TB is not just a history lesson – but it is curable and controllable

WHEN we hear the word "tuberculosis" (TB), many of us picture a scene from a B&W movie, a sickly character coughing into a handkerchief in a crowded, dinghy room. We like to think of it as a disease of the past, something our grandparents worried about.

But the Feb 5, 2026, announcement that a TB cluster had emerged in Kota Tinggi, Johor, has reminded us that the disease is still very much present. Among the 33 cases were six schoolchildren.

As a paediatrician, I foresee the anxiety this news could create. I’m sure parents will be wondering, is my child safe at school, should I keep them home? The fear is real, but let’s replace that with power – the power of understanding.

It’s usually not ‘kid to kid’

Since Covid-19, I think the most terrifying headline for a parent is "Outbreak in school". We immediately imagine a classroom where one sick child infects the whole row.

Here is the scientific reassurance you need: TB in children is very different from TB in adults. Children are often what we call "paucibacillary" – they carry a much smaller load of bacteria. Unlike adults, young children rarely have the lung force to cough up infectious phlegm deep from their chests. This means that in the vast majority of cases, children do not spread TB to other children.

Almost every time we find a child with TB, we find an adult in their close circle – a parent, a grandparent, a caregiver – who has been coughing for months. The child is the victim, not the vector. The recent cases in Johor were detected through contact tracing, which means the health authorities were doing their job: finding the adults, and then checking the kids.

It’s not always a cough

If you are waiting for your child to cough up blood before you worry, you are waiting too long. In children, TB is a master of disguise. It doesn’t always attack the lungs loud and clear.

Parents should be vigilant for these subtler signs:

> The “static” weight: If your child is eating well but not gaining weight, or worse, losing it, please take note. Seek medical advice.

> The lost spark: Is your active child suddenly lethargic? Does he/she stop playing earlier than usual? A child who is "too tired to play" is a red flag.

> The mystery fever: A low-grade fever that comes and goes for more than two weeks, without a runny nose or flu symptoms.

> The lumps and bumps: Swollen glands, particularly around the neck (cervical lymphadenopathy), that don’t go away with standard antibiotics.

The BCG shield – it’s a helmet, not a force field

"But Doctor, my child has the BCG scar! Isn’t she immune?"

I hear this often. The BCG vaccine, that little scar on the left arm most Malaysians have, is a miracle of public health. But we must be realistic about what it does.

Think of BCG as a helmet. It protects the brain. It is excellent at preventing the most deadly forms of TB in babies, like TB meningitis (infection of the brain) or miliary TB (disseminated infection). Without BCG, these conditions would be fatal.

However, like a helmet, the vaccine doesn’t stop you from getting "bruised". It does not fully prevent TB in the lungs. A vaccinated child can still get pulmonary TB if exposed to a heavy load of bacteria. Do not let that scar make you complacent.

When to seek help

The stigma of TB is our enemy. I have seen families hide a diagnosis because they are ashamed, only to infect their own children and grandchildren.

If there is an adult in your house with a cough that has lasted more than two weeks, especially with night sweats or weight loss, take them to a Klinik Kesihatan immediately. It might just be a smoker’s cough, but if it is TB, treating that adult is the single best way to protect the rest of your family, especially your children.

If your child has been identified as a "close contact" by the Health Department, please let the officers do their work. They may need to do a skin test (the Mantoux test) or a chest X-ray. If the doctors suggest a course of preventive antibiotics (prophylaxis), take it. It is not a punishment; it is a shield.

The bottom line

The cases in Johor are under control. The students are being treated, and they will recover. TB is fully curable, even in children.

Just let them be a reminder that TB is still living among us. It thrives in silence and stigma. We defeat it not by closing schools, but by opening our eyes. Malaysia has a robust TB control programme with established school and contact screening protocols. Watch for the signs, check your own cough, and trust the science.

DR NAVEEN NAI GANGADARAN

Paediatrician

Seremban