Low Awareness of Lyme Disease in Canada, Survey Finds

Awareness of Lyme disease in Canada remains surprisingly low, even among people who spend large amounts of time outdoors.

Researchers surveyed 137 participants from 11 professional and recreational organizations across New Brunswick between December 2018 and February 2019 to better understand knowledge of Lyme disease in Canada and the protective behaviors people use to avoid tick bites.

Thirty-six percent of participants spent time outdoors for their occupation, while 64% spent time outdoors primarily for recreational activities.

Only one participant reported having previously been diagnosed with Lyme disease in Canada, while 14 were unsure whether they had ever been infected.

“Of these participants, two reported that their symptoms began six or more years prior to the completion of the survey and one participant indicated that they were still suffering at the time of the study,” the authors write.¹

Survey participants were also asked how frequently they used protective behaviors to prevent tick bites. One question asked, “How often do you wear long pants to avoid ticks infected with Lyme disease?”

Outdoor activities and tick exposure in Canada

Among recreational participants, hiking (66%) was the most common outdoor activity, while golfing (12%) was the least common. Other activities included sport fishing, home gardening, sport hunting, dog ownership, and recreational paddling.

Participants who worked outdoors included individuals who owned small wood lots, farmers, tree planters, forestry professionals, and a dog trainer. Owning a wood lot (63%) was the most common activity, while dog training (2.1%) was the least common.

These findings highlight how frequently individuals in rural regions may be exposed to ticks that carry Lyme disease.

Comfort often determines tick prevention behaviors

The only two safety behaviors that occurred more than “sometimes” involved wearing long pants and protective footwear. However, these behaviors appeared to be motivated more by comfort than by tick bite prevention.

The authors noted that “protective behaviors are only frequently adopted if they protect the individual from immediate discomfort, such as long pants protecting one’s legs from scratches and protective footwear preventing foot and ankle injuries.”

Participants were less likely to adopt other recommended protective measures, including:

tucking pants into socks
spraying insecticide in the environment
avoiding sitting on grass
avoiding walking in long grass

Low knowledge about Lyme disease in Canada

“Overall, the entire sample reported a low level of knowledge about Lyme disease,” write St. Pierre and colleagues in their article entitled “Knowledge and Knowledge Needs about Lyme Disease among Occupational and Recreational Users of the Outdoors.”¹

“Our findings call attention to a desire for further information about all aspects of tick exposure and Lyme disease among individuals who spend time outdoors in New Brunswick,” the authors write.

The researchers also found that behaviors intended to prevent tick bites were performed relatively infrequently.

Questions raised by survey participants

Participants raised a number of questions that illustrate the need for better public education about Lyme disease in Canada and the distribution of infected ticks.

Comments included:

• “Knowing which areas are active with Lyme-infected ticks would be very helpful.”

• “Clear explanations about how to remove ticks and whether they should be brought to the doctor.”

• “What are the side effects of delayed or untreated Lyme disease?”

• “Is there a point where the effects of Lyme disease become permanent?”

• “Is Lyme disease life-threatening?”

• “How soon should someone seek medical attention if symptoms develop?”

• “Why is it easier to diagnose Lyme disease in animals than in humans?”

• “Have there been advances in diagnosis and treatment?”

• “Do patients still need to travel to the United States for testing or treatment?”

Why Lyme disease education remains important

These questions highlight a persistent knowledge gap about Lyme disease among people who spend time outdoors.

Improving awareness about tick exposure, early symptoms of Lyme disease, and proper tick bite prevention strategies may help reduce delays in diagnosis and treatment.

Editor’s note: The questions raised by individuals living in Canada mirror many of the questions I hear regularly from patients in my own clinical practice.