Next steps for further investigation
Most submitters to the inquiry agreed that more research is needed to
both identify the cause of Lyme-like illness, and to improve diagnostic and
treatment options for sufferers.
This chapter examines current research projects underway to investigate tick-borne
illnesses in Australia, and opportunities for further research identified by
governments, medical authorities and patient advocacy groups. The committee
recognises that these issues are not unique to Australia, and further investigation
of overseas responses to Lyme-like illness is warranted.
Opportunities for research
The committee notes that the Australian Government, through the
Department of Health (department), has recently undertaken a number of projects
to address Lyme disease in Australia, including establishing the Clinical
Advisory Committee on Lyme Disease (CACLD).
The Chief Medical Officer, Professor Chris Baggoley, told the Community Affairs
Legislation Committee at 2015-16 Supplementary Estimates that the department is
'particularly concerned about the plight of people who suffer from a disease
which has been diagnosed as Lyme disease, because many of them have very
difficult and miserable lives'.
In 2013, the department commissioned a scoping study into Lyme disease
in Australia that identified 11 key research questions for further
investigation, and recommended the following major research programs:
an experimental program to determine whether there is a Borrelia
species in ticks in Australia causing Lyme-like disease, or whether another
tick-borne pathogen is involved in human Lyme-like disease;
whether Australian ticks can transmit B.burgdorferi, or
other Borrelia species associated with relapsing fever;
whether Australia has the best diagnostic tests for detecting
novel Borrelia species, including B. miyamotoi, especially in
clinical studies of patients presenting with symptoms suggestive
of Lyme or Lyme-like disease; and
retrospective investigation of chronic cases of Lyme
Of these programs, the scoping study highlighted that:
...the single most important issue to be addressed is whether Borrelia
strains exist in Australia which can cause Lyme disease, or whether other
pathogenic organisms are responsible...
On 27 May 2014, the department hosted the Lyme Disease Treatment Round
Table Meeting. Participants included members of the CACLD, general
practitioners and other medical professionals. The round table suggested the
following possible research activities, which were considered by the CACLD at
its final meeting on 15 July 2014:
a validation study on the methods currently used in Australian
laboratories and if possible relevant international laboratories to diagnose
an initial epidemiological study into patients presenting with
symptoms of Borrelia infection acquired in Australia;
an epidemiological study on returned travellers from endemic
research into the incidence of neuroborreliosis cases using CSF
[cerebrospinal fluids] samples already collected from aseptic meningitis
a clinical randomised control trial (blinded) on the treatment of
patients diagnosed with chronic Lyme disease; and
the development of a register of patients with chronic
neurological symptoms in partnership with neurologists and treating general
practitioners (GPs) to compare if treatment with antibiotics demonstrates any
improvement in patient outcomes.
Many submitters agreed that research into chronic debilitating symptoms
must be broader than seeking to identify Borellia bacteria as the symptoms
may reflect a number of interactions between multiple pathogens causing a
number of chronic illnesses. For example, the Communicable Diseases Network
Australia (CDNA) noted:
Given the constellation of symptoms it is likely that there
are multiple different diseases with different causes within the widely
inclusive term 'Lyme-like illness'. The search for a causative agent for
'Lyme-like illness' should not assume or be narrowed to 'a unique local
causative agent.' It is possible the causative agent(s) or clinical
determinants are multiple and may not be unique to Australia. As 'Lyme-like
illness' may not be caused by an infectious agent, investigation should not be
limited to infectious agents. It is likely that there are multiple underlying
causes for the constellations of symptoms experienced by these patients, many
of which are not infectious, such as hormonal, metabolic, neuromuscular and
The department agreed with this assessment in its submission:
...we can say with greater confidence that past and recent
research in Australian ticks makes finding a classical Lyme disease causing Borrelia
sp unlikely. However, the groundswell of interest from patients, their
families and some members of the medical profession in the hundreds of
Australians presenting with a constellation of chronic debilitating symptoms
associated with tick bites cannot be ignored and must be explored.
In addition to the research priorities identified by the department,
which focus on identifying the possible causative agent or agents for chronic
debilitating symptoms, patient advocacy groups support research into the
symptoms being experienced by patients. Ms Elaine Kelly, from Sarcoidosis Lyme
Australia, told the committee:
... epidemiological and clinical studies are required as a
matter of urgency to be inclusive of patients' symptomatology and general
pathology. Current research is focusing on the causative agents and the
disease, but an epidemiological study would focus on the patients and the
Following advice from the CACLD, the department sought public comment on
its 2013 scoping study. In addition to the five research programs recommended
by the scoping study, submitters to the department identified the following areas
epidemiological research of patients who have been diagnosed with
a Lyme-like illness, including geographical location, detailed symptoms and
comparisons with other countries that have detected a different causative
agent, such as Brazil (recent research into Baggio-Yoshinari Syndrome, a
Lyme-like illness in Brazil has identified that the disease is transmitted by
ticks, but the causative agent is not yet known);
treatment options or guidelines for Lyme disease or Lyme-like
patient focussed strategic approach to the 'Lyme problem' in
The committee notes the Lyme Disease Association of Australia's (LDAA)
2014 submission to the department's response to the scoping study included a
Patient‑focussed Action Plan. This action plan included four key
ensure patients can readily access affordable and reliable
diagnosis and 'best practice' laboratory testing by 2016;
ensure patients with Lyme‐like
illness are able to access appropriate and affordable treatment by 2016;
reduce the risk of an epidemic of late stage Lyme‐like illness by
ensuring the Australian public is aware of the potential risks of exposure to
possible transmission(s) and by improving access to early intervention
treatment protocols throughout Australia by 2016; and
ensure an end to discrimination by raising public awareness of
The LDAA expressed particular concern that the work done by the
department to date has been largely a 'bureaucratic process' and has not
directly assisted patients. Ms Sharon Whiteman, President of the LDAA, told the
In the past few years, the Australian government has done
several things to try and support the Lyme community, however, it has largely
been a bureaucratic process that has gone nowhere. It commenced with a clinical
advisory committee, which abandoned after five meetings with no tangible
progress. The advisory committee provided advice to the Chief Medical Officer,
who sought advice from the Communicable Diseases Network, who needed more
advice from the Joint Criteria Assessment Group, who provided even more advice.
That advice resulted in more advice for the chief medical officers in each of
the states and territories, who provided more advice to clinicians. Those are the frontline doctors who rely on contemporary and
evidence based advice. That advice currently states that Lyme disease is not in
Australia. At the core of all this advice stating that Lyme disease is not in
Australia is: 'because it cannot be found in an Australian tick'.
In its submission to this inquiry, the LDAA recommended a number of key research
a study of the prevalence and incidence of Lyme-like illness in
Australia, including a clinical study of patients; and
a progressive and contemporary approach to research that
harnesses next generation sequencing and new molecular techniques to better
understand the pathogens that reside in Australian ticks and how they can
Alternative methods of transmission
In particular, the LDAA recommended further research into alternative
methods of transmission of Lyme-like illness besides tick bites, including through
blood transfusions, in-utero or sexually transmitted. The LDAA highlighted that
10 per cent of respondents to its patient survey suggested that they did
not acquire their illness from a tick bite and suggested that these methods
warrant further research.
Some submitters expressed particular concern that Lyme disease may be
transmitted via blood transfusions. Ms Vicki White told the committee at its
hearing in Perth that she acquired her illness following a blood transfusion:
... I hope to say to the medical experts that were here this
morning but have not stayed to listen, 'Would you take a blood transfusion from
one of us?' I doubt they would. But that is exactly what happened to me. My
symptoms began after receiving blood transfusions.
Dr Hugh Derham, a 'Lyme literate' practitioner from Western Australia,
told the committee that there is some evidence to suggest transmission from
Lyme disease is possible from mother to foetus and between sexual partners, but
has not been demonstrated to be transmitted via blood transfusions:
The evidence is that Borrelia can be passed from
mother to foetus and between sexual partners. It has been shown that it
survives in blood transfusion products, but nobody has ever shown that it has
been given to somebody via blood transfusion.
Dr Donna Mak from the Western Australian Department of Health told the
committee that there was limited evidence to support alternative methods of
transmission of Lyme disease:
The scientific evidence so far shows that there is no
evidence of transmission from mother to child through the placenta, or through
blood transfusions. It is a tick-borne disease. We are aware that there are
many doctors who say that it can be acquired through these alternative ways,
but after looking at the scientific publications we do not actually believe
that that is the case. We cannot find any evidence to support that.
In its submission to the inquiry, the Red Cross Blood Service noted that
while evidence that Lyme disease can be transmitted by blood transfusions has
yet to be confirmed, it has a series of safeguards in place to minimise the
risk of protecting its blood supply from possible infectious agents:
While transfusion-transmitted Lyme disease or the
transfusion-transmission of a Lyme-like illness has not been confirmed to date,
the Blood Service remains vigilant in maintaining the safety of the blood
supply. In the absence of a specific licensed screening test for the causative
agent of Lyme disease and the absence of an identifiable causative agent in
Lyme-like illness, the strict donor questionnaire and selection guidelines that
the Blood Service has in place effectively minimises the risk from infectious
agents to as low as reasonably achievable.
Funding for research
A number of submitters and witnesses highlighted the need for increased
funding for the projects identified by the department and those advocated for
by patient support groups.
The LDAA, like many patient advocacy groups, expressed concern about the
current lack of specific funding for research into Lyme-like illness:
While we are fatigued by the political arguments of fiscal
constraints and lack of research funds, the reality is that no one is
listening, and no one is helping patients with Lyme-like illness. Continuing to
seek ideas on how these issues could be solved without any intention of
prioritising the funding required to solve them is reprehensible. Funding has
been prioritised for research into diseases with fewer incidences that are of
equivalent impact to Lyme-like illness.
The department noted in its submission that it is not a research funding
agency and that researchers could access funds from other means:
...the Department of Health is not a research funding agency.
The majority of Australian Government health and medical research funding is
administered by the National Health and Medical Research Council (NHMRC). The
Australian Research Council (ARC) has funded some Special Research Initiatives
in the health and medical areas however the ARC does not generally fund medical
research. Researchers may also seek other avenues for funding including the
higher education sector, business sector or the private non-profit sector.
Some patients expressed concern that the department was not being
proactive enough in supporting and encouraging research, and that patients who
are sick now need support. Ms Elaine Kelly told the committee:
The statement that the Department of Health is not a funding
body, which we continually hear, is a roadblock, an excuse. Lack of funding
translates into lack of recognition of urgency, lack of commitment to the many
Australians who are ill. Ticks did not go knocking on the door of the Department
of Health; patients did ... Let us be done with the official complacency. Patients
do not have the time to wait a decade until research on ticks and other vectors
is complete. It is time to remember the sick humans.
The committee heard that there are currently few research projects into
Lyme-like illness and other tick-borne illness funded by the Australian
Government. Professor Anne Kelso, Chief Executive Officer of the National
Health and Medical Research Council (NHMRC) told the committee that between
1997 and 2015 few projects into Lyme disease had been funded:
NHMRC received 13 applications investigating diseases related
to Lyme disease and one directly investigating Lyme disease. The one
application directly investigating Lyme disease was submitted in 1999 and was
not successful in winning funding. Of the 13 other applications, only one was
successful. This was a postgraduate scholarship for the period 1999 to 2001 for
work on a bacterium, Bartonella henselae, which is carried by ticks as
well as some other insects and is often observed in patients with Lyme disease.
But this project was not directly on Lyme disease.
Professor Kelso highlighted that the NHMRC has initiated a new process
for 'targeted calls for research' that could be utilised for funding research
into chronic debilitating symptoms:
We recognise the need to consider the priorities not only of
government but also of the wider community, so in addition to working with
Australian governments we will shortly offer a web portal through which
community and professional groups may submit topics for consideration for
targeted funding. These will be evaluated and prioritised by a committee made
up of consumers, health system and service experts, clinicians, Aboriginal and
Torres Strait Islander health experts and experienced researchers.
Recommendations of this committee will assist NHMRC in rolling out a series of
targeted calls for research to address significant government and community
health needs which are not already being supported through our other funding
Professor Kelso told the committee that the NHMRC would 'welcome
high-quality research proposals on Lyme-like illness to our
investigator-initiated research funding schemes'. Professor Kelso also noted
NHMRC would welcome applications that address the many
questions that currently surround Lyme-like illness in Australia, and shortly
we will also offer a mechanism by which community and professional groups can
assist NHMRC in identifying important under researched areas of unmet need. 
The committee heard that the 'Targeted Calls for Research' scheme
currently being developed would be open soon, and that the NHMRC is currently
establishing a committee made up of a broad range of people to consider and prioritise
the submissions put forward. Professor Kelso indicated that the NHMRC is also
investigating ways to 'bring in and leverage' extra funding for areas that are
not currently being adequately researched, such as Lyme disease:
From that point of view, Lyme disease fits that type of field
of something where it is under researched—there is clearly a gap, an unmet
need—and it might be a suitable priority area.
Current research projects
The committee heard that current research into tick-borne illnesses in
Australia focusses on identifying a possible causative agent. A number of
submitters and witnesses highlighted two major projects by Murdoch University
and the University of Sydney Tick Borne Diseases Unit. These projects are
The committee also heard that the following research into tick-borne
illnesses is currently being undertaken:
Marie Bashir Institute: metagenomic studies aiming to identify
and characterise a common microbial agent or agents in ticks and patients;
Professor Edward Holmes, University of Sydney: metagenomic
studies in human specimens and local tick populations, which have identified a
range of bacteria and a novel tick virus;
Professor Stephen Graves, Australian Rickettsial Reference
Laboratory: DNA analysis of 350 ticks from around Australia that has identified
the presence of Rickettsia and Coxiella bacteria.
Professor Peter Irwin, a veterinarian and expert in vector-borne
diseases, and Professor Una Ryan, a molecular biologist with expertise in
infectious pathogens, are currently collaborating on a research project at
Murdoch University into vector-borne infectious organisms. The project is
funded by the Australian Research Council (ARC) and industry partners Bayer
Australia and Bayer AG (Germany).
Professor Ryan told the committee that funding for this project is due to run
out at the end of 2016.
The Murdoch University team submitted that to date their research has
not provided 'evidence for the presence in Australia of any known tick-borne
pathogens (except Rickettsia)', including the causative agent for Lyme
disease, B. burgdorferi, but has confirmed that the 'Australian ticks we
have studied so far (I. holocyclus and A. triguttatum) are full
of different types of bacteria'.
Professor Ryan told the committee that the research into Australian
ticks has identified a number of micro-organisms, including two new species of Neoehrlichia,
and a novel Borrelia species in echidnas that is not related to the Borrelia
species that causes Lyme disease.
In their submission, the Murdoch University team submitted that discovery of new
organisms is only 'part of the story' and more research is needed into the
causal relationship between the organisms and disease, noting that if
relationships do exist they are 'likely to be multifactorial and complex'.
Professor Irwin told the House of Representatives Standing Committee on Health
that further study would be required into whether these organisms may cause disease:
I think we need to confirm this by more testing, and we would
need to find it in many more ticks, I think, before we could say that it is a
plausible cause of disease.
Professor Ryan told the committee that the 'next step' in this research
is to examine humans who have been bitten by ticks:
We continue to search for and describe the types and species
of bacteria, protozoa and viruses in Australian ticks as this is an essential
scientific foundation for the current debate. The next logical step for our
research is to screen the blood of and perform biopsies on Australian humans
who have been bitten by ticks in Australia and have presented with and without
Lyme-like illness. This will require careful epidemiological studies and case
selection in collaboration with medical infectious disease specialists, but
clearly further research is required.
In its submission, the department welcomed the research by the Murdoch
University team, noting that the discovery of new microorganisms, while
important, should not be overstated and requires further investigation:
The clinical significance of this finding is still to be
determined and should not be overstated. The department will remain engaged
with Professor Irwin to consider the implications of this research for human
health in Australia ... Prof. Baggoley [Chief Medical Officer] had an opportunity
to speak with Professor Irwin, who emphasised that it is not yet appropriate to
link the bacteria he found in the ticks to them causing disease in humans.
Nothing can be assumed without further research ... Determining whether these
newly discovered organisms cause disease in humans and animals, like closely
related bacteria do overseas, is of public health importance and requires
University of Sydney – Tick Borne
The committee heard that another key source of research into tick-borne
illnesses is being undertaken by the Tick Borne Diseases Unit at the University
of Sydney, funded by the Karl McManus Foundation.
The Tick Borne Diseases Unit does not receive any government funding and is
funded entirely through donations and fundraising by the Karl McManus
Foundation, the only charity in Australia funding research into tick-borne
diseases. The Karl McManus Foundation noted that research outcomes are 'delayed
due to lack of funding'.
Dr Mualla McManus, founder of the Karl McManus Foundation, told the
committee that part of their work includes hosting an annual tick-borne disease
conference. Dr McManus noted that the aim of these conferences is to bring all
the key parties in Australia and overseas together to discuss how to address
We want to hear everyone's opinion, and the only way a
problem can be resolved is if people talk to each other. If they do not talk
you will just continue going on in the same silence, and nothing will be
There is a common ground—everyone agrees that there is
something in our ticks that is making people ill in Australia ... Yet we do not
have the knowledge in the medical fraternity to address these people and treat
them. A lot of them get misdiagnosed, and that is not right.
The committee also heard that further investigation into international
responses to Lyme disease, tick-borne illnesses and chronic debilitating
symptoms is warranted.
International responses to Lyme
The committee notes that in countries where Lyme disease is considered
endemic, health authorities have taken significant steps to improve the public
awareness, diagnosis and treatment of Lyme disease.
In the United States (US), the US Centers for Disease Control and
Prevention (CDC) provides information and educational material on the diagnosis
and treatment of Lyme disease.
The National Institute of Allergy and Infectious Diseases supports research
into Lyme disease to identify more effective diagnosis and treatment options.
In Europe, the European Society of Clinical Microbiology and Infectious
Diseases Study Group for Lyme Borreliosis (ESGBOR) supports research into the
diagnosis and treatment of Lyme disease. Established in 2010, the ESGBOR aims
to 'review diagnostic and treatment guidelines for LB [Lyme borreliosis],
facilitate research, organise thematic meetings and maintain the website as an
information resource for health professionals'.
In Canada, the federal government has undertaken to develop a national
framework for addressing Lyme Disease. In December 2014, the Canadian
Parliament passed the Federal Framework on Lyme Disease Act (Bill C-442).
The committee notes that under the Act, within 12 months of commencement the
Minister of Health must convene a conference with provincial and territorial
ministers and stakeholders for the purposes of developing a comprehensive
federal framework that includes:
- the establishment of a national medical surveillance
program to use data collected by the Agency [Public Health Agency of Canada] to
properly track incidence rates and the associated economic costs of Lyme
- the establishment of guidelines regarding the prevention,
identification, treatment and management of Lyme disease, and the sharing of
best practices throughout Canada; and
- the creation and distribution of standard-ized [sic]
educational materials related to Lyme disease, for use by any public health
care provider within Canada, designed to increase national awareness about the
disease and enhance its prevention, identification, treatment and management.
Mr Stephen Le Page, from the ME/CFS and Lyme Association of WA Inc, told
the committee that some research bodies in Canada, such as the Nightingale
Research Foundation of Canada,
offer a different approach to assessing patients presenting with Lyme-like
A good model to follow is the Nightingale Research Foundation
of Canada, run by expert diagnostician and author, Dr Byron Hyde. He typically
spends between Can$5 000 and Can$8 000 thoroughly investigating each patient,
funded by the Canadian healthcare system. His advanced investigation and
testing methods reveal pathologies which would likely have gone undetected.
Once pathologies have been identified, many can be treated, and this is often
enough to bring patients back from the brink of disability, enabling them to
function again and to return to the workforce as contributing members of society
no longer needing financial support from the government but instead earning an
income and paying income tax. This has a far better outcome for the government,
with the Can$8 000 investment per patient seeming trivial. This also has a far
better outcome for the patient than leaving them in a state of chronic illness,
dependent on a pension in order to survive.
The committee heard that a new approach to addressing Lyme disease is
being implemented in Scotland, acknowledging that the causative agent in Scotland
may be different to the causative agent elsewhere.
Dr Margaret Hardy told the committee:
The Scottish Highlands have an incredible prevalence of Lyme
disease; something like 2 000 to 3 000 cases are diagnosed every year. It is
not what I will call the American Borrelia. It is not the American Lyme
disease. It is a different species. They realised that their testing was coming
back positive for Borrelia, so it was showing that there was something
there, but it was irregular. So they have gone back and done their own clinical
development. They have their own laboratory assays as well as their own
The committee also heard that a new approach to addressing tick-borne
illnesses has been taken in Brazil where a similar Lyme-like illness has been
identified, but the causative agent is yet to be identified.
To avoid the controversy about Lyme disease, Dr McManus told the committee that
authorities in Brazil refer to the illness as 'Baggio-Yoshinari syndrome', to
indicate a different causative agent.
In their submission, the LDAA suggested that the Australian Government consider
the approach taken by authorities in Brazil:
In Brazil they studied patients and found that
epidemiological, clinical and laboratorial features in the country were very
different from those exhibited by North American and Eurasian Lyme disease
patients. Like Australia, they were not able to consistently and reliably
isolate B.burgdorferi (the causative agent of classical Lyme disease);
their serology also showed little positivity to B.burgdorferi and
provided discordant results between labs – as is the case here. It is difficult
to understand why our government has not prioritised a journey to Brazil to see
how they approached a resolution to the identical problem we face.
The committee acknowledges the research currently being undertaken into
tick-borne illnesses, particularly by Professor Irwin and Professor Ryan at Murdoch
University, and the projects and conferences funded by the Karl McManus
Foundation. The committee acknowledges that determining the causative agent or
agents for chronic and debilitating symptoms is only part of the story and that
research is needed across a range of areas, including a clinical assessment of
The committee acknowledges the work done by the department through the
CACLD and the scoping study to identify areas for research. The committee supports
ongoing efforts by the Chief Medical Officer and department to engage with the
medical and patient communities in relation to this issue.
The committee is aware that funding for this area of research is limited
and dependent on researchers being successful in applying for a limited pool of
funds. The committee notes that the new NHMRC targeted research funding process
provides a possible option for securing funding into chronic debilitating
symptoms; however, the committee notes that this is reliant on successful
submissions from community and/or professional groups.
The committee notes that further inquiry is needed into other opportunities
for research funding and international approaches to addressing Lyme-like
illness in countries such as Canada, Scotland and Brazil.
The committee recognises that there are a large number of Australians
suffering chronic debilitating symptoms and illnesses.
The committee recognises that there is a significant debate about the
cause of these symptoms and recognises the need for further research across a
range of areas to better assist patients and their families.
The committee notes the challenges some patients have faced in accessing
affordable and appropriate medical treatment. The committee also notes the
treatment of patients by some medical practitioners and emphasises that all
patients deserve to be treated with dignity and respect when seeking medical
The committee notes that its inquiry to date has identified a range of
issues that warrant further investigation in the next parliament. The committee
recognises that the committee's inquiry is not yet complete, and further
investigation into a range of areas is required before the committee is in a
position to make any detailed recommendations, including:
the treatment of patients with chronic debilitating symptoms by
the medical profession;
the cost and efficacy of treatments for patients diagnosed with
discordant laboratory results for Lyme-like illness between
accredited laboratories in Australia and non-accredited Australian laboratories
and international laboratories;
opportunities for further research into Lyme-like illness and
other tick-borne illnesses; and
international comparisons of the public health response to Lyme-like
illness from other countries.
The committee recommends that the Community Affairs References Committee
continue its inquiry into this matter in the 45th Parliament.
The committee notes that Dr Gary Lum has indicated that the department
would be open to doing more to improve communication with the Australian
medical profession about classical Lyme disease and how to diagnose and treat
it appropriately in Australia.
The committee notes that patients, patient advocacy groups and medical
professionals support improving awareness and education among the public about
the prevention of tick bites and when to seek medical attention. The committee
also notes support for improving awareness and education among the medical profession
about diagnosis and treatment of known tick-borne illnesses in Australia to
better assist patients.
The committee notes the work done by the department to date and supports
improving education and awareness in Australia about how to prevent tick bites,
the treatment of classical Lyme disease acquired overseas, and the diagnosis of
known tick‑borne illnesses in Australia.
The committee recommends that the Department of Health further develop
education and awareness strategies for:
the public about the prevention of tick bites and seeking medical
the medical profession about how to diagnose and treat classical
Lyme disease acquired overseas and known tick-borne illnesses acquired in
The committee recognises the work undertaken by the Chief Medical
Officer to identify future research projects and engage with the medical and
patient communities about Lyme disease and Lyme-like illness. The committee
supports the Chief Medical Officer in continuing to engage with these
communities through mechanisms such as the Clinical Advisory Committee on Lyme
Disease (CACLD). The committee supports ongoing meetings facilitated by the
department, such as the CACLD, to continue to raise awareness about ongoing
research into Lyme disease and other tick-borne and vector-borne illnesses, as
well as diagnostic and treatment options for patients presenting with
tick-borne related illnesses.
The committee recommends that the Chief Medical Officer continue to
consult with the medical and patient communities through mechanisms such as the
Clinical Advisory Committee on Lyme Disease, and for the Department of Health
to continue to facilitate meetings with medical and patient representatives.
Senator Rachel Siewert
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