Lyme Disease in Canada

Compared to the standard two-tier testing algorithm (STTT) for Lyme disease serology using an enzyme immunoassay (EIA) followed by Western blot, data from the United States (US) suggests that a modified two-tiered testing (MTTT) algorithm employing two EIAs has improved sensitivity to detect early localized Borrelia burgdorferi infections, without compromising specificity. From 2011-2014, in the Canadian province of Nova Scotia where Lyme disease is hyperendemic, sera submitted for Lyme disease testing was subjected to a whole cell EIA, followed by C6 EIA and subsequently IgM and/or IgG immunoblots on sera with EIA positive or equivocal results. Here we evaluate the effectiveness of the MTTT algorithm compared to the STTT approach in a Nova Scotian population.