Extended Tuberculosis Outbreak in Pasifika Communities in Western Sydney

Overview

A 10-year tuberculosis outbreak involving 20 disease episodes among 18 individuals in a Pasifika extended family in Western Sydney was characterized by complex social and cultural factors. Whole-genome sequencing linked cases to a single Beijing lineage strain, and control efforts required culturally sensitive, family-centered care amid COVID-19 disruptions.

Background

Tuberculosis remains a leading infectious cause of morbidity and mortality worldwide, with recent setbacks due to the COVID-19 pandemic reversing progress in control efforts. The Pacific Islands have variable tuberculosis incidence rates, and a significant Pasifika diaspora resides in Australia. Tuberculosis outbreaks in low-incidence countries like Australia pose unique challenges, especially within culturally diverse communities where social structures and health literacy impact disease transmission and management.

Data Highlights

Key Findings

• The outbreak was linked by whole-genome sequencing to a single Beijing lineage strain with minimal genetic variation.
• Transmission was facilitated by extended family cohabitation across multiple households and social mingling.
• COVID-19 pandemic disruptions and social factors complicated health system engagement and treatment adherence.
• Directly observed therapy and tailored, family-centered care approaches improved treatment completion despite challenges.
• Reinfection occurred in young children following reexposure, highlighting ongoing transmission risks within households.
• Contact tracing was complicated by frequent travel and cultural factors including stigma and confidentiality concerns.

Clinical Implications

Effective tuberculosis control in culturally diverse communities requires culturally sensitive, family-centered approaches that accommodate social structures and work schedules. Robust health system engagement, including flexible treatment supervision and community involvement, is essential to overcome barriers exacerbated by pandemics or social disruptions. Awareness of reinfection risk in children underscores the need for ongoing surveillance and preventive strategies within households.

Conclusion

This prolonged tuberculosis outbreak among Pasifika communities in Western Sydney underscores the importance of integrating whole-genome sequencing with culturally tailored public health interventions. Addressing social determinants and fostering community engagement are critical to controlling tuberculosis transmission in low-incidence settings.

References

1. Global Tuberculosis Report 2023 -- WHO
2. Tuberculosis Prevention and Care Guidelines -- Australian Health Authorities
3. Whole-Genome Sequencing in Tuberculosis Outbreak Investigation -- 2016