Global health: Sydney researcher helping to end tuberculosis

Tuberculosis (TB) is the number one infectious disease killer on the planet. It's one of the major killers of young children in 'high TB burden' countries like India, Vietnam and South Africa. Due to a lack of resources, child TB deaths are often misdiagnosed as pneumonia, meningitis or malnutrition.

Even if correctly diagnosed, TB can still be incorrectly treated - "because TB diagnosis using classic sputum smear microscopy is unable to differentiate drug-susceptible from drug-resistant strains," says Professor Ben Marais, Co-Director of the Marie Bashir Institute for Infectious Diseases and Biosecurity at the University of Sydney. 

"As a result of inadequate diagnostics, few cases with drug-resistant TB receive appropriate treatment globally, fuelling further spread of the epidemic."

Children are particularly susceptible to TB, including drug-resistant strains, according to Professor Ben Marais, "paediatric cases have been described in all settings where adults have been diagnosed with drug-resistant TB. Children suffer a large burden of preventable and curable disease in TB endemic areas. Luckily children can be effectively treated, if they have access to adequate diagnostics and appropriate therapy."

Capacity building

Professor Marais' work has focussed on increased awareness and capacity building among health care professionals. During his time in South Africa, Professor Marais developed an International Child TB training course with the International Union Against Tuberculosis and Lung Disease and worked with Columbia University to develop a 2-week training course for new PEPFAR funded paediatric HIV teams throughout sub-Saharan Africa.

In Australia, Professor Marais worked with Professor Warwick Britton to establish the Centre of Research Excellence in Tuberculosis, which supports capacity building in the Asia Pacific region and the development of a strong TB research community in Australia. The new Sydney Global Child Health Network also includes a strong focus on infection and immunisation.

Novel eradication strategies

Professor Marais is currently working with Associate Professor Greg Fox and Professor Guy Marks who lead large cluster randomised trials in Vietnam to identify novel eradication strategies. The ACT-3 trial showed that active case finding at the population level can greatly reduce TB prevalence in the community, but further research is required to consider the most cost-effective interventions at the population level.

The VQuin trial, led by Associate Professor Greg Fox, will evaluate the efficacy of levofloxacin (antibiotic) to prevent drug-resistant TB among household contacts in Vietnam. "This is the first trial of its kind and will provide crucial information on strategies to reduce the burden and spread of drug-resistant TB. Complementary studies will assess variable strain transmissibility, as well as the impact of the antibiotic treatment on the human microbiome," says Professor Marais.

An important global issue

TB is a curable disease that can be eliminated. It's a telling sign of global health and social inequity. According to Professor Marais, "TB offers an important opportunity for constructive regional/global leadership, which could provide important diplomatic, economic and academic dividends".

"Research priorities have been outlined in multiple roadmap documents, however, the enduring challenge presented by TB is closely tied to reducing global inequities, improving dysfunctional health care systems, and minimising population displacement through war and environmental stress."

"Persistent high rates of disease and death caused by TB is unacceptable, since TB is curable and it is within our power to make a difference for good."