Clinical Scorecard: Extended Tuberculosis Outbreak Among Pasifika Communities in Western Sydney, Australia: The Role of Community Involvement
At a Glance
Category
Detail
Condition
Prolonged tuberculosis outbreak linked by whole-genome sequencing
Key Mechanisms
Transmission facilitated by cohabitation in extended families, social and cultural factors, and COVID-19 disruptions
Target Population
Pasifika extended family members in Western Sydney, Australia
Care Setting
Hospital, community, and home settings with family-centered and culturally sensitive care
Key Highlights
20 tuberculosis disease episodes over 10 years among 18 individuals, mostly of Samoan ethnicity
Whole-genome sequencing confirmed outbreak with Beijing lineage isolates fully drug susceptible
Challenges included treatment adherence, contact tracing, stigma, and health system exhaustion exacerbated by COVID-19
Guideline-Based Recommendations
Diagnosis
Use whole-genome sequencing to confirm outbreak clusters
Employ clinical evaluation and microbiological testing including tuberculin skin test and chest X-ray
Management
Provide culturally sensitive, family-centered care tailored to extended family structures
Implement directly observed therapy and flexible treatment approaches across home, community, and hospital settings
Offer tuberculosis preventive treatment to identified contacts
Monitoring & Follow-up
Monitor treatment adherence closely, especially in children and those with social challenges
Conduct thorough contact tracing including extended family and frequent visitors
Use whole-genome sequencing retrospectively and prospectively to track transmission
Risks
Reinfection risk in children with prior treatment due to ongoing exposure
Treatment interruptions and adherence challenges linked to social and work factors
Stigma and confidentiality concerns complicate contact tracing and care engagement
Patient & Prescribing Data
Pasifika individuals in extended family households with tuberculosis disease episodes
Treatment completion achieved in majority despite interruptions; prolonged therapy needed in children with adherence challenges; no drug resistance detected
Clinical Best Practices
Engage community and family members to enhance culturally appropriate care and support
Adapt treatment supervision to patients’ social circumstances including casual work schedules
Address stigma and confidentiality proactively to improve contact tracing and treatment adherence
Utilize whole-genome sequencing to guide outbreak investigation and management
by Archana Koirala, Katherine Smith, Philip N Britton, Annaleise R Howard-Jones, Vitali Sintchenko, Ellen J Donnan, Evan Ulbricht, Elena Martinez, Reta Toma, Ben J Marais
