Biology subjects

Tay, E. L.

Publications and source records attributed to Tay, E. L..

6 recordsLinked to original sources

bioRxiv2025

Defining new Buruli ulcer endemic areas in urban southeastern Australia using bacterial genomics-informed possum excreta surveys

Buruli ulcer (BU) in southeastern Australia is a zoonosis caused by infection with Mycobacterium ulcerans. Australian native possums are a major wildlife reservoir and infected possums shed M. ulcerans in their excreta, with mosquitoes being the major transmitting vector in this region. BU is geographically restricted and this feature, combined with an average 4.8-month incubation period, makes tracking M. ulcerans environmental spread and timely identification of new BU endemic areas challenging. While human movement complicates transmission tracing, we used the highly territorial behaviour of native possums and high-resolution pathogen genomics to confidently identify new BU endemic areas in Melbournes inner northwest and southern suburbs of Geelong. Using pathogen genomic phylodynamic modelling, we estimated that M. ulcerans was introduced to these areas 2-6 years before the emergence of human BU cases. This study shows how possum excreta surveys combined with pathogen genome data can pinpoint new BU endemic areas, thus providing critical local knowledge for targeted public health interventions to reduce exposure risk and ensure early diagnosis.

microbiology↗

bioRxiv2023

Bringing TB genomics to the clinic: A comprehensive pipeline to predict antimicrobial susceptibility from genomic data, validated and accredited to ISO standards.

BackgroundWhole genome sequencing (WGS) is increasingly contributing to the clinical management of tuberculosis. Whilst the availability of bioinformatic tools for analysis and clinical reporting of Mycobacterium tuberculosis sequence data is improving, However, there remains a need for accessible, flexible bioinformatic tools that can be easily tailored for clinical reporting needs in different settings and are suitable for accreditation to international standards. MethodsWe developed tbtAMR, a flexible yet comprehensive tool for analysis of Mycobacterium tuberculosis genomic data, including inference of phenotypic susceptibility and lineage calling. Validation was undertaken using local and publicly-available real-world data (phenotype and genotype) and synthetic genomic data to determine the appropriate quality control metrics and extensively validate the pipeline for clinical use. FindingstbtAMR accurately predicted lineages and phenotypic susceptibility for first- and second-line drugs, with equivalent computational and predictive performance compared to other bioinformatics tools currently available. tbtAMR is flexible with modifiable criteria to tailor results to users needs. InterpretationThe tbtAMR tool is suitable for use in clinical and public health microbiology laboratory settings, and can be tailored to specific local needs by non-programmers. We have accredited this tool to ISO standards in our laboratory, and it has been implemented for routine reporting of AMR from genomic sequence data in a clinically relevant timeframe. Reporting templates, validation methods and datasets are provided to offer a pathway for laboratories to adopt and seek their own accreditation for this critical test, to improve the management of tuberculosis globally. FundingVictorian Government Department of Health; Australian National Health and Medical Research Council and Medical Research Futures Fund. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed for studies using the search terms: "Mycobacterium tuberculosis", "clinical", "bioinformatics", "genomics", "drug resistance (OR antimicrobial)", published prior to 31st July 2024 without language restrictions (n=258). We considered all studies from this search that used genomics to infer likely drug-resistance in M. tuberculosis. Many of these studies highlight the challenges in making meaningful interpretations from genomic data for the purpose of inferring AMR for clinical applications. Despite the development of bioinformatics tools and compilation of catalogues of resistance conferring mutations, few of these studies directly address the challenges specific to implementation of a whole genome sequencing (WGS) and bioinformatics pipelines to deliver validated and accredited results for use in clinical applications and none provide sustainable solutions. Added value of this studyTo the best of our knowledge, this study is the first to detail practical solutions to challenges to validating and accrediting the routine inference of AMR from WGS data for clinical applications for treatment of M. tuberculosis. We developed, validated and accredited a bioinformatics tool, tbtAMR, which is robust and flexible, using a data-driven approach to inferring resistance, allowing for simple customisation of behaviour on a large collection of in-house data supplemented with publicly available data. Furthermore, we have made this pipeline and the accompanying data available for use by the wider public health community to aid others in implementing similar programs. Consultation with infectious disease clinicians, microbiologists and epidemiologists has allowed us to develop a robust workflow, that encompasses sequencing, analysis, interpretation, reporting, discrepancy resolution and ongoing verification. Implications of all the available evidenceThis study addressed the specific needs of reporting genomic AMR for M. tuberculosis in a clinical and public health laboratory. Furthermore, this work makes available a pipeline and data for laboratories to utilise to implement genomic AMR for M. tuberculosis. Through the use and further development of publicly available and open-source bioinformatics software, we have demonstrated the feasibility of clinical reporting of genomic AMR results for M. tuberculosis in a low-incidence high-income setting. We believe that this work lays the foundation for making reporting of genomic AMR for M. tuberculosis more accessible to public health and reference laboratories in general.

genomics↗

bioRxiv2023

Season of transmission of Ross River/Barmah Forest Virus and Mycobacterium ulcerans closely align in southeastern Australia, supporting mosquitoes as the vector of Buruli ulcer

Ross River Virus and Barmah Forest Virus infections (alphaviruses) have short incubation periods and are transmitted to humans by mosquitoes. Mycobacterium ulcerans infection (Buruli ulcer) has a much longer incubation period and its mode of transmission is contested. We studied the relationship between month of notification of alphavirus infections and Buruli ulcer in the temperate Australian state of Victoria over the six-year period, 2017-2022. Using cross-correlation, a signal processing technique, we found that a five-month temporal shift in month of Buruli ulcer notification provided optimal alignment with month of alphavirus notification. This closely matches the previously determined 5-month Buruli ulcer incubation period. Inferred transmission of both conditions showed coordinated maxima in summer and autumn and coordinated minima in winter and spring. The close alignment in season of transmission of alphavirus infection and Buruli ulcer in Victoria supports mosquitoes as the primary local vector of M. ulcerans.

microbiology↗

bioRxiv2023

A transmission chain linking Mycobacterium ulcerans with Aedes notoscriptus mosquitoes, possums and human Buruli ulcer cases in southeastern Australia

In temperate southeastern Australia over the past two decades there has been a marked progressive increase in human cases of Buruli ulcer, an infection of subcutaneous tissue caused by Mycobacterium ulcerans. Native possums are the major local environmental reservoir of M. ulcerans as they not only develop Buruli lesions but they also shed M. ulcerans in their excreta. However the way humans acquire M. ulcerans from possums has not been determined. Previous case-control studies, insect field surveys and vector competence studies have suggested a role for mosquitoes in M. ulcerans transmission between possums and humans. To explore these links we conducted an extensive, 4-month structured mosquito field survey and four ad hoc field surveys across an area of 350km2 on the Mornington Peninsula, an area endemic for Buruli ulcer to the south of the major metropolitan city of Melbourne. We then compared spatial and temporal patterns of M. ulcerans-positive mosquito occurrence with M. ulcerans-positive possums (established by previous possum excreta surveys) and human Buruli ulcer cases across the region. We used metabarcoding to assess mosquito blood-feeding host preference and to reconstruct M. ulcerans genomes from positive mosquitoes to test epidemiological inferences. We collected 66,325 mosquitoes spanning 26 different species from 180 repeatedly sampled traps over a 4-month period. Culex molestus and Aedes notoscriptus were the dominant species (42% and 35% of trapped mosquitoes, respectively). PCR screening 25% of trapped mosquitoes revealed a significant association between M. ulcerans and Ae. notoscriptus (p<0.0001) with a maximum likelihood estimate (MLE) of 5.88 M. ulcerans positive mosquitoes per 1,000 tested. Using spatial scanning statistics, we also observed significant overlap between clusters of M. ulcerans-positive Ae. notoscriptus, M. ulcerans-positive possum excreta and human Buruli ulcer cases. Metabarcoding analyses of blood-fed Ae. notoscriptus showed individual mosquitoes had fed both on humans and native possums. Enrichment genome sequencing from PCR-positive mosquitoes confirmed shared M. ulcerans genome single-nucleotide polymorphism (SNP) profiles between mosquitoes, possum excreta and clinical human isolates within the same regions. These findings indicate that Ae. notoscriptus likely transmit M. ulcerans in southeastern Australia and highlight mosquito control as a plausible means to control the Buruli ulcer epidemic in our region.

microbiology↗

bioRxiv2022

Structured surveys of Australian native possum excreta predict Buruli ulcer occurrence in humans

Buruli ulcer (BU) is a neglected tropical disease caused by infection of subcutaneous tissue with Mycobacterium ulcerans. BU is commonly reported across rural regions of Central and West Africa but has been increasing dramatically in temperate southeast Australia around the major metropolitan city of Melbourne. Previous research has shown that Australian native possums are reservoirs of M. ulcerans and that they shed the bacteria in their fecal material (excreta). Field surveys show that locales where possums harbor M. ulcerans overlap with human cases of BU, raising the possibility of using possum excreta surveys to predict the risk of disease occurrence in humans. We thus established a highly structured 12-month possum excreta surveillance program across an area of 350 km2 in the Mornington Peninsula area 70 km south of Melbourne, Australia. The primary objective of our study was to assess if M. ulcerans surveillance of possum excreta provided useful information for predicting future human BU case locations. Over two sampling campaigns in summer and winter, we collected 2282 possum excreta specimens of which 11% were PCR positive for M. ulcerans-specific DNA. Using the spatial scanning statistical tool SatScan, we observed non-random, co-correlated clustering of both M. ulcerans positive possum excreta and human BU cases. We next trained a statistical model with the Mornington Peninsula excreta survey data to predict the future likelihood of human BU cases occurring in the region. By observing where human BU cases subsequently occurred, we show that the excreta model performance was superior to a null model trained using the previous years human BU case incidence data (AUC 0.66 vs 0.55). We then used data unseen by the excreta-informed model from a new survey of 661 possum excreta specimens in Geelong, a geographically separate BU endemic area to the southwest of Melbourne, to prospectively predict the location of human BU cases in that region. As for the Mornington Peninsula, the excreta-based BU prediction model outperformed the null model (AUC 0.75 vs 0.50) and pinpointed specific locations in Geelong where interventions could be deployed to interrupt disease spread. This study highlights the One Health nature of BU by confirming a quantitative relationship between possum excreta shedding of M. ulcerans and humans developing BU. The excreta survey-informed modeling we have described will be a powerful tool for efficient targeting of public health responses to stop BU.

microbiology↗

bioRxiv2018

Descriptive analysis in time and space of recorded data for Buruli Ulcer occurrence in Victoria over 22 years

BackgroundBuruli ulcer (BU) is a subcutaneous necrotic infection of the skin caused by Mycobacterium ulcerans. There has been increasing BU incidence in Victoria, Australia. The aim of this study to provide an epidemiological update of BU cases in Victoria to understand the pattern of distribution over time and space and attempt to identify local risk factors.\n\nMethodsA comprehensive descriptive epidemiological analyses were performed on BU notification data from 1994 to 2016. In addition, retrospective temporal, spatial and spatio-temporal analyses were conducted to understand the distribution of cases. Quantum GIS was used to generate maps. Demographic, new housing settlements and historical rainfall data were analysed to assess their effects on BU incidence in Victoria.\n\nFindingsThere were a total of 902 patients notified from 1994-2016. The incidence rate was 0.8/100,000 persons in Victoria. Space and time analyses showed that the most likely disease cluster was the Bellarine and Mornington Peninsulas with incidence rate 50 times higher than the State of Victoria rate. Gender was not a risk factor, but age was, with increased susceptibility among the over 60 year old group. There was an unusual high risk in the 15-24 age group in Point Lonsdale. Correlation analyses indicated that increase in population and construction of new settlements might be some of the reasons contributing to the rise in cases in Victoria.\n\nInterpretationThe findings agreed with published works in Australia of the increase in BU cases in Victoria. However, our findings also highlights the endemic nature of cases. The identified spatial disease clusters could be relevant for future environmental sampling studies or screening tests for M. ulcerans exposure.\n\nAuthor SummaryBuruli ulcer (BU) has been reported in 33 countries, mainly from the Tropics and Sub-tropics. Tropical cases are mainly within the West African region. Australia is the only country outside Africa in the top six highest incidence countries for BU. The exact mode of transmission remains unclear. Disease cases are rising in Australia, especially in Victoria for reasons that remains unclear. We have provided a descriptive epidemiological analyses in space and time of 22 years of recorded data on BU cases in Victoria from 1994 to 2016. We have also discussed demographic and new settlement dynamics over the study period. There were a total of 902 PCR-confirmed BU cases from 245 suburbs. Five suburbs on the Bellarine and Mornington Peninsulas were identified as the most endemic locations in Victoria. Spatial analyses detected a wider disease cluster area on the Peninsulas. We propose environmental sampling for risk factors analyses should focus on the endemic regions and some secondary clusters.

epidemiology↗