Tuberculosis has come under the spotlight in Malaysia recently, with reports of 10 active TB clusters in the country. In the first six weeks of 2026 alone, 3,161 cases were recorded across all states – a 10% increase from last year.
As health experts advise caution in crowded, poorly ventilated spaces in this period of increased social interaction during Chinese New Year and Ramadan, public concern has intensified. Some Singaporeans are even questioning if it’s safe to visit Malaysia.
The anxiety is visible in online comments: “Is this Covid 2.0?” “Another MCO coming?” “Will we all have to get vaccinated?” And there’s the inevitable misinformation: TB cases were falsely linked on social media to Covid-19 vaccinations.
Some experts believe there may not be a “surge” as headlines suggest. As counterintuitive as it may seem, the higher numbers could even be positive, reflecting better case detection.
TB is a “slow-burn” disease requiring prolonged exposure for infection and weeks or months for symptoms to show (if at all). It’s a very different disease from Covid-19 and flu, which are highly contagious, with symptoms appearing rapidly, even in hours.
As TB spreads so slowly, tracking transmission chains is difficult. A “surge” may date back months. People can carry latent TB for years before it becomes active. With a long incubation and an available cure, TB is more a slow-motion public health challenge than an emergency. But it is still a critical one.
The recent clusters could signify a genuine increase in cases, or they may reflect improvements in case detection and control, explains Prof Dr Helmy Hazmi, an epidemiologist with Universiti Malaysia Sarawak.
The Health Ministry has recently strengthened detection efforts, actively tracing and screening close contacts of cases to break transmission chains.
In the recent cluster in Johor for example, 804 close contacts were screened, yielding 37 cases (as of Feb 7, 2026), including 29 children. The index case was a 72-year-old female religious teacher. Speaking and reciting can increase dispersion of the bacterium, Dr Helmy notes.
He says TB incidence appears to be relatively stable in Malaysia in recent years, although high.
Incidence dipped in 2021, due to Covid-19 disrupting healthcare services and causing underreporting, followed by a rebound as “missed” cases got detected, with 26,781 cases reported in 2023. Estimates by the World Health Organisation, which aim to show the true burden and account for gaps in detection, show higher figures, yet no real surge. Estimated TB deaths, however, are rising.
Death rates are particularly high in Kuala Lumpur, Sabah, and Sarawak. In 2024, TB mortality in Sabah and Sarawak was roughly double the national average.
In Sarawak, this was due to a “cascade of delayed detection, access barriers, interrupted treatment, and sustaining long-term follow-up” says Dr Helmy. Access to healthcare in that state can even depend on the tides and boat availability.
Dr Helmy says that, frankly, we are lagging in several areas (against 2015 targets set in 2015), and he calls for intensified efforts in detection, screening, and hotspot areas.
Universiti Kebangsaan Malaysia public health specialist Prof Dr Sharifa Ezat Wan Puteh says post-Covid-19, many families faced financial hardship and malnutrition. Along with overcrowding and poor healthcare access, this can fuel TB. She calls for identifying and screening people at high risk to detect more cases.
Sabah, which bears the highest burden of TB, has deeply entrenched poverty – in 2022, the rate was 20%. Other issues are resource strain and access to care, especially in the interior, and overcrowding in respiratory wards.
Poor awareness is a major problem nationwide. Welcoming the coverage on TB, one Klang Valley clinician highlighted the tragic outcomes of poor awareness. He routinely sees “nightmare cases” of young patients who come in at a very late stage of TB.
“By the time they come to us, their lungs are severely scarred and damaged. They’re ‘respiratory cripples’.” They won’t be recorded as dying from TB, but their life expectancy is lower and burden of illness is heavy, impacting their families as they cannot fully perform. Moreover, they may be infecting others if they live in high-density settings, such as a dorm or asrama.
The clinician says TB is “a disease of the underprivileged”, with many cases among the B40 (lower income) group, and also drug users, prisoners, and smokers. Foreigners make up 15% of cases.
Critical to combating TB is “good cough hygiene”.
“If you are coughing a lot, you should excuse yourself from public spaces, try not to be in enclosed places, or if you have to be out, wear a mask. If you have been coughing for two weeks, you need to see a doctor,” the clinician says.
While many illnesses cause coughing, signs for TB are prolonged fever, night sweats, and loss of appetite. Patients with advanced cases have an emaciated look.
Dr Helmy says latent TB can be triggered by reduced immune function, including from chronic diseases. Our high diabetes prevalence and ageing society may lead to a rising TB burden.
It is a profound moral failure that despite there being a cure since the 1950s, the world’s oldest and deadliest infectious disease still kills so many. TB persists not because of the bacterium itself, but because we fail to adequately address the conditions that allow its spread. Far more needs to be done to curb this preventable tragedy.
