Causes for under-detection of Lyme disease in Canada

The authors estimate that the number of Lyme disease cases in Canada that go undetected is greater than the 10-fold difference in the U.S.

For example, “Calculation of expected human Lyme disease cases based on tick and canine infections in New Brunswick indicates a minimum of 12.1 to 58.2-fold underestimation (1.7% to 8.3% cases detected).”

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The discrepancy, they say, is due to several reasons:

• Non-reporting of clinically diagnosed acute Lyme disease;

• Failure by both patients and healthcare providers to identify acute Lyme disease;

• Failure to consider Lyme disease as a differential diagnosis in disseminated stages and hence initiate serological testing;

• Insensitivity of the two-tiered serological testing algorithm to accurately capture infections.

The authors suggest that “for every person with a reported case of Lyme disease, there are approximately 30 other people with Lyme disease excluded by serological insensitivity.”

In 2016, there were 992 cases of Lyme disease reported in Canada, but the true number should range between 8,432 and 56,147, the authors write.

“Under-estimation of the problem likely results in inadequate allocation of health care and research resources,” they say.

“But most importantly, significant health, social and economic costs from impaired health, quality of life, ability to function and to contribute to society, and the attendant personal suffering for those who truly have Lyme disease.”

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