Seroprevalence of Borrelia burgdorferi sensu lato antibodies in English adult blood donors: A nationwide cross-sectional study, 2021-2022

Eilish Hart; John Tulloch; Daniel Bailey; Tim Brooks; Heli Harvala; Peter Simmonds; Roberto Vivancos; Neil French; Amanda Semper

doi:10.1016/j.ttbdis.2025.102439

Seroprevalence of Borrelia burgdorferi sensu lato antibodies in English adult blood donors: A nationwide cross-sectional study, 2021-2022

Ticks Tick Borne Dis. 2025 Jan 23;16(1):102439. doi: 10.1016/j.ttbdis.2025.102439. Online ahead of print.

Authors

Eilish Hart¹, John Tulloch², Daniel Bailey³, Tim Brooks⁴, Heli Harvala⁵, Peter Simmonds⁶, Roberto Vivancos⁷, Neil French⁸, Amanda Semper⁹

Affiliations

¹ National Institute for Health and Social Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Diagnostics & Pathogen Characterisation, UK Health Security Agency, Porton Down, UK. Electronic address: eilish24@liverpool.ac.uk.
² National Institute for Health and Social Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK. Electronic address: John.tulloch@liverpool.ac.uk.
³ Diagnostics & Pathogen Characterisation, UK Health Security Agency, Porton Down, UK; Diagnostic Evaluations & Innovations Group, UK Health Security Agency, Porton Down, UK; Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK. Electronic address: Daniel.bailey@ukhsa.gov.uk.
⁴ National Institute for Health and Social Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK; Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK. Electronic address: Tim.brooks@ukhsa.gov.uk.
⁵ Microbiology Services, NHS Blood and Transplant, Colindale, UK; Radcliffe Department of Medicine, University of Oxford, Oxford, UK. Electronic address: Heli.harvala@nhsbt.nhs.uk.
⁶ National Institute for Health and Social Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK. Electronic address: Peter.simmonds@ndm.ox.ac.uk.
⁷ National Institute for Health and Social Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK; Health Protection Operations, UK Health Security Agency, Liverpool, UK; National Institute for Health and Social Care Research Health Protection Research Unit in Gastrointestinal Infections, UK; Warwick Medical School, University of Warwick, Coventry, UK. Electronic address: Roberto.vivancos@ukhsa.gov.uk.
⁸ National Institute for Health and Social Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK. Electronic address: french@liverpool.ac.uk.
⁹ National Institute for Health and Social Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK; Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, UK. Electronic address: Amanda.semper@ukhsa.gov.uk.

PMID: 39855077
DOI: 10.1016/j.ttbdis.2025.102439

Abstract

Background: Estimates of Lyme disease incidence in England are based on reporting of cases with a laboratory-confirmed diagnosis only, underestimating total cases. In 2017 - 2018, two independent reviews commissioned by the UK Government highlighted the lack of official data on Lyme disease prevalence and incidence as a critical knowledge gap.

Aim: To estimate the prevalence of IgG antibodies in the English adult population specific for Borrelia burgdorferi sensu lato (Bbsl), the causative agent of Lyme disease.

Methods: The prevalence of Bbsl-specific antibodies in the English population was estimated in a cross-sectional cohort, selected from an archive of residual NHS blood donor plasma samples (age range 17 - 84, collected between 2021 - 2022). 10,000 samples were randomly selected proportionate to the population size of each of the nine English administrative regions. 9,994 samples were tested using a standard two-tiered testing strategy, with an IgG/IgM ELISA followed by an IgG immunoblot (array) test for any sera with positive or indeterminate reactivity in the ELISA.

Results: Out of the 9,994 samples tested, 482 were seroreactive by screening ELISA. After two-tier testing, 49 were confirmed positive. Regional and demographic differences in seroprevalence were observed after two-tier testing, but due to the low overall seroprevalence, were not significant upon multivariable analysis.

Conclusion: The seroprevalence of Borrelia burgdorferi sensu lato-specific IgG in the English adult population (2021 - 2022), determined using two-tier testing was estimated at 0.49 % (95 % CI 0.36 - 0.65). This is lower than neighbouring UK nation Scotland and other northern European countries.

Keywords: Epidemiology; Immunoblot; Lyme borreliosis; Lyme disease; Multivariable analysis; Serology; Serosurveillance.