the clinical laboratory, will act to build capacity at national and international levels, which is essential for the elimination of TB in low- and high-incidence settings. In conclusion, genomics stands to significantly enhance TB elimination efforts through direct and indirect routes. When combined with the framework’s recommended interventions, we believe WGS has the potential to accelerate progress towards TB elimination in low-incidence countries, with the knowledge gained in these settings working to support the final priority action area, thereby informing TB prevention, care, and control in countries with a high burden of disease. @ERSpublications Genomics can aid TB elimination in low-incidence settings via enhanced epidemiology and rapid resistance prediction http://ow.ly/TkPWS Jennifer L. Guthrie 1 and Jennifer L. Gardy 1,2 1 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. 2 Communicable Disease Prevention and Control Services, British ColumbiaCentre for Disease Control, BC, Vancouver, Canada. Correspondence: Jennifer L. Guthrie, 2206 E Mall, Vancouver, BC, V6T 1Z9, Canada. Email: jennifer.guthrie@alumni.ubc.ca Received: May 19 2015 | Accepted: June 30 2015 Conflict of interest: Disclosures can be found alongside the online version of this article at erj.ersjournals.com References 1 Lönnroth K, Migliori GB, Abubakar I, et al. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45: 928–952. 2 World Health Organization 67th World Health Assembly. Draft global strategy and targets for tuberculosis prevention, care and control after 2015. Report No: A67/11. Geneva, World Health Organization, 2014. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_11-en.pdf 3 Wlodarska M, Johnston JC, Gardy JL, et al. A microbiological revolution meets an ancient disease: improving the management of tuberculosis with genomics. Clin Microbiol Rev 2015; 28: 523–539. 4 Galagan JE. Genomic insights into tuberculosis. Nat Rev Genet 2014; 15: 307–320. 5 Hodkinson BP, Grice EA. Next-generation sequencing: a review of technologies and tools for wound microbiome research. Adv Wound Care 2015; 4: 50–58. 6 Gardy J, Loman N, Underwood A, et al. ABPHM15 EtherPad Archive figshare. http://dx.doi.org/10.6084/m9. figshare.1408783 Date last updated: May 9, 2015. Date last accessed: May 17, 2015. 7 Louw GE, Warren RM, Gey van Pittius NC, et al. A balancing act: efflux/influx in mycobacterial drug resistance. Antimicrob Agents Chemother 2009; 53: 3181–3189. 8 Köser CU, Bryant JM, Becq J, et al. Whole-Genome Sequencing for Rapid Susceptibility Testing of M. tuberculosis. N Engl J Med 2013; 369: 290–292. 9 Wlodarska M, Johnston JC, Gardy JL, et al. A microbiological revolution meets an ancient disease: improving the management of tuberculosis with genomics. Clin Microbiol Rev 2015; 28: 523–539. Eur Respir J 2015; 46: 1840–1841 | DOI: 10.1183/13993003.00788-2015 | Copyright ©ERS 2015 From the authors: We read with interest the correspondence by J.L. Guthrie and J.L. Gardy, which discussed the role of whole genome sequencing (WGS) in tuberculosis (TB) elimination based on the recently published World Health Organization (WHO) article [1]. The WHO document [1] focused on the priority interventions that should be applied by countries aiming to achieve TB pre-elimination (i.e. TB incidence <10 cases per million inhabitants) and elimination (i.e. TB incidence <1 case per million inhabitants) [1, 2]. The TB elimination strategy is expected to be initially adopted by low-TB incidence countries where the circulation of Mycobacterium tuberculosis strains is lower when compared to that observed in middle- and high-TB incidence countries. On this basis, the WGS can represent an important clinical and public health tool, whose effectiveness was preliminarily demonstrated; although more operational research is needed to assess the feasibility and the potential impact of this technique. As pointed out by J.L. Guthrie and J.L. Gardy the WGS might play a crucial role in the identification of genomic strains’ similarities and, then, in the true recognition of transmission dynamics in outbreaks. Tracking in-country and cross-border outbreaks by next generation sequencing can improve the identification of unsuspected transmissions allowing proper action to be taken. The recently issued WHO guidelines on the programmatic management of latent TB infection (LTBI) raised the issue of the current diagnostic gaps for both LTBI and TB diseases, which could be filled by modern, rapid, and easy-to-use molecular- and biomarker-based techniques [3]. 1841