Ever since completing his PhD whilst working as a young paediatrician in South Africa, Professor Ben Marais from the University of Sydney has been on a mission to raise awareness of childhood tuberculosis (TB) and the transmissibility of drug-resistant TB — having seen first-hand the deadly impacts when this disease is left undiagnosed and untreated.
Professor Marais points out that TB remains the number-one infectious diseases killer on the planet and a top 10 cause of death in children under the age of five.
“Wealthy countries with good socioeconomic conditions and health care systems like Australia are at low risk of major TB outbreaks — but Australia can make a big contribution through research and advocacy.”
Research into the transmission of drug-resistant TB was traditionally neglected, because it was believed to occur when patients do not take their medicine and therefore all that is required to address the problem is better treatment supervision to ‘turn off the tap’.
In 2018, the last year for which there are global data, TB killed approximately 1.5 million people.
Ref: World Health Organisation. “Tuberculosis Fact Sheet” World Health Organisation. 24 May 2020. Accessed 25 August 2020. www.who.int/news-room/fact-sheets/ detail/tuberculosis
“For many years the spread of drug-resistant TB was overlooked by the TB community, in much the same way as childhood TB was before, because of the perception that it does not pose a transmission risk.
“In the case of children, the fact that they rarely transmit TB does not imply that they are unaffected. In fact, TB is a leading cause of death in young children living in TB endemic areas, while easily preventable if appropriate care is provided.
In addition, since drug-resistant TB is readily transmitted, children in close contact with an adult who has drug-resistant TB are also at risk.
“Our program of research focuses on a number of aspects. We document the burden and spectrum of disease suffered by children in different developing country settings and aim to identify better ways of preventing and treating their disease.
“We also map the spread and evolution of drug-resistant strains of TB. Regionally, the use of genome sequencing allowed us to assess drug resistance patterns and track transmission pathways within communities, in order to guide appropriate public health interventions.”
In Australia, New South Wales became the first jurisdiction in the world to introduce routine sequencing of all TB strains in 2016. This facilitates personally tailored treatment that optimises patient recovery and keeps the community safe.
“We all need to work together to contain the emergence and spread of deadly diseases like drug-resistant TB and COVID-19.”
TB provides a constant reminder that infectious diseases do not respect borders. In 2020, COVID-19 provided another powerful example, with efforts to contain COVID-19 employing TB control concepts, such as strict infection control and quarantine, meticulous contact tracing and the use of genomics for transmission tracking.
Professor Marais is currently looking into strategies for population-level TB elimination in the Pacific (PEARL project in Kiribati) and the prevention of drug-resistant TB in Vietnam (V-Quin project), as well as continuing his research into how children are affected by the global tuberculosis epidemic and the spread of drug-resistant TB.