Title Figure. Mouth parts of a tick. The center of the mouth (yellow) is 

covered in tiny barbs that help keep the tick lodged on the host while 

feeding. Image credit: Igor Siwanowicz, Janelia Farm Research Campus, 

Howard Hughes Medical Institute, Ashburn, VA. This image is subject to 

the creative commons license. 

PREPARED BY THE NIH TICKBORNE 

DISEASES STRATEGIC PLANNING TEAM

NIH STRATEGIC PLAN

FOR TICKBORNE

DISEASE RESEARCH 

October 9, 2019
1 

Table of Contents

Executive Summary...................................................................................................................................... 2

Introduction..................................................................................................................................................... 4

NIH Strategic Plan for Tickborne Disease Research..................................................................... 7

Strategic Priority 1: Improve Fundamental Knowledge of TBDs...................................... 8

Strategic Priority 2: Advance Research to Improve Detection and Diagnosis of 

TBDs............................................................................................................................................................. 12

Strategic Priority 3: Accelerate Research to Improve Prevention of TBDs............... 14

Strategic Priority 4: Support Research to Advance the Treatment of TBDs............. 16

Strategic Priority 5: Develop Tools and Resources to Advance TBD Research....... 18

Conclusion ..................................................................................................................................................... 18

Appendices .................................................................................................................................................... 20

Appendix 1. Developing the Strategic Plan............................................................................... 20

Appendix 2. NIH Tickborne Diseases Strategic Planning Team...................................... 25

 
2 

Executive Summary 

The U.S. National Institutes of Health (NIH) is committed to addressing the insidious

threat to public health posed by the rising incidence of tickborne diseases (TBDs) in 

the United States. The number of reported TBD cases more than doubled from 2004 

to 2016 , and reached a record high of 59,349 cases in 2017. From 2004 to 2016, 

TBDs represented more than 75 percent of all vector-borne disease cases (642,602 

total cases) reported in the United States. Current strategies to address TBDs are 

hindered by suboptimal diagnostics, a paucity of treatment options for viral and 

other TBDs, and a lack of vaccines. 

 

This NIH Strategic Plan for Tickborne Disease Research proposes building on current 

trans-NIH efforts to better understand the complex interplay among host, tick, and 

pathogen factors that contribute to TBDs and the body’s defenses against them. 

The plan aims to leverage this understanding to develop new tools that can more 

effectively prevent, diagnose, and 

treat TBDs. These tools will include 

rapid diagnostics that can discern

different TBDs, preventive 

vaccines, and treatment options for 

all disease stages of TBDs, in the 

diverse populations and age groups 

affected (Figure 1). 

 

To address the rising threat that TBDs represent, in 2016 the 21st Century Cures Act

mandated the establishment of the HHS Tick-Borne Diseases Working Group to 

provide expertise, ensure interagency coordination across the Department of Health 

and Human Services (HHS), and examine research priorities related to TBDs. As part 

of their directive, the working group developed a 2018 report to Congress that 

outlined recommendations for TBD research, including a significant emphasis on 

intensifying research efforts to advance fundamental knowledge of TBDs and enable 

the development of improved diagnostics as well as treatment and prevention 

strategies. The 2018 report also called for developing an NIH strategic plan to 

coordinate a trans-NIH research effort to address TBD research priorities. 

The NIH Strategic Plan for Tickborne Disease Research highlights the agency’s TBD 

research mission (Box 1), which aligns with the HHS working group 

recommendations. The plan includes five strategic priorities that capitalize on 

existing research initiatives and resources to develop the knowledge and tools 

needed to combat TBDs:

1. Improve fundamental knowledge of TBDs to understand the host, vector, 

and pathogen factors that drive TBD pathogenesis and transmission. Elucidate 

the host immune mechanisms in response to and exploited by TBD pathogens.

Box 1. NIH Strategic Plan for TBD Research

Mission

Accelerate efforts across the research 

spectrum to improve the understanding of 

TBDs and advance the development of

effective tools and strategies for diagnosis, 

prevention, and treatment 
3 

2. Advance research to improve the diagnosis of TBDs using both host- and 

pathogen-targeted approaches, including research for rapid diagnostics and 

multiplex platform approaches that detect multiple tickborne pathogens.

3. Accelerate research to improve TBD prevention by supporting science to 

design, develop, and evaluate vaccines, vector control strategies, and other 

prevention approaches. 

4. Promote research to improve treatment for all forms of TBDs, including 

studies to develop effective therapies to treat symptoms that persist after TBD 

treatment, therapies for non-infectious TBDs, and new antimicrobials. 

5. Support tools and resources to advance research in understanding, 

preventing, diagnosing, and treating TBDs, including repositories, genomic 

resources, animal models, and preclinical services to aid the development and 

assessment of diagnostic, vaccine, and therapeutic candidates.

To accelerate research within these five strategic priorities over the next 5 years 

and beyond, NIH will leverage current resources and expand collaborations across 

NIH institutes to promote a multidisciplinary approach to TBD research. These 

trans-NIH efforts will draw on diverse expertise—from vector biologists to 

neurologists—to answer complex biological questions and encourage the 

application of state-of-the-art technologies used successfully in other fields. 

Furthermore, by supporting systems biology research along with the more 

traditional approaches, NIH will develop new strategies to help stem the rising 

incidence of TBDs in the United States. 

Figure 1. The NIH Strategic Plan for TBD Research builds on the existing foundation of research and 

resources to advance five TBD research priorities targeted at 1) improving fundamental knowledge, 2) 

advancing diagnosis, 3) preventing new TBD infections, 4) improving treatment for all forms of TBDs, and

5) supporting tools and resources to advance priorities 1 through 4.

 
4 

Introduction 

Tickborne diseases (TBDs) are the most common illnesses transmitted by 

arthropods (insects, ticks, and mites) in the United States, and the annual number of 

reported TBD cases continues to increase (Figure 2). In the United States, more than 

20 different disease-causing bacteria, viruses, and parasites are transmitted to 

humans through the bite of a tick (Table 1), and many additional TBDs occur 

internationally. Most of these TBDs were unknown 50 years ago, and many were 

only discovered during the past decade. 

Figure 2. Annual Reported Cases of TBDs in the United States

Figure 2. Annual reported cases of TBDs in the United States have increased from 2004 to 2017, with a 

record high number of reported cases in 2017. Figure from CDC: Tickborne Disease Surveillance Data 

Summary.

Newly identified tick-transmitted pathogens continue to be reported, raising 

concerns about missed diagnoses, inadequate treatment, and gaps in our 

understanding of where, when, why, and how TBDs occur. Tick bites are also 

responsible for the non-infectious disease tick paralysis, and likely the recently 

discovered alpha-gal allergic syndrome, or “red-meat allergy.”Depending on the 

disease, clinical manifestations of TBDs can range from mild, self-limiting infections 

to serious illness, extended disability, or even death.

Multiple tick species transmit TBDs, and the changing dynamics and geographic 

ranges of ticks in the United States and globally have caused additional concerns 

regarding who is at risk. These changes further reinforce the need for vigilance in 

responding to new and emerging TBD threats at a time when the true global burden 

of tickborne infections remains unknown. 

TBDs have received increasing public attention given their shifting ranges, 

increasing incidence, the emergence of new pathogens, and the potential for serious 
5 

illness (Box 2). TBDs have been and remain an important research focus at NIH as 

well. NIH supports a broad range of research studies designed to unravel the biology 

of ticks and tickborne pathogens and the interactions between ticks, tickborne 

pathogens, and the mammalian 

host, with the goal of 

developing better ways to 

prevent, diagnose, and treat 

TBDs. 

Tickborne Diseases in the 

United States 

TBDs have been recognized in 

the United States since at least 

the late 19th century, and NIH 

has been involved in their 

study since early in its history. 

The Rocky Mountain 

Laboratories (RML), a 

component of the NIH National 

Institute of Allergy and 

Infectious Diseases (NIAID), 

traces its origins to the early 

1900s as a research station in 

Montana established to 

investigate a deadly measleslike disease. That disease was ultimately identified as Rocky Mountain spotted fever 

(RMSF), caused by the bacterium Rickettsia rickettsii and transmitted by ticks. RML 

became a component of NIH in 1937 and remains an active site for TBD and other 

infectious disease research. The causative agent of Lyme disease, for example, was 

first isolated by RML scientists.

RMSF remained one of only a few recognized human TBDs in the United States for 

much of the 20th century. The emergence of Lyme disease in the 1970s; however, 

ushered in a new appreciation for the potential diversity and public health burden 

of tickborne infections. Within a decade of the identification of Borrelia burgdorferi, 

the causative agent of Lyme disease, researchers began to identify additional 

tickborne pathogens associated with human disease in the United States. These 

include human ehrlichiosis (1987),human anaplasmosis (1990), Rickettsia parkeri

spotted fever (2004), Pacific Coast tick fever (2008), Ehrlichia muris–like infection

(2009), Heartland virus (2009),B. miyamotoi infection (2013), Bourbon virus

(2014), and B. mayonii infection (2016). 

In 2009, researchers reported a novel allergy to red meat associated with certain 

antibodies against a molecule in meat called galactose-alpha-1,3-galactose (alphagal). They soon accumulated evidence that the trigger for this so called red-meat 

Box 2. Scope of the U.S. Tickborne Disease Threat 

• Between 2004-2016:

- Tickborne pathogens caused more 

than 75% of 642,602 reported cases

of vector-borne disease. 

- Reported cases for most TBDs at least 

doubled; some increased up to sixfold. 

- Lyme disease accounted for more 

than 80% of TBD cases.

• TBD cases continue to rise, with 59,349 

cases reported in 2017 compared to 

48,610 cases in 2016.

• Approximately 30,000 cases of Lyme 

disease are reported annually.

• The Centers for Disease Control and 

Prevention (CDC) suspects Lyme disease 

underreporting; actual annual Lyme 

disease cases are estimated at ~300,000 

annually.
6 

allergy, or alpha-gal syndrome, was the bite of the lone star tick. This was the first 

report of an arthropod bite leading to food allergy in people.

Table 1. Tickborne Diseases of the United States

Pathogen 

Type

Disease Pathogen (U.S.) Tick vector (U.S.) 

Bacteria Lyme disease Borrelia burgdorferi

Borrelia mayonii1

Blacklegged tick, western 

blacklegged tick1

Borrelia miyamotoi

infection

Borrelia miyamotoi2 Blacklegged tick

Tickborne relapsing 

fever

Borrelia hermsii, B. 

turicata, B. parkeri and 

others

Soft ticks (Ornithodoros

species)

Anaplasmosis Anaplasma 

phagocytophilum

Blacklegged tick, western 

blacklegged tick

Ehrlichiosis Ehrlichia chaffeensis

Ehrlichia ewingii

Ehrlichia muris 

eauclairensis

Lone star tick

Lone star tick

Blacklegged tick (possible)

Tularemia Francisella tularensis American dog tick, Rocky 

Mountain wood tick, lone 

star tick

Rocky Mountain spotted 

fever

Rickettsia rickettsii American dog tick, brown 

dog tick, Rocky Mountain 

wood tick

Other spotted fever Rickettsia parkeri Gulf Coast tick

Pacific coast tick fever Rickettsia philipii Pacific Coast tick

Virus Powassan disease Powassan virus Blacklegged tick, 

groundhog tick

Colorado tick fever Colorado tick fever virus Rocky Mountain wood tick

Bourbon virus Bourbon virus Undetermined

Heartland virus Heartland virus Lone star tick

Parasite Babesiosis Babesia microti, B. duncani Blacklegged tick

Unknown Southern tickassociated rash illness

Unknown Lone star tick

None Alpha-gal syndrome None Lone star tick

Tick paralysis None American dog tick, Rocky 

Mountain wood tick

Table 1 

1 Borrelia mayonii is a recently discovered pathogen that causes Lyme disease. It has not to date been associated with 

the western blacklegged tick. 

2 Borrelia miyamotoi is a recently discovered pathogen that causes a relapsing fever and is genetically more similar to 

the relapsing fever Borrelia species.
7 

An Interplay of Pathogen, Vector, Reservoir, and Host 

Unlike infectious diseases that spread directly from person to person or through 

intermediate surface contact, TBDs are transmitted through a complex interplay of 

human hosts, pathogens, ticks, and animal reservoirs. A comprehensive strategic 

research plan therefore requires elements from multiple biological disciplines.

In the United States, nine species of “hard ticks” transmit the majority of tickborne 

infections, whereas several “soft ticks” primarily transmit bacteria causing 

tickborne relapsing fever. The recent identification of Borrelia miyamotoi infections 

in the United States represents the unusual transmission of relapsing fever by a 

hard tick (Table 1). 

As the number of tickborne pathogens continues to increase in North America, so 

has the number of tick species. In 2017, the Asian longhorned tick, Haemaphysalis 

longicornis, was identified in the United States for the first time. The tick, which can

transmit human disease in its native Asia, has not yet been shown to carry any 

known human pathogens in the United States. As of August 2019, Asian longhorned 

ticks have been identified in 12 states. 

In general, the association between a pathogen and a tick is specific, and not every 

tick can transmit every microbe. This specificity depends on many variables, 

including the molecular interactions that enable the pathogen to survive and 

develop within ticks, behavioral factors such as the tick’s host-seeking strategy, 

environmental factors such as temperature and humidity, and human behavior and 

intrusion into natural tick and pathogen habitats. This complexity makes the study 

of TBDs and their prevention a challenge.

Similarly, wild and domestic animals, including mammals, reptiles, and birds, are 

important players in tickborne pathogen survival, reproduction, and spread. As is 

the case for the tick vectors, these animal reservoirs also vary in their susceptibility 

to pathogens and their ability to sustain and transmit them. 

NIH Strategic Plan for Tickborne Disease Research 

The growing health burden of TBDs, along with their underlying biological 

complexity, warrants a comprehensive strategic research plan. The NIH Strategic 

Plan for Tickborne Disease Research outlines the agency’s strategic TBD research 

priorities to support the understanding of TBDs and advance the development of 

tools and strategies to prevent, diagnose, and treat TBDs. NIH will continue to 

support a range of basic, translational, and clinical research to improve our 

knowledge of illnesses transmitted by ticks and to develop new tools for their 

prevention, diagnosis, and treatment in all populations, including children. 

NIH will support this research through extramural and intramural research 

programs, including the use of systems biology approaches, to generate a 

comprehensive understanding of the complex biology of tickborne pathogens.
8 

Strategic Priority 1: Improve Fundamental Knowledge of TBDs 

A comprehensive understanding of the biological processes involved in tickborne 

pathogens’ transmission, survival, and ability to cause disease is paramount to 

developing new tools to combat TBDs. This includes 

an understanding of the microbial, vector, and host 

factors and the interactions that contribute to 

disease. NIH conducts and supports research on 

tickborne pathogens and their properties 

associated with human disease. NIH also conducts 

studies on tick physiology and tick-pathogen 

interactions, conducts some ecological research, 

and coordinates these efforts with other agencies.

The emergence of a non-infectious TBD, alpha-gal 

syndrome, has expanded NIH TBD research to 

include efforts to better understand the allergic 

mechanisms behind alpha-gal sensitivity, in 

addition to research on tick and human factors 

involved in this disease process.

Objective 1.1: Understand the fundamental biology of tickborne pathogens

• Determine biochemical mediators of pathogen survival. All microbes 

have evolved genetic pathways enabling them to thrive within their 

environments. Tickborne pathogens must adapt to survive within ticks, as 

well as in human and animal reservoirs. Elucidating the genes and gene 

products that are important for pathogen transmission, tissue invasion, and

other key elements of survival is key to developing a complete picture of 

their life cycles. As with most pathogens, scientists have an incomplete 

understanding of the microbial genetic and biochemical pathways required 

for the survival of tickborne bacteria, viruses, and parasites. NIH will 

continue to support basic research to expand our knowledge of known 

microbial genetic and biochemical pathways, to identify new ones, and to 

exploit those findings for new approaches to preventing, diagnosing, and 

treating TBDs. 

• Elucidate microbial structural biology. The functions of microbes, 

including their abilities to invade, reproduce, and cause disease in their 

hosts, depend in part on their structural makeup. Tickborne bacteria, 

viruses, and parasites all have biological structures that enable them to 

interact with tick and host cells and tissues. Those structures may enable the 

microbes to invade host cells, acquire nutrients, suppress immune 

responses, bind to specific tissues, move about the host, replicate their DNA, 

or any other property critical for survival. Understanding the structural 

Figure 3. A Lone star tick. Bites from lone 

star ticks are associated with alpha-gal 

syndrome and other TBDs. Image credit: 

NIAID.
9 

biology may assist in developing targeted interventions to disrupt pathogen 

transmission or survival within the host. NIH will support research to 

advance our understanding of the underlying microbial structures that are 

required for pathogen survival. 

• Investigate the ways in which intracellular TBD pathogens interact 

with the host cell . Many tickborne pathogens—such as viruses and some 

bacteria—reside inside host cells. Viruses and intracellular bacteria, such as 

those that cause Rocky Mountain spotted fever, anaplasmosis, and 

ehrlichiosis, co-opt the host cell and manipulate its genetic and biochemical 

components to ensure their reproduction or survival. Knowledge of the 

needs of intracellular pathogens and the mechanisms they employ to satisfy 

those needs will shed light on potential new targets for drugs to combat 

TBDs. NIH will support research on the biological processes required for the 

survival of tickborne viruses and bacteria within cells, including efforts to 

develop improved technologies for studying intracellular bacteria.

Objective 1.2: Understand host interactions with tickborne pathogens

• Understand the human immune response to tickborne pathogens. A 

better understanding of human immune defenses is vital to developing

vaccines and other technologies to prevent TBDs. Detailed knowledge of the 

human host response to infection will not only provide insights into new 

approaches for diagnosis, treatment, and prevention, but will likely elucidate 

why individuals may respond to the same pathogen in different ways. NIH 

will support research on the human response to infection, including both the 

innate and adaptive immune systems, with a focus on the factors that lead to 

protective immunity. 

• Understand how TBDs interact with and affect human organ systems. In 

addition to better understanding the interplay of the human immune 

response to tickborne pathogens, it is crucial to understand how TBDs affect 

other organ systems. For example, in rare cases Lyme disease can affect the 

heart, a process that is poorly understood. TBD impacts on respiratory, 

hepatic, musculoskeletal, and other organ systems have also been reported. 

A few tick-borne pathogens, such as Powassan virus, can cause fatal or 

disabling meningoencephalitis, an inflammation of the brain and 

surrounding tissue, due to their ability to infect the brain and nervous 

system. TBDs can also contribute to neuropsychiatric complications that can 

persist after the TBD is treated. In addition, changes to the host immune 

system as a result of TBD infection can trigger and propagate other immune 

pathways and contribute to the development of sequelae, such as Lyme 

arthritis. Research supported by NIH will provide insights into how TBDs 

affect the health of multiple organ systems, and the implications for 

persistent symptomology. This includes developing animal and cell models 
10

that will facilitate studies of human organ system pathogenesis to better 

address the full range of TBD sequelae.

• Understand how tickborne pathogens spread within the body following 

infection. Following infection, most tickborne pathogens spread to specific 

cells or tissues within the body. Understanding the host and microbial factors 

that determine where pathogens 

migrate will provide insight into 

potential mechanisms to interrupt the 

disease process. Taking advantage of 

established procedures and emerging 

imaging technologies, NIH will 

support studies to identify where 

tickborne pathogens go following 

initial infection, how they get there, 

and the microbial and human factors 

that enable that movement.

• Understand how tickborne pathogens evade human immune defenses.

Many pathogens have evolved to evade or shut down elements of human 

immune responses. While many mechanisms have been identified, scientists

do not fully understand the role of immune evasion for different tickborne 

pathogens, or how that evasion is accomplished. NIH will support research to 

identify the complete spectrum of immune evasion strategies with the goal of 

developing countermeasures to enable improved treatment and prevention. 

• Determine the cause of persistent symptoms in humans infected with

TBDs. For some TBDs, such as Lyme disease, some individuals report 

continuing, sometimes debilitating, symptoms following standard treatment, 

or in cases where the infection has not been promptly treated. The cause(s) 

of these symptoms remain unknown but have been postulated to be due to

persistent infection, an autoimmune response, lingering inflammatory 

processes triggered by nonliving bacterial components, or even other 

diseases unrelated to tickborne infections. NIH will continue to support 

research into the causes of long-term symptoms attributed to TBDs, 

including treatment-refractory infections.

Objective 1.3: Understand the pathogenesis of noninfectious TBDs

• Understand the factors underlying the development of alpha-gal 

syndrome. Alpha-gal syndrome is the only known food allergy that can be 

induced by an arthropod bite, in this case, the lone star tick. Understanding 

the host immune–mediated and vector-associated mechanisms that lead to 

alpha-gal syndrome will help develop tools to predict who will develop an 

allergic reaction, as well as interventions to counteract this condition. NIH 

will continue to support fundamental studies to understand the impact of 

Figure 4. Black-legged tick. Bites from black-legged 

ticks are associated with Lyme disease and other 

TBDs. Image credit: CDC; Michael L. Levin, PhD.
11

blood feeding by ticks and insects on immunologic events and TBD

pathogenesis, including alpha-gal syndrome.

Objective 1.4: Understand tick biology and tick-pathogen interactions

• Unravel tick-pathogen interactions. Identifying and characterizing the 

factors and biochemical processes—both of the pathogen and tick—that 

allow bacteria, viruses, or parasites to invade and survive within their vector 

are critical components to understanding TBDs. The specificity of pathogens 

for their tick vectors, and the competency of those vectors to support the 

pathogen, are regulated by a host of biochemical structures and pathways. 

NIH will support research aimed at understanding and potentially 

interrupting these pathways, with the goal of stopping TBDs at the level of 

the tick before a person has been bitten.

• Understand pathogen transmission. Pathogen transmission between tick 

and vertebrate hosts (human and reservoir) is a complex process. That 

process requires genetic signals from both the tick and the microbe, resulting 

in biological changes in both that enable the pathogen to move from an 

invertebrate to a vertebrate host. Furthermore, not all pathogens are 

retained within a tick as it molts from one developmental stage to another, 

nor are all passed from a female tick to her eggs. In addition, environmental

factors are important in the biology of ticks and reservoir species. NIH will 

support research to determine additional avenues to interrupt transmission 

throughout the reservoir-tick-human life cycle.

• Characterize the tick immune system. Ticks have their own immune 

systems that protect them from infection. Tickborne pathogens have evolved 

to partially avoid these defenses as they establish themselves within the 

vector. The resulting state of mutual tolerance, where ticks elicit a sufficient 

immune response to keep microbe numbers in check, is carefully regulated 

and incompletely understood. Disrupting this regulation may provide an 

avenue for tick-targeted interventions to prevent TBDs. NIH will support 

research to identify key components of tick immunity and pathogen attempts 

to overcome those defenses.

• Assess the role of the tick microbiome in pathogen acquisition and 

transmission. As with humans, ticks normally carry a number of commensal 

microbes within their midguts and other organ systems. They may also be 

coinfected with other pathogens, including other bacteria, viruses, or protists 

that they can transmit to people. Research has shown that the presence of 

some microbes, whether harmful or harmless, can affect the ability of ticks to 

acquire and harbor others. Studies with other insect vectors have also 

demonstrated that genetically modified commensal microbes can deliver 

toxic compounds to those vectors and interfere with pathogen transmission. 

NIH will support research to elucidate the tick microbiome to examine the 

impact of multipathogen infections in ticks and to explore the potential 
12

application of genetic approaches developed for non-tick vectors to TBD

pathogen elimination.

• Understand how tick-derived factors contribute to the establishment 

and severity of TBDs. Tick-derived factors, such as salivary proteins that 

are co-delivered with tickborne pathogens during a blood meal, can 

contribute significantly to TBDs. Pathogens have evolved to take advantage 

of these molecules, exploiting them to facilitate 

the infectious process by modulating and 

suppressing the immune response at the bite site 

and assisting the pathogen in spreading within the 

host. Understanding how tick salivary proteins 

contribute to TBDs could help identify novel 

targets for vaccines and therapeutics with the 

potential to prevent and treat a range of TBDs, 

respectively. NIH will continue to support 

fundamental studies to understand the impact of 

blood feeding by ticks on immunologic events and 

TBD pathogenesis.

Strategic Priority 2: Advance Research to Improve Detection and Diagnosis of TBDs 

Rapid, accurate diagnosis is critical for the optimal treatment of TBDs. Diagnosis of 

tickborne infections utilizes the same technologies as diagnosis of many other 

infectious diseases. Serological tests, which detect host antibodies to the infectious 

agents, tests to identify pathogen nucleic acids in blood or tissues, and, for some TBDs, 

blood smear examination for direct detection of the pathogen itself, are the first-line 

approaches. While these tests are clinically useful, they all have limitations. By looking 

for antibodies as a marker of infection, serological tests do not detect the presence of a 

pathogen directly. They therefore may miss an early infection, when antibodies have 

not yet been produced. Conversely, in certain clinical contexts, it may be difficult to 

distinguish between an active infection and past infection when antibodies remain in 

the blood following clearance of the pathogen.

Molecular diagnostics to detect pathogen nucleic acids must be carefully designed to 

avoid false positive or false negative results. In addition, these tests only indicate the 

presence of a microbe’s DNA or RNA, rather than of the microbe itself. Furthermore, 

both approaches may detect the presence of both the targeted pathogen and a closely 

related microbe, thereby confusing diagnosis. 

For alpha-gal syndrome, blood tests can measure the level of antibodies to alpha-gal in 

the bloodstream, and a skin test can confirm sensitivity to the antigen. 

NIH will support research to improve TBD diagnostic tests and develop multiple 

diagnostic technologies, including both pathogen- and host-targeted approaches, that 

can be implemented in all populations affected by TBDs. 

Figure 5. Tick salivary gland. 

NIH scientists are exploring tick 

salivary glands as a tool to 

study virus and bacteria 

transmission and infection. 

 
13

Objective 2.1: Develop new or improve existing diagnostic tests for TBDs

• Support research on new rapid diagnostic tests. While diagnostic tests 

exist for all known TBDs, new tests are needed that are 

rapid and easy to interpret while maintaining high 

specificity (low chance of a false positive test) and high 

sensitivity (low false negatives). For example, in the 

case of most tick-borne encephalitides, diagnosis is 

often delayed until after significant brain injury has 

occurred. The tests should also be able to detect a 

pathogen both early and late in the infectious process, 

and to differentiate between active and past infection. 

Multipathogen diagnostic tests are an ultimate goal 

because of their clinical potential to provide a singletest answer when a TBD is suspected. NIH will

continue to support research on novel tests to address 

current diagnostic gaps.

• Support research on direct-detection technologies. Antibody tests do not 

detect a pathogen in the earliest stages of infection, which can lead to delays 

in treatment. Direct-detection technologies could potentially provide rapid 

diagnostic identification of pathogens during different stages of infection, 

including early phases. NIH will continue to support novel approaches to 

developing direct-detection diagnostic tests for TBDs. 

Objective 2.2: Develop diagnostic tests capable of predicting treatment success

• Develop diagnostics to monitor treatment response or success. 

The success of treatment protocols for TBDs varies and typically is 

determined by the sustained absence of symptoms and long-term 

complications. In Lyme disease, patients sometimes report continuing or 

recurrent symptoms long after treatment has been completed. Tests that can 

monitor treatment response or determine the presence of physiologic or 

biochemical factors that mediate that response could help predict whether a 

person will respond to standard therapy or require adjunct treatments. NIH 

will support research on diagnostic methods that can predict response to 

treatment.

• Develop diagnostics to differentiate TBD signs and symptoms from 

those caused by other diseases. Many symptoms, including 

musculoskeletal, cardiovascular, rheumatologic, neurologic, and 

neuropsychiatric symptoms, have been attributed to TBDs. Those symptoms 

may occur in the absence of a clear diagnosis of a tickborne infection, leading 

to uncertain treatment approaches and poor response to therapy. NIH will 

support the development and use of diagnostic tests that can clearly 

Figure 6. Spirochetes of the Lyme 

disease bacteria, Borrelia 

burgdorferi. Image credit: NIAID.
14

differentiate between TBDs and the most common confounding diagnoses, 

thereby improving patient outcomes. 

Objective 2.3: Develop host-based diagnostic tests 

• Identify human biomarkers that detect infection. Infection with tickborne 

pathogens can affect multiple organ systems and trigger or perturb multiple 

biochemical pathways, depending on the infectious agent. These pathogenspecific alterations in host biochemistry may leave molecular biosignatures 

that can be detected and used to diagnose infection. NIH will continue to 

support research to differentiate between early and late stages of infection 

and to distinguish TBDs from other diseases with similar symptoms. 

• Discover biomarkers of persistent symptoms. Biomarker studies typically 

take a whole-system approach to detecting how the body interacts with 

infectious agents, both immunologically and through other biochemical 

processes. For TBDs, biomarkers may prove useful in predicting the 

likelihood that persistent symptoms will emerge, or in assessing the cause of 

continued symptoms in those individuals. NIH will support research on the 

potential of biomarkers to expand our knowledge of the effects of tickborne 

pathogens on humans, including the emergence of persistent symptoms.

Strategic Priority 3: Accelerate Research to Improve Prevention of TBDs 

Prevention of TBDs in the United States and globally is focused on reducing or 

eliminating ticks in the environment, avoiding areas where ticks are present, or using 

clothing, repellents, and personal surveillance to prevent tick bites. 

Vaccines are among the most effective public health tools for combating infectious 

diseases, yet there are no currently licensed vaccines in the United States for any TBD. 

A vaccine to prevent tickborne encephalitis—a viral disease occurring primarily in 

parts of Europe and northern Asia—is available in countries where the disease is a 

threat.

In 1998, an FDA-approved vaccine that reduced the chance of contracting Lyme 

disease by 76% became available in the United States. The vaccine’s manufacturer 

later ceased production, a decision that generated considerable discussion. 

In cases where an individual notices a tick bite, a single dose of doxycycline taken 

within 72 hours of the bite has been shown to prevent Lyme disease. Doxycycline is also 

the first-line treatment for many other tickborne bacterial diseases, and its use as a

prophylactic for each TBD is yet to be assessed. 

There is no current prevention for alpha-gal syndrome in those with prior episodes, 

other than avoidance of red meat for food-induced disease. 
15

NIH will support research on the prevention of TBDs that includes vaccines and other 

immune-based technologies as well as approaches that reduce transmission of 

tickborne pathogens in the wild.

Objective 3.1: Support the discovery, design, development, and evaluation of safe and 

effective vaccines and other preventive interventions

• Support research and development of vaccines to prevent TBDs. Safe 

and effective vaccines for some TBDs have been developed in the past, and 

those approaches could be revisited in moving 

toward next-generation vaccines. Furthermore, 

multiple vaccine strategies—attenuated, nucleic 

acid, and peptide—have been pursued for other

pathogens and may be applied to TBDs. In 

addition to pathogen-targeted approaches, 

vaccines that target tick salivary components or 

other tick proteins introduced during feeding 

could be developed as antigens for “anti-tick” 

vaccines. NIH will continue to support antigen 

discovery and vaccine development for TBDs.

• Support research on adjuvants to improve TBD vaccine efficacy. The 

effectiveness of many vaccines is enhanced by the presence of adjuvants that 

stimulate host immune responses or direct the response towards certain 

immune cell types or pathways. Adjuvants vary depending on the pathogen

and vaccine. NIH will support research to identify safe and effective 

adjuvants for TBD vaccines.

• Support research on post-exposure prophylaxis. For Lyme disease, a 

course of common antibiotics can prevent illness if given shortly after 

infection. NIH will continue to support research on prophylactic use of 

antimicrobials or other post-exposure approaches to prevent TBD infections 

or reduce the severity of disease. 

Objective 3.2: Develop or improve approaches to interrupt pathogen acquisition, 

transmission, or survival in ticks and reservoir species

• Discover and advance biological approaches to reduce transmission. A 

tickborne pathogen depends on its tick vector for survival, providing a target

outside of the human body for prevention efforts. Paratransgenic 

approaches, which involve modifying other microbes that coinfect vectors, 

have been used for some insect vectors and may be effective in blocking 

pathogen transmission to humans or among tick developmental stages. 

Transgenic approaches, which have been studied most extensively in 

mosquitoes, provide another approach to reduce transmission. NIH will 

continue to support research on strategies that reduce the capacity of ticks to 

acquire, support, or transmit infectious pathogens to humans.

Figure 7. Syringe and vaccine vial. 

Image credit: NIAID
16

• Investigate reservoir-targeted vaccines. Not all tickborne pathogens are 

transmitted from a female to her eggs. In some cases, ticks acquire the 

pathogen through feeding on reservoir animals such as mammals or birds. 

The central role played by those reservoirs in maintaining pathogen 

transmission cycles makes them a promising target for intervention. Oral 

vaccines inserted into baits, may prevent mice from carrying a pathogen, 

thereby reducing the numbers of ticks carrying the microbe as well. NIH will 

support research on novel approaches to interrupting the tickborne 

pathogen life cycle in the animal reservoir.

Objective 3.3: Vector control

• Support biological strategies to reduce tick populations. Tick control 

approaches are an important tool for preventing and controlling tickborne 

diseases. Novel biological interventions, such as the transgenic and 

paratransgenic approaches described above, can be used for vector control.

NIH will continue to support research aimed at reducing vector populations 

as a means of reducing TBDs in people.

Strategic Priority 4: Support Research to Advance the Treatment of TBDs 

For infectious diseases, effective treatment varies depending on the pathogen involved, 

and additional therapeutic strategies may be needed to manage post-infectious 

symptoms. 

Furthermore, treatment regimens for many TBDs have not been optimized for all 

patient populations. While bacterial TBDs can typically be treated with standard 

antibiotic therapies, drugs that specifically target viral TBDs have not yet been 

developed. Lyme disease, which usually resolves following a course of antibiotics, has 

been associated with continuing symptoms in some individuals. In addition, there are 

currently no known effective treatments for encephalitis caused by tick borne 

pathogens. 

No ideal drugs exist for treating alpha-gal syndromes, including red meat allergy. 

Avoidance of foods that cause a reaction is currently the best strategy for disease 

management. However, as the triggering allergen is also found in non-dietary sources, 

including some medications, effective therapies beyond dietary restriction are needed 

for controlling alpha-gal allergic reactions. Developing effective treatment options will 

require therapeutic expertise different from that needed for antimicrobial 

development.
17

Objective 4.1: Develop and evaluate new and improved therapeutic regimens for TBDs 

• Identify and characterize new molecular targets for therapeutics.

Current antimicrobial drugs generally target a limited set of biochemical 

processes in pathogens. The need for new 

drug targets for most infectious diseases is 

widely accepted, including tickborne 

pathogens, most of which have limited 

therapeutic options. NIH will support 

research to identify drug targets for TBDs and 

develop them into therapeutic interventions 

for tickborne infections.

• Develop antivirals for tickborne viruses. 

No antiviral drugs are currently approved for 

treating domestic tickborne viruses, and 

treatment options for most non-domestic 

tickborne viruses are limited. NIH will 

support research toward the development of new antivirals, as well as 

testing the effectiveness of existing antivirals against related tickborne 

viruses.

• Assess safety and efficacy of new therapies for TBDs. Moving potential 

new therapies from their discovery in the laboratory to their use in the clinic 

requires extensive studies of dosing, efficacy, and safety. NIH will utilize its 

resources to advance promising new treatments through the pipeline, with 

the goal of hastening product development and acceptance.

• Identify safe and effective complementary and integrative health 

therapies for TBDs. Currently, the efficacy of complementary approaches 

for TBDs have not been supported by scientific evidence, and in some cases 

the treatments (e.g., peroxide, bismuth therapy) are potentially unsafe. NIH 

aims to stimulate new research on the safety and usefulness of 

complementary and integrative health approaches for TBD and post-TBD 

symptom treatment strategies, and support research to develop a 

mechanism- and evidenced-based approach to TBD care.

Objective 4.2: Advance research on treatment for extended symptoms and postinfectious sequelae

• Assess treatment strategies for extended or long-term symptoms 

attributed to TBDs. For some TBDs, patients report long-term symptoms 

following treatment or in the absence of prompt treatment. Reported 

illnesses often include musculoskeletal, rheumatological, cardiovascular, 

neurological, and neuropsychiatric symptoms, among others. For TBDs, 

optimal treatment of these symptoms may involve antibiotic and/or other 

treatment regimens. NIH will support research on the mechanisms leading to 

Figure 8. Bottle of doxycycline capsules. 

Oral antibiotics, such as doxycycline, are 

often prescribed after exposure to 

tickborne Lyme disease. Image credit: 

NIAID.
18

these symptoms and on treatments to improve outcomes for long-term 

sequelae of tickborne infections.

Strategic Priority 5: Develop Tools and Resources to Advance TBD Research 

Enhanced access to reagents, pathogens, vectors, data, and analytical tools can 

accelerate research progress for TBDs. Many resources for studying TBDs are difficult 

to maintain through investigator grants due to the limited time restrictions of such 

grants. In some cases, centralized repositories or research resources will be important 

components of the NIH research support effort.

Objective 5.1: Support sample and reagent repositories to enable fundamental research 

and product development

• Facilitate access to biological samples to assist research on TBDs. Wellcharacterized biological samples and reagents are critical to the effective 

conduct of research on TBDs. Consistent samples are required for 

development of new diagnostic tests, as well as for early validation of new 

treatments or vaccines. NIH will support pathogen and clinical sample 

repositories as well as reagent repositories to ensure that these resources

are readily available to researchers. 

Objective 5.2: Support genomics resources

• Support access to and generation/analysis of TBD genetic data.

Understanding the biology of tickborne pathogens and their reservoirs is 

enhanced by the availability of genomic information. This information can be 

used to provide a comprehensive understanding of the genes and proteins 

critical in maintaining tick-pathogen-reservoir-host life cycle interactions.

NIH will continue to directly support DNA sequencing and functional 

genomics efforts, in addition to providing access to bioinformatics resources.

Objective 5.3. Incentivize product development through preclinical services

• Support pre-clinical development of promising products. Developing 

new drugs, vaccines, and diagnostic tests is a time-consuming and expensive 

endeavor. Resources to provide support for different steps along the product 

development pathway can be valuable in ensuring that promising products 

continue to move forward. NIH will utilize NIAID preclinical services and 

animal models contracts to offer critical screening and testing services 

needed for identifying and developing new products for the prevention, 

diagnosis, and treatment of TBDs without additional cost. 

Conclusion 

The increase in TBD incidence in the United States represents a growing public 

health threat as new pathogens emerge and the geographic distributions of tick 

vectors expand. This calls for a renewed strategic approach to TBD research and 

control that will improve our understanding of tickborne pathogens, ticks, reservoir 
19

animals, and humans—and the interactions among them. The resulting information 

will be used to develop new or improved tools for disease prevention, diagnosis, and 

treatment.

A comprehensive strategy will require a coordinated effort among governmental, 

nongovernmental, and community-based organizations. The NIH Strategic Plan for 

Tickborne Disease Research defines the areas of TBD research within the NIH 

mission and outlines the agency’s research priorities and goals. This strategic plan

builds on other national efforts, such as the HHS Tick-Borne Disease Working Group

and A National Strategy for Vector-borne Disease Prevention and Control in the 

United States, currently being developed by the CDC. 

Collectively, these reports and working groups highlight a commitment from 

multiple government agencies to improve coordination of TBD research and 

discovery efforts, disease and vector surveillance, and public and medical provider 

education. NIH reaffirms its commitment to conduct research to improve knowledge 

of these diseases and develop new tools for their prevention, diagnosis, and 

treatment. NIH aims to address these needs through a comprehensive scientific 

agenda that will strengthen TBD research.

 
20

Appendices 

Appendix 1. Developing the Strategic Plan 

Introduction

In response to the growing public health threat that tickborne diseases (TBDs)

represent in the United States, and in accordance with recommendations from the

United States Department of Health and Human Services (HHS)–supported

Tickborne Disease Working Group (established in 2016 as part of the 21st Century 

Cures Act), NIH convened a trans-NIH strategic planning team with subject matter 

and policy experts from five NIH institutes and the NIH Office of the Director (see 

Appendix 2) to develop a strategic framework to advance TBD research for the next 

5 years and beyond. The framework outlined five areas of opportunity in TBD

research, including improving fundamental knowledge, diagnosis, prevention, 

treatment, and research tools and resources.

Using a Request for Information (RFI) (NOT-OD-19-077; see Appendix 1), NIH 

sought input from stakeholders in the scientific research community, industry, and 

the general public regarding the proposed framework. Comments were submitted 

through a web-based form from February 13 to March 13, 2019, on, but not limited 

to, the following three focus areas: 

• Significant research gaps and/or barriers not identified in the framework

• Resources required or lacking that may be critical to advancing the areas of 

research opportunity

• Emerging scientific advances or techniques in basic research, diagnostics, 

prevention, therapeutics, or resources that may accelerate NIH research 

priorities detailed in the framework

NIH staff categorized the responses into cross-cutting themes when possible or 

otherwise summarized the responses by each of the areas identified in the bulleted 

points above.

Characteristics of Respondents

NIH received 92 responses to the RFI. The majority of responses were from 

members of the public (36) and members of academic institutions (33). Other 

respondents included individuals from advocacy organizations (8), private 

healthcare practice (6), government (3), and industry (2). One response each was 

received from a professional society, a private foundation, and a public online Lyme 

disease support group. One response did not include any identifiable information 

and could not be classified.

Cross-Cutting Themes

Several themes emerged from comments submitted on the topic areas identified in 

the RFI. Overall, the submissions were positive and supportive of the framework. 

More than 30 respondents agreed that detection and diagnosis of TBDs is a key 
21

strategic priority. Specifically, respondents were supportive of research for direct 

detection of tickborne pathogens and multipathogen platform testing. Other 

responses highlighted the need for diagnostics to determine treatment success or 

eradication of the pathogen, differentiation among different stages or 

manifestations of Lyme disease, biomarkers to detect the likelihood of disease 

persistence, and detection of emerging tickborne pathogens.

Consistent with topics included in the strategic framework, 18 respondents were 

strongly in favor of advancing therapeutic discovery, with objectives varying from 

treating persistent Lyme disease and associated sequelae to identifying therapeutic 

alternatives to antibiotics for Lyme disease (e.g., biologics, immunotherapies, and 

natural and nonpharmaceutical interventions). Two respondents also drew 

attention to the paucity of viral TBD treatments (e.g., viral replication inhibitors). 

Two other treatment-related topics mentioned included the need to understand 

treatment failure and to determine appropriate means for treating TBD coinfections. 

Finally, several respondents mentioned the need to conduct therapeutic clinical 

trials in Lyme disease patients whose symptoms persist after antibiotic treatment or 

in Lyme disease patients who are not diagnosed/treated during the acute phase of 

the disease.

Fifteen respondents called for research emphasizing persistent TBD, with a primary 

focus on improving diagnosis and treatment of persistent Lyme disease. Other major 

themes regarding persistent TBD were understanding disease pathogenesis and 

factors that contribute to or may predict post-treatment Lyme disease syndrome. 

Respondents also requested research on disease pathogenesis in people who are 

infected with Lyme disease for greater than 6 months without receiving treatment 

and research investigating bacterial persistence in disease reservoirs.

 

Respondents also highlighted several perceived organizational barriers to 

advancing TBD research, including inadequate funding for TBD research (10 

responses) and the lack of dedicated study sections or inclusion of multidisciplinary 

reviewers for TBD research grant applications (4 responses). Other barriers 

mentioned in the responses included a lack of collaboration among NIH institutes 

and centers and across government agencies (1 response) and inconsistencies in 

surveillance and diagnostic testing criteria among states and healthcare systems (2 

responses).

Significant Research Gaps and/or Barriers Not Specifically Identified in the RFI 

Although many respondents approved of the proposed research foci, several people 

identified gaps and barriers that were absent from or not emphasized in the 

framework. Specifically, comments focused on increasing the understanding of 

vector ecology (11 responses), the pathogenesis and treatment of TBD coinfections 

(11 responses), and transmission dynamics (5 responses). Respondents cited the 

need for tickborne virus ecological field studies to determine how native and nonnative tick species become invasive and share hosts/pathogens; the impact 
22

environmental change and entomopathogens have on tick abundance and TBD

emergence, spread, and persistence; and how anthropogenic disturbances influence 

these factors. Nine respondents also noted the need for research on vector control 

strategies, including gene drives, and non-pesticide alternatives.

Other comments focused on determining and exploiting vulnerabilities in the hostpathogen-vector life cycle, including targeted genetic analyses that may identify coadaptations and regulation of transmission. Additional comments cited the need for 

studies to determine the impact of the tick microbiome and innate immunity on 

vector-pathogen interactions. Respondents also requested or proposed strategies to 

determine the best treatment course for TBD coinfections and the impact of 

concurrent TBDs on vector dynamics and disease presentation, severity, and 

recovery potential. The need for computational models of ecological systems and 

aspects of TBD pathogenesis and immune dynamics also featured in several 

responses.

Widening the focus to broader U.S. government TBD activities coordinated by the

CDC, nine respondents pointed out the need for more comprehensive surveillance 

efforts nationwide.

Seven respondents recognized a lack of studies on TBD immune dynamics, 

particularly for mechanisms that TBDs use to subvert or evade the immune system. 

Three respondents thought molecular signaling pathways, including G protein–

coupled receptors, warranted study to help identify therapeutic targets and 

understand disease pathogenesis.

Requests for research to understand and treat Lyme disease sequelae featured in 

nine responses, including neuropsychiatric sequelae (e.g., depression, anxiety, and 

mania), Lyme-induced encephalitis, Lyme arthritis, and Lyme neuroborreliosis. 

Resources Required that May be Critical to Advancing the Areas of TBD Research

Respondents identified several resources that are key to progress in TBD 

biomedical research. Seven suggestions focused on creating new avenues to 

promote multidisciplinary TBD research, including a collaborative research 

network, workshops or forums to encourage interaction among TBD investigators, 

and early investigator awards to draw new talent into the TBD research field.

Seventeen respondents indicated a lack of resources for conducting “big data” 

analyses, including databases for fully annotated tick and bacterial genomes, 

curated microbial databases for tick gut microbiome analysis, a database of human 

genetic analyses pre- and post-Lyme disease treatment, comparative genomic 

analysis resources, and data-sharing platforms. Respondents suggested building 

new genetic and bioinformatic tools as well as computational models to aid in 

studies of TBD disease pathogenesis, epigenetics, population genetics, and 

development of assays and reagents.
23

Six respondents cited a need for models and supporting tools to conduct TBD 

research. Specifically, submissions requested genetic knockout tick models for 

functional genomic studies. Other responses noted the need for in vitro models for 

therapeutic target screening and animal models for viral TBDs and coinfection 

studies. Others requested models that accurately reflect human disease. One 

respondent noted a need for a system for membrane feeding of ticks to reduce 

dependence on live animals.

Another need identified by several submissions (nine responses) was repositories 

to support TBD research. Most prominently, submissions indicated a need for a free

or low-cost U.S. resource center for TBD strains (e.g., emerging tick species and

infected and uninfected ticks) to aid TBD research. Other responses focused on the 

need for clinically well-defined patient samples for basic research studies and 

validation of assays/biomarkers (e.g., skin biopsies, serum, and cerebrospinal fluid).

Lastly, four respondents noted the need for reagents to support TBD research, 

including antibodies and molecular tools for imaging studies and reagents that can 

be used in multiplex assays.

Emerging Scientific Advances or Techniques in Basic Research, Diagnosis, Prevention, 

Therapeutics, or Resources That May Accelerate NIH Research Priorities

NIH provided an opportunity to RFI respondents to identify any new developments 

in the areas of basic, diagnostic, therapeutic, or vaccine research that would 

accelerate TBD research priorities. Respondents suggested incorporating several 

technological advances into various aspects of the strategic plan. One respondent 

suggested using 3D printing to generate human skin and organoid models to study 

localized immune and microbiome milieus. Another submission suggested 

leveraging machine learning into computational models of TBD. A few respondents 

also cited the potential benefits of using advanced imaging techniques and singlecell analyses to gain more comprehensive insights into disease pathogenesis and 

immune dynamics. Gene-editing tools featured in three responses, indicating this 

may be a beneficial avenue for developing vector control strategies and genetically 

modified tick models for functional genomic studies. Finally, one respondent 

suggested that next-generation sequencing of nucleic acids, metagenomic analysis, 

protein-peptide affinity capture, and tandem mass spectrometry could be used to 

guide the development of new diagnostics.

Other Comments

Some respondents expressed a desire for greater transparency in the research 

planning and implementation processes, whereas others suggested changes to the 

peer review process to include wider representation from the TBD community, such 

as advocacy group representatives, community physicians, or members of the 

general public. 
24

Provider and public education about TBD prevention, diagnosis, and treatment 

featured in 14 RFI responses. Respondents requested public education materials on 

preventing tick bites as well as training for medical professionals in the proper 

diagnosis and treatment of Lyme disease. 

Conclusion

NIH solicited feedback using an RFI (NOT-OD-19-077) on a draft strategic 

framework to advance TBD research and development for the next 5 years and 

beyond. The responses were submitted by a wide array of stakeholders, including 

scientists, patient advocacy groups, industry, and members of the general public. 

Many of the remarks included strong support for efforts to identify the knowledge 

and tools needed to advance TBD research, diagnosis, prevention, and treatment. 

They also provided numerous suggestions and commentary that informed the 

development of and reinforced the TBD research priorities detailed in the strategic 

framework. The NIH Tickborne Diseases Strategic Planning Team carefully 

considered the suggestions and incorporated them, where appropriate, in the NIH 

Strategic Plan for Tickborne Disease Research. 

 
25

Appendix 2. NIH Tickborne Diseases Strategic Planning Team 

First Name Last Name Institute

Yisong Wang NCCIH1 

Lillian Abbey NIAID2 

Nick Bushar NIAID

Thomas Calder NIAID

Adriana Costero-Saint Denis NIAID

Maliha Ilias NIAID

Wolfgang Leitner NIAID

Adriana Marques NIAID

Sarah Miers NIAID

Samuel Perdue NIAID

Johanna Schneider NIAID

Meredith Shaffer NIAID

Cindy Caughman NIAMS3 

Van Nguyen NIAMS

Reaya Reuss NIAMS

Rosanna Ng NIH OD4 

Sarah Rhodes NIH OD

Ajay Vatave NIH OD

Marina Volkov NIH OD

Elizabeth Walsh NIH OD

Phyllis Ampofo NIMH5 

Mindy Chai NIMH

Meredith Fox NIMH

Rachel Scheinert NIMH

Paul Scott NINDS6 

Christine Torborg NINDS

May Wong NINDS

Table Legend

1 National Center for Complementary and Integrative Health

2 National Institute of Allergy and Infectious Diseases 

3 National Institute of Arthritis and Musculoskeletal and Skin Diseases 4 National Institutes of Health, Office of the Director 

5 National Institute of Mental Health 

6 National Institute of Neurological Disorders and Stroke