The incidence of tuberculosis (TB) among non-Indigenous Australian-born individuals is <1 per 100,000, one of the lowest rates in the world. The incidence among Indigenous Australians is unacceptably five-times higher but declining. Overseas-born individuals account for 85%-90% of Australia’s incident TB cases. The annual rate of multidrug-resistant tuberculosis (MDRTB) has remained below a 2% threshold for more than 15 years (if PNG nationals seeking medical care in the Torres Strait Protected Zone are excluded from the analysis). A few cases of extensively-drug-resistant tuberculosis (XDRTB) have been documented.

This is an exciting time for mycobacteriology laboratories in Australia with the introduction of new technologies (eg. immunochromatographic tests for MPT64, fully-automated real-time PCR assays such as the Cepheid GeneXpert platform, and whole genome sequencing). This is also a challenging time for mycobacteriology laboratories with an ageing workforce, increasing budgetary pressures and the continuing need to maintain appropriate PC2+/PC3 facilities to perform TB diagnostic testing safely. New drugs (eg. bedaquiline and delaminid) and new shorter regimens (eg. Pa-824/pyrazinamide/moxifloxacin) will require new susceptibility breakpoints hopefully based on criteria accepted in general bacteriology such as epidemiological cut-offs (ECOFFs) and pharmacokinetic/pharmacodynamic (PK/PD) parameters. The National Tuberculosis Advisory Committee (NTAC) will be circulating shortly a draft revision of their “Guidelines for Australian Mycobacteriology Laboratories” that addresses the above issues.