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WHEN news emerged of a tuberculosis (TB) cluster involving several children in Johor, many were shocked.

Tuberculosis sounds like a disease from another era — something our country should have eliminated long ago.

The truth is more concerning. Recent national updates from the Health Ministry confirm that TB remains a significant public health threat. It has never truly disappeared.

Instead, it has continued spreading quietly within communities, only becoming visible when clusters grow large enough to attract attention.

TB is an airborne disease. It spreads through microscopic droplets when an infected person coughs, sneezes, laughs, or even speaks. One untreated individual can expose many others without anyone realising it. Children, the elderly, and people with weakened immunity are particularly vulnerable.

Despite ongoing efforts, Malaysia’s TB control strategy still has critical gaps — especially in enforcement and early detection.

Malaysia currently relies on the Prevention and Control of Infectious Diseases Act 1988 to manage infectious diseases. While this law allows action against confirmed cases, there remains a grey area when close contacts refuse screening.

Individuals exposed to TB may carry the infection without symptoms. If they decline testing, public health authorities have limited power to compel compliance.

This is not merely an individual choice. It is a public health risk. Stronger legal authority is needed.

Amendments should allow firmer enforcement for high-risk contacts who refuse screening, including meaningful financial penalties, court-ordered medical evaluation, and clear legal consequences when individuals knowingly place others at risk.

Such measures are not about punishment — they are about protecting communities. Equally urgent is improving how we detect TB.

Traditional screening methods can miss latent TB, where a person carries the bacteria but shows no symptoms.

More accurate blood tests, such as Interferon-Gamma Release Assays (IGRA), are available but remain costly and underutilised.

If Malaysia is serious about TB elimination, access to these tests must be expanded nationwide.

This issue becomes particularly important in migrant worker health programmes. Mandatory IGRA testing should be implemented as part of entrance medical screening for all migrant workers entering Malaysia, followed by regular yearly screening throughout their employment period.

Early detection allows prompt treatment, reducing the risk of transmission in workplaces, dormitories, and communities.

If screening identifies workers suspected of TB infection — including latent disease — treatment should be compulsory under medical supervision.

Individuals who refuse treatment or continue to pose a public health risk should not be permitted to remain employed in Malaysia, and repatriation may need to be considered in accordance with national policies.

Protecting public health must remain the priority, while ensuring humane and ethical management of affected workers.

Tuberculosis control is not just a medical challenge. It is a policy challenge. A legal challenge. A national responsibility.

History has shown that infectious diseases do not disappear through complacency. They retreat only when nations act decisively, combining science, law, and political will.

The Johor cluster is not just news. It is a warning. We must respond by taking bold reforms that prevent the next outbreak before it begins.

Dr Muhammad Ikhwan Mud Shukri

The views expressed here are the views of the writer and do not necessarily reflect those of the Daily Express. If you have something to share, write to us at: Forum@dailyexpress.com.my