28 March 2014
PHE is an executive agency of the UK Department of Health, tasked with protecting and improving the nation’s health and addressing inequalities. The new TB strategy is intended to combine best practice in clinical care, public health and social support to reduce the incidence of TB in England, which is the second highest in Western Europe and set to exceed that of the entire USA within two years, based on current trends.
It combines elements relating to improved diagnosis and care to better case tracking and disease surveillance, as well as tackling drug resistance; multi-drug resistant (MDR) TB is on the increase and is a serious public health threat.
PHE’s director of health protection and medical director Dr Paul Cosford noted that: “While the majority of cases are due to reactivation of infection, genetic coding shows evidence of recent transmission in England”.
This demonstrates one of the emerging applications of rapid whole genome sequencing (WGS) technology to the surveillance and control of infectious diseases like TB, in enabling precise identification of different Mycobacterium tuberculosis strains to follow the introduction and transmission of new infections to the country (for example, see previous news).
The strategy itself also notes the capacity of WGS also to identify the drug sensitivities and resistances of an infecting mycobacterial strain, important for individual treatment planning as well as tracking the spread of MDR strains, especially since it can identify drug susceptibility much faster, within weeks rather than the months that older techniques require due to the slow growth of mycobacteria in culture.
WGS can also make it easier to identify individuals with latent (inactive) infections who can inadvertently spread the disease to others.
PHE is currently evaluating the use of WGS for rapid TB detection, as well as conducting research into new diagnostic tests, drugs and vaccines.
Dr Leila Luheshi, who leads the PHG Foundation’s current project on pathogen genomics, commented: “It is great to see PHE pushing ahead with the application of whole genome sequencing to determining antibiotic resistance and investigating outbreaks for TB. We hope that lessons can be learned from the implementation of WGS for TB that will be applicable to many other infectious diseases in the near future. In particular we support the establishment of a national strategy which may facilitate collaboration across the many disparate parts of the health system involved in tackling this important infectious disease”.