Latent cases may disrupt nation's plan to become TB-free

01 Dec 2023 09:44am
Image for illustrative purposes - FILE PIX
Image for illustrative purposes - FILE PIX
KUALA LUMPUR - A fortnight ago, social media was abuzz with stories about a tuberculosis (TB) outbreak in Cheras, sparking concern among the public.

Health Minister Dr Zaliha Mustafa promptly dismissed it as fake news and stressed that although "tuberculosis does exist, it is under control” in Malaysia.

The public concern was understandable as the World Health Organisation (WHO) was reported as saying that globally TB cases are on the rise again after years of recording a decline.

WHO, which envisions a world free of TB by 2035, estimated that the number of deaths due to TB rose by 14 percent over a two-year period to 1.6 million in 2021.

It was reported one of the reasons for the increase was the COVID-19 pandemic which disrupted access to TB diagnosis and treatment.

Malaysia too is seeing a hike in TB cases with 25,391 cases reported in 2022, which is 17 percent higher than the 21,727 cases registered in 2021.

The Ministry of Health (MOH) has adopted various approaches, including developing the National Strategic Plan to End TB (2021-2030), to ensure the nation remains aligned with WHO targets.

With 12 years remaining before the 2035 target of a TB-free world is realised, the recent increase in TB infections does raise a question or two about Malaysia’s ability to attain the WHO goal within the set timeframe.

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Commenting on this, MOH public health medicine expert Dr Asmah Razali said one of the main threats in MOH and the public’s efforts in eradicating TB is latent infections.

Latent TB occurs when the bacteria causing the infection - Mycobacterium tuberculosis (M. tuberculosis) - lives in a person’s body without making them feel ill.

"This is why under our National Strategic Plan to End TB, we’re emphasising the principles of scanning, screening and prevention as part of efforts to curb the spread of the TB bacteria in Malaysia,” Dr Asmah, who is attached to the TB/Leprosy Sector at the Disease Control Division, MOH, said during an interview on the talk show Ruang Bicara aired on Bernama TV on Monday.

She said latent TB cases can only be detected via screening as most of them do not show symptoms of the disease despite being carriers of M. tuberculosis as their immune systems are still strong.

WHO defines latent TB as a state of persistent immune response to stimulation by M. tuberculosis antigens without evidence of clinically manifested active TB.

According to Dr Asmah, the TB germs can remain in the human body in a dormant state or inactive phase for many years.

However, after a certain period, the bacteria will become active, triggered by factors such as advancing age, presence of other diseases or being HIV-positive. This is when the patient will begin to show symptoms which include a persistent cough lasting over two weeks, fever in the evenings, chills, fatigue and sudden weight loss.

Dr Asmah said as a short-term solution, MOH is conducting screening sessions at certain locations such as detention centres and prisons - which are potential hotbeds for the spread of infectious diseases - to detect latent TB cases.

The longer it takes for a patient to seek treatment, the higher the risk of them spreading the disease to others, she added.

Once a case is confirmed as TB, MOH will proceed to screen close contacts including family members who had interactions with the index case to prevent further transmission.

On the number of deaths caused by TB, Dr Asmah said 2,408 cases were reported this year as of Nov 11.


She also said contrary to talk that the re-entry of foreign workers into Malaysia is the reason behind the rise in TB cases, MOH data indicated that only 15 percent of the TB cases confirmed last year involved foreign nationals.

"Foreign workers entering the nation legally are required to go through a pre-entry screening process conducted by Fomema (an agency appointed by the government to assist MOH in the monitoring and supervision of the health screening of all legal foreign workers). This screening is carried out before they enter Malaysia and as soon as they arrive here.

"If they are suspected of having TB or any other infectious disease, they will be sent back to their homeland. What we are worried about are migrant workers that enter the country illegally as we are not aware of their health status. And, if they have TB and freely interact with the local community, they can contribute to the spread of TB in certain localities,” she said.

Dr Asmah also urged individuals diagnosed with TB to continue their treatment for at least six months even if they feel well.

She said the failure to seek treatment or discontinuation of treatment can lead to the TB bacteria becoming dormant or resistant to anti-TB drugs. When this occurs, it will not only endanger the patient but also the health of the people around them.

"Action can be taken against patients who stop or refuse to continue their treatment under the Prevention and Control of Infectious Diseases Act 1988. MOH will seek and track down those who abandon their treatment,” she said.


MOH previously established the MyChampion - Community Health Agent programme, a volunteer initiative, to help track down TB patients who discontinue their treatment.

The TB bacteria usually attack the lungs but can, through the bloodstream, affect other parts of the body including the bones, brain and eyes.

Public health medicine expert and epidemiologist Datuk Dr Zainal Ariffin Omar, meanwhile, said the responsibility for addressing TB should not be placed solely on the shoulders of MOH if the nation aims to fulfill the WHO’s aspiration of achieving TB-free status by 2035, pointing out that "all parties must play a role to realise the goal”.

He said the public, on their part, can control the spread of TB by adhering to the COVID-19 standard operating procedures (SOPs) such as wearing face masks in public places and avoiding crowded areas. This is because just like the COVID-19 virus, the TB bacteria are transmitted through the air and saliva.

"TB patients must be considerate and isolate themselves as well as avoid gatherings and minimise interactions with other people. They must also follow the prescribed treatment regime,” he said.

According to Dr Zainal Ariffin, providing BCG immunisation to newborns offers up to 80 percent protection against tuberculosis meningitis through the stimulation of the baby’s immune system.

"Employers are also reminded to provide a clean and non-crowded environment not only for their local workforce but also for foreign workers,” he added - BERNAMA

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