There is a more severe risk around rabies. We basically do not have it in the UK or Ireland; it has been eliminated for over a century except a tiny incidence of a virus in the same family in bats. But because we have essentially eradicated it, doctors do not often think to ask about it, even in people who have travelled, which led to someone suffering awfully last year.
And since a dog bite or even a fox bite in the UK or Ireland carries literally zero risk of rabies, those who are bitten or scratched while travelling abroad do not have it uppermost in their mind.
About 20 years ago my gran got to the facial palsy stage of Lyme's before it was even considered and diagnosed by a visiting locum doctor who'd grown up in another country.
Antibiotics were given, her face recovered (albeit slowly).
It's a horrendous disease.
A few thousand cases every year now, when the first indigenous case ever properly recorded in the UK was only in 1986, and it's not like in the USA where really wide areas are high risk. Some of the pockets of highest risk Lyme in the UK are no more than a few miles across.
Nurse stations and pharmacy clinics are great at properly removing ticks if you know you have been bitten, and from there you will now get good advice about Lyme.
But a system that has no endemic experience of Lyme is just not going to test for it. Because it's remote, and people are usually unaware they have been in risk areas, and often unaware they've even been bitten.
Epidemiologically recent (and also dofm-recent because I'm old).
But the graphs typically show that Scotland ballooned in the last twenty years, from below a hundred a year into the thousands.
Apparently in the UK it is now mostly stable, so it is endemic in deer. Much more common in middle-aged people who are I guess more likely to walk the dog and be keen active gardeners.
(There are more voles in the UK than mice, as it goes. Outnumber them by about thirty million or something. Fairly recently acquired trivia for me, but it turns out that if you see a mouse scurrying in the wild in the UK, away from houses, it's a bit more likely to actually be a vole.)
England in comparison is much more built up.
We do have Lyme disease here unfortunately. I know someone who has it.
Genetic studies and museum tick specimens prove the bacteria existed in North America for thousands of years before the lab was built. Whether there was gain of function done on it is not publicly verified.
COVID lockdowns changed us and we're a bit more outdoorsy.
But mostly it is the deer population. There are now four times as many wild deer in the UK as there were before the first indigenous case of Lyme was detected. From under half a million to well over two million over that timeframe.
In the south east around where I am, wild boar are now a potentially significant vector in the high risk areas, too — we've gone from literally zero to a couple of thousand wild boar in the same forty-year period of time just in the 20 miles around me. They apparently can carry upwards of a hundred without suffering.