Tuberculosis Spotlight: Data Should Guide Our Response and Diffuse Alarm
by Dr Shanmuganathan T.V. Ganeson
President of Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM)
The recent tuberculosis (TB) cluster in Kota Tinggi and the reported 10% increase in TB notifications compared to the same period last year have raised understandable public concern.
It is important to clarify that tuberculosis was never eliminated in Malaysia. We remain an intermediate-burden country, like many in our region. An increase in reported cases, especially after active screening of a cluster, does not automatically mean the disease is spreading uncontrollably.
The more important question is: Are we detecting cases early, and are patients completing treatment?
TB spreads through the air during prolonged close contact. It thrives in crowded, poorly ventilated environments, and when diagnosis or treatment is delayed.
Malaysia has an established TB control programme, and treatment is available. However, TB control does not depend on the health sector alone. It also depends on coordination with immigration, labour, housing, and primary care systems.
What the Data Should Tell Us
As noted by Dr Lim Kuan Joo, Advisor to FPMPAM and a former clinician in TB management, notification numbers alone do not tell the full story.
To understand whether this rise is serious, we need to know:
- Are patients being diagnosed early, or only after the disease becomes advanced?
- Are these new infections or relapses from patients who previously defaulted?
- What is the secondary attack rate among close contacts?
- Are treatment completion rates stable?
- Has drug-resistant TB increased?
- Are there more TB cases among children, which would suggest recent transmission?
These indicators help determine whether we are facing improved detection or active transmission.
TB and Undocumented Migrants: A Public Health Issue
There has also been concern about TB among undocumented migrants.
From a public health perspective, infectious diseases do not distinguish legal status. TB control depends on early diagnosis and uninterrupted treatment — for everyone.
If undocumented individuals fear arrest or deportation, they may delay seeking medical care. When diagnosis is delayed, they remain infectious longer. This increases the risk of spreading TB to others and to the world.
If a patient undergoing TB treatment is detained or moved without proper medical coordination, treatment may be interrupted. Interrupted treatment increases the risk of relapse and drug resistance.
For TB control to be effective, policies should ensure:
Safe access to diagnosis and treatment, Uninterrupted therapy, even during detention, Close coordination between health and immigration authorities, Proper screening and follow-up in high-density worker housing.
Addressing TB among undocumented migrants is not about politics. It is about preventing transmission.
Better Integration Between Public and Private Care
Currently, TB treatment, including Directly Observed Therapy (DOTS), is mainly delivered in public clinics. In private clinics, suspected TB cases are referred to government facilities for treatment.
While this system works, there is room to strengthen integration. Malaysia has thousands of private general practitioners who could support continuity of care in a structured and coordinated way.
TB treatment requires months of supervision. Stronger public–private cooperation would help ensure patients do not drop out between diagnosis and completion of therapy.
Moving Forward Tuberculosis does not spread because of one isolated case. It spreads when systems are not fully aligned.
The recent spotlight should not create panic or stigma. Instead, it should encourage better coordination across health, immigration, labour, housing, and primary care systems.
Malaysia has the experience and infrastructure to manage TB effectively. The key is ensuring policies work together, not separately.
