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Background: Australia has among the world's lowest rates of tuberculosis (TB). However, it remains a leading global cause of morbidity and mortality. In Australia, TB remains more common in Indigenous than non-Indigenous Australians, and rates are rising among migrants, reflecting changing immigration patterns and rising rates in their homelands., Objective: This article reviews recent developments in TB of relevance to Australian general practice and provides an update of advances in the diagnosis and management of TB, and the role of the general practitioners in co-managing people with TB., Discussion: First hand experience with imported multidrug resistant TB (MDR-TB) is increasing and is anticipated to rise in Australia. The reach of extensively drug resistant TB is also expanding. Although standard guidelines for management of drug susceptible TB remain unchanged, recent progress in the understanding, diagnosis and management of TB has occurred, driven by the need to respond to the challenges of MDR-TB and HIV-TB co-infection.

The National Notifiable Disease Surveillance System received 1,201 tuberculosis (TB) notifications in 2006, of which 1,142 were new cases and 59 were relapses. The incidence of TB in Australia was 5.8 cases per 100,000 population in 2006 up from 5.3 per 100,000 in 2005, but still below 6 per 100,000 as it has been since 1985. Eighty-five per cent of TB notifications in 2006 were in people born outside Australia. The incidence in people born overseas and Indigenous Australians were 20.7 and 6.6 cases per 100,000 population, respectively. By contrast, the incidence of TB in the non-Indigenous Australian-born population was 0.9 cases per 100,000 population. Household or other close contact was reported as the most common risk factor for TB infection. The number of cases of TB reported in health care workers increased in 2006; these were mostly in health care workers born in TB-endemic countries and there were no reports of TB transmission in Australian health care settings. Outcome data of the 2005 TB cohort indicates that treatment success was attained in more than 95% of cases. Progress towards TB elimination in Australia will rely on continued TB awareness, maintenance of high standards of TB diagnostic and control practices, and promoting regional and global TB control activities.

The National Notifiable Disease Surveillance System received 1,072 tuberculosis (TB) notifications in 2005, of which 1,022 were new cases and 50 were relapses. The incidence of TB in Australia was 5.3 cases per 100,000 population in 2005 and has remained at a stable rate since 1985. The high-incidence groups remain people born overseas and Indigenous Australians at 20.6 and 5.9 cases per 100,000 population, respectively. By contrast, the incidence of TB in the non-Indigenous Australian-born population was 0.8 cases per 100,000 population. Rates in the Australian-born, both Indigenous and non-Indigenous have been declining since 1991, while rates in the overseas-born have been increasing. TB control in Australia relies on pre-migration screening and provision of free and effective treatment.

The National Notifiable Disease Surveillance System (NNDSS) received 982 tuberculosis (TB) notifications in 2003, of which 947 were new cases, 33 were relapses and two were cases with unknown history. The incidence of TB in Australia has remained at a stable rate since 1985 and was 4.9 cases per 100,000 population in 2003. The high-incidence groups remain people born overseas and Indigenous Australians at 19.9 and 8.7 cases per 100,000 population, respectively. By contrast the incidence in non-Indigenous Australians was 0.9 per 100,000. Comparison of the 2003 TB notification data against the performance indicators set by National Tuberculosis Advisory Committee highlights that enhanced TB control measures should be considered among these high-risk groups.

In 2002, there were 1,028 cases of tuberculosis (TB) reported to the National Notifiable Disease Surveillance System, of which 997 were new cases, 30 were relapses and 1 unknown. The incidence rate of TB in Australia in 2002 was 5.2 cases per 100,000 population. The highest incidence of TB was reported in people born overseas (20.2 cases per 100,000 population), followed by Indigenous Australians (8.5 cases per 100,000 population). By contrast, the incidence rate of TB in the nonIndigenous Australian-born population was 1.1 cases per 100,000 population. This pattern of TB incidence rates amongst the sub-populations of Australia has been observed for over 10 years. The rates were evaluated against the performance indicators set by the National Tuberculosis Advisory Committee to ensure that Australia's record of TB control is maintained and improved.

In 2001, there were 997 cases of tuberculosis (TB) reported to the National Notifiable Diseases Surveillance System, of which, 967 were new cases of TB and 30 cases were relapses. The incidence rate of TB in Australia in 2001 was 5.1 cases per 100,000 population. The highest incidence of TB was reported in people born overseas (19.3 cases per 100,000 population), followed by Indigenous Australians (9.8 cases per 100,000 population). In contrast, the incidence rate of TB in the non-Indigenous Australian-born population was 1.0 cases per 100,000 population. This pattern of TB incidence rates amongst the sub-populations of Australia has been observed for over 10 years. Eighty-six per cent of TB cases completed treatment in 2001. Treatment was unsuccessful in 7 cases and only 22 cases defaulted. The National Tuberculosis Advisory Committee has published a National Strategic Plan with performance indicators to ensure that this enviable record of TB control is maintained and improved.

Australia has one of the lowest incidence of tuberculosis in the world. The crude annual notification rate for tuberculosis (TB) has remained stable at between 5 and 6 per 100,000 population since 1991. In 1999, there were a total of 1,159 TB notifications in Australia of which 1,117 were new TB cases, and 42 were relapsed cases. The corresponding annual notification rate for new and relapsed TB was 5.9 and 0.2 per 100,000 population respectively. People born overseas accounted for 83 per cent of the notified cases. TB notification rates remain highest among overseas-born residents from high prevalence countries, and indigenous Australians. The lowest rates of disease are in the non-indigenous, Australian born population and data from the last 7 years indicate that the rate of tuberculosis in this population is continuing to fall.

Since the inception of the National Mycobacterial Surveillance System (NMSS) in 1991, annual crude notification rates for tuberculosis have remained stable at between 5 and 6 per 100,000 population. In 1998, there was a total of 923 TB notifications in Australia of which 884 were new TB cases, and 39 relapsed cases. The corresponding annual crude notification rate for new and relapsed TB was 4.72 and 0.21 per 100,000 respectively. Seventy-seven percent of notifications that had a country of birth reported were overseas born. In keeping with trends observed over recent reporting years, the populations for which notified TB rates are highest include the overseas born from high prevalence countries and Indigenous Australians. The lowest rates of disease have continued to be reported in the non-Indigenous, Australian born population. Surveillance reports over the last seven years indicate that the rate of disease in this population is gradually declining.

Aborigines have higher rates of Mycobacterium tuberculosis than the rest of the community. There are insufficient contemporary data to assess how much risk tuberculosis poses to the Aboriginal community. Tuberculosis is of particular concern because of its interaction with human immuno-deficiency virus (HIV). We aimed to ascertain the available data about tuberculosis in Australian Aborigines: to determine morbidity and mortality of tuberculosis in Australian Aborigines, to ascertain the extent of known risk factors for tuberculosis in Australian Aborigines and to consider the public health implications of our findings. Sparse evidence suggests that Aborigines have higher rates of infection and of clinical tuberculosis than non-Aboriginal Australians, along with a high prevalence of known risk factors for tuberculosis. However, there is a paucity of data about specific risk factors and tuberculosis in Aborigines. In addition, Aborigines have a high prevalence of risk factors for HIV infection. The existence of concurrent risk factors for tuberculosis and HIV, in a population that already has a high rate of infection with tuberculosis is cause for grave concern. Tuberculosis control is centred on correct and rapid diagnosis and appropriate treatment, as well as efficient contact tracing. These are the most important strategies for control of tuberculosis among Aborigines, and are especially important when there is concurrence of other risk factors. Appropriate preventive therapy for infected people should also be considered.

In Papua New Guinea the slow acetylator phenotype is unusual and peripheral neuropathy during isoniazid therapy is uncommon. Acetylator status and other factors influencing isoniazid-induced peripheral neuropathy are discussed, and statistics from Papua New Guinea are presented. The relevance of acetylator phenotype to other side-effects of isoniazid is less well defined. Prophylactic pyridoxine supplementation during short-course chemotherapy for tuberculosis is not generally necessary in the daily 'A' regimen, but should be maintained in the twice-weekly (high-dose isoniazid) 'B' regimen for adults and children over 20 kg.