The WHO has set ambitious targets for eliminating TB in low-incidence countries such as the US and Canada. While it’s true that the majority of TB cases in these settings arise from reactivation of latent TB infection in persons born outside North America, person-to-person transmission of active TB within the US and Canada also contributes to the burden of disease; thus, reducing TB transmission is an integral part of regional and national TB elimination programs. Recently, whole genome sequencing (WGS) has emerged as a new paradigm for both rapid TB diagnosis and phenotyping, as well as for better identifying clusters of cases representing local transmission and even identifying specific transmission events, giving us an unique perspective on understanding TB transmission. In this talk, I’ll describe how the province of British Columbia, Canada has implemented WGS to better understand our local TB epidemiology and to change TB policy and practice in our setting. Topics to be covered include the role of WGS in the modern reference TB laboratory, methods for inferring transmission from TB genomic data alone, the key role for communication and knowledge translation when implementing WGS in a public health system, and insights gained from our sequencing of over 2000 TB isolates, representing cases diagnosed in BC dating back over a decade.
1. TB is the leading infectious disease killer in the world, despite being treatable.
2. Drug resistance is an emerging issue in TB, with resistance driven by point mutations.