One way to help stop transmission and prevent future outbreaks is to trace how and where the disease spreads using DNA sequencing. Canada is aiming to eliminate tuberculosis among the Inuit by 2030. In Canada, tuberculosis disproportionately affects the Inuit, a group of indigenous people inhabiting the Arctic regions. Tuberculosis epidemiology genomic epidemiology global health outbreaks transmission within-host diversity. This has implications not only for TB, but all genomic studies of transmission - regardless of pathogen.
It is increasingly evident that within-host diversity should be incorporated into transmission analyses deep sequencing may facilitate more accurate detection of super-spreaders and transmission clusters. In contrast with previous genomic analyses using ~50x depth, deep sequencing allowed us to identify a novel super-spreader who likely transmitted to up to 17 other cases during the outbreak (35% of the remaining cases that year). Consensus and heterogeneous variants were identified and compared across genomes. Samples were sequenced to ~500-1000x and reads were aligned to a novel local reference genome generated with PacBio SMRT sequencing. We investigate whether 'deep' sequencing can provide additional resolution compared to standard sequencing, using a well-characterized outbreak from the Arctic (2011-2012, 50 cases). To address this, it is imperative we understand transmission dynamics in this population. Tuberculosis disproportionately affects the Canadian Inuit.
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