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Background: Lyme disease (LD) emerged in southern Québec at the start of the century, with many municipalities now endemic. A coordinated active surveillance programme has been in place in the province of Québec since 2014, including a limited number of sentinel field sites resampled each year and a larger set of accessory field sites that change yearly according to the LD surveillance signal. We aimed to evaluate whether a sentinel approach to active surveillance was more representative of LD risk to human populations, compared to risk-based surveillance. Methods: We compared enzootic hazard measures (average nymph densities) from sentinel and accessory sites with LD risk (number of human LD cases) across the study area between 2015 and 2019 using local bivariate Moran's I analysis. Results: Hazard measures from sentinel sites captured spatial risk significantly better than data from accessory sites (x2=20.473, p<0.001). In addition, sentinel sites successfully tracked the interannual trend in LD case numbers, whereas accessory sites showed no association despite the larger sample size. Conclusion: Where surveillance aims to document changes in tick-borne disease risk over time and space, we suggest that repeated sampling of carefully selected field sites may be most effective, while risk-based surveillance may be more usefully applied to confirm the presence of emerging disease risk in a specific region of interest or to identify suitable sites for long-term monitoring as LD and other tick-borne diseases continue to emerge. [ABSTRACT FROM AUTHOR]