A $2.5 million, six-nation initiative to fight tuberculosis has opened at the Centenary Institute, Sydney. It brings together over 14 institutes.
Tuberculosis (TB) once killed more Australians than cancer. In 2011 we saw just four deaths. But the fight against TB is getting harder, and our nearest neighbour, PNG, has more than 70 times the cases.
The Centre of Research Excellence in TB Control (TB-CRE) links researchers in six countries to improve TB control, with the ultimate goal of eliminating TB transmission in Australia, and contributing to the world-wide campaign to eliminate TB by 2050. It is funded by the NHMRC, the National Health and Medical Research Council.
“In the late 19th Century tuberculosis was the leading cause of death in Australia—20 times deadlier per capita than all cancer conditions today put together,” says centre director Professor Warwick Britton.
TB remains a threat in the 21st century as new varieties of the disease which are deadlier and harder to treat have taken hold across the globe. The TB crisis in PNG illustrates the problem.
Papua New Guinea has the highest TB burden in the Pacific region with over 14,500 new cases diagnosed a year. The incidence of TB in the nation, which occurs at a rate of 434 cases per 100,000 people, is more than 70 times higher than in Australia.
Some of the worst cases are treated here in Australia. A young woman with extensively drug-resistant TB has become a medical refugee in Cairns. Originally from Daru Island, a few hundred kilometres north of Cape York, the woman spent a year in quarantine and died in March this year.
The threat is not only to developing countries. “Australia’s aging population and high numbers of people with chronic health conditions increase our vulnerability as a nation,” says the University of Sydney’s Associate Professor Jamie Triccas, a chief investigator for the centre.
Despite these threats Australia is uniquely positioned to lead multi-national research into the prevention, detection and management of TB within the Asia pacific region and beyond. The new centre hopes to establish Australia as a powerhouse for TB-based research.
The new Centre is working to:
- Develop new vaccines.
- Improve TB prevention, particularly for vulnerable children.
- Develop ways of finding new cases faster and start treatment sooner – reducing the risk of transmission.
- Track, map and understand the spread of the disease.
- Tackle the ethical and legal barriers of TB control such as establishing the rights of people with drug-resistant TB who pose a risk to others.
The centre is a collaboration between: Centenary Institute, University of Sydney, Woolcock Institute for Medical Research, University of Melbourne, Vietnam, Indonesia, WHO/Fiji, China and New Zealand.
Toni Stevens, 0401 763 130 firstname.lastname@example.org
LauraBeth Albanese, 0450 798 089 L.Albanese@centenary.org.au
Centre of Research Excellence in Tuberculosis Control: further information
Professor Warwick Britton (Centenary Institute)
Assoc. Professor Barend (Ben) Marais (The Children’s Hospital, at Westmead)
Professor Guy Marks (Woolcock Institute of Medical Research)
Assoc. Professor Vitali Sintchenko (The University of Sydney)
Assoc. Professor Stephen (Steve) Graham (The University of Melbourne)
Assoc. Professor James (Jamie) Triccas (The University of Sydney)
Senior Research Fellow Bernadette Saunders (Centenary Institute)
Assoc. Professor Ian Kerridge (The University of Sydney)
Professor Belinda Bennett (The University of Sydney)
Professor Gwendolyn (Lyn) Gilbert (The University of Sydney)
1) Professor Tania Sorrell; Director of the Sydney Institute for Emerging Infectious Diseases and Biosecurity (SEIB), University of Sydney
2) Professor Philip Hill; McAuley Professor & Director Centre for International Health, Department of Preventive and Social Medicine, University of Otago, New Zealand
3) Professor Nigel Curtis; Head of Paediatric Infectious Diseases, Royal Children’s Hospital Melbourne, The University of Melbourne
4) Professor Dick Menzies, Montreal Chest Clinic, McGill University, Toronto, Canada
5) Doctor Magda Ellis; CJ Martin Fellow, Centenary Institute, Sydney
6) Doctor Nick West; NHMRC CDA2 Research Fellow, Centenary Institute, Sydney
7) Doctor Michael Selgelid; Centre for Human Bioethics, Monash University, Melbourne
8) Adjunct Associate Professor Genevieve Howse, School of Public Health, La Trobe University, Melbourne
9) Doctor Anna Ralph; Global and Tropical Health, Menzies School of Health Research, Darwin
10) Doctor James Wood; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney
11) Doctor Nguyen Viet Nhung; Deputy Manager, National TB Programme, and Vice-Director, National Lung Hospital, Hanoi, Vietnam
12) Doctor Nasrum Massi; Head Novartis, Eijkman, Hasanuddin (NEHCRI) TB Laboratory, Department of Microbiology, Hasanuddin University, Makassar, Indonesia
13) Doctor Nguyen Linh; WHO TB office for the Pacific islands, based in Fiji
14) Doctor Jeremy McAnulty; Director of Health Protection, NSW Ministry of Health, Sydney
15) Amanda Christensen; NSW TB Advisory Committee (TBAC) convenor and TB Programme Manager, NSW Ministry of Health; and National TB Advisory Committee (NTAC) member
This CRE aims to improve coordination between and strengthen existing research initiatives on public health interventions, epidemiological and basic science approaches to TB control, and hence, establish Australia as an international leader in this field. The ultimate goal of research in this field is to eliminate transmission of TB within Australia, and to make substantial contributions to the WHO goal of global elimination of TB by 2050. A particular focus will be the improvement of the management and prevention of childhood TB. This CRE will encourage expanded collaboration on TB research within Australia and our region and provide new training initiatives in public health and operational TB research.
The work will focus on the following themes:
A. Improved TB prevention
The evaluation of novel and pragmatic risk assessment and preventive therapy strategies, including a strong focus on vulnerable children, and the development of new vaccines, essential for the long-term control of TB in high burden settings, particularly where DR-TB is prevalent.
B. Enhanced case detection and management
From the implementation of active case-finding strategies to overcome the case detection gap and improve timely access to effective TB therapies in order to reduce transmission, to the assessment of novel biomarkers.
C. Advanced tracking of transmission events
Improving our understanding of MTB transmission dynamics and enhancing our capacity for targeted public health responses to TB outbreaks by linking the development of highly discriminatory strain typing methods to detailed cluster analysis and spatio-temporal mapping.
D. Ethical-legal barriers to TB control
Detailed analysis of ethical and legal issues will provide a basis for improved policy and practice: from access to appropriate care and infection control, especially for patients with DR-TB whose free movement may pose a risk to others, to individual preventive therapy that minimizes community risk.
What is TB?
- Tuberculosis (TB) is a disease that is caused by a bacterium called Mycobacterium tuberculosis.
- TB infection attacks the lungs, but can also infect other areas of the body.
- TB is spread when a person with an active pulmonary infection sneezes, coughs, spits or simply speaks. Like the common cold, infectious droplets are sprayed into the air and can be inhaled by people nearby.
- Two billion people carry TB bacteria, with no symptoms—but one in 10 of them will develop active TB. They will become contagious and be at risk of serious illness and death.
Current treatments and efforts
- TB bacteria can usually be treated with a course of four standard antibiotics, known as ‘first line’ drugs, taken over six months or more.
- Multi-drug resistant TB (MDR-TB) is spreading.
- This takes longer to treat and can only be cured by ‘second-line’ drugs.
- Even tougher forms of TB are starting to appear. There are few effective drugs against these extensively drug-resistant forms of TB (XDR-TB).
- The World Health Organisation (WHO) estimates that there may be as many as 25,000 cases of XDR-TB. Most cases are fatal.
TB globally and in our region
- Per capita, the global TB incidence rate is falling, but the rate of decline is slow – less than 1%.
- There were 9.4 million new TB cases worldwide in 2009.
- 22 countries account for 80% of the tuberculosis cases in the world.
- Vietnam: 29,000 died from TB, 290,000 infected in 2010.
- China: 54,000 died from TB, 1.5 million infected in 2010.
- 500,000 people in South-East Asia died from TB in 2010.
- Bangladesh and Cambodia have the highest prevalence rates of TB in the world outside Africa.
- A third of all new cases are in India and China.
TB in Australia
The incidence of TB in Australia has remained at a stable rate since 1986. A total of 1,322 cases of TB were reported in Australia in 2009, representing a crude rate of 6 cases per 100,000 population. In 1960, the rate was closer to 40 per 100,000. But TB is already expanding its reach into Australia via our closest neighbour Papua New Guinea (PNG).
The rate of TB in PNG has increased by 42 per cent in the past decade and is still rising, according to national health data. The WHO estimates about 3,600 people in PNG die from TB every year, though uncertainties around surveillance and diagnosis mean the toll may well be higher.
About the Centenary Institute
The Centenary Institute is an independent leader in medical research seeking improved treatments and cures for cancer, cardiovascular and infectious diseases.
We are working to discover new prevention, early diagnosis and treatment options to enable each generation to live longer, healthier lives than the one before.
Centenary’s affiliation with the RPA Hospital and the University of Sydney means that our discoveries can be quickly applied to the fight against disease in the clinic. More at: www.centenary.org.au