Rolling out TB whole-genome sequencing into routine clinical and public health practice: a collaborative process
PHE ePoster Library. Robinson E. 09/13/17; 186588; 161
Dr. Esther Robinson
Dr. Esther Robinson
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Abstract
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Abstract IntroductionTuberculosis (TB) is a public health problem in England with ongoing transmission. Whole-genome sequencing (WGS) accelerates diagnosis of drug resistance and initiation of appropriate therapy. WGS improves cluster detection and resolution when compared to conventional methods. Translating this complex technology into routine clinical and public health practice presents enormous challenges that can be addressed by collaborative working of multi-professional teams.Methods and ResultsWGS of all mycobacterial isolates sent to NMRS- North and Central started in December 2016, replacing previous methods. Conventional phenotypic testing continued. Resistance prediction for the four first-line anti-tuberculous drugs, plus three agents used to treat drug-resistant TB, was reported. Expert input to multi-professional team meetings facilitated use of these data in clinical practice, supporting early initiation of effective therapy in MDR and XDR cases.WGS single nucleotide polymorphism (SNP) typing replaced MIRU-VNTR for all TB isolates. SNP data were shared with epidemiology and health protection teams. Methods of presenting and interpreting data were iteratively improved, based on user feedback. Approximately 15 WGS clusters per month were detected across 5 PHE centres. The speed and increased resolution of SNP typing informed cluster investigation. WGS data were vital in communication around two international drug-resistant outbreaks.ConclusionsWGS for TB diagnosis and typing is a disruptive technology, requiring reappraisal of existing ways of working. Preliminary work involving clinical, laboratory and public health professionals suggests that building multi-professional collaborations of users of TB WGS data could deliver tangible clinical and public health benefits and should be further evaluated.
Abstract IntroductionTuberculosis (TB) is a public health problem in England with ongoing transmission. Whole-genome sequencing (WGS) accelerates diagnosis of drug resistance and initiation of appropriate therapy. WGS improves cluster detection and resolution when compared to conventional methods. Translating this complex technology into routine clinical and public health practice presents enormous challenges that can be addressed by collaborative working of multi-professional teams.Methods and ResultsWGS of all mycobacterial isolates sent to NMRS- North and Central started in December 2016, replacing previous methods. Conventional phenotypic testing continued. Resistance prediction for the four first-line anti-tuberculous drugs, plus three agents used to treat drug-resistant TB, was reported. Expert input to multi-professional team meetings facilitated use of these data in clinical practice, supporting early initiation of effective therapy in MDR and XDR cases.WGS single nucleotide polymorphism (SNP) typing replaced MIRU-VNTR for all TB isolates. SNP data were shared with epidemiology and health protection teams. Methods of presenting and interpreting data were iteratively improved, based on user feedback. Approximately 15 WGS clusters per month were detected across 5 PHE centres. The speed and increased resolution of SNP typing informed cluster investigation. WGS data were vital in communication around two international drug-resistant outbreaks.ConclusionsWGS for TB diagnosis and typing is a disruptive technology, requiring reappraisal of existing ways of working. Preliminary work involving clinical, laboratory and public health professionals suggests that building multi-professional collaborations of users of TB WGS data could deliver tangible clinical and public health benefits and should be further evaluated.
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