Tuberculosis in Far North Queensland, Australia: a retrospective clinical audit

Background: Compared with global numbers, Australia has enjoyed relatively good tuberculosis control over the past 30 years, with an annual incidence of 5.7 per 100 000 population. Thanks to its unique geography and proximity to high-burden countries, such as Papua New Guinea (PNG), Far North Queensland (FNQ) has previously been shown to have higher rates of tuberculosis compared with both the state and national average. Aims: To document tuberculosis epidemiology in FNQ compared to two previous audits of the region. Methods: Retrospective clinical audit of all cases of tuberculosis reported to the Cairns Tuberculosis Control Unit between 2006 and 2016. Results: A total of 453 cases were identified, 374 with microbiological/histological confirmation. There were 312 cases of pulmonary tuberculosis, 155 extrapulmonary and 21 disseminated. Three-quarters (327/453) were identified in the overseas-born population. Of the remaining 126 cases, 40 were Torres Strait Islander and 19 Aboriginal Australians. Where drug susceptibility was known, two-thirds (247/368) were fully sensitive, 42 mono-resistant, 78 multidrug resistant and 1 extensively drug resistant. Rates of human immunodeficiency virus co-infection were less than 3% (10/362). Conclusion: Tuberculosis remains a significant problem in FNQ. Case numbers have increased threefold since the 1990s. Much of the increase comes from the overseasborn population. Although PNG accounts for the majority, the number of positive notifications among those born abroad has increased fivefold since 2010. Tuberculosis among Aboriginal Australians has decreased following policy changes in response to previous audits. However, tuberculosis in Torres Strait residents has increased from 12 cases (1993-2002) to 40 cases (2006-2016).