England & Wales
Lyme borreliosis is monitored in England and Wales through:

Passive surveillance. Cases of Lyme borreliosis are not statutorily notifiable by medical practitioners in England, Wales and Northern Ireland. However, since October 2010, under the Health Protection (Notification) Regulations 2010, every microbiology laboratory (including those in the private sector) in England is required to notify all laboratory diagnoses of Lyme borreliosis to the Zoonoses Surveillance Unit at the National Public Health Service (NPHS), Wales. Previously, reporting by laboratories was on a voluntary basis.

Enhanced surveillance. This was introduced in late 1996 as a means to collect additional clinical and epidemiological data and improve reporting levels. Since August 2000, a single reference laboratory has existed for England and Wales which provides specialised tests for Lyme borreliosis. These tests were previously provided by the Health Protection Agency (HPA) Lyme Borreliosis Unit (LBU) but are now provided by Public Health England’s Rare and Imported Pathogens Laboratory (RIPL). The RIPL reports all laboratory-confirmed cases directly to the Zoonoses Surveillance Unit at the National Public Health Service (NPHS), Wales.Between 1997 and 2003, the HPA LBU sent questionnaires to clinicians requesting additional data on laboratory-confirmed cases. The data collected helped to enhance knowledge of the disease in the United Kingdom.

Public Health England states that, “Reporting levels have improved, but the data remain incomplete because they do not include cases diagnosed and treated on the basis of clinical features such as erythema migrans (the early rash of Lyme borreliosis), without laboratory tests. It is estimated that between 1,000 and 2,000 additional cases of LB occur each year in England and Wales”.