The public health utility of whole genome sequencing: Insights from a tuberculosis outbreak in Australia and perspectives of public health professionals
9 affiliations
- 1National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- 2Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- 3Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- 4Victorian Tuberculosis Program, The Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital, Melbourne, Australia
- 5Department of Infectious Diseases at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
- 6Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection & Immunity, Melbourne Health, Melbourne, Australia
- 7Sydney Infectious Diseases Institute, University of Sydney, Sydney, Australia
- 8Centre for Infectious Diseases and Microbiology – Public Health, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, Australia
- 9Communicable Diseases Branch, Department of Health, Brisbane, Australia
Abstract
Whole Genome Sequencing (WGS) is increasingly being used to enhance tuberculosis (TB) surveillance and management. However, evidence on how WGS shapes real-world decision-making remains limited. This study explored the utility of WGS in the context of a TB outbreak in Victoria, Australia. We conducted a case study to (1) describe a TB outbreak in Victoria using epidemiological and genomic data and (2) explore the perceived benefits and limitations of WGS through qualitative interviews with laboratory and public health professionals involved in the investigation. The interviews were analysed thematically. From 2017 – 2023, 36 people were linked to a large lineage 4 TB outbreak comprising 3 sub-clusters. WGS connected two patients who were initially not epidemiologically linked to the outbreak, prompting additional contact screening at a medical clinic. From interviews with 10 laboratory and public health professionals, WGS was considered a useful tool, although there was a gap between its potential and realised utility. WGS strengthened confidence in suspected transmission links, which was particularly valuable when epidemiological evidence was sparce or uncertain. This was relevant in this investigation where TB stigma, a prolonged timeframe, and cross-jurisdictional transmission were challenges. Barriers to public health action from WGS included long turnaround times, difficulties drawing conclusions from identical isolates, and uncertainties around public health follow-up actions. This case study demonstrates that WGS can inform meaningful public health action, while also identifying opportunities to improve its utility. WGS for public health should involve real-time sequencing along with steps to support the translation of findings into actions such as action-focused WGS training, mechanisms to support consistent follow-up, and improved record-keeping systems.
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BibTeX
@article{wang2026public,
title = {{The public health utility of whole genome sequencing: Insights from a tuberculosis outbreak in Australia and perspectives of public health professionals}},
author = {Daisy Wang and Angeline Ferdinand and Justin T. Denholm and Katie Dale and Simone Bittmann and Maria Globan and Ben J. Marais and Vitali Sintchenko and Christopher Coulter and Martyn D. Kirk},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0007016},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007016},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The public health utility of whole genome sequencing: Insights from a tuberculosis outbreak in Australia and perspectives of public health professionals
AU - Daisy Wang
AU - Angeline Ferdinand
AU - Justin T. Denholm
AU - Katie Dale
AU - Simone Bittmann
AU - Maria Globan
AU - Ben J. Marais
AU - Vitali Sintchenko
AU - Christopher Coulter
AU - Martyn D. Kirk
PY - 2026
DA - 2026/09/10
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007016
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007016
AB - Whole Genome Sequencing (WGS) is increasingly being used to enhance tuberculosis (TB) surveillance and management. However, evidence on how WGS shapes real-world decision-making remains limited. This study explored the utility of WGS in the context of a TB outbreak in Victoria, Australia. We conducted a case study to (1) describe a TB outbreak in Victoria using epidemiological and genomic data and (2) explore the perceived benefits and limitations of WGS through qualitative interviews with laboratory and public health professionals involved in the investigation. The interviews were analysed thematically. From 2017 – 2023, 36 people were linked to a large lineage 4 TB outbreak comprising 3 sub-clusters. WGS connected two patients who were initially not epidemiologically linked to the outbreak, prompting additional contact screening at a medical clinic. From interviews with 10 laboratory and public health professionals, WGS was considered a useful tool, although there was a gap between its potential and realised utility. WGS strengthened confidence in suspected transmission links, which was particularly valuable when epidemiological evidence was sparce or uncertain. This was relevant in this investigation where TB stigma, a prolonged timeframe, and cross-jurisdictional transmission were challenges. Barriers to public health action from WGS included long turnaround times, difficulties drawing conclusions from identical isolates, and uncertainties around public health follow-up actions. This case study demonstrates that WGS can inform meaningful public health action, while also identifying opportunities to improve its utility. WGS for public health should involve real-time sequencing along with steps to support the translation of findings into actions such as action-focused WGS training, mechanisms to support consistent follow-up, and improved record-keeping systems.
SN - 2767-3375
ER -