Tick-borne disease is a growing problem across the country: According to the CDC, each year approximately 30,000 cases of Lyme disease are reported, but recent estimates show the number of people who may get Lyme disease each year in the United States is closer to 476,000.1

While some patients show symptoms such as fever, rash, body aches, fatigue, headache, and chills, others may have a delay or absence of symptoms. In addition, co-infection with multiple tick-borne diseases is common, making timely selection of the appropriate test critical to proper treatment.

Diagnosing Lyme disease earlier is possible through an updated recommendation from the CDC for modified two-tier testing (MTTT),2 which utilizes immunoassays rather than immunoblots in the second tier of the algorithm. The Quest MTTT may be able to identify Lyme disease within the first 30 days of infection.3

The MTTT follows a two-step process:

 Step 1: Test serum in an immunoassay measuring combined IgG and IgM antibodies to specific borrelial proteins

Step 2: Verify the results using a separate IgG and IgM immunoassay in place of a Western blot (immunoblot)

The CDC indicates clinicians and laboratories should consider serologic assays that utilize a second EIA in place of Western immunoblot assay as acceptable alternatives for serologic Lyme disease diagnosis,2 and research studies have determined that MTTT is more sensitive than the standard two-tier test (STTT) in the early stages of the disease.4,5

For more information on tick-borne testing, visit Quest Diagnostics.


  1. Lyme disease data and surveillance. Updated January 24, 2021. Accessed May 7, 2021. https://www.cdc.gov/lyme/datasurveillance/index.html#:~:text=Investigations%20are%20often%20%20dependent%20on%20available%20resources%20and,state%20health%20departments%20%20and%20the%20District%20of%20Columbia
  2. Mead P, Petersen J, Hinckley A. Updated CDC recommendations for serologic testing of Lyme MMWR Morb Mortal Wkly Rep. 2019;68(32):703. doi:10.15585/mmwr.mm6832a4
  3. Zeus Clinical data. Accessed May 7, 2021. https://www.zeusscientific.com/clinical- data
  4. Porwancher RB, Hagerty CG, Fan J, et al. Multiplex immunoassay for Lyme disease using VlsE1-IgG and pepC10-IgM antibodies: improving test performance through Clin Vaccine Immunol. 2011;18(5):851-859. doi:10.1128/CVI.00409-10
  5. Branda JA, Linskey K, Kim YA, Steere AC, Ferraro MJ. Two-tiered antibody testing for Lyme disease with use of 2 enzyme immunoassays, a whole-cell sonicate enzyme immunoassay followed by a VlsE C6 peptide enzyme Clin Infect Dis. 2011;53(6):541-547. doi: 10.1093/cid/cir464