can reduce tick pops if done annually. 

Creating tick zones, and barriers can be effective. 75% of ticks people pick up are likely from their yard. 

We need to design guidelines for professionals. We need communication between researchers and lawn 

care professionals. Conservation biology is used to protect species, can it be used to prevent species?

Session IV: Many different forums can be used to reach people- health fairs, booths, seminars, 

conferences, community meetings etc. Public needs to recognize the seriousness of the problem. Lyme 

disease curriculum available to schools. Blast program gives us an excellent acronym. Multi-lingual 
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programs are important. We need to look at the risk and benefit to humans. Social science tools are 

important. How do you motivate people even if they are aware that using risk reduction methods are 

imperative?

Introduction Day 2

Chris Zarba (EPA-Office of Research and Development)

The goals of the meeting are to develop a broad strategy, identify research priorities, and develop 

partnerships. We are identifying who may be good candidates for filling out our outline. We are 

exploring options for putting the document from the conference up so it is accessible to conference 

participants. We are looking at Google docs. Hopefully people will take lead and help in the 

development of the report. We will draft a first draft; distribute it to individuals registered for the 

conference and work to finalize the document. It is more powerful to have a broad consensus to move 

this forward. We can have people working on different aspects of the strategy. There will be different 

projects and proposals that different organizations can do. It is time for EPA to step up and do its part. If 

we work together our chance for success is much more likely. Within 9 months to a year we will have a 

proposal that is fund ready. 

Session V: Protecting Outdoor Workers Exposed to Ticks

Moderator Tom Delaney, the Professional Landcare Network (PLANET)

Panelists Brenda Jackslitsch, National Institute for Occupational Safety and Health (NIOSH)

Rob Harrison, Orkin, Inc.

David Brassard, U.S. EPA

Sarah Fletcher, Sterling Family Practice 

Jim Fredericks, National Pest Management Association (NPMA)

Tom Delaney (Professional Landcare Network (PLANET)) 

Topic is protecting outdoor workers from exposure to ticks. Our workers are outside and exposed to 

ticks frequently. PLANET has a diverse membership. Our members design, build, and maintain 

landscapes. They also do chemical care for lawns and interior scapes. We create and maintain the 

quality of life in our communities across America. The Tick and Lyme Disease Survey was done between 

March and May 2010 as a Zoomerang survey with 102 companies participating. Most answering were 

companies in our OSHA PLANET-STARS program which are concerned about safety in the work place.

Licensing- there are different types of licenses- structural pest control and ornamental and turf work. If 

you look at the labeling you can determine if something is an ornamental and turf label or structural 

label. We had a good percentage of people say that their workers encountered ticks. 78% of the 

companies study said that their workers came in contact with ticks while working in the landscape. The 

companies saying that their workers came into contact with ticks were then asked if they know about 

Lyme disease. While there is a fair number who know about Lyme disease, 32% were not aware and this 

is concerning. 89% of the companies said they would like to have information to make their employees 

aware of the problems associated with ticks and Lyme disease. There was not a large percentage of 

companies that treat for ticks and fleas (only 24%). When this does occur, it is a perimeter pest control 

service in states that allow for this. Members give monthly publications to their customers. We cannot 

do a good job if customers do not do their part. We should partner with homeowners. 71% of 

companies said that they would like to have information to pass on to their customers about Lyme 

disease. Members who were more aware of tick issues, were located in states with higher incidences of 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Lyme disease. Our members want more information and are willing to disseminate information to their 

customers. We have taken information that NIOSH put together and put it out for members. These were 

questions we wanted the panel to talk about. Learning from examples is a valuable tool. When we hear 

about various ways that people are exposed, we can try to pin point behavioral things that should be 

avoided in the future. This is similar to pesticide poisoning- when you learn how someone was exposed, 

you can determine ways to avoid this exposure.

Brenda Jacklitsch (National Institute for Occupational Safety and Health (NIOSH))

Yesterday there was a lot of talk about different groups that are affected by ticks such as children. Today 

we are talking about outdoor workers. Outdoor workers spend their entire day outside and are in 

contact with environments with ticks frequently. NIOSH- part of the Department of Health and Human 

Services under the CDC. NIOSH is a research agency that provides recommendations. Occupational 

Safety and Health Administration is under the Department of Labor -regulatory. 

NIOSH provides various services including: 

• NIOSH Topic Pages: 

Occupational safety & health info arranged by subject

• Health Hazard Evaluation Program: 

Investigates potentially hazardous working conditions when requested by employers or 

employees at no cost

• NIOSH Publications:

FREE documents & brochures available online or mailed

• Databases:

Ex. Pocket Guide to Chemical Hazards, etc.

• CDC Info:

Ask questions and get answers

Tick-borne diseases at NIOSH are not necessarily a high priority item right now however they do have 

several people working on this. They have been working on building up materials for dissemination to 

workers. We ask that employers provide workers with training on Tick-borne diseases, transmission, 

symptoms and prevention before employees go out into the field. We also recommend that employers 

encourage symptoms and illness reporting by employees. We ask employers to tell workers about the 

various diseases that ticks transmit, that the ticks that transmit these diseases look like, and the 

pathogens that cause the illness. We ask that employers focus on diseases specific to their area. Ticks 

may have multiple hosts throughout their life cycle. Ticks can regularly be found on deer, small 

mammals, and birds. People come in contact with ticks when they spend time in wooded or grassy areas 

where these other host animals can be found. We want some simple life cycle information to be 

communicated to workers. We ask that employers remind workers about when tick season begins. We 

want them to be careful during these months and ensure that they are taking preventative measures. 

We ask employers to go through a list of possible symptoms. We ask they tell the workers they may not 

have all the symptoms but rather only a few. Common symptoms include: 

• Fever

• Fatigue

• Headache

• Joint pain

• Body/muscle aches

• Rash
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We ask that employers show workers national and state data on Lyme disease. We ask that workers 

take charge of protecting their employees by looking into the areas that the workers are in. For 

example- eliminating the leaf litter, setting rodent traps, putting up barriers, keep the grass mowed 

short. We also ask that employers discuss or provide employees with proper clothing and repellents. 

This includes: 

• Long sleeves and long pants

• Tucking pants into socks or boots

• Light colored clothing for easy tick spotting

• Repellents with >20% DEET for skin

• Permethrin for clothing

Employers should provide instructions for appropriate ways to check for and remove ticks. This may 

include checking skin and clothes daily for ticks, when washing and drying clothes use the hot setting in 

the dryer, if a tick is attached use only appropriate removal techniques. The proper removal technique is 

to: 

• Remove the tick as soon as you notice it.

 Use fine-tipped tweezers to firmly grasp the tick very close to your skin. 

 Avoid crushing the tick’s body. 

 With a steady motion, pull the tick’s body away from your skin. 

 Do not be alarmed if the tick’s mouthparts remain in the skin, the tick can no longer 

transmit bacteria. 

 Clean your skin with soap & warm H2O or alcohol. 

NIOSH also has resources for outdoor workers including laminated cards and various other resources 

available on the website. 

Q&A: 

Question Jorge Arias- Do you have these materials only in English or in other languages? 

Response Brenda- Right now our materials are in English and in Spanish.

Question Candy Brassard (EPA)- Is there one particular occupation that you feel has a higher incident 

rate of tick-borne diseases? Where should we target as federal partners?

Response Brenda- NIOSH does not have any studies on this. I would say anyone out in the woods.

Question Emily CDC- Are there regular studies NIOSH does regularly? Maybe we could incorporate 

some questions in surveys to determine where people are exposed, if they have been sick, 

and if they use repellent.

Response Brenda- I am not aware of surveillance that we have regarding tick-borne or vector borne 

diseases. If we get enough response, we will be able to put this on our agenda.
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Question Judy Anderson (DEET education program)- I want to suggest to you that people do not 

know how to properly apply repellents. It may be useful for people to be told about this 

information. A lot of people do not understand how to use repellents properly. People for 

whom English is a second language, do not understand that a repellent is different than an 

insecticide. There are nuances that people in this room need to be mindful of. This is 

critical. Another point that you mentioned was that for ticks you need about a 20% 

concentration of DEET.

Response Brenda- Those are some very good points, and I believe we have some information on 

repellent application. 

Comment Joe Piesman- There are a lot of studies that have been conducted on occupational 

exposure. The literature is sprinkled with some of this information however there is a need 

for more. 

Comment Anne Kjemptrup- We have done some studies on U.S. Forest Service and National Park 

Service workers and some have been put into our report systems. One thing we found was 

that people who took clothing precautions were more likely to receive a tick bite. We think 

that this is because they are more aware of the tick problem. 

Ron Harrison (Orkin, Inc.)

The way we confront ticks in Orkin is that someone’s child has a tick, a pet has a tick, or people find ticks 

in their house, people find ticks outside their house. We are faced with risk. What is the risk involved 

with putting products in a house, outside, and on the pets. Typically if you find ticks inside, we do some 

service inside if customers want it. People see the risk of the pesticide application as being greater than 

the risk of ticks. We have a better time offering a service for ticks in the Northeast however this is not 

the case in other areas. The frequency of the service is another issue. The once a year service, which 

works, does not fit most PCO’s models. To come in once a year is not lucrative or favorable. To make 

money, businesses are saying that they want reoccurring service for tick control but it is not needed so 

we are not doing it. 

Jim Fredericks (National Pest Management Association (NPMA))

This is an exciting time for me. I have spent all of my waking hours thinking about bedbugs so it is nice to 

talk about something different. Take a look at our website: pestworld.org for the best management 

practices for bedbugs so please take a look at it. 

We conducted an online survey through our members. We represent the professional pest management 

industry. We use online surveys to take the temperature of our membership and learn more about our 

members. We had a lot more responses to our bedbug survey than our tick survey. Although there is 

awareness, it is not a priority and they are not taking precautions. 

Nearly all of the workers were coming into contact with ticks. These Pest Management Professionals 

(PMPs) are outside the homes surveying the property to make recommendations and for treatment 

purposes. One thing our technicians often encounter is that termites will swarm in the spring so a lot of 

treatments occur before the swarm. We consider wildlife control technicians. These people are out in 

the surrounding area and in the transition area. We see that there is a lot of exposure out there. 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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There are a number of tick-borne diseases out there but we focused on Lyme disease. We found that 

most people would like information to provide to their employees. The NPMA prides themselves on 

educating PMPs so we wanted to determine how best to present educational material to our 

membership. We have a webinar series we do almost weekly. A great topic would be on protecting 

yourself from tick-borne diseases. We usually reach 200 people and up to 500 people. We sell 

educational materials through our bug store. Things like educational material may be good to put on our 

bug store. One service we provide to our member companies is a pre-printed newsletter that they can 

customize and send to their customers. A great article for the newsletter would be about preparing 

yourself for ticks, how to be aware etc. We are well positioned to educate our employees and our 

customers. 

These educational opportunities can go into awareness. We can give recommendations about landscape 

design, personal protection, and IPM. PMPs are prepared to get the word out about this. A good 

example is when WNV was all the rage. A number of PCOs did backyard barrier treatments in yard to 

reduce the number of mosquitoes biting in the yard. In addition to providing treatments, many PMPs 

went out and gave IPM recommendations on how people can reduce the problem in their yard and 

community such as getting rid of standing water. We try to educate our customers on the service that 

they need not necessarily the service that they want. 

Almost everyone who participated do treat for fleas and ticks (93.33%). This is indicative of respondents 

but not necessarily indicative of the industry. Many PCOs are not providing this service. We are trying to 

figure out how this fits into the professional pest management business model. The industry is built on 

recurring services. We hear that one single well timed application can provide treatment for an entire 

year. This provides a challenge to the PPM business. While this is a challenge, it can be overcome and 

integrated closely with existing IPM programs and strategies. 

Members wanted different educational materials including newsletters, website references, and 

brochures to download and print. 

Example: Bed Bug Survey (March 2010) 550 responses. Our response level was very low for this survey. 

This is indicative of the level awareness and top of mind. If this was a survey about bedbugs we would 

have gotten a great response. We want to educate workers but we also want to have our clients 

engaged as well and interested in IPM. We communicate with workers and recommend that technicians 

change and launder clothes daily. This thinking comes from pesticide exposure. Showering every day is 

important to reduce exposure. These recommendations are in place but can be applied to ticks. One 

area we can do a better job is performing a diligent tick check. We need to teach people how to properly 

remove ticks. There are many ways to do this and very few are the right way. We need to help people 

become more aware of the symptoms of tick-borne illness. We need systems and programs within our 

member companies to report this to management. All in all we are in a position to impact community 

wide IPM. As part of bringing this service, we have a lot of work to do to educate our customers and 

workers about tick-borne illness. 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Q&A:

Comment Pat Smith- Assume that when you mention laundering clothes that you include putting 

them in the dryer because this is what kills the ticks. Also, people need to know that when 

showering, it is typically easier to detect ticks. The ticks do not simply detach. A number of 

firms have laundry services so that workers can come back take off their uniforms and have 

them washed. More and more firms are buying a washer and dryer for the office. 

Question Karl Malamud Roam (IR-4)- For protecting your workers, do you have a sense of how many 

are wearing uniforms with permethrin in them? Is this something you could recommend? 

In regard to protecting communities, what do you see the role of government verses the 

role of individuals in terms of vector protection services?

Response Jim- There are very few if any companies that are using permethrin impregnated uniforms 

right now. There is an opportunity for real collaboration and cooperation. The education 

piece has a role both from governmental agencies and the private industry. As part of the 

services that PCOs provide, education is necessary. We need to educate our clients to truly 

help the situation. We give recommendations on how to help technicians do their job 

properly, how to detect problems early etc. We could integrate tick prevention in this as 

well. A piece meal approach to tick management is something that needs to be addressed. 

Question Kevin Moran (Northeast Rep. for Turfgrass Association) - One of the issues the industry is 

seeing, especially in the northeast, is a disconnect between state regulators and the 

industry. Some states discourage the professional industry from becoming involved. Small 

cottages surrounded by woodland- recreational area- is where they are picking up ticks. It 

is the structural industry in ant control and termite control that will be in these homes. We 

need to work with states to encourage the structural industry to become involved with tick 

control. It is a peridomestic problem. We hope we get states to encourage industry to train 

their personnel.

Response Jim- There has been some confusion with our member firms with what types of licensing 

that they need to do for tick control. There are differences state to state on how this is 

defined. This is an area we are trying to navigate. This is a new type of service and we need 

to iron out wrinkles like this. 

Question Robert Koethe (EPA Region 1) - Customers- part of what you all do is to inform the 

customer of what they need rather than what they want. Is there monitoring? Does 

anyone do any tick drags before they determine what is needed?

Response Jim- I do not know the answer to your question, I see that as being an effective way to 

begin this conversation in neighborhoods. We saw this with mosquito control. Companies 

would go into neighborhoods and lay oviposition traps with their names on it and then go 

through and collect them and talk to the customers about the issue. Tick drags would be an 

effective way to start getting the conversation going.
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Question Robert Koethe (EPA Region 1) - This survey was on ticks and fleas. Was this about pets as 

well?

Response Jim- Yes. Most questions focused on ticks however. Robert- An excellent education tool 

may be the four poster feeding stations. Regardless of how effective they are, they are 

visible and may be an education tool so people are thinking about ticks. 

Comment Tom Mathers (URI)- Pat Smith brought up a nice point and it is not trivial. Back in the day, 

we check for ticks by checking our head. I was being interviewed a year ago, he said I 

suppose you recommend everything that people say to do to prevent ticks. I said I do not. I 

could recommend it but no one does it. It just adds to the blah blah blah of the message. It 

is time to shake things up a little bit. Putting DEET on exposed skin- this message may not 

be that effective. I am wondering why this is effective. I would say 1 out of 100 people may 

tuck their socks in. This has us thinking more and more about tick repellent clothing aspect. 

This is something that your industry should endorse. This is a tremendously effective 

practice. A little known service- Insect Shield- actually has a service for $7.95 per item they 

will take your clothes and treat them. They will go through 70 washes before they need to 

be treated. This is a cost effective truly protective method that should be used to protect 

PCOs. For almost $120 a year, this can be done. One thing I would like to mention is my 

thoughts on getting people out flagging. It would be a good idea, but it could backfire 

because they may not be able to find a tick. My tick crew every year is college students. It 

takes them about a week to really learn to flag for ticks. I wonder if this is the right thing to 

do. If you have a truly motivated person, this will work. If they go out and do not find 

anything it may have a deleterious impact. This is a low yield proposition. If we flag in 

yards, and we find ticks, people are fighting over each other to see the ticks. 

Comment Kent McClure (Veterinarian)- Ws you talk about educating people about lawn treatments 

and protecting themselves. Vets are talking to people on a regular basis about fleas and 

ticks. We provide educational materials to people. As you talk about putting information 

out, I encourage you to reach out to Vets. Downloadable information would be very 

valuable. This would be a useful thing driving people to obtain information.

Response Jim- we try to make a conscience effort to reach out to people who benefit from our 

educational materials.

Comment Todd Peterson (EPA)- You mentioned the thing about customers, they want something, 

your PCOs go out and have to tell them what they really need. We have had a lot of 

comments about misuse of pesticides and misunderstanding. The industry is out there as a

face of this issue. Wouldn’t it be nice we could tell people to watch a video on the issue 

before the PCO is going into their yard? It may be helpful for people to be educated before 

the service is provided. WE see a lot of misuse of products and encourage people to read 

the label. People do not read the label. Maybe we should be asking people to do 

something different.

Response Jim- We do have a role here and could put out informational videos. 
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Comment Susan Little- DEET education program- One of the really important things in this whole 

process is consistent messaging. I would like to place a bit of caution- we may not want 

PCOs to directly talk with customers about this rather we should provide them with 

materials to distribute instead. I would like to follow up with what Tom Mathers said- it is 

very difficult to tuck socks in when it is hot outside but it is effective. We need a toolbox 

initiative of data that can be used.

Question Craigs Hollinsworth University of Massachusetts- Comment about tucking your pants into 

your socks- Gators are an option. 

Question Candy Brassard (EPA) - My question is, do you find the practices for your PCO in tick-borne

endemic areas may be different than the rest of the company.

Response Jim- I do not know for sure. I am willing to speculate and say that yes in New England, MidAtlantic- there is better awareness. In areas of the country where awareness about tickborne illness is greater there will be different practices. 

Question Dave Brassard (EPA)- I have a question, a couple years ago a product came out called maxforce tick bait station. It was like a four poster device for mice. It was a little trap the mice 

walked in, it fed, and as it walked in their coat is treated with an acaricide. I expected to 

see this on the shelves of Home Depot. They decided to market it through the PCO 

community instead. My question to NPMA is what went wrong? This product is no longer 

being marketed because it was a disaster in how it was rolled out. How could this have 

been rolled out better?

Response Jim- It is a neat product and was exciting. I am not a marketing person. I do not have 

expertise on how it could have been done better. 

David Brassard (EPA) 

Sarah Fletcher (Family doctor in Sterling, VA) - There is a disconnect between education and changing 

behavior. 

Q&A

Question I heard a discussion about ticks being inside the home. I understand that ticks do not infest 

homes with exception of the brown dog tick. I do not understand treating inside the home.

Response Ron Harrison- We see ticks wandering around, migrating towards a house, animals bring 

them in. We had three customers saying that they have ticks all over their house and they 

would like something to happen. Customers do not care about why but they do not want 

to ticks inside. We know that the ticks are not going to survive but that they are there.

Comment One of the best products that people are embracing is permethrin clothing sprays. When I 

go to the stores, I have been seeing these products less and less. There is something 

seriously wrong with the marketing of the best products available for tick prevention. I do 

not know how we get the word out there. If a consumer cannot buy a product on the 

market, how are they going to obtain the product?
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Question Company that makes clothing repellents- name and phone number? 

Response Insect Shield in Greensboro North Carolina.

Question Ed Brandt (EPA)- Sarah, we had a conversation beforehand and I would like to elaborate on 

it. We were talking about tick checks and bathing.

Response Sarah- These are typically along clothing lines such as the bra line, panty line. This is where 

we pull off most of them.

Response Tom Mathers- We have a product called Tick Encounter. You can put in the tick you might 

find and it may suggest areas where you may look. I see dilemmas. Checking for ticks is 

very important but people do not check themselves in the mirror. They are usually in 

places where people do not want to look. Messages are lost. We have to really bring it out 

to people. My former graduate student made this observation because they say it is great 

for kids but people take showers with their glasses off. We need to qualify information! I 

keep talking about treated clothing; this is as easy as getting dressed in the morning. We 

can start a revolution trying to bring about tick control. We need stakeholder groups that 

can start to do this sort of thing. PCOs understand these products but do they use them on 

themselves? We need them to carry these things on in their home lives and to spill over to 

their neighbors. Groups need to step up and do it to start the initiative. 

Comment Tom Delaney- 40 to 50 percent of landscapers are Hispanic. In people of color, it may be 

more difficult to find ticks and to see rashes.

Response Sarah Fletcher- I work in a free clinic and see a lot of Hispanic workers coming in very sick. 

These people do not seek medical care until they are very sick and have to go in. 

Question a Carrie Gaudien from Richfield Connecticut- Who is participating in the survey when you 

send it out? Is it reaching a secretary and not necessarily going to the right person? 

People think they know about Lyme disease, even as far as tick removal people say they 

know how to remove ticks. We need to reeach people on how to properly remove ticks.

Response a Tom Delaney, PLANET- the individuals participating were the safety officers. It is tough 

regarding who the contact person is with a company.

Question b Carrie- would it help to do this at their trade shows or training events?

Response b Tom Delaney- yes

Question Karl Malamud Roam- This has to do with uniforms and the Armed services. Lesson learnedwhen you have uniforms, compliance is very high. Phase I- having people spray clothing; 

Phase II- professional spraying services. Professional spraying is more effective. Are we 

receiving any compensation claims for tick related illness?

Response Ron Harrison- We have not had any. I think people will only change behaviors when they 

understand the risk. In certain areas of the country, people are not concerned at all. We 

are working with CDC with these 1600 properties; our technicians will be protected with 

treated clothing for this study.
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Comment David Gaines- Permethrin treated clothing is the best way of preventing ticks that I have 

found in the field. The sprays available to the home consumer can be applied unevenly. 

They can also be applied unevenly. I wish we could buy products used by the military. 

These products are more effective and can be applied evenly.

Comment Lindsey McClellan- People in the industry have discussed economic models being difficult 

for one year services. Iin our community, we called a company and had a treatment done 

in the community. We need to leverage neighborhood groups.

Question Kevin Moran- How do we educate people that they do not need treatment inside the 

home? Are we going to work on getting outside the home and embrace IPM? Dr. Fletcher -

Where is the medical community going by working with the industry?

Response Sarah Fletcher- Doctors are hesitant to change behavior or change their knowledge base. 

They do not do these things themselves and they do not tell their patients to do it. 

Ron Harrison- we are trying to correlate Lyme disease with ticks. There is a lab in Dallas 

where if you send them a tick, they can tell you if the tick carries the pathogen.

Sarah Fletcher - Insurance companies no longer pay for the testing. In the past I told 

patients to save their ticks, and insurance companies stopped paying for testing them.

Comment Jennifer Reid (BLAST Program)- Availability of products- people ask me where they can find 

permethrin, DEET, Damminex® tubes. It is harder and harder to find these items in the 

store. We need to figure out how to better market them, where to put them into the store, 

and discuss strategies with retailers.

Question Lisa Torrey (National Tick-borne Disease Advocates)- You talked about workman’s compthis is an extremely unreliable view. We are still being misdiagnosed. Many tick-borne

diseases are misdiagnosed. Testing is unreliable. My question to you, Ron, is how many do 

you have with chronic illness.

Response Ron Harrison, Orkin - Example- people complaining with back pain from moving mattresses 

there is a direct correlation here. If we do not have direct correlation, it is difficult to 

determine. 

Comment Emily Zielinski- CDC- We are working with Ron’s group and will be doing a webinar on tick 

and mosquito borne disease. This will educate the workers and also help them to share 

resources. We can share these slides with other groups as well. 

Comment Sarah Fletcher- Men generally have a much less severe express than women. This may 

complicate understanding of how many people have Lyme disease. 
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Comment National Center for Lyme disease- We are getting workers comp cases. We are finding that 

workers are not being educated about the risks. We are negotiating rates for ticks. If you 

do a program it needs to be affordable for the average citizen and resident.

Response Ron Harrison- Economics is the bottom line for us. There is a large population that cannot 

afford our bedbug service; we have to turn a profit. Sometimes we do volunteer work. 

Session VI: Measuring the Impact of Prevention Strategy

Moderators Ben Beard, Centers for Disease Control and Prevention

Panelists Joseph Piesman, Centers for Disease Control and Prevention

Joshua Smith, Fairfax County Health Department

Ellen Stromdahl, U.S. Army Public Health Command 

Paul Mead, Centers for Disease Control and Prevention

Ben Beard (CDC)

I want to thank Ed and Candy for organizing the meeting. I have found the sessions very educational. We 

wanted to focus on data gaps in this session. A few years ago I took part in HHS’s healthy people 

initiative. Part of this was a 40% reduction of Lyme disease. It was based on the vaccine Lymerix. With 

this being taken out, a lot of the recommendations that we have been using are lacking evidence to 

support their value. I think we can make recommendations on what it makes sense to use. If you can 

reduce tick populations it is possible to reduce infection however this is an assumption. It costs a lot to 

go a step further and say that these methods reduce illness. We want to look at these efforts. This 

session is to look at what is going on and later take a look at new interventions that may be palatable. 

Our first speaker is Joe Piesman. 

Joe Piesman (CDC)

A decade ago CDC was engaged in a series of cooperative agreements in Connecticut New Jersey, New 

York and Massachusetts. The assumption was that the vaccine would have an impact on the disease but 

it was removed from the market due to commercial reasons. We are left with antibiotic prophylaxis, tick 

control, IPM prevention. We have a lot of area wide acaricides on the market that are highly effective

including carbaryl, cyfluthrin, fulvalinate, permethrin, deltamethrin etc. can give 68-100% control of 

nymphal Ixodes scapularis. In surveys in highly Lyme disease endemic communities- a majority of 

homeowners are not willing to use these area wide acaricides. We need to identify other options. The 

percentage of people using the following prevention measures include: 

• Long pants 49.8%

• Cleared Brush 48.6%

• Tick checks 45.7%

• Avoid woods 35.1%

• Pesticide on ground 24.4%

• Fenced property 23.1%

• Tucked pants/sock 18.3%

• Repellents/clothes 14.2%

• Used woodchip/gravel barrier 11.4%

• Vaccine 10.1%

• Pesticide on Rodents 9.0%
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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There are various alternatives to area wide acaricides. Alternatives to area wide acaricides include host 

removal, host targeted treatments (deer and rodents), least toxic substances (soaps, desiccants, tree 

extracts), fungal agents, and landscape management. 

About 20 years ago I gave a lecture at Oregon State University. After my talk- Everything you want to 

know about Lyme disease but do not want to ask- we began a screening program on tree extracts to see 

what was toxic. What stood out was the extracts from the Alaska yellow cedar. The extract we isolated 

was Nootkatone which is found in Alaska cedar and grapefruit. This is a 15 carbon ring compound. It is 

found in citrus rind as well. It is not a common structure in nature but it is a repellent and toxicant to 

arthropods. In the laboratory, tests show it is highly effective as an acaricide. With Joe Karchesy (chemist 

at Oregon State) we were able to make a water based formulation that we were able to spray. We 

loaded backpack sprayers with nookatone. When sprayed in the field, this formula had a good 

knockdown effect. We had good populations of ticks in non-spray areas. We had good knockdown. 

When we used a high pressure sprayer, we received high amounts of control around 98% for the entire 

duration of the tick season. When you spray this with a backpack and coat the leaf litter- you kill the 

ticks only on the surface which is only about 10%. The ones underneath then avoid the area. Using a 

higher pressure spray you can kill more ticks in the litter. We found that: 

• Natural products such as nootkatone may have a role to play in controlling the vectors of Lyme 

disease spirochetes

• Backpack spray application kills and/or repels ticks that are at the surface of the leaf litter but 

ticks deeper in the leaf litter column are not killed and begin questing after 1-2 weeks

• High pressure spray kills virtually all the nymphs on forest plots and provides protection for 

entire nymphal questing season

Nookatone itself is used in the food industry and has a low mammalian toxicity. To get it to the 

homeowners- the idea was to spray with a backpack, get the quick knock-down and come back with a 

spray two weeks later there was effective knock-down of the tick population. With a backpack sprayer 

you need more than one application, likely two. 

In association with the group in New Jersey we did an Integrated Tick Management (ITM) project. We 

did this in Monmouth County, New Jersey. The pieces of our ITM study in NJ included a 4-poster project, 

bait boxes for rodents, and a barrier spray. The 4-poster deer project was baited with corn and the 

acaricide used to treat the deer was amitraz. Maxforce® bait boxes were used to treat rodents. The 

purpose was to get fipronil (Frontline®) onto rodents. It gives 7 weeks of absolute protection. The idea 

was to have a bait box, lure the rodents in, and then have them wicked. The bait box was tested by Mark 

Dolan and Gary and proved effective on Mason Island. It was marketed through the pest control 

operators by Behr. They discontinued the bait box for commercial reasons. There is interest by other 

parties to relicense the bait box. We found that control of nymphal ticks was highly successful starting at 

58.5% and two years later moving up to 94.3 percent. During phase II, the research team was interested 

in determining if they can continue the level of control achieved with 3-pronged approach (barrier spray, 

4-poster, bait boxes) with just one method (4-poster). We continued with just the 4-poster. Once we got 

the tick population down, we had huge results from the 4-poster project. Area-wide acarcides are 

effective when people feel comfortable using them. Natural products like garlic or nookatone. Control 

has to be practical and economical. People are willing to spend $100 on average. This is a dose of reality. 

The future of ITM includes area wide acaricides where permitted, host targeted acaricides, host targeted 

vaccines, natural products, biological control agents, and it must be practical and economical for wide 

acceptance.
Promoting Community IPM to Prevent Tick-Borne Diseases Conference Notes

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Question Mindy Block - In the field, what else did you see with nookatone? What else did it kill in the 

area?

Response Joe Piesman- We did not do a study on impacts on non-targeted impacts. This compound is 

active for a short duration. 

Question Jorge Arias- Do you think that general use of these products by the public will allow for 

resistance?

Response Joe Piesman- For Ixodes scapularis, I think this resistance is highly improbable. For cattle 

ticks we have seen some insecticide resistance but these ticks are in an ideal situation to 

develop resistance. 

Question We are embracing biologicals, are they truly working?

Response Joe Piesman- if it was based solely on efficacy we would not be searching for natural 

products. Area wide acaricides are highly effective. Concern over human health and safety 

makes these natural products an alternative that people are willing to use. Cost is very 

important. Nookatone in its current formulation would be highly expensive. We are 

interested in driving the price down. 

Ellen Stromdahl (U.S. Army Public Health Command)

Tick-borne disease is an occupational health risk for military personnel. The DOD operates a variety of 

activities on tick-borne disease because it is an occupational health risk to soldiers training in the field. 

DOD has been concerned with ticks because it poses a health risk to soldiers in the field and on bases. 

Military researchers have a long history of work on arthropod vectors of human disease. The earliest 

work on tick surveillance and on the development of repellents was lead by DOD entomologists, and 

innovative research and discovery on ticks continues today. Pathogen analysis is one thing that we do. In 

the public health command region-North ticks are collected by a variety of methods including tick drags, 

CO2 traps, small, medium, and large mammal trapping. Army was involved in the National Scout 

Jamboree since it was held on their land-40,000 scouts plus associated visitors during a 10 day periodlast week in July through the first week in August-every 4 years. Pre-Jamboree surveillance to provide 

background information and track population trends was conducted. We know from previous 

surveillance and tick biology that A. americanum is the major pest during the Jamboree. Based on 

information we can provide threat maps and educational materials for use during the event. Targeted 

control efforts based on previous surveillance at the jamboree site. Including the 4-poster deer feeders 

deployed prior to the Jamboree.

GIS mapping:

There are 70 acres of high threat tick habitat within the Jamboree "Action Areas” that require control.

There are 78.5 miles of tree line to be treated in the Jamboree area.

Producing a theoretical threat map showing the probability of encountering lone star ticks (Amblyomma 

americanum).

For example for the National Boy Scout Jamboree- GIS efforts were used to place prevention equipment 

like four posters

US Army Public Health Command also provides the DoD Human Tick Test Kit Program. This provides tick 

id. We test several thousand ticks every year from around 100 participating military installations. Results 

are provided back to the victim and we also try to publish results. 
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The Public Health Command has developed a field-portable device or camera that creates sequential 

images of overlapping depth of field. Then software combines this “stack” of images to produce a 

totally an ultra high resolution image that remains focuses even as you zoom in on key taxonomical 

characters – like goblets in the spiracular plate. You do not lose focus. These images are available for 

public use online. 

The Walter Reed Biosystematics Unit is developing TickMap for ticks internationally. Has modeling 

capabilities to predict distribution of ticks. It can also overlay human distribution and see problem areas. 

This includes tick-borne disease in armed forces members. This can be accessed and you can perform 

queries to determine disease rates. 

The Defense Medical Epidemiology database can be accessed and queries can be conducted to 

determine disease rates. 

The Naval Medical Research Center is developing molecular assays for detecting tick-borne pathogens. 

They are currently looking at Rickettsia. Designed elegant assays to sort out rickettsia. Other PCR and 

primers are also being used. Assays are reliable and easy to use. They have been adopted by military 

PCR labs and are helping to standardize procedures. 

The Naval Medical Research Center conducted a pilot study on “Prevalence and Clinical Characteristics 

of Infection caused by the Newly Emerging Pathogen, Rickettsia parkerii, in Adults and Children 

Presenting to Clinics and Emergency Departments with Acute Febrile Illness.” The main objectives of this 

pilot study are to survey up to 100 adults and children presenting to participating clinical sites during the 

usual tick-borne illness season (March - October) with acute febrile illness in regions where sporadic 

Rickettsia parkeri infections have been reported in DOD personnel to determine its rate of occurrence 

among individuals presenting with fever with rash or eschar, eschar alone or other illness suspected by 

the non-study associated health care provider of being a possible rickettsial infection and to describe 

their clinical presentations and clinical courses and outcomes. The initial phase of the project will take 

place in the Tidewater region of Virginia at Naval Medical Center Portsmouth and its associated clinics, 

where the first known cases of human infection with R. parkeri had occurred and the Naval Hospital 

Jacksonville catchment area where R. parkeri has been identified in ticks. The subsequent phases may 

branch out to other MTFs including but not limited to National Naval Medical Center, Brooke Army 

Medical Center, Naval Hospital Camp Lejeune, and Naval Branch Health Clinic Kingsbay. 

Many patients presenting to health care facilities with fever of undetermined etiology are misdiagnosed 

or remain undiagnosed, but it is now recognized that many of these cases can be attributed to a 

rickettsial infection. The role of R. parkeri in such cases has not been defined. Therefore, the key 

component of the study will be identification of R. parkeri infection through culture and polymerase 

chain reaction (PCR) techniques from participant specimens including blood, swabs from eschars, and 

punch biopsies (adults only) of eschars and skin rashes. The secondary component will be to describe 

risk factors for infection and clinical presentation and course of infection. Identifying cases and 

describing the clinical aspects of R. parkeri infections among DoD beneficiaries with illness previously 

diagnosed as having “fevers and rashes of unknown etiology” will for the first time, better define the 

role of this emerging pathogen in this population and potentially identify clinical features that 

distinguish it from viral and other rickettsial illnesses that may present with fever with or without rash. 

The epidemiological information obtained from this survey will also have application for training and 

operational forces with activity associated risk in endemic areas.
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We would like to send human samples into the lab. We would like to produce more convenient system 

for military documents. It is easier to discover a new pathogen than to associate it with human disease 

or to establish surveillance. The Armed Forces Pest Management Board website is full of info. The 

literature retrieval system has papers. You can order a free DVD on tick identification. 

The Army Surgeon General considers permethrin-treated uniforms one of the most important protective 

measures for Soldiers, and fully endorses permethrin factory treatment. In the past you had to use 

spray. Now uniforms are factory treated with permethrin and eventually use will be universal. In 1980 

permethrin was identified as an effective repellent for clothing. This is the quality insurance process to 

ensure the safety and efficacy of treatment. A number of vendors impregnate the clothing. At present 

Soldiers deploying to combat areas are issued Permethrin Factory-Treated Flame Resistant Army 

Combat Uniforms (FRACU-P). This is the new MultiCam uniform and designed for Afghanistan area of 

operation. This uniform is also pretreated with permethrin. 

Question Jerry Lawson (EPA)- My family, wife and daughter, have chronic Lyme. I appreciate the 

work that the Army is doing. Is any of this making its way to the CDC?

Response Ellen Stromdahl- I am an entomologist, not a physician. Our information does go to CDC. 

Most of our papers are co-authored with entomologists in the CDC. We deal with what is in 

the tick.

Question Anne Kjemtrump- Testing ticks when you pull them off- getting them tested for whateverpossibly for medical decision making. In California, we do not recommend testing ticks for 

making medical decisions. Our incidence is so low that this may lead to false positives. I am 

wondering if any analysis has been done on the utility in testing ticks found on people. We 

recommend identifying the ticks, which is more indicative if you will be exposed to a 

pathogen. I think this method creates a false sense of security or a false sense of risk.

Response Ellen Stromdahl- we test ticks because we send soldiers in the field because they have 

raised their hands and promise to obey. We use this in our suite of things that physicians 

can use you determine potential Lyme disease. 

Question Pat Smith (Lyme Disease Association)- You are under Surgeon General? Ellen we are under 

DoD and part of this is with the Surgeon General. Pat- I have a concern that although yes 

there is a crossover we are not getting a lot of information happening on military bases 

concerning tick-borne diseases. Who do we go to so we can obtain this information and 

make it public? Specifically- what is occurring on military bases as far as prevention efforts, 

what they are seeing with troops disease wise. The public has a right to know. We need 

this information so in civilian land we have comparable things going on.

Response Ellen Stromdhal- Outside of HIPA information-MSMR information is free online. Just about 

everything that can be made public is made public. What is wrong with what you are asking 

is that when you say military, you expect it to be coordinated. With my human tick test 

program we have 100 installations and each one works with our program differently. Some 

programs comply and others do not. Everything that is public is made public. 
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Joshua Smith (Fairfax County Health Department)

We have a lot of cases of Lyme disease in Fairfax County. I am here to talk about tick and pathogen 

surveillance that we do. Fairfax County is suburban and peri-urban with approximately 1,000,000 

residents within an area of ~400 square miles. We deal with the vector side in our office. We are trying 

to do our part to find out what people and know and determine knowledge gaps. Fairfax County

specifically does tick and pathogen surveillance, community outreach and education, and tries to 

identify what people know. Our focus was on Lyme disease at first. Our program has expanded and we 

are looking at other types of ticks we find in the county as well as the pathogens. To sample for ticks 

Fairfax County uses CO2 traps, dragging, flagging, and host examination (of white tailed deer and small 

mammals). They also visit local vet clinics and animal shelters. Fairfax County does not offer tick testing 

services however they do provide a tick identification service. Summary of methods on what we are 

using to gain information on ticks in the county. We find a majority of lone star ticks using the id service, 

trapping, and vets and shelters. We have different monitoring styles. Timing is very important as well. 

We have been collecting in the winter. When the temperature is going up to 40 degrees we were still 

collecting ticks. We want to remind people that even though it is winter time ticks are out there and 

they are active. We do have Lyme disease in the county as well as other pathogens. We did not find any 

R. rickettsia for Rocky Mountain spotted fever. 

We also conduct community outreach and education efforts. It is always good to get political support 

behind you. Every year we have a Lyme Disease Awareness Month. This picture is of us with the Board 

of Supervisors and they have helped by providing forums as well. We hand out educational materials at 

every opportunity that we get. We understand that people are not always coming to these events. We 

want people to get our material- we came up with an idea to make a reference guide that we mailed out 

to every household in the county. When we had our first draft done, and people sent it back saying it’s

too technical. We received very good feedback from a variety of people. Even though we know we have 

a well educated population in Fairfax County, people do not want to come home and read a very 

technical document. We translated it into Korean and Spanish households as well. At outreach events 

we occupy kids with tattoos so we can talk to parents. 

When we do our surveillance with the ticks we can learn about vector and disease ecology. It is difficult 

to measure the impact of our outreach strategies. One way to do this is to conduct a KAP (Knowledge, 

Attitudes, and Practices) Study. This can be used to find out the level of knowledge about a certain topic 

in the community. You can then find knowledge gaps and figure out ways to fill in these gaps. It is 

important to do and an initial survey then to do a follow up survey. You can then use this to measure 

response to a specific intervention (e.g., outreach and education), track changes in KAP, and tailor your 

activities. What we found in our initial survey was that 80 percent of people heard of Lyme disease of 

this 80 percent 70 percent knew it was tick-borne disease. We did a subset of 100 people of Spanish 

ethnicity. We found there was a very significant lack of understanding in the Spanish speaking 

community. In 2008, we started a series of ads to try and focus on the Spanish speaking community. We 

have a few Spanish speakers on staff and we have someone who can speak Spanish at our events. 

We use a combination of surveillance, communication, and creativity. We are hoping this combination 

will have a positive impact. This year we put out a clip that was shown in the movie theatre. 
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Question Lisa Torrey from National Lyme disease Advocates- I have been receiving more calls from 

people who are sick with Lyme disease. They go to their physician that they are concerned. 

The doctors are saying that they do not have to worry that it is not an issue. I think that a 

lot of compliance will need to be done on the state level. There seems to be a real obstacle 

with the CSTE- how much power do you have as a County Health Department with the 

State Health Department.

Response Josh Smith- We have a relationship with VDH but we are separate agencies. 

Paul Mead (CDC)

TickNet was established in 2007 to foster coordination among public health officials on surveillance, 

research, education, and prevention of tick-borne diseases. Collaborators include state and local health 

departments, CDC DVBD, DPDM & Emerging Infections Program (EIP). Current extramural program goals 

are to support and enhance surveillance (ELC) and applied research (EIP). We have developed a number 

of fliers targeted towards landscape workers and outdoor workers. We have developed a widget on our 

page that can be used by employers with information on tick checks, repellents and other prevention. 

We are starting some radio spots reminding people that it is tick season. Our current extramural 

program is a big part of tick net. The money we give to partners and states that support and enhance 

surveillance we also have grants for applied research (EIP). EIP funds grants for applied research works 

on food borne illness, meningitis other pathogens, tick-borne disease etc. Tier 1 ELC states- these are 14 

states with high rates of Lyme disease. We try to give this funding out yearly to these states. Tier 2 ELC 

states- these states border states with high rates of Lyme disease and are risk of developing high rates. 

Tier 3 EIP sites- Applied research arm. We have four research projects being done in our EIP sites. 

Laboratory Survey (CT, MD, MN, NY)-Two-stage survey to evaluate national testing volumes, test type, 

and rate of positivity among commercial, clinical and state laboratories for 5 tick-borne diseases. An 

underreporting study is being conducted in MD, MN, and NY to try and quantify the underreporting of 

physician diagnosed Lyme disease and to assess medical record coding practices. They are also using 

active surveillance for RMSP and Erythema mirgrans in Western Tennessee (TN). Active surveillance is to 

better define the epidemiology and clinical features of spotted fever group rickettsioses and EM in four 

West-Central Tennessee counties. 

Another study being conducted is the Lyme and other Tick-borne Diseases Prevention Study (LTDPS) in 

CT, MD, and NY. The LTDPS is not a pesticide or IPM trial. It is a randomized, blinded, placebo-controlled 

trial to assess the efficacy of a targeted, single, springtime application of a commercially available 

acaricide. The primary outcome measure is prevention of human illness due to tick-borne diseases. 

We know that pesticides can kill ticks. A single application of granular deltamethrin reduced nymphal I. 

scapularis by 95% at 9 days. Even though this is the case, there is a substantial minority of households 

that use chemical pesticides to control ticks. For example 29% of 2,400 CT households used chemical 

pesticides for ticks during the survey year. Only 7% of 900 New England/Mid-Atlantic households 

currently use chemical pesticides for ticks. Residential acaricide use has not been shown to reduce tickborne disease. The assumption is that it probably works. However, this is not necessarily true. If the 

major source of infection is from people visiting places outside their yard, what they do inside their yard 

may not actually make a difference. If it does not work people should not use it and save money. If it 

does work however we demonstrate evidence to promote greater usage. We have further impetus for 

finding safer acaricides or other methods of yard-based control. If this works, we show that what you do 

in your yard is important. By being able to tell people what it means in regards to illness will be an 

important step forward. 
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The new LTDPS study is recruiting approximately 1600 households in 3 states (NY, CT, MD) through 

fliers, advertisements, and targeted mailings to county residents. The inclusion criteria include 

households with > or equal to 2 residents, freestanding, private property, lot size of .5 to 5 acres, not 

within 100 ft of water bodies, and have not been treated in the previous year. Houses will be 

randomized to receive treatment. People will not be informed about what they are getting until after 

the study is over. The applications will be done between May 1st and June 15th. Applications will be 

applied to the ecotone 10 feet into lawn and 20 feet into brush or wooded areas. We may end up using 

truck mounted sprayers rather than backpack sprayers. Post-treatment tick collection and pathogen 

testing for 10% of properties will occur. Outcome measures include monthly surveys to ascertain tick 

bites and ticks found on participants and pets; self-reported tick-borne disease during study period; and 

medical record review to validate reported illness. 

Q&A

Question Pat Smith- I assume you are using CDC criteria to determine disease etc.?

Response Paul Mead- No. We are using physician diagnosed Tick-borne disease. We verify it with the 

doctor rather than just the report from the patient.

Session VII: Research Strategies

Mat Pound

First off- clear up a few misconceptions. Why control ticks on deer? If we do not have ticks we do not 

have the disease. The size of the animal has to do with its importance in the lifecycle of the tick. Mice 

(small mammals)- larvae feed on small mammals, takes a blood meal, drops to the ground and molts to 

a nymph. The nymph goes onto a medium size mammal. Takes a blood meal, drops to the ground, and 

finds another meal. Once it molts into an adult, females feed on deer. The objective of Host-targeted 

control of ticks on deer is primarily to prevent the successful feeding of adult ticks on white-tailed deer 

to effectively remove them as a source of blood and interrupt the tick life cycle. In addition, control of 

larval and nymphal ticks increases overall efficacy. Methods of preventing ticks from feeding on deer 

include depopulation or density reduction of deer herds (capture and transport, dispatch and donate, or 

immune-contraception) and anti-tick vaccines for deer. For chemical control there are systemically 

active acaricides (which can be topically applied, injected, or given through oral application) and 

topically active acaricides (pyrethroids, formamidines, macrocyclic lactones, organophosphates, 

phenylpyrazoles, neonicotinoids and possibly others)

My primary job is to develop technology to help APHIS eradicate cattle fever ticks back to where they 

were in Mexico. They eradicated ticks by treating cattle and horses. The white tail deer population was 

low due to screw worm fly. They charged me with making sure cattle ticks do not move forward on the 

border. Whole kernel corn as a bait and dosing medium for white-tailed deer can be used. Corn is a good 

dosing medium due to deer foraging behavior. Deer require high protein, by feeding them corn, we are 

not increasing their population densities. If you fed deer only corn (other than very old deer), they will 

likely die. We used ivermectic-medicated whole kernel corn mixed with re-cleaned whole kernel corn. 

We did medicated bait field trials in the following areas:

• Kerr Wildlife Management Area, Hunt, TX

– After 3 seasons of treatment achieved 92, 93, and 100% control of free-living adult, 

nymphal, and larval lone star ticks.
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• Fairfield Glade, TN

– White-tailed deer within a large housing development were fed ivermectin-medicated 

corn, and residents were so pleased with reduced tick densities that they elected to 

fund continued treatment of deer after research terminated.

• Apache Ranch, Webb County, TX

– In 1992, an elk herd was selectively fed ivermectin-medicated corn on this 6,500 acre 

ranch, and a cattle fever tick infestation was successfully eradicated for the first time 

since 1956.

• Catarina Ranch, Webb County, TX

– Beginning in 1996, white-tailed deer on 22,000 acres of the 40,000 acre ranch were 

treated with over 22 tons of ivermectin-medicated corn, and in 1997 a cattle fever tick 

infestation lasting over 90 years was eradicated for the first time. 

Free-living ticks these are ticks that are NOT on a host. We know that by treating deer you can affect tick 

populations. In these trials we were looking at cattle fever ticks and lone star ticks. 

We also looked at topical control of ticks using a 10% permethrin on 4-poster bait stations. 4-poster 

deer treatment bait stations are good because we are not applying any pesticide to the environment. 

Rather we are aiming at primarily adult ticks to break the cycle. The 4-poster deer treatment bait station 

trials resulted in:

• Kerr Wildlife Management Area, Hunt, TX

– After 3 seasons of treatment achieved 94, 92, and 88% control of free-living adult, 

nymphal, and larval lone star ticks using an oily 2% formulation of amitraz.

• USDA Northeast Area-wide Tick Control Project – MD, NJ, NY, CT, and RI

– After 5 years of treatment achieved 60 to 82% control (meta-analysis of 71% for the 

entire project) of blacklegged ticks using an oily 2% formulation of amitraz.

• Goddard Space Flight Center, Greenbelt, MD

– After 3 years of treatment, achieved 98% control of free-living nymphal blacklegged 

ticks. As a result of this high degree of efficacy, Goddard Space Flight Center elected to 

expand the treatment area and continue treatments.

The USDA Northeast Area-wide Tick Control Project results are available- there are 12 publications from 

this project. The 2% oil formulation of amitraz was volatile; it is no longer on the market. This 

formulation is volatile and is no longer used. There is not enough fluid to help transfer amitraz to the 

deer. We decided to go to a 10% permethrin formulation without a volatile component. This 

formulation used MUCH better. 

There are various different types of poster treatment. One includes cylindrical feed chute deer feeders

with ARS 2-poster treatment adapters. This method coats the side of the neck of the deer. They spread 

the chemical when they groom so it ends up everywhere. We have seen 97% control of all of the ticks on 

the deer using the poster methods.
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We also did a study on amitraz collars applied to white-tailed deer. It is effective in reducing free-living 

populations of lone star ticks. We developed an automatic deer collaring device. A deer comes into the 

device. As it comes in, at initial entry, the device sense and individually identifies previously collared 

deer and senses the presence of uncollared deer shaped mammals. It has a sensor on it. A child cannot 

make it fire. It also has a thermometer and records the temperature. Deer run about 104 degrees. It has 

a needleless agricultural injector on it- it can detach collars, attach collars, do an immunocontraception 

shot if the deer walks by. The device is fully solar driven, made out of steel, 800lbs. It costs a lot of 

money! To get around the cost of it, we have made 10 sham devices that are just sheet metal. We put 

these out in various areas and see the amount of corn that is consumed to target areas where a lot of 

deer are feeding. Almost every night we can collar deer. The efficacy of host targeted technologies to 

reduce free living populations of lone star ticks was pretty high. 

Interference from non-target animals was a huge problem. The most important non-target animals that 

interfere with deer treatments are raccoons, feral hogs, bear, and squirrels. Raccoons are actually an 

asset because they carry ticks and, if they feed on the traps, it’s good. Squirrels mess up the corn, bear 

and feral hogs can mess up the device. To exclude non-target animals we tried fencing. We use a low 

fence around the edges of it that is topped with a garden hose and has 3 electric fence wires on it. This 

excludes feral hogs and raccoons. Permits access by fawns, yearlings, and adult deer. The hog and 

raccoon excluder fence is 30 ft in diameter. It is not very expensive to implement and places a garden 

hose at the top so the deer have a visual cue to jump over the fence. We have an abundance of exotic 

wildlife that have been let loose in Texas. These can also carry ticks. 

Q&A

Comment VA Dept. of Game and Fisheries- I appreciate you coming up and talking about this. In FFX 

County we are starting a 4-poster project. In Fairfax County, we have to have authorization 

before we can use something of this. These programs have costs and benefits. They work 

but they cost money. As wildlife professionals one concern is feeding of wildlife in general. 

I was reminded yesterday that here in the landscape session. Someone had mentioned not 

planting foods that attract wildlife in areas- baiting is acutely attractive to wildlife. This is 

something that we should not be doing. Our wildlife society had a position statement and 

review done on feeding wildlife. One is on feeding wildlife using corn. I have a picture of a 

feed site with deer standing in it in the winter with all these trails going into it. We change 

the distribution of wildlife when we feed them. There are non-target impacts- for instance 

we do not want to feed raccoons because they carry rabies. In areas with bears we will 

have a big issue. Disease transmission such as tuberculosis is problematic. Feeding stations 

may maintain diseases in wildlife. I mentioned the habituation of wildlife and damage. This 

seems like a silver bullet to people but people should be aware of other considerations. 

Question Sam Talbert- Posters are good to reduce risk presently. Reducing deer populations may be 

better in long term.

Response Mat- The studies done have been 2 or 3 year studies. The question is can you knock the 

populations back then skip a year and do your treatment. 
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Question Bob Pilgram- EPA- we have been working with 4-posters for a while. With regards to host 

organisms- we were hearing that a lot of the species with adult ticks are raccoons and 

opossums- if we are addressing deer only, are we truly addressing the problem?

Response Mat Pound- When you only treat the deer you are drastically affecting tick populations. 

Session VIII: Cost Effectiveness of Prevention

Martin Meltzer

Cost effectiveness of prevention. The main question here is: What is the cost effectiveness of 

prevention? Meltzer could not find readily accessible published studies on this. If it is not readily 

accessible it is probably hidden for some good reason. Why is there no answer? There is a lot of missing 

critical data. Standardize terms- cost effectiveness- it is very simple it is expressed as dollars per case 

prevented. I am interested in Lyme disease in HUMANS. Cost per case equals cost of intervention minus 

the money saved over the number of cases that have been averted through the intervention. Cost 

effectiveness DOES NOT meant cost savings. We want to know a reasonable cost to pay to prevent one

case of Lyme disease in society. We have to determine how much money we should spend. This is 

subjective. There is no automatic one standard one size fits all. There is no such thing as must do. Every 

community and state in the country has a budget crunch. Just because something has cost savings does 

NOT mean that it is a must do and we should do it. We have to balance priorities. We need to consider 

return. Economics does not automatically make the decision for people. It is part of the decision making 

process but not the sole criteriion. You need epidemiology and clinical information. You need to know 

the cost of the clinical illness. You need to understand the interventions and determine effectiveness. 

We need to consider alternatives; For example, developing packages of interventions. Someone will 

always ask what that means for the household or tax payer. There is a geographical risk based indicator 

for Lyme disease. It is difficult to find a state that has not had a case. For an economist- targeting the 

approach is the most cost effective method. 

We looked at epidemiological data. Risk factors in Chester County, Pennsylvania included age, living in a 

rural setting, single homes, homes with woods or close to woods, and gardening. We MUST place risk in 

context- if you put out interventions the returns on the investment demonstrate that some people will 

benefit more than others. Once you get a clinical case what happens to you? Here are examplesstandard rash, arthritis, Bell’s palsy, heart block, etc. Probability of outcomes is consistent over time for 

Lyme disease, which is surprising. We looked at five years of data- different stages of Lyme disease cost 

different amounts to treat. This suggests patients and doctors learned how to better manage the 

disease and focus on the most effective treatments. We know that doctors tended to use lab tests less 

and less because they became better at identifying it. Productivity loss- i.e. time at the doctors, out of 

work, staying home sick etc. For each confirmed Lyme disease patient there are about $2,970 in direct 

medical costs, $4,762 in indirect medical costs, non-medical costs, and productivity lost. The economic 

burden of LD in the U.S. in year 2000 is $184 million which is conservative and an underestimate. These 

are median values. Not every case will cost this. There is a very wide distribution of costs. We are well 

aware that there are cases that are very expensive to treat, and cases that are not very expensive to 

treat. 

Interventions include vaccination, control of tick hosts, personal protection, and controlling ticks. 

Decision tree model. Nothing ever works perfectly- even if you are vaccinated there is a possibility of 

contracting Lyme disease. Probabilities change which is why you vaccinate. You vaccinate to greatly 

reduce probabilities. Based on the probability of Lyme disease and cost per person vaccinated the cost
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effectiveness results indicate that we should target the vaccine to people who are currently at risk for 

Lyme disease. Vaccination cost effectiveness has public health policy implications. There is value in 

targeting by risk of acquiring Lyme disease. There is also value in increasing probability of correct early 

diagnosis and successful treatment. However, the vaccine was pulled off the market. 

Interventions to control hosts include control of white-footed mice and white tailed deer. A 2007 study 

by Jordan et al, Journal of Medical Entomology suggests that the risk from Lyme disease in humans stays 

the same despite deer reductions. With deer eradication, however, we see different results. 

Protective clothing does work and allow for reduced risk based on a study in CT conducted by Vazquez 

et al. (2008) in Emerging Infectious Diseases. This study shows that protective clothing provides for a 

40% risk reduction, repellents 2-% and checking for ticks or spraying the property 0%. Another study 

conducted by Connally et al. (2009) in the American Journal of Preventative Medicine had completely 

different results. Bathing within 2 hrs resulted in 40% risk reduction, repellents for 41%, checking for 

ticks 45%, fencing the yard 46%, and spraying/landscaping no effect. What people get as economists 

from this information is that we can expect some impact but cannot obtain a complete elimination of 

risk. 

Also considered self-medicating applicators. A study conducted by Sonenshine et al (1996) in Medical 

Veterinary Entomology found that this method does work. A different study in 2009 by Brei et al. shows 

7 year treatment- see up to 90% reduction of nymphs on deer. Alternative hosts are a potential 

problem. This is not necessarily true everywhere. With different ecologies this information changes. We 

need tick controlling technologies on hosts and make sure there are not other reservoir hosts. You have 

to consider interventions for multiple species. 

Trouble with all these data- they are all done well. What is missing is what is the relationship between 

the reduction in the number of ticks and the number of human cases of tick related disease. If I am to do 

measure cost effectiveness strategies, I need more information on this curve. We do have information 

on vaccination cost. We do not have cost of large scale community intervention. This tells me a lot on 

where we are when it comes to introducing this into communities. People’s support for these types of 

interventions changes over time. People have a change of heart sometimes. Support of community 

intervention depends on risk perception, the disease, and who you are talking to. We need a large trial 

in the field that measures effectiveness over time. Effectiveness of intervention is likely not consistent 

so this should be done over time. It turns out that CDC is about to do a study like this. This is the type of 

study that is needed for a cost effectiveness analysis. 

Q&A

Question Bill Meredith- AMCA president- I want to make a comment about cost effectiveness- it 

concerns the ability of organized mosquito control programs to work on tick control. We 

heard from two counties that are well heeled, progressive districts that they have 

programs. Many programs on the other hand do not have a lot of money and cannot do 

this. They are struggling to meet their mosquito control districts. We are resource limited. 

We can do a lot with surveillance and monitoring, treatment, public outreach and 

education. What we really need is how we can increase resources for organizations that 

cannot afford it. Without the increase in resource we are going to be sidelined. I want to 

challenge and invite EPA and CDC to work with the AMCA to see how we can get more 

funding to front line control agencies. We do get some support but not enough when it 

comes to being out in the field. Let’s see how we can get more funding and leverage 

current funding. In Delaware 4 years ago we tried to develop a program, once the economy 
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went south, it all tanked.

Response Martin- I agree with that. When you consider community control, you need to be very 

honest with the community about what to expect. You need to understand that what 

people do and say are different, that you need to manage perceptions, and you need to 

consider compliance. Ben Beard- I really liked to hear that, my background is in mosquitos. 

What I discovered is that mosquito borne and tick-borne disease people do not go to the 

same meetings. I welcome the offer that AMCA may be interested in this. If we have 

community investment in this, we can empower mosquito control districts to help us work 

towards this. We need to have conversations and show the data that will bring community 

dollars to bring tick control out. Tick-borne disease in the country cost more than mosquito 

borne diseases. 

Question Bart Hoskins- EPA- filling this data bucket is going to be difficult. Diagnosis of Lyme disease

is so poor.

Response Martin- I am not a clinician but I do delve into the data. If you look at WNV (West Nile 

virus) and dengue the probability of accurate diagnosis is actually very low. As an 

economist, I find a lot of similarities between tick-borne disease and mosquito borne 

diseases.

Question Kevin Moran- this cost benefit analysis- I am very interested in knowing more about what 

Paul Mead is doing with Orkin. We in industry are being asked by our customers to get 

involved. If this study with Paul Mead and Orkin works well, we need assistance in getting 

the industry properly trained to do this on the home level because this is what is being 

asked of by the customer.

Response Martin- I agree. These studies are very hard to run. It is difficult to get compliance over 

time. 

Session IX: Case Study for Public Health Protection

Maction Komwa

Studies the approaches in the control of mosquitoes in developing countries specifically Uganda and 

Zambia. The main objectives are: to highlight cost-effective approaches to reduce mosquito infestations 

and ensure minimal exposure to humans through the analytical evaluation of mosquito behavior and 

control programs; and to apply lessons learned from this analytical approach to the control program 

efforts of Lyme diseases. 

Similarities between Malaria & Lyme diseases:

 Both are all transmitted through arthropods (insects or arachnids)

 Ticks and mosquitoes are classified as parasites 

 Transmit diseases to people by blood-sucking 

 Both diseases are strongly influenced by environmental factors

 Both are of important public health parasites to be discussed

 Control of these can be partially attained through the spraying of insecticides or other methods 

of reducing the insect population such as Environmental Management
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Malaria:

• Is caused by one of the four types of protozoa and is a major health problem in much of the 

tropics and subtropics.

• It is spread by mosquito bites

• The CDC estimates that there are 300-500 million cases of malaria each year and more than 1 

million people die from it

• Problem is that there is resistance to insecticides. This has led to difficulty in controlling both the 

rate of infection and spread of the disease.

Lyme disease:

• Lyme disease is the most common tick-borne illness in the northern hemisphere

• It is caused by the bacterium Borrelia burgdorferi

• It is spread by deer tick bites that harbor the bacterium

• Just like malaria, if the disease is left undiagnosed the effects can be devastating for example 

causing arthritis and neurological symptoms

Public Health Protection in Uganda:

• Malaria is a major public health problem in Uganda

• Accounting for 25-40% of all outpatient attendances, 

• 9-14% of admissions and a case fatality rate of 3% in Uganda (Republic of Uganda 2008).

• Strategies recommended for vector management in Uganda are:

• indoor spraying of houses with residual insecticides and

• insecticide-treated bed nets 

• Treatment through the use of anti-malaria drugs though mosquitoes are becoming drug 

resistant.

Lyme disease and Malaria Control:

 Deer tick often hides in shady moist places – this is also true with mosquitoes 

 Vegetation clearance around homes reduces the infestation of mosquitoes + ticks

 House or yard screening (for mosquitoes, tick identification

 Environmental management –Target life cycle of both diseases

 Modification of river boundaries, draining swamps, oil application to open water bodies

 Both malaria and Lyme diseases can be treated if diagnosed early so see a physician as early as 

possible

Treatment of Lyme disease and Malaria:

 Treatment of Lyme disease mostly with antibiotics.

 Long term use of anti-malaria drug or antibiotics for Lyme disease can have the following 

consequences:

 Costly

 Inefficient and potentially harmful 

 Due to drug-resistant conditions

 What are cost-effective preventative and control measures being used in malaria 

control that could be part of lessons to be applied to Lyme disease control?

Environmental management is a strategy to control Malaria. Understanding the life cycle of the diseases 

can help in using this tool. 
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The cost effectiveness of environmental management Roll back malaria in Zambia was studied by 

Utzinger, et al. 2001). Results indicate that:

 3-5 Yrs

 70±95% low malaria related mortality, morbidity and incidence rates

 Estimated costs per disability adjusted life year (DALY) averted 

 were US$ 524±591.

 Within 20 years 

 Estimated 4173 deaths and 161,205 malaria attacks.

 Estimated costs per death and malaria attack [US$ 858 and US$22.20 respectively]

Community low cost control measures in Uganda:

 Community-implemented malaria control program

 Tailored strategy to the prevailing ecological & epidemiological conditions

 Understanding the ecological conditions which affect & regulate the distribution and 

abundance of mosquito populations.

 Local priorities depend on local resources in order to have sustainable program 

(through the support of government agencies).

 Home Management of Malaria

 Providing training of the community members as medicine distributors (travel cost 

reduction to clinics)

 Distribution of anti-malarial medicines

 Campaign, and community sensitization to caregivers (Adherence by caregivers, home 

cleanliness campaign etc.)

 Accessibility of anti-malarial medicine in many villages

 “bring appropriate drugs closer to home”

 Availability of anti-malarial medicine at an affordable price

 Volunteers from the community (Community Medicine Distributors (CMD) are trained

 Normally two are selected per village and trained

 They evaluate and treat febrile children and are provided with ant- malarial drugs to 

household care takers

 CMDs report to the nearest Health facility for supplies etc.

 This is part of cost-effective since household caretakers don’t travel a long distance to seek for 

emergency treatment

 Risks are minimized (a journey of 5 km to the nearest clinic including poor infrastructure 

can ultimately reduce preventable conditions and deaths)

Advantages of community low cost control measures:

 Likely to be most effective and cost-effective in areas with high malaria transmission

 Limited health care infrastructure

 Poor access to ant-malarial treatment

 Communities understand that malaria is the main killer disease therefore becomes 

excited to participate.

Funding of community based control programs:

 National Malaria Control Programme & MoH

 Private Sector in Uganda

 Non-governmental organizations

 WHO-Geneva through the Makerere University 

 U.S. President’s Malaria Initiative
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 UNICEF-UNDP-World Bank-WHO Special Programme for Research and Training in Tropical 

Diseases 

Differences between the United States and Uganda:

 The control program of these diseases are scientific, technical activity that requires skilled 

personnel

 The majority of Ugandans are not well educated compared to US so this can have 

different settings

 Availability of local resources will dictate local priorities.

 Funding is a problem and as a result in Uganda most villages rely on community efforts to 

sustain their programs.

Lessons Learned:

 Considering the similarities of the behavior of mosquitoes and ticks behavior employing both 

prevention interventions combined with alternative low cost strategies can help to reduce 

malaria and Lyme disease.

 Community efforts in Uganda can be a foundation for further research that could help 

to develop effective local strategies that can ensure sustainability.

 Historical studies can help to modify strategies to control mosquitoes and likely ticks 

infestation.

Conclusions:

 Ticks, and mosquitoes will continue to be important public health parasites for discussions.

 Effective control measures will not only be measured by the effectiveness of a particular 

method or combination of methods, but also in the methodology that will ensure sustainability 

and minimal exposure to humans.

 Community involvement and institutional participation could also strengthen the control 

measures.

 Environmental management has a long-term track record of successful malaria control in a 

diversity of ecological, epidemiological and socio-economic settings.

 Specific control strategies should be developed for specific

country conditions 

Q&A

Question Bill Meredith- I would like to make a comparison between mosquitoes and ticks. We are in 

this together and are dealing with vector control issues. We have only been trying to 

address Lyme disease for the past 20 years. Mosquito control we have been at for 150 

years. One thing we want to compare between mosquitoes and tick control is to look at 

what happened before modern mosquito control. There are programs in place to stop 

Dengue outbreaks or mosquito born disease. We need this for tick-borne disease. 
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Question Karl Malamud Roam- What is your experience in areas where incidence of malaria goes up 

and down? Do people remain engaged?

Response Maction- Public support when incidence drops- what I noticed in Uganda was that yes in 

the sense that it is not all the people with bed nets. Bed nets require money and for them 

to have nets for everyone is impossible. To have this for the whole family it difficult. A 

majority of people do not sleep under bed nets. My research was on a different topic but 

people were worried about malaria.

Question Karl- do the interventions become more acceptable over time?

Response Maction- Many people in the community encourage villagers to participate in the program. 

The problem is that people want incentives to do things. For example food for work- they 

do construction, they get food. People see their children are dying from Malaria- so they 

need.

Question Lindsey McLellan from Fairfax County VA. Malaria does not have an animal reservoir. It is 

transmitted between humans and mosquitoes and back to humans. This is one situation 

where we have a fundamental difference between ticks and mosquitoes. Mosquito control 

in the keys helped to keep Malaria levels down. We have a tougher problem with Lyme 

disease. Even though we can stop the disease in people, we still have an animal reservoir.

Response Maction- it was a powerful comment. Thank you. 

Session X: Summary of Research Needs and Knowledge Gaps

Discussion 

Leaders

Ben Beard, CDC

Karl Malamud-Roam, IR-4 Rutgers University

Herbert Bolton, USDA

We found that we have a lot of questions to discuss. We hope these will yield take home points. 

Ben Beard- The questions I have had include:

1. There has been some discussion on the need for specific recommendations on preventing Lyme 

disease, how important is data on creating these recommendations? 

2. If we know we are killing ticks and we know it is working, why do we need to go through the 

process of documenting cases etc?

3. Can we assume that if we are reducing tick populations, we can assume we are reducing risk to 

people? It is very hard to receive data on human cases and community trials are very expensive.

4. Another question I have is given the current portfolio on prevention strategies including 

personal protective measures, four poster etc. what is showing the largest reduction in human 

cases? 

5. From our TickNet study we felt the best foot forward was using acarcides. What other things can 

be brought into community trials? 

6. Another question is which of these interventions are likely to be accepted or utilized in 

communities? 
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7. Which of these afford the best cost benefit ratio? People believe there is a risk in using synthetic 

pesticides but how can we weigh this against prevention? Should we lean more towards zero 

tolerance? 

8. Moving on- multiple federal partners have done studies on Lyme disease prevention, what 

activities provide synergistic partnerships? 

9. What efforts are being made for coordinated efforts? It can be disconcerting that we are doing 

all these projects but are unaware of what other people are doing.

10. What are the potential obstacles towards these federal partnerships? These obstacles are not 

insurmountable but do exist. 

11. While agencies such as ourselves have federal mandates to reduce the impact of Lyme disease, 

what else can we do other than a vaccine? 

12. Who is responsible for reducing Lyme disease? Is it individuals, city planners, local public health 

officials, states? 

Karl Malamud Roam - Chris Zarba was hoping to receive a document for EPA research. We would like 

the discussion to help answer the question regarding EPA’s role. We do have people recording 

everything so let’s have a brainstorming session. If we had someone magically handed everyone in this 

room a million dollars for research projects what would you do? A few elements include1. Which interventions work under which circumstances? 

2. Given the difficulties in evaluating cost effectiveness formally can we give a rough 

approximation of what people should be doing? 

3. Linking entomological and epidemiological success together- how do we do this? Inevitably a 

number of research programs that happen will have entomological outcomes. How do we use 

this to create a robust model for future studies? 

4. The final question I have is do we know enough to make for recommendations that local 

governments should undertake to control tick-borne diseases? My answer is I do not think so. I 

would like to hear what you think. How do we get from point a to point b. 

Herbert Bolton- We have learned about various techniques and approaches. There is some need for 

discussion on doing demonstration projects for community IPM. We should evaluate community IPM 

efforts and see what is working. We need a multidisciplinary approach. We have heard a lot about Lyme 

disease, however I would like to emphasize that we need to consider all types of tick-borne diseases. We 

have different parts of the country represented. Models may be different based on location in the 

country. We should give some thought to what would go into these research gaps. We heard little 

fragments and pieces; we need to look at holistic community approaches. I think if we do these kinds of 

studies we have to look at going back to social scientist perspectives on how people obtain knowledge in 

the best way. Entomologists are not the best people to know how to communicate with the 

communities at hand. First people acquire knowledge, then they have to change their behavior. We 

need to better understand messages received and changes in behavior ideally leading to a condition 

change. There are other groups that are going though the same process whether it is with bedbugs, or 

asthma. Change in knowledge, behavior and then condition. Many things we do are outputs and 

activities, however this is a problem for many groups. Even if you have valuable techniques that work, 

messaging is imperative. We need qualified competent social scientists and community leaders to get 

messages out. I am working on a federal task force. They are trying to develop an asthma disparity zone. 

Maybe we should have a study where we have a tick-borne disease zone demonstration project where 

we get all the people together and try to see what it would take. We would like to provide an 

opportunity for discussion and for people to say what they think are research gaps. 
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Discussion

David Gaines, Virginia Department of Health- I was thinking that as it is pretty evident that Lyme 

disease is related to landscape ecology and landscape. I am wondering if it might be worthwhile to 

increase outreach to schools of landscape architecture about what type of community development 

would be less prone to Lyme disease. In Virginia, a lot of the Lyme disease is occurring in new 

developments. If we could get county planners and landscapers to design communities that are less 

prone to producing large deer, tick and white-footed mice populations or other reservoir hosts we may 

have an impact on the disease in the future. Herb, this might be one type of demonstration project. We 

may need a different model in this community area. We may need to consider established areas versus 

new areas. 

Kevin Moran- If EPA and CDC are looking for guidelines, education is key. IPM requires education on 

identifying pests, their habitats, stakeholders, modifying landscapes, and treatment. It appeared to me 

that one key aspect is the education of the medical community. We need the medical community to be 

more proactive. There are veterinarians very interested in this subject. Brochures- maybe we need to 

change social media about this. People need to know when they are in tick habitat. Maybe if people 

know, they will engage in personal protective measures. I am wondering if EPA and CDC can work on 

effective control measures. We need research guidelines that can be given to industry to educate them 

on proper guidelines. If we are looking for public money, this is just not there. We heard yesterday that 

ticks are described as a peridomestic pest. I am not sure if we should focus area wide control measures, 

maybe we should be spending more on localized smaller scale control efforts. I do think that we can 

assume that if we reduce the population we will reduce exposure and we will reduce the potential for 

disease spread. I hope we can agree on this. I know we want studies on this but we should take this to 

the bank anyways. It scares me to think about deer birth control. I know Massachusetts looks at archery 

hunting the same way as they do with rifle hunting. There are very few places to hunt deer. We need to 

better educate that area of government. Herb- one group we did not have here are people from APHIS 

wildlife research laboratory in Colorado. They have looked closely into birth control methods for deer. 

We should include them as partners. Kevin- maybe EPA and CDC can come up with a backyard version of 

the 4 or 2 poster. 

Howard Ginsberg, USGS- There has been a lot of discussion in entomological risk factors. We need to 

target intervention to minimize exposure to ticks. We can compare a pesticide application with a public 

education intervention and we can compare but we do not know how targeted either was. 

Kathy White, LDA of Greater Kansas City- There are a great many lone star ticks causing diseases in 

Kansas. Rabbits are the primary host of ticks in this part of the country. We may want to have some 

research directed into how to kill ticks on rabbits. 

Todd Peterson, EPA - I am a plant physiologist. I was looking at the presentation on malaria where we 

have mosquitoes, humans, and disease. However in ticks we have the ticks, humans, disease organisms 

and the reservoirs. Has CDC been looking at the organism itself? Does anyone understand that 

organisms enough where they can use the deer population and mitigate the organism itself? Ben Beardone area that has not been talked about is reservoir targeted vaccines. We are funding a project 

evaluating reservoir targeted vaccines. We are looking at plot studies there. This is a transmission 

blocking vaccine. The thought is this could be used. It is modeled after the rabies vaccine. Another thing 

we didn’t talk about is the use of oral antibiotics. This is parallel to things the USDA was doing with oral 

ivermectin. One study that we have shows that if you put oral doxycycline baits out using these bait box 

delivery systems, you can protect mice. Ticks feeding on the mice are then sterilized from the 

spirochete. This works so well we wondered what would happen if we put it out in the field. We 
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discovered when you put this out in plots you can trap animals, put the bait out, trap them after and you 

have eliminated Borrelia burgdoferi in the area. This develops concerns over antibiotic resistance. There 

is a large back and forth that can be waged on this. One thing we thought about was using a reservoir 

vaccine- we thought about using the vaccine and antibiotic together at first. Then you can stop using the 

antibiotic instead of vaccine. This is an overall collaborative effort. 

John Carroll, USDA- Mat Pounds discussed ivermectin- one concern over the four poster is the cost. 

Using ivermectin would be something that would be less expensive and easier to use. However allowing 

it to be used- there is a concern over deer and hunting season. This may be something used in the 

future. I do not know who would tell people to be careful when using it.

Pat Smith, LDA- I am a firm believer in education. I have spent my life there in one way or another. I 

firmly believe we should be bombarding people with materials on this issue. We could go through 

schools and provide them with materials because they are already set up for this. If I had a million 

dollars to use I would hit upon education. We have a distribution system already in place. I would like to 

reemphasize this- if we expect people to be responsible, people’s biggest fear is the risk benefit ratio. I 

would like to look at alternatives to chemicals that people can use on their properties. From some of the 

work I have done and we have funded, I know materials are out there. We just need efficacy 

information on these chemicals. If people are not using highly effective chemicals what is the point. If 

we have more people using natural products because they are not afraid of them then we will get more 

use. If we expect to change people’s behaviors- we need to present to them that this is serious. We 

need to make this serious it is hitting a lot of people. The surveillance that we have is terrible. For those 

of you who do not know a lot about what is happening, the CDC has criteria but the states are not using

it. Everyone is using something different to report the numbers. It relates to this because we are not 

getting an accurate picture of this issue. I hear this from people everywhere from people in official and 

unofficial position. CSTE (Council of State and Territorial Epidemiologists) is charged by Congress to do 

surveillance- in this time they have changed the definition of this disease twice. They put forth what 

they feel benefits their state. What benefits their state primarily is money. States do not have money. 

This is what is seen and what a lot of people think. We have to work to change this, surveillance needs 

to be brought up to speed; this is an epidemic. Until we convey this message to everyone, we will not 

get a behavior change. People do not feel it is a serious issue. 

Carol Parker, EPA- This has been an incredible conference with a wealth of material. I hope in your 

targeting efforts in the future you bring forward a lot of what has been discussed. We need to bring 

communities together. What they really want are model plans. I have heard a lot of great things. We 

should not move away from the efficacy. People want to know what works. You have given us a wealth 

of resources. People do not want to use pesticides but may be more willing to do so if they learn they 

only need one targeted application.

Kathy White, LDA of Greater Kansas City- I would like to reiterate what Pat Smith said. This is a huge

problem and it is very underreported. I have had all sorts of problems due to a tick bite. The reported 

criteria is much too strict and is not counting a lot of us.

Tom Brennan, EPA- first I will let people on the webinar have final thoughts. Karl has one question and I 

have brief wrap up.

Webinar questions: 

Are some people more susceptible to contracting Lyme disease when bitten? In other words do 

preexisting conditions predispose people to contracting Lyme disease? Ben Beard- this is about IPM and 
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it is not about diagnostics. These are issues that always come up. I think that it does a disservice to go 

off the IPM direction. 

In community-based IPM programs do you provide recommendations for landscaping that will reduce 

ticks in certain areas? Tom Brennan- this is part of an integrated approach. We had a session on this.

Have there been fears of property values falling due to ticks in certain areas? Kirby- I am not aware of 

any given the extent of the distribution of Lyme disease today, one person’s property is going to have 

similar risk as another property in the same area if it has similar property. Tom Mather- in Rhode Island 

we have a million residents, our estimation of tick distribution about 3⁄4 of residents have a possibility of 

encountering a tick where they live. I could see it happening in a place initially where Lyme disease first 

becomes an issue. I think it could have a short term impact. I do not see it now though because it is such 

a pervasive problem. Pet owners are spending money that they would not have spent if the tick problem 

was not there. There are estimates that Lyme disease and associated costs are around 30 million dollars 

a year in Rhode Island. 

Conference Wrap Up

Tom Brennan (EPA)

Thank you to Candy, Raderrio, and Ed. Also help from our colleagues at EPA- thank you to you as well. 

Two people who have to the happiest people in the room- Kylie and Holly. Rise who set up the webinar. 

The panelists who have been working for months. The audience- your participation has been the best 

part. We charged you to stay on point with IPM and to not drift too far from this and go into diagnosis. I 

would like to give us all a round of applause. I cannot get away without saying that today is the first day 

of baseball season. Today is a fresh start. I was thinking, even though vector management has been 

around for as long as baseball we should think of today as a fresh start. On opening day, anything is 

possible; as a Nationals fan anything is possible. To move away from that, this is such an important 

topic. 

It is eye-opening when we consider the number of people who have been impacted. The highest risk 

group are children of 5 to 9. These illnesses are spreading across the continent. When I get back to the 

office, I will look at what our group does IPM and school IPM- we have heard a comment to wrap this 

into school IPM- we are trying to be creative about reaching these audiences at the same time. I 

challenge you to reflect on what your role is and what you can rededicate to yourself on this day. 

Teamwork and collaboration are very important and huge. We see so many diverse interests, talents, 

and abilities, we need to harvest our diversity and get our partners to work together. One way we do 

this is through our PESP members many of whom are in here and are pushing for IPM. Anyone who liked 

this meeting should be part of our group. Within federal agencies we will be huddling together to 

discuss outreach and education. Look beyond your own organizations and cross lines. Together we will 

get a lot farther. Thank you for a great meeting and safe travels home.