Materia Medica Malaysiana

TB returns as No 1 infectious killer disease

Tuberculosis is back as the nation's number one killer among infectious diseases.
This despite all efforts by the Government to reduce the number of Malaysians being infected.
Since the beginning of the new millennium, the number of Malaysians infected by TB has been steadily increasing, with more than 900 deaths reported annually.
In 2000, the Ministry recorded 15,057 TB cases with 942 deaths, followed by 14,830 cases and 942 deaths in 2001, 14,389 cases and 1,035 deaths in 2002, and 15,912 cases with 966 deaths in 2003.
The Ministry foresees some 16,000 new cases each year.
The Health Ministry's Communicable Disease Control Division director, Dr Ramlee Rahmat said: "TB is a leading public health problem worldwide, particularly in developing countries. It's a re-emerging disease which is serious and needs to be tackled urgently."
In 1993, the World Health Organisation declared TB as a global emergency. Of the 1.7 billion people estimated to be infected with the TB bacillus, 1.3 billion live in developing countries.
Currently, it is estimated that there are between 16 and 20 million TB cases worldwide, with eight million new cases every year. Two million of these people die each year.
In the southeast Asian region, nearly three million cases and 700,000 deaths occur every year. Five countries - Bangladesh, India, Indonesia, Myanmar and Thailand - account for 95 per cent of these deaths.
Dr Ramlee said Malaysia was surrounded by countries with a high prevalence of TB and the movement of people was one of the reasons why many Malaysians were being infected.
"The situation is further worsened by the high number of HIV/AIDS patients in the country. They are susceptible to being infected by TB due to their low immunity system," he said, adding that the emergence of multi-drug resistant strains of TB was another worrying factor.
Moreover, tuberculosis is the largest killer of women in Southeast Asia, besides accounting for nearly 40 per cent of all tuberculosis cases.
Deputy Disease Control Division director Dr Nirmal Singh, who is in charge of TB, said it was a chronic disease that needed to be diagnosed early and treated.
"One infected patient can infect an average of 10 to 15 people. Imagine if there were 1,000 people with TB who were not detected. They will infect some 15,000 people," he said, adding the worst source of infection was from lung or pulmonary TB with cough.
"Coughing produces the tiny infectious droplet nuclei. A single cough can produce 3,000 droplet nuclei. Droplet nuclei can also be spread into the air by talking, sneezing, spitting and singing, and can remain suspended for long periods," he said. Many cases remain undiagnosed, primarily due to the failure of the health system to promptly identify and properly treat those who seek help.
Dr Nirmal Singh also said that of the patients diagnosed, many did not complete their six-month treatment unless they were committed or under supervision. Errant patients may then continue to infect others in the community.
He said 90 per cent of Malaysians infected with TB did not show signs and those diagnosed were put on treatment.
"Upon coming across a TB patient, health officials will immediately carry out contact tracing to ascertain that people whom they came into contact with at home, their work place and their social contacts were not infected with the disease."
Malaysia protects its population through primary BCG vaccinations but there are questions raised by health authorities as to whether that protection is lifelong.
Dr Nirmal Singh said TB control activities put in place were BCG vaccinations for all newborn babies, health education, training of healthcare providers on the detection of TB in patients, and the involvement of NGOs and the private sector to fight the re-emerging disease.
The Ministry's target is to reduce the TB incident rate by half or less than 40 cases per 100,000 population, the cure rate to more than 95 per cent, and the death rate less than three per 100,000 population by the year 2010.
TB symptoms are coughing for a period of two weeks, cough with phlegm, fever at night and evening, sweating during the evening, loss of appetite and body weight, chest pains when coughing or during deep breathing, difficulty in breathing and coughing with blood.
Dr Nirmal Singh said TB was treatable and people can recover with proper treatment.