Understanding the tuberculosis epidemic in a regional hot-spot using a genomic epidemiological approach

To work towards ending the tuberculosis (TB) epidemic, high TB-burden countries must implement innovative, multifaceted strategies that tackle all aspects of the TB ‘search, treat, prevent’ cycle. Strategies for the ‘search’ component (finding active TB cases) and the ‘prevent’ component (stopping infection spread and giving preventive medicine to people in contact with TB) rely on high-quality knowledge of local TB epidemiology – that is: who has it, why, and how it spreads.

TB control is recognised as a leading global priority. It is the leading infectious cause of death in the world. It can cause catastrophic costs to individuals and health care systems. The World Health Organisation has set ambitious TB elimination targets; to achieve these, innovation and major new investments are needed. Regionally, Australia provides the required expertise to support TB control.

Eastern Malaysia, close to our north, has high rates of TB, yet there is limited understanding of the epidemiology there. We have previously reported on aspects of this. But now we have the opportunity to progress this work to the next stage – genomic epidemiology – using new technology on samples of TB bacteria. The method to be used in this study is ‘whole genome sequencing’ (WGS), providing the full genetic profile of TB strains. When samples from different patients are available, WGS can show how the TB strains are related to each other, and whether there is likely to be resistance to antibiotics. Such information would be especially valuable in eastern Malaysia, since public health investigations to find out how an individual acquired TB are not done, and laboratory facilities to test for antibiotic resistance are not readily available.

To understand the molecular epidemiology of TB in Kota Kinabalu, this study will use WGS on >100 samples from patients with TB, and pair this with patient location and demographic data. This will show which TB strains are circulating and how the disease is spreading, to help shape local public health responses to control the epidemic.