Increase in TB cases major concern in Selangor

November 20, 2012

A man suspected of Tuberculosis

(TBC) does an X-ray at a TBC hospital in Makassar October 23, 2009. Reuters file picSHAH
ALAM, Nov 20 The number of tuberculosis (TB) cases in Selangor has increased compared
with last year, raising fears that the once dreaded disease is back.
State executive councillor in charge of health, estate workers and poverty, Dr Xavier Jayakumar
said from January 1 to November 3 this year, 2,697 cases were reported, a figure that was 307
cases more than what was reported in 2011 for the same period.
From the 2,697 cases, 100 deaths were recorded compared with 95 for the same period last
year, he said when answering a question from Saari Sungib (PAS-Hulu Klang) who wanted to
know the number of TB cases in Selangor.
He said Petaling District registered the highest number of cases with 831, followed by Hulu
Langat (601), Gombak (461), Klang (430), Hulu Selangor (98), Kuala Langat (87), Kuala
Selangor (86), Sepang (52) and Sabak Bernam (52).
Dr Xavier said lack of comprehensive screening of foreign workers who entered the country and
an increase in the number of convicts in the Kajang and Sungai Buloh prisons had also
contributed to the increase.
He added that the placement of inmates from Puspen (drug addicts rehabilitation centre) in
Tampin, Negeri Sembilan to the Puspen in Serendah, Selangor was another contributing factor.
Bernama

By Lee Wei Lian

March 24, 2012
KUALA LUMPUR, March 24 Tuberculosis (TB), Malaysias number one killer among
all infectious diseases, rose seven percent to 20,666 cases last year the health
minister said today.

This is not a good trend, Datuk Seri Liow Tiong Lai said at a press conference following the
launch of World TB Day here.
Liow said that the increase was largely due to an emphasis on early screening for the disease.
He added that while the Multi-Drug Resistant (MDR) strain of TB has made an appearance on
our shores, it was less than two per cent of all cases and there were no cases of Extremely Drug
Resistant (XDR) TB bacteria.
In his speech during the launch, Liow urged those who showed symptoms such as coughing
blood and suffering from night sweats to seek screening for TB as treatment for all
communicable diseases are fully paid for by the government.
The ministry is also working out details for general practitioners (GPs) to become part of the
governments programme to treat TB patients.
Liow said one of the main issues regarding TB eradication was compliance with the treatment
and the ministry was introducing the Directly Observed Treatment (DOT) system to ensure
patients are observed taking the prescribed medication for six months.
He said that the last resort for difficult patients was for the ministry to invoke the quarantine
law although he added that most members of the public were not difficult.
Liow said that TB is one of the top three causes of death among women aged 15 to 44 and also
the number one cause of death among all reported infectious diseases.
More than three quarters of all TB cases occur among Malaysians aged 15 to 54.
Liow said that more than 80 per cent of patients treated for TB eventually recover and his
ministry was targeting a recovery rate of 85 per cent.
The governments target for TB elimination is 2050.
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+9 Vote up Vote down

MainDuaBola 149p 52 weeks ago

TB cases jump 7pc
This is because the Health Minister sleeps.
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yes

0 replies active 52 weeks ago

+11 Vote up Vote down

rakyat selangor 52 weeks ago

How come we are seeing this when we should have eradicate the disease long time
ago . I remember the words of a very prominent government doctor who i know
every well he told me if our country do not control the influx of foreign workers it
will be a matter of time we will see this disease and others coming back . This was
in the mid 80's . I think now the prophecy is coming true . It is not the foreign
workers problem but the way we screen them and allow them to come in in droves .
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0 replies active 52 weeks ago

+12 Vote up Vote down

1Malaysia 52 weeks ago

If I am not mistaken, TB was eradicated or at least it was reduced to almost to

negligible level during the 60s and 70s. It has become a menace once again due to
our failure in adequately managing health risks mainly in the immigrant workers.
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yes

0 replies active 52 weeks ago

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TB screening for long visits to Britain

Tuesday December 18, 2012

KUALA LUMPUR: Travellers from Malaysia going to Britain for more than six months will be
screened for tuberculosis (TB) before they are granted a visa.
The procedure will apply to anyone applying for a British visa from Malaysia, regardless of
nationality.
This ruling takes effect from Dec 31, a statement from the British High Commission here said
yesterday.
Tourists or other visitors going to Britain for less than six months will not be affected.
The British Government decided on this move in countries with a high incidence of TB to tackle the
rise of the disease in Britain.
From Dec 31, all applications for visas longer than six months must be accompanied by a TB
clearance certificate, the statement said, adding that the screening could be done at clinics
nationwide with screening facilities approved by the UK Border Agency.
A list of approved clinics and details on the screening is available on the UK Border Agency website
in Malaysia at www.ukba.homeoffice.gov.uk/countries/malaysia.

Tuberculosis remains among top 10 killer

infectious disease in Sarawak
By LAMAH BAKAR
sarawakstar@thestar.com.my
Monday February 18, 2013

MOST of those who lived through the worst period of tuberculosis (TB) in the 1950s would
remember of the dangers and fear brought about by the disease.
TB, which is caused by the microbe Mycobacterium tuberculosis, was the number one killer in
Malaysia from 1945 to 1957. Even today, it ranks second only to HIV as a leading cause of death
among infectious diseases according to last years World Health Organisation (WHO) Global TB
Report.
There was this advertisement that used to run on national television when I was younger back in the
1980s, which featured a man who kept coughing till he finally spat out blood. I remember how it
scared the daylight out of me because if Im not mistaken, that poor man died in the end.
So when I was diagnosed with TB, I felt like my whole world came crumbling down, said a patient
who wanted to be known only as Azizah.
The 32-year-old mother was actually misdiagnosed for asthma and post partum stress by a
specialist at separate private medical centres in Kuching last April before another later affirmed to
her that she had TB.
Prior to the correct diagnosis, Azizah said she had to endure severe coughing for three months.
She added that her husband, who is in his 40s, was also diagnosed with TB two months after hers.

However, my greatest fear was for my 13-month-old daughter whom I was breastfeeding at the
time. I was worried that she might contract the disease from me. Even today, I still look out for
symptoms on her to see if she has TB. From what I heard, its really difficult to detect the disease in
children, Azizah said.
In Sarawak, there is an average increase of 0.8% of TB cases every year and about 100, or 2%, of
overall annual cases involve children.
The standard TB screening usually comprises tests on sputum and an x-ray examination of the
chest. However, in children, especially those in their pre-schooling years, the diagnosis can be
difficult as they usually cannot produce sputum samples for testing.
Instead, TB examination on children is based on a few factors whether the child has been in
contact with a TB-contaminated sputum, or if the boy or girl exhibits symptoms such as coughing
almost incessantly for more than 21 days and having fever with temperature above 38C for more
than 14 days.
Even today, there is still no accurate benchmark in TB diagnosis and treatment for children as most
available ones do not have a high degree of sensitivity and the drugs used are not really suitable.
Children suspected of having TB are usually given an Isoniazad preventive therapy (IPT) for six
months.
In the past, the rising TB cases in Malaysia had falsely been blamed on the increasing number of
immigrants due to high number of people inflicted with the disease in Indonesia, Thailand and the
Philippines the three countries among 22 with high TB cases.
In fact last year, only 10% of the cases in the country involved foreigners.
The number of cases goes in line with the population. Although there hasnt been any dramatic
increase in detected cases over the years, TB is still among the top ten killers among all infectious
diseases in Sarawak, the state Health director Dr Zulkifli Jantan told The Star when asked to
comment on the matter.
There were 2,000 TB cases reported in 2010 and 2,055 in 2011. Last year, 2,430 were registered, of
which five multi-drug resistant (MDR) cases were recorded.
There is a standard policy that applies to all medical practitioners where a patient with a chronic
cough must be screened for TB, Dr Zulkifli highlighted with regard to misdiagnosis by private
medical practitioners.
He added that although commonly, TB bacteria affected the lungs they could also infect other parts
of the body once they entered the bloodstream. Besides continuous coughing, other symptoms also
included weight loss, night sweating, loss of appetite, high fever and weakness. Dr Zulkifli urged
those who exhibited these symptoms to go for TB screening.

We use up a lot of resources for TB screening but it needs to be done. TB is under the list of
notifiable diseases where all cases must be reported and precautions must be taken immediately,
he said.
The states TB Control Programme operates from the Anti Tuberculosis Association of Sarawak
(Atas) clinic near Jalan Masjid India in Kuching. The programme involves the states Health
Department and the association.
We organise ad hoc campaigns whenever there are cases in a certain area to improve the level of
awareness. We prefer this to big campaigns to avoid dilution of information, the programmes head
assistant director Dr Marilyn Umar said.
The Atas clinic provides free screening and treatment for TB which include consultation, interval Xrays and diagnostics as well as medication for six months all of which can easily cost over
RM1,000 per person at private hospitals.
Under the programme, the usual flow of treatment once a TB case is detected is a patient is asked to
report to Atas clinic.
The infected person is then queried on his or her family medical history and on others in the same
household, who are also advised to go for TB screening. A patients degree of infection is then
assessed for medicinal purpose.
The patient is also asked to come in from time to time for medication refills and general check-up
that includes weighing body mass and checking of sputum samples. On this, proper hygienic
practices like frequent hand washing and good coughing etiquette must be followed.
The infected person is also advised to stay in for the first two weeks of treatment and encouraged to
wear a mask, especially if he or she has to attend to a child. .
TB is generally easy to cure as long as patients stick to the regime of antibiotics for at least six
months. Usually, they report that they start feeling better after one week of medication. This
sometimes lead them to stop the strict antibiotic regime, says Dr Marilyn.
She cautioned that those who did not complete the whole regime would risk developing MDR where
the TB strain would become resistant to Isoniazad and Rifampicin two of the first line of defence
drugs against the disease.
All MDR cases reported in Sarawak are caused by failure of the patients to follow through with the
course of treatment. As a result, these patients are treated with the second line of antibiotics which
they have to go through for another 18 months, Dr Marylin said, adding that MDR TB was just as
infectious as the normal one by air whenever an infected person coughs, sneezes, talks or spits.
She said it required only a small number of TB microbes to get a person become infected.

Not all people who are exposed to these TB bacilli (rod-shaped bacteria) get sick. Those with
healthy immune systems are able to kill off the microbes.
However TB microbes can remain dormant for years once they enter the human body. This means
that a person who begins to show symptoms of infection and later, tested positive for TB may have
been exposed to the bacteria much earlier. It is usually failure of the immune system that leads to
active TB, Dr Zulkifli explained.
It is known that there are a few groups of people who are more at risk contracting TB than others
including smokers; HIV-positive individuals; those who have been on steroid treatment over a
considerable period of time; those with diabetes, high blood pressure and kidney problems; those
with lung problems; and the elderlies.
These people are more at risk as their level of immunity is already very low. Heavy smokers,
especially, are more susceptible to severe TB as their lungs are already damaged from the bad
habit, Dr Zulkifli added.
Despite having been around for years even before the formation of Malaysia, TB somehow is still
misunderstood by many. The social stigma that goes with it stems from the perception that TB is a
disease of the poor and it is hereditary in nature.
Such misconception has even been known to break marriages and cause problems at the
workplace. The sad thing is that in many cases, people refuse to go for screening until it it is too late.
A TB-positive patient who only wanted to be named as Stiefa, said after she was diagnosed with the
disease, people avoided her like the plague.
Some wont answer my phone calls or keep in touch with me over social network, thinking that TB
could spread over the phone lines and Internet, she lamented.
Stiefa was diagnosed with TB just a few days after her wedding.
Some members of my in-law family refused to get screened for TB believing that they were not at
risk. Whats worse is that my husband, who has asthma, still smokes despite all the risks he faces.
The Malaysian Association for the Prevention of TB has been campaigning against such stigma by
educating the public on the disease that it can be cure provided that it is detected early and
patients undergo effective treatment.
This year would be the second running of the two-year campaign in association with the World TB
Day, which falls on March 24 every year.
With the slogan Stop TB In My Lifetime, the campaign aims, among others, to achieve zero death
from TB, universal access to care for the disease and an affective vaccine against it.

For things to improve, accurate and affordable screening of TB at all stages is very much needed,
stressed Dr Zulkifli.

Published: Tuesday October 12, 2010 MYT 9:19:00 PM

Updated: Tuesday October 12, 2010 MYT 9:21:48 PM

17,000 TB cases reported in Malaysia in

2009

PUTRAJAYA: The number of tuberculosis (TB) cases in the country has shown a slight increase
annually, with 17,000 cases reported last year, Health Minister Datuk Seri Liow Tiong Lai said
Tuesday.
He said that of the total, 1,005 patients died while more than 85% completed their treatment.
"There is some slight increase. At one time, we managed to reduce (the number to) very low but it
has come up again," he told a press conference after chairing the second day of the 61st session of
the World Health Organisation (WHO) Regional Committee for the Western Pacific Region meeting
at the Putrajaya International Convention Centre (PICC) here.
"We can actually reduce it further," he added.
Liow said one of the contributing factors to the increasing number of TB cases was the co-infection
between TB and HIV.
He said multidrug-resistant TB was also one of the challenges for the Government in reducing TB
cases in the country, adding that the important thing in curing the disease was to tackle the TB-HIV
co-infection and effective treatment.

Liow said the crucial part in reducing the cases was tracking and following-up with the patient.
Meanwhile, Health Director-General Tan Sri Dr Mohd Ismail Merican said the detection of the cases,
awareness and ensuring the patient complied with the treatment were crucial.
He said counselling was the most important part before the patient started the treatment, to make
sure he got a clear picture of the treatment.
According to the latest WHO estimates, there are approximately 1.9 million TB cases and 260,000
TB deaths each year in the Western Pacific Region. - Bernama

Sunday May 6, 2012

TB outbreak in Johor claims 53 lives this

year
MUAR: A total of 53 people have died of tuberculosis in the state so far this year and the authorities
want those who suffer from prolonged coughing to seek treatment quickly.
State Women, Family, Health and Community Development Committee chairman Dr Robia Kosai
said the disease had been regarded as an outbreak.
As of March, she said 497 cases were reported with 49% involving contagious pulmonary TB which
could spread fast and also cause death.
Last year, we recorded 2,038 cases and 93% of the patients had never contracted or suffered from
TB before.
This year, about 550 cases have been reported and 91% of the cases are new patients with 52%
suffering from pulmonary TB, she said after distributing BR1M aid to 213 villagers in Sungai Balang
yesterday.
Dr Robia said Johor Baru recorded the highest number with 246 cases.
She said two deaths caused by the contagious pulmonary TB had been reported in Muar up to
yesterday.
Those who suffered from coughing for more than two months should undergo checks, she said.
She said diabetic patients and senior citizens were regarded as high-risk groups.