DHA Public Health Launches MilTICK SURE Path: Surveillance for Understudied, Rare Emerging Pathogens

The Military Tick Identification/Infection Confirmation Kit program has expanded, and the Defense Health Agency-Public Health vector-borne disease team is now conducting additional off-season screening of ticks submitted through the MilTICK program.

The MilTICK program, which serves all military branches, tests human-biting ticks submitted by Department of Defense beneficiaries.

“The results of the MilTICK tick identification and testing are reported out to the submitter in an official report, and the ticks may also be retained for additional testing and surveillance for emerging tick-borne pathogens,” said Robyn Nadolny, chief, DHA-PH VBD branch. “Ticks submitted to MilTICK are tested for commonly occurring pathogens within a 30-day turnaround time, usually much quicker. This enables the person bitten by the tick to seek medical advice in a timely manner if the tick is found positive for a human pathogen.”

SURE Path Expands Testing for Rare and Emerging Pathogens
The new Surveillance for Understudied, Rare, and Emerging Pathogens, or SURE Path, program began in December 2023, said Nadolny.

“MilTICK SURE Path utilizes MilTICK specimens already submitted, and subjects them to additional testing for rare pathogens at the end of each calendar year,” said Nadolny. “The SURE Path program allows the VBD team to better understand emerging tick-borne threats to military communities, and notify installations and individuals if rare pathogens are discovered.”

Rare pathogens are disease-causing organisms found in ticks with fewer than 200 human cases in the U.S. each year as reported by the Centers for Disease Control and Prevention, said Nadolny. The MilTICK program does not routinely test for these agents in order to expedite turnaround time for pathogens more likely to cause human disease and have a higher medical relevance, like the agents of Lyme disease or ehrlichiosis.

The MilTICK SURE Path testing process begins at the end of each calendar year, after the bulk of MilTICK screening is completed during the summer months, said Nadolny. This end-of-season testing is typically completed from November to March. Samples are tested for rare and emerging pathogens, such as Powassan virus, the agent of tularemia, novel spotted fever group Rickettsia, and others. This testing is conducted during the off season as to not slow down seasonal testing for more common agents of human disease.

“If a MilTICK SURE Path tick tests positive for a rare pathogen, the infection status of the sample will be double-confirmed through an additional test in order to verify the positive result,” said Nadolny. “The VBD team may collaborate with other federal laboratories to confirm the positive with sensitive and specific molecular tests. Once a positive is confirmed, notifications will be distributed to the point of contact listed on the MilTICK form originally submitted with the tick, and to the leaders at the submitting clinic and the installation (if applicable) as soon as possible.”
Notifications will describe the potential disease-related threat, the MilTICK SURE Path process, and suggestions on how to proceed, said Nadolny.
Benefits of SURE Path Screening

The identification of the rare pathogen provides the health care team with critical information to be shared with the individual that submitted the tick to begin a dialogue on symptoms and potential care, said Nadolny. Additionally, clinic and installation leadership are afforded an opportunity to better understand emerging tick-borne disease risks at their installation and promote timely actions that could mitigate the potential threat.

Nadolny explained some likely actions and benefits of a confirmed MilTICK SURE Path pathogen. There are a number of possible actions the clinic, command, and the MilTICK staff can take:
• Clinic leaders can raise awareness with clinic staff to be on the alert for symptoms associated with rare tick-borne diseases.
• Installation leaders can work with public health or entomology personnel to conduct additional tick surveillance to better identify local “hotspots” where ticks are infected.
• The MilTICK program can use these results to implement additional “spot testing” of ticks from installations where rare threats may be emerging.
• MilTICK staff can work with state public health officials and inform them of positive results.

Resources
• MilTICK Website
• MilTICK Data dashboard (CAC-enabled)
• MilTICK Mailbox

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