Same-Day Diagnostic and Surveillance Data for Tuberculosis via Whole-Genome Sequencing of Direct Respiratory Samples

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This is a proof of concept paper, but the implications are significant. There is a tremendous desire across the world to apply molecular testing to TB, to access more patients, and to better manage the growth of drug resistance. Whole genome sequencing has the benefit of allowing sharing of bacterial DNA information, to allow global surveillance of spread of strains and resistance. By showing this can be done with both mature (Illumina) and new, portable (Nanopore) technology, we make a big step towards removing technical barriers for this. Considerable technical work still needs to be done, to improve the handling of contamination (from other bugs living in patients mouths/airways), stabilising the new nanopore tech, etc. Beyond that, there are always the bigger challenges of how to integrate into public health. However it is worth noting that Public Health England announced this year (2017) that they now sequence all TB cases by default (in addition to the traditional pipeline). It's hard to predict how this will all fall out, but there is a real chance this could significantly change TB management across the world.

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