Is Lyme disease underreported in Canada?

As the expansion of the range of the tick vector Ixodes scapularis moves into Canada, more cases of Lyme disease are being reported. The Canadian government began a national surveillance for human Lyme disease cases in 2009. According to the data, there was an increase of 144 cases in 2009 to more than two thousand cases in 2017.

Extensive surveillance for tick vectors has taken place in Canada providing a clear picture of the risk. The reported incidence of Lyme disease in Canada is consistent with this pattern of environmental risk, and the differences in Lyme disease incidence between US states and neighbouring Canadian provinces are consistent with geographic differences in environmental risk. Data on serological responses in dogs from Canada and the US are consistent with known differences in environmental risk, and in numbers of reported Lyme disease cases, between the US and Canada.

This study suggests that there is a high level of consistency in data from human case and tick surveillance, and data on serological responses in dogs which means that under-reporting of Lyme disease in Canada is not likely.

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What is the real number of Lyme disease cases in Canada?