Molecular epidemiology of tuberculosis in northern Australia

Australia has one of the lowest rates of tuberculosis (TB) globally; however, the rates of TB in the Northern Territory (NT) Top End and in Far North Queensland are consistently higher than the national average. Genomic sequencing of Mycobacterium tuberculosis (MTB) is increasingly being implemented for transmission surveillance and antimicrobial resistance prediction. Genomic epidemiological studies in northern Australia have demonstrated the utility of sequencing for tracking TB transmission. In the NT Top End, this has demonstrated that most TB transmission is occurring in remote regions, with recent transmission and reactivation from latency contributing to incident TB. In Far North Queensland, genomics has been used to track transmission of a multidrug-resistant MTB clone across the Torres Strait. The next steps include implementation of MTB genomic sequencing in jurisdictional laboratories with real-time cross-jurisdictional analysis to inform public health management of TB.