Cooking smoke and indoor air pollution: Impaired immunity to tuberculosis at Australia’s northern border?

PNG has some of the highest rates of tuberculosis (TB) in our region, with drug resistant Mycobacterium tuberculosis (Mtb) posing a public health catastrophe and a biosecurity risk to Northern Australia. A multifactorial approach to TB control requires an understanding of individual resilience or predisposition to Mtb in these highly TB endemic areas i.e. why do some people acquire active TB and others don’t?

Our preliminary data obtained from an ongoing, collaboration with investigators from the Balimo (Middle Fly, Western Province) district hospital and the local health services and community, has revealed very high rates of TB. Pre-existing impairment of lung health is known to play a significant role in the development and natural history of TB by impairing immune responses within the lung. Our anecdotal evidence suggests that there is a high burden of pre-existing chronic lung disease, associated with indoor cooking smoke in this community.

Our study will determine the burden and characteristics of Chronic Obstructive Pulmonary Disease (COPD) in the Balimo region of PNG and investigate the resultant lung immune response defects. In doing so we will build local capacity in lung function testing and laboratory analysis and validate and optimise a pipeline of sample collection, transport and analysis of lung immune responses from PNG to JCU, Townville.

This pilot study will lay the foundation for further work to clarify the interactions of smoke inhalation and the progression of TB and the associated public health implications. Vaccines may ultimately be the most effective response to TB control but it is essential that we know if individuals have underlying immune defects that may render the vaccines ineffective. Such information will help inform a more socially tailored TB control programme to complement the existing programmes in the South Fly region of the Western Province.