• There is greater strain diversity in Canada than was previously recognized (Ogden et al 2011).
• Clinician vigilance for human cases is required throughout Canada (Ogden et al 2009).
• The Public Health Agency of Canada considers the risk of Lyme disease in Canada to be low but increasing (Ogden et al 2009).
• Serology, especially in the early stage of the disease is unlikely to be informative (Aguero-Rosenfeld et al 2005). Immune evasion by antigenic shifting has been demonstrated in Lyme disease (i.e. Bankhead and Chaconas 2007, Coutte et al 2009, Rupprecht et al 2008).
• Treatment for a suspected Borrelial erythema migrans rash is at the discretion of the clinician (CPHLN 2007).
• Early treatment is essential for optimal outcomes (i.e. IDSA guidelines, ILADS guidelines, Deutsche-Borreliose Gesellschaft guidelines).
• National reporting of Lyme disease in Canada began in 2010. However, experience in the United States is that most American cases are in States that share a border with Canadian provinces.
• There is a relatively higher risk of exposure in Nova Scotia, New Brunswick, Ontario, Quebec and Manitoba. Migratory birds spread ticks throughout Canada (i.e. Scott et al 2001, Morshed et al 2005, Scott et al 2008, Scott et al 2010, Brinkerhoff et al 2011), consequently there is a risk of contracting Lyme disease in all Canadian provinces. Precise areas of risk vary from region to region and year to year because distribution of ticks is unpredictable.
• Dogs show serological response throughout Canada (Villeneuve et al 2011) Coinfections make presentation and treatment of Lyme disease more complex (i.e. DosSantos and Kain 1998, Rawling et al 2009)