It is demonstrated by numerous examples in the medical literature that a current or previous Borrelia infection can be present in just about any person. In the most recent, conservative estimations, based on seroprevalence and medical records it is estimated that Lyme borreliosis prevalence was 12.7 million cases in Europe and 4 million cases in North America, in 2018. The total infection burden for the world gives an astonishing 250 million (32).

For instance in a Dutch trial a positive sero-reaction for the Borrelia burgdorferi sensu lato strains was found in 6 percent of blood donors (28). In other trials the antibody of Borrelia burgdorferi could also be found in 4 percent of the blood of healthy volunteers (29), while the prevalence in the general population was between 7 and 29 percent (30). This latter research followed the health of subjects for two years, and Lyme borreliosis developed in 4.6 percent and 3.2 percent of the subjects, in the first and second year respectively, which means that the clinical symptoms may not appear and the definite diagnosis may not be established until one or two years later. An Estonian research compared the infection rate of the Estonian population with healthy volunteers from Lapland, and it found that the rate of subclinical Lyme borreliosis was high among Estonians (31).

The most recent meta-analysis published in BMJ Global Health, providing the highest level of evidence, reported an estimated global Borrelia burgdorferi seroprevalence of 14.5%, the top region was Central Europe with 20.7% (34). These numbers are not easily translated to currently existing infections, knowing the low sensitivty of serology, and the missing evidence on spontaneous healing and effective treatment schedules.

Such high numbers of incidence and prevalence may contradict the current experience of surveillance systems and would imply a very high rate of not diagnosed or misdiagnosed cases, and also a cumulation of infected patients. The estimated un/misdiagnosed cases in the US totals 1.7 million in 2018 (32), counting just the most frequent manifestations where misdiagnosis is possible. Whereas a recently published book identifies over 300 medical conditions that present with the same symptoms as LB (33).


  1. Serological and molecular evidence for spotted fever group Rickettsia and Borrelia burgdorferi sensu lato co-infections in The Netherlands. Koetsveld J, Tijsse-Klasen E, Herremans T, Hovius JW, Sprong H. 2015., Ticks Tick Borne Dis.
  2. Seroprevalence of Borrelia burgdorferi and tick-borne encephalitis virus in a rural area of Samsun, Turkey. Aslan Başbulut E, Gözalan A, Sönmez C, Cöplü N, Körhasan B, Esen B, Akın L, Ertek M. 2012., Mikrobiyol Bul.
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