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THE emergence of a tuberculosis (TB) cluster in Kota Tinggi, Johor, involving an elderly woman and dozens of subsequent infections should be taken as a stark “wake-up call” that the disease can spread silently in any community, including rural areas, Health Minister Datuk Seri Dr Dzulkefly Ahmad said on Tuesday.
Referring to the case in Parliament, Dr Dzulkefly said the incident demonstrated that TB transmission remains a real risk wherever individuals are exposed to the airborne bacterium mycobacterium tuberculosis.
“This is a case that serves as a wake-up call that jolts us. What we can say is that this is the re-emergence of an infectious disease,” he said.
He explained that the index case, identified on Jan 25, involved a 72-year-old woman who taught Quranic classes and had close contact with children from various backgrounds.
“What happened on Jan 25, the index case cluster was a 72-year-old elderly woman who was a Quran teacher. Moreover, she dealt with children among her students from various groups,” he said.
“As a result, by Feb 7, there were 37 cases involving 29 children and eight adults. Of the 37 cases, 36 were detected actively, meaning our health enforcement teams went to the ground to conduct contact tracing. From the screening conducted, 903 close contacts were identified and underwent TB screening,” he added.
Dr Dzulkefly, who is also the Kuala Selangor MP, was responding to a supplementary question from Suhaizan Kaiat (PH-Pulai), who sought details on how a TB cluster could emerge in a non-urban setting.
Addressing that concern, the minister said TB outbreaks were not confined to crowded or high-density locations.
“Why Kota Tinggi? A place that is not busy, that is where we need to pay attention. When a case is rather unique, we study why the index case occurred and so on. It is actually related to immunity, so it can happen anywhere and to anyone,” he said.
“We may be exposed to the microbacteria, but it happens silently. However, when something happens to our body, where immunity drops drastically, the microbacteria will flare up, and that is when a case of TB occurs,” he added.
Dr Dzulkefly also addressed a supplementary question from Datuk Dr Ahmad Yunus Hairi (PN-Kuala Langat), who asked whether TB transmission indicated a failure of the National Immunisation Programme, which mandates the Bacillus Calmette-Guérin (BCG) vaccine for children.
Responding, he said Health Ministry records showed childhood immunisation coverage remained high, at 98 per cent, with BCG vaccination continuing for about 500,000 newborns annually.
“There are other approaches as well, including the issue of citizens and foreign workers that also need attention,” he said.
“That is why early screening is very important, but as we know, latent TB is very difficult to detect. Even with X-ray scans, it is very challenging and needs to be handled by specialists. It is not easy and is often overlooked,” he added.
“This phenomenon can be described as a global challenge. In the future, antibiotic resistance is expected where infections can no longer be easily treated. Imagine that, it is very frightening,” he said.
Separately, the Health Ministry reported that 10 new TB clusters had been recorded nationwide as of Feb 7. Dr Dzulkefly said Selangor topped the list with four clusters, the highest in the country.
“For 2026, as of Feb 7, 10 new TB clusters were reported, with Selangor leading with four clusters,” he said during Ministers’ Question Time in the Dewan Rakyat.
“In Johor, one case was recorded recently involving an elderly woman, a 72-year-old Quran teacher, which ended with 903 close contacts being identified,” he added.
Providing a breakdown, Dr Dzulkefly said all 10 clusters remained active, with six other states recording one cluster each.
“A TB cluster refers to the occurrence of two or more infection cases that have an epidemiological link in terms of time, place or contact relationship, indicating the possible existence of the same transmission chain,” he said.
“The index case identified at the beginning of a cluster refers to the TB case that is detected first and becomes the main reference in contact investigation and outbreak control,” he explained.
“In Selangor, there are four clusters involving 10 cases. Johor recorded 37 cases, while Kedah and Kelantan recorded two cases each. Pahang recorded four cases, Perlis two cases and Sabah five cases,” he said.
On measures to curb TB in high-risk institutions such as boarding schools and prisons, Dr Dzulkefly said screenings were carried out based on the Tuberculosis Information System Manual (TBIS 2018), covering contact identification, contact assessment and contact examination.
He said the screening process included symptom assessment such as prolonged cough, fever, loss of appetite and weight loss, clinical lung examination, chest X-rays and sputum tests, including microscopy and culture.
“Control measures to curb the spread of TB include ensuring that those confirmed to have the disease receive early anti-TB treatment,” he said.
“For close contacts who do not have TB, screening is carried out to detect latent TB infection and preventive TB treatment is initiated,” he added.
“Treatment monitoring through daily Directly Observed Therapy (DOT) is implemented at the nearest health facilities,” he said.
Dr Dzulkefly also advised symptomatic individuals to practise proper cough etiquette, including covering the mouth and nose when coughing or sneezing, to reduce the risk of transmission. - February 10, 2026