Borrelia burgdorferi Antibodies, Total  

IMPORTANT! Pre-approval needed from state or local health department. Local or State Health Department. Send approval to or call (402) 559-9444.

NPHL has moved to an electronic ordering system, NUlirt, and it is now the preferred method to order all tests. Once ordered, print a "batch list" (see NUlirt Guide).

Forms Required - Nulirt batch list or NPHL Test Request Form (completed in entirety) must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history. Testing will not be performed without all required information.

Please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459 for further clarification.


Test: Borrelia burgdorferi Antibodies, Total by ELISA
Order in NUlirt or complete NPHL Test Order Form  
Synonym: Lyme Antibodies Detection, Lyme Disease, Lyme Disease Ab ELISA  
Method:  Semi-Quantitative Enzyme-Linked Immunosorbent Assay  
Availability: Test performed Daily, Results within 1-2 days  
Specimen: Blood. Separate serum from cells ASAP or within 2 hours of collection. Transfer 2 mL serum to an ARUP Standard Transport Tube.  
Collection Device: Serum separator tube.
Specimen Labeling: Test subject to CLIA regulations and required 2 patient identifiers on specimen container and requisition forms  
Volume: 2.0 mL serum (Min: 0.15 mL)  

Prior to shipment:  Refrigerate 2-8°C; Separate serum from cells ASAP or within 2 h of collection  
Shipping instructions, including specimen-handling requirements during transport:  Seal screw-top tubes with Parafilm™ or tape and place in biohazard bag with absorbent material.
Ship in insulated box on frozen gel-packs. Place packing list or other paperwork on top of Styrofoam and lid. Mark out rigid box as UN3373 Category B, Biological Substance. Transport by NPHL ground courier. If courier not available, ship by FedEx, UPS or USPS (1st Class, Priority or Express Mail). Follow appropriate DOT/IATA Regulation Guidelines.  For assistance, call NPHL State Training Coordinator at (402) 559-3590.  
See instructions and shipping address:
NUlirt packing list or appropriate paperwork (completed in entirety) must accompany specimens.

Unacceptable: CSF. Contaminated, heat-inactivated, hemolyzed, or severely lipemic specimens.  
Specimen Stability: After separation from cells: Ambient: 48 h; Refrigerated: 2 w; Frozen: 1 yr (avoid repeated freeze/thaw cycles)  
Reference Interval: < 1.00 LIV: Negative - Antibody to Borrelia burgdorferi not detected.
1.00-1.20 LIV: Equivocal - Repeat testing in 10-14 days may be helpful.
> 1.20 LIV: Positive - Probable presence of antibody to Borrelia burgdorferi detected.  
Reportable Disease: Positive results are reported to local or state health department within 7d. Refer to Nebraska DHHS Title 173, Communicable Diseases.  
Comments: Pre-approval needed from state or local health department. Send approval to or call (402) 559-9444.

Once this test is performed, if:
a) Negative - no further testing is done;
b) Positive or equivocal - immunoblot testing will be performed on the original sample upon receiving a request. Sample will be held for 30 days only.

Current CDC recommendations for the serologic diagnosis of Lyme disease are to screen with a polyvalent ELISA test and confirm equivocal and positive results with Immunoblot. Both IgM and IgG Immunoblots should be performed on specimens less than 4 wk after appearance of erythema migrans. Only IgG Immunoblot should be performed on specimens greater than 4 weeks after the disease onset. IgM Immunoblot in the chronic stage is not recommended and does not aid in the diagnosis of neuroborreliosis or chronic Lyme disease. Please submit requests for appropriate Immunoblot testing within 10 days.  
Revised: 3/21/2021 
If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459.