In the fight against an ancient killer, scientists are wielding a powerful new weapon.
Tuberculosis (TB) remains one of humanity's most persistent infectious disease threats, causing an estimated 1.5 million deaths globally each year1 5 . Now, Brazilian scientists are launching an ambitious project in the country's most affected areas, using cutting-edge DNA sequencing technology to track and combat drug-resistant TB strains with unprecedented precision.
Deaths annually from TB worldwide
Complicating treatment and outcomes
Whole-genome sequencing changes the game
Tuberculosis is not a disease of the past. Despite being preventable and curable, it continues to wreak havoc, particularly in vulnerable communities. The situation is especially dire in Brazil's northern and northeastern regions, where economic disparities, limited laboratory capacity, and delayed diagnosis create perfect conditions for TB to spread5 .
The challenge extends beyond standard tuberculosis. Drug-resistant TB (DR-TB) strains have emerged, complicating treatment and worsening outcomes. Patients with DR-TB face grueling treatment regimens using second-line drugs that often cause severe adverse effects, prolong treatment duration, and reduce quality of life2 .
The COVID-19 pandemic demonstrated how rapidly genomic capacity could be scaled up when backed by political will and sustained investment2 . The REVIGET project aims to harness this hard-won capacity and apply it to one of Brazil's most persistent health challenges.
The REVIGET project represents a comprehensive, multi-faceted approach to genomic surveillance. This observational, cross-sectional, prospective study will span 24 months (2024-2026) across selected locations in Brazil's North and Northeast regions5 . The study employs a mixed-methods approach, combining quantitative and qualitative elements to gather both statistical data and practical insights from healthcare professionals1 .
| Location | Region | Primary Role in Study |
|---|---|---|
| Pará (Ananindeua and Belém) | North | Sample collection, processing, capacity building |
| Amazonas (Manaus) | North | Sample collection and processing |
| Ceará (Fortaleza) | Northeast | Sample collection, processing, capacity building |
| Bahia (Salvador) | Northeast | Sample collection, processing, capacity building |
| Rio de Janeiro | Southeast | Reference laboratory for drug susceptibility testing |
At the heart of the REVIGET project lies a sophisticated array of laboratory techniques and bioinformatics tools designed to extract maximum information from each bacterial sample.
Samples are collected after routine diagnostic testing when bacterial samples are archived, following the standard diagnostic workflow of Brazil's Central Laboratories (LACENs)5 .
Unlike targeted approaches that examine limited genetic regions, WGS decodes the entire bacterial genome, enabling comprehensive analysis5 .
Advanced computational tools like TBProfiler and Mykrobe analyze sequencing data to identify resistance mutations and classify lineages2 .
The GEMIBRA platform integrates genomic data with clinical and epidemiological information to visualize transmission patterns and spatial distribution1 .
| Tool | Primary Function | Advantages |
|---|---|---|
| TBProfiler | Resistance prediction, lineage classification | Open-source, regularly updated, suitable for offline use |
| Mykrobe | Resistance detection and lineage classification | User-friendly, actively maintained |
| MTBseq | Comprehensive resistance and phylogenetic analysis | Enables transmission mapping, though computationally intensive |
| PhyResSE | Web-based resistance and lineage analysis | Suitable for well-connected laboratories |
The REVIGET project recognizes that technology alone cannot solve public health challenges. The initiative includes extensive capacity-building activities, including theoretical and hands-on bioinformatics training for healthcare professionals in the North and Northeast regions1 . This decentralized approach ensures that expertise is distributed beyond traditional research centers in major cities.
The project also focuses on developing educational materials—including booklets, books, videos, and apps—to increase awareness about drug-resistant TB among the general public, students, health professionals, and patients5 . By engaging diverse audiences, the project aims to build a comprehensive ecosystem for TB control that extends from the laboratory to the community.
Implementing a genomic surveillance network requires specialized materials and technologies. The REVIGET project utilizes a range of sophisticated reagents and platforms to achieve its objectives.
| Reagent/Platform | Function | Application in REVIGET |
|---|---|---|
| Whole-Genome Sequencing Platforms | Complete decoding of bacterial DNA | Comprehensive strain characterization and transmission tracking |
| Deeplex® Myc-TB Combo Kit | Targeted NGS for resistance markers | Identification of known resistance mutations; requires only 9pg of DNA input |
| GEMIBRA Platform | Data visualization and integration | Mapping transmission patterns, spatial distribution, clinical decision support |
| Culture Media | Mycobacterial growth and isolation | Obtaining viable isolates for sequencing from patient samples |
| Drug Susceptibility Testing Reagents | Phenotypic resistance confirmation | Validating genomic predictions of drug resistance |
Samples are collected after routine diagnostic testing when bacterial samples are archived, following the standard diagnostic workflow of Brazil's Central Laboratories (LACENs)5 .
Unlike targeted approaches that examine limited genetic regions, WGS decodes the entire bacterial genome, enabling comprehensive analysis5 .
Advanced computational tools like TBProfiler and Mykrobe analyze sequencing data to identify resistance mutations and classify lineages2 .
The GEMIBRA platform integrates genomic data with clinical and epidemiological information to visualize transmission patterns and spatial distribution1 .
The REVIGET project represents more than just a research study—it's a transformative approach to public health practice.
By adopting a translational research model, the project facilitates the rapid integration of scientific findings into public health action1 .
The project's networked, decentralized approach provides a blueprint for other resource-limited regions seeking to implement genomic surveillance5 .
By making all data publicly available through repositories like GitHub and Zenodo, the project contributes to global knowledge about tuberculosis evolution and transmission1 .
The project will generate crucial evidence to validate the integration of WGS into Brazil's national TB surveillance system, potentially informing the National Plan to End TB1 .
The implications extend beyond Brazil's borders. By identifying transmission dynamics and emerging resistant strains, the initiative could ultimately help reshape how Brazil and other high-burden countries combat this persistent threat.
The REVIGET initiative represents a paradigm shift in how we approach infectious disease control. By marrying advanced genomics with practical public health interventions, the project offers hope for more targeted, effective TB control strategies.
The project's progress can be followed at www.reviget.org, where findings and updates will be shared with the scientific community and public alike1 .
As the project unfolds over the coming years, its findings may not only transform Brazil's response to tuberculosis but also provide a roadmap for other nations battling similar challenges in resource-constrained settings.
In the relentless fight against tuberculosis, genomic surveillance has emerged as a powerful new ally—and Brazilian scientists are at the forefront of this revolutionary approach.