Lyme Disease (LD) is a tick transmitted infection caused by Borrelia burgdorferi. This is one of the most common vector borne diseases in North America. Its prevalence is quite low in British Columbia (BC) compared to eastern North America. BC has a long history of studying and providing diagnostic test services to the BC residents. Extensive field work as well as passive surveillance data clearly showed the low presences of this spirochete in the vector (ticks) as well as in the predominant host (deer mice). Lyme disease become notifiable in BC since 1995, however, it become reportable in Canada in 2009. Annual Canadian cases are increasing every year but BC confirmed LD cases are low and static and also consistent with field epidemiological data. LD diagnosis is usually straightforward, but can be more complex and it depends on diseases conditions, exposure and endemic region. BC Centre for Disease Control Public Health Laboratory adheres to the universally accepted LD testing guidelines and recently introduced the newly recommended Modified Two Tier test algorithm for diagnosis. There are other commercial alternative tests; however, the quality of these tests is often questionable and their use is not recommended. In this presentation, geographic distribution of ticks and human Lyme disease cases in North America, Canada as well as challenges in laboratory diagnosis treatment will be discussed.