Tuberculosis in Malaysia: Disease timeline, epidemiology, control initiatives and outlook

In Malaysia, tuberculosis remains a public health problem despite initiatives in disease control and prevention. This review explores the timeline of pulmonary tuberculosis (PTB) in Malaysia, epidemiology, management and outlook of the disease in the country. PTB was first reported in Malaya in the early 20th century and caused high morbidity and mortality. With the establishment of the National TB Control Programme in 1961 and chest clinics in every state general hospital, mortality was successfully reduced. Nonetheless, PTB incidence rate increased steadily after 2011, and Malaysia is currently an endemic country for the disease. Diagnosis for PTB is performed according to the Ministry of Health's Clinical Practice Guidelines which include chest X-ray, sputum culture and antibiotic susceptibility testing. Patients are treated according to WHO guidelines. While the country has seen a 0.02% decrease in drug-resistant cases in recent years; two cases of extensively drug-resistant tuberculosis have been reported. All major Mycobacterium tuberculosis lineages (Indo-Oceanic; East-Asian (including Beijing), East-African-Indian and Euro-American) have been reported in the country. The Beijing family of strains were found to have a higher prevalence in Peninsular Malaysia compared with Sabah and Sarawak, suggesting divergence of pathogen evolution between the two locations. Most antibiotic-resistant strains were found to harbour mutations in rpoB, katG, embB and pncA. Increasing usage of molecular platforms and artificial intelligence in diagnostics, apps and alert systems for better surveillance, and implementation of universal coverage in terms of treatment will be important for the country to achieve a tuberculosis-free status in 2035.