Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Tuberculosis (TB) is a major cause of disease and death in much of the world. More than 20 years after the World Health Organization declared tuberculosis a global emergency, TB remains entrenched in the world's population. In Canada, after decades of decline in TB incidence, progress towards control has stalled. Foreign-born Canadians, Indigenous communities, as well as incarcerated and under-housed individuals are at the greatest risk of TB. Indeed, the incidence in certain sectors of the Canadian population can exceed that in developing countries. While TB represents a significant burden to the health-care system it also exacts a physical and emotional toll on these already vulnerable individuals. The stigma associated with TB often results in lost social status, housing and jobs. Recent advances in technology now allow the full DNA sequence to be read from TB bacteria isolated from patients. Analysis and comparison of tuberculosis DNA sequences from TB patients in British Columbia over a 10-year period will allow us to detect small changes in the DNA which occur as TB is spread from one person to the next. Combining this information with key patient data we will piece together person-to-person transmission of the disease. Therefore, utilizing these new advances in DNA sequencing combined with traditional epidemiology (study of the distribution and determinants of disease), we seek to significantly improve our understanding of TB transmission. This novel approach is the largest of its kind ever attempted in Canada, and the knowledge gained will be used to strengthen efforts in TB control by identifying common patterns of disease spread, potential risk factors for transmission, as well as communities in which there is ongoing person-to-person spread of the disease. Understanding the transmission dynamics of TB is crucial to improving awareness, education, early detection, and ultimately stopping the spread of tuberculosis in Canada's most at-risk communities.