Tuberculosis (TB) is an important public health issue in Sabah, Malaysia, on the island of Borneo. Our TB team including Menzies genomics doctoral researcher Dr Ella Meumann has been working with Malaysian, Singaporean and Australian TB genomics experts to explore the genomic epidemiology of TB in Sabah to help tailor public health interventions in the region.
The expert team found numerous strains of TB circulating in Sabah, however they were predominantly from the same lineage – lineage 1. Strain diversity was highest in border towns. Importantly, almost all isolates were sensitive to standard antibiotics.
The TB transmission clusters that were found, where people that were infected with the same strain, were geographically spread rather than being confined to households. In one example, a tuberculosis strain was initially sensitive to antibiotics, but was transmitted to another person and then evolved to the multi-resistant form.
Menzies researcher Professor Anna Ralph, who is the head of the Global and Tropical Health team, says these findings provide some good news for TB control in Sabah - the TB strains are mostly types that are easier to treat.
“But the findings point out that the current focus on household contact tracing needs to be expanded since TB is spreading in the community, beyond households,” Professor Ralph said.
The findings are a reminder that TB prevention by screening and treating contacts is an important way to stop development of multi-drug resistant TB.
Professor Ralph also noted: “The high transmission of diverse strains in border towns re-emphasises the importance of prioritising TB care for at-risk migrant populations, as previously reported by the team.”
The findings also indicate that the current focus on household contact tracing needs to be expanded since TB is spreading in the community.
The team’s previous research about contact tracing has highlighted the need to make TB contact tracing easier. A new mobile app has been implemented to improve contact tracing and treatment for people with TB in Sabah called CONTRA TB.
Developed by Menzies researchers Christel van den Boogaard, Michelle Goroh, Chris Lowbridge and collaborators, CONTRA TB supports better real-time, accurate communication between those involved in TB contact tracing in Sabah, namely nurses and doctors in the TB clinics, health inspectors working out in the community to undertake household contact tracing and the Sabah State Health Department, which oversees the TB program.
Read the full paper on genomic epidemiology here: https://pubmed.ncbi.nlm.nih.gov/33945455/
Read more about contact tracing in Sabah here: https://pubmed.ncbi.nlm.nih.gov/32751073/
Find out more about CONTRA TB here: www.menzies.edu.au/CONTRATB