TB ­– a ticking time bomb?

PETALING JAYA: While much attention has been given to Covid-19 over the past few years, the re-emergence of “forgotten diseases” such as tuberculosis (TB) should be a cause for concern, say medical experts.

The re-emergence of TB, they believe, is due to several factors, such as infected people not seeking treatment and possibly the high presence of foreign workers.

Universiti Kebangsaan Malaysia’s community health expert Prof Dr Sharifa Ezat Wan Puteh said those who are infected may not have sought treatment, causing the spread of the disease.

“TB has a long duration of treatment, sometimes up to six months,” she said when contacted.

TB is regulated by the Prevention and Control of Infectious Diseases Act 1988 (Act 342) and patients can be penalised for failing to comply with the requirement for treatment.

Prof Sharifa Ezat said people may be infected but appear to be well until their immune system deteriorates due to old age or illnesses such as diabetes. In such cases, the TB may flare up.“Children may get it from other sources, usually other people. They can end up with bad infections too, like pneumonia,” she said.

She added that people may also develop multi-drug resistant TB if they don’t seek proper treatment.

“Sometimes due to not finishing the course of treatment, TB flares up again.

“By then, the old treatment doesn’t work anymore, so TB bugs become resistant to the old treatment. More expensive drugs would then be needed,” she said.

Fomema’s health screening system is effective in preventing the entry of infectious diseases through foreigners, she said.

That being said, there may be gaps that must be addressed, Prof Sharifa Ezat stressed.

“Our Fomema screening is definitely quite strict, so whatever disease a migrant worker has, it may only become apparent later on.

“This could be due to the disease being in its window period. Hence, it would be undetectable.

“So, in TB cases too, there might be a time phase called latent TB where the usual customary tests may yield a very low or no response although the person may be a carrier.

“Now, these are screened workers, so you can imagine the situation if they (are) combined with those who do not undergo proper medical screening and refugees who enter Malaysia.”

She noted that migrant workers in Malaysia mostly originate from Indonesia, Bangladesh, Myanmar, Nepal and other Asian countries in smaller numbers such as India, Cambodia and Laos.

“Most of these countries have a high burden of infectious diseases, including TB,” she said.

She proposed effective screening procedures for infectious diseases to cover not only legal migrant workers but also refugees and illegal migrants.

Malaysian Medical Association president Dr Azizan Abdul Aziz said numerous cases of communicable diseases among foreign workers have been detected despite the requirement for them to undergo pre-departure medical screening in their country of origin.

“The issue at the moment is that there is no standard health screening at source countries.

“Some migrant workers who pass the screening at their source countries fail the Fomema screening here when they arrive.

“We do not have the data on TB among undocumented migrants.

“However, it is alarming that 6,413 cases of TB were detected among legal entries of foreign workers in 2023, as confirmed in data provided by Fomema,” she added.

Public health expert Datuk Dr Zainal Ariffin Omar said TB is still very much around in society, adding that the prevalence of latent TB among citizens and non-citizens alike is worrying.

Besides foreign workers, refugees too should be screened for any possible diseases, the former health ministry official added. - Star