3 Tips to Work From Home Without Hurting Your Posture


Consultant Orthopaedic, Spine & Trauma Surgeon
ALTY Orthopaedic Hospital

While working from home does come with benefits but it also limits physical movements and takes a toll on our postures.

We started seeing a rapidly rising number of young Malaysian adults that are suffering with neck and back pain, especially those working from home and who work for long hours on their devices.

Consciously, we must remind ourselves to pay attention to the signs our back and neck is giving us, so that we can lower the risk of developing serious spinal conditions down the road.

Tip 1
  • Invest in a proper desk and office chair.
  • Ensure that the chair and desk you’re going to be working on is comfortable, supportive, adjustable, and ergonomically sound.
  • Pick a work desk with an optimal height so that the neck, shoulders, and arms remain at a neutral position.
  • Sett up your workstation perpendicular to the window and away from direct light, to minimize the strain on your eyes.
Tip 2
  • Good standing or sitting posture involves having the body be symmetrical, weight evenly distributed and well aligned so it does not strain the neck and back muscles.
  • Use a monitor as a primary working computer instead of a laptop to help improve your posture. If that is not possible, use a book or laptop stand to raise the laptop, so it is at eye level.
  • While being seated, place a small pillow behind your lower back to maintain an arch to lean back in and relieve your back muscles.
  • Keep your forearms and hands leveled and straight by having the keyboard and mouse close to the laptop.
Tip 3
  • The issue isn’t sitting or remaining still while working; It’s being stuck in one place for too long. The body accumulates stress between managing tight deadlines, budget demands, performance reviews, and even the everyday challenges of the day.
  • To keep the mind and, by extension, body healthy, you can combine basic stretches with breathing exercises and other relaxation techniques while you work.
  • Stretches, short walks, or even small bursts of exercise are a great way to get the muscles active and engaged throughout the day.
  • Set alarms or reminders throughout the day to get up and stretch. A 30-second “microbreak” is just enough to change your posture briefly and helps take the pressure off and relax.

Important Advice & Tips to Plan & Prepare for a Flood


Medical Director
International SOS

“With forecasts indicating that our rainy season is far from over, Malaysians need to be prepared in case of floods,” advises Dr Chan Yanjun. “While there are many different actions people should undertake in a flood situation, the most important rule is do not try to walk, swim or drive through flood water. Cars and people can be swept away, so always remember safety first and to stay alert so you don’t get hurt.”

  • Identify flood or landslide-prone areas near you. Watch weather alerts and warnings.
  • Stock up enough water (ration roughly 4 litres per person per day) and dry food for 3 days.
  • Know your community’s evacuation routes and emergency shelter locations.
  • If you are stranded, injured or ill, contact your local emergency services department and wait for help.
  • Check the drainage system behind or outside your house to see the water levels. The higher the water level climbs, the more likely you will have to evacuate.
  • Switch off all gas, electricity, and water when electricity supply is down, water has entered your home, or before you evacuate. Make sure to unplug appliances to avoid electrical shock when power returns.
  • Move to higher ground. Only move to the roof if necessary.
  • If your family is advised to evacuate, do so immediately (lock gates and doors before leaving if possible).
  • Stay off bridges as they can be washed away in severe floods.
  • Stay inside your vehicle if you are trapped by rapidly moving water.
  • Move to the roof of your car if water starts to fill the interior.
  • Do not return home unless advised to do so. Wait for a signal by authorities or emergency services on the status of your housing area.
  • Look out for animals that may be inside your house. This includes snakes, lizards and even crocodiles.
  • Keep children and pets out of the affected area until clean-up has been completed.
  • Wear rubber boots, rubber gloves, and goggles during clean-up of affected area.
  • Remove and discard items that cannot be washed and disinfected (such as, mattresses, carpeting, carpet padding, rugs, upholstered furniture, cosmetics, stuffed animals, baby toys, pillows, foam-rubber items, books, wall coverings, and most paper products).
  • Remove and discard drywall and insulation that has been contaminated with sewage or flood waters.
  • Thoroughly clean all hard surfaces (such as flooring, concrete, moulding, wood and metal furniture, countertops, appliances, sinks, and other plumbing fixtures) with hot water and laundry or dish detergent.
  • Help the drying process by using fans, air conditioning units, and dehumidifiers.
  • Have your onsite waste-water system professionally inspected and serviced if you suspect damage.
  • After completing the clean-up, wash your hands with soap and clean water.
  • Wash all clothes worn during the clean-up in hot water and detergent. These clothes should be washed separately from uncontaminated clothes and linens.
  • Seek immediate medical attention if you become injured or ill.

Important Advice to Stay Prepared During the Monsoon Season


Chief Pharmacist
Alpro Pharmacy

The Malaysian Meteorological Department (MetMalaysia) recently announced that Malaysia will experience continuous heavy rainfall from mid-November, leading to probable major flash floods in several states, and the monsoon season will last until early next year.

We would like to outline several precautionary measures for residents in flood-prone areas, from a community pharmacist’s point of view, to proactively mitigate flood damages ahead of the period and in the aftermath.

  • Closely monitor your surroundings and stay up to date on weather forecasts and warnings
  • Assemble disaster supplies, including long-term medications and first aid kits in water-proof bags in case of evacuation.
  • People, especially the elderly, with chronic diseases, are advised to visit their nearest pharmacy and bring along with their chronic medications, in order to keep a record in the pharmacy and have an up-to-date medication list; this will be useful should one lose the hard-copy of their prescription and face difficulties in retrieving their medication
  • Due to poor sanitation and hygiene in flood areas, there is a high risk of flood-borne diseases such as leptospirosis, cholera, and dengue fever. Keep an eye out for general symptoms such as fever, headache, diarrhoea, muscle aches, and vomiting. In the case of any such symptoms, please visit the nearest healthcare centres immediately.
  • Alpro Pharmacy and DOC2US have launched the Life-saving Medication Care Programme, which provides a one-time supply of medications for up to 7 days for free. Those with contaminated or lost chronic disease medications can visit an Alpro Pharmacy outlet and speak to the pharmacist for more details. Note that a police report copy of the flooding is required for verification purposes.

A Health-Centric Wishlist for the Malaysian GE15


Executive Director
ALTY Orthopaedic Hospital

Building upon the successful collaboration between public and private healthcare during the pandemic, a long-term policy on greater partnership will benefit both the government and the private sector, with all Malaysians being the key beneficiary.

There still are waiting lists for procedures in the public hospitals, and these can certainly be reduced if there is a structure long term arrangement for the private hospitals and centres to assist in reducing and maintaining a short wait time, especially for elective procedures which can greatly enhance an individual’s productivity, although it may not be life threatening.


These include the necessary social safety nets, proper care facilities and also post hospitalization care and support.

Here, the government should consider partnering the many physio and home care organizations to ensure patients have good compliance to post hospital care, including physio, wound care and others.

An aging population also typically means reduced mobility due to various issue—for example orthopaedic-related issues, where it can be address with proper intervention, and where needed surgery.

Government subsidy for implants, such as knee and hip implants can reduce the burden for the uninsured (which is a large majority of those who need such care) – and thus ensuring they have good mobility and thus independence even as they age.


The government should consider encouraging the adoption of such technologies especially in healthcare.

Grants or even personal subsidies to access such health technologies where appropriate can propel the adoption and perhaps even development of such tech.

For example, 3D printed casts or prosthesis will improve recovery and long-term quality of life. The regulatory framework also needs to support the faster adoption of such health technologies, to ensure Malaysia is able to maintain its advantage as a healthcare travel destination.


Competitive and facilitative immigration policies, for healthcare travelers especially, will allow Malaysia to be serve a greater no of patients, which in turn lowers the cost of investment in health-related technologies and equipment, thus enabling more Malaysians to access it as well.

Some of our neighbouring countries continue to attract patients from a number of different countries, despite being less competitive overall than Malaysia, primarily due to the ease of arriving into the country.

Thus, they are able to invest in technology such as proton beam, as fee-paying foreign patients ensure there is a sufficient volume of patients for these advanced and latest modalities.

Why You Need to Dispose Unwanted and Unused Meds Properly, and One Convenient Solution to Do This



If you gather all these medications and dump them into the trash bin, you’re not exactly doing it properly.


Well, the best way to dispose of unwanted or unused meds is to drop them off at a proper facility—a facility that is equipped to dispose of these medications in a manner that will not cause possible harm to other people as well as the environment.


Well, as of the time of writing, there is a convenient drop-off point for all your unused and unwanted medications: the nearest CARiNG Pharmacy outlet.

This is made possible through the Do It Right programme, a collaboration between the Faculty of Pharmacy of Universiti Malaya and the pharmacy retail chain.

CARiNG Pharmacy outlets will operate as a drop-off point for these medications, which will then be transported to Kualiti Alam Incineration Centre for further processing and proper disposal.

“Unwanted medicines left at home are a safety issue. Over 10,205 people required hospitalization because of medicine poisonings across Malaysia. Unwanted medicines in homes pose a health hazard especially to children,” Loo Jooi Leng, the Marketing Director of CARiNG Pharmacy, says to us in order to explain the rationale of this programme.

Do It Right programme logo

  1. READ
    Read the labels of the medicines in your cabinet and check which are expired and no longer needed.
    Remove the expired or unwanted medicines from your cabinet and place them into a bag.
    Return the bag to any CARiNG Pharmacy near you and their staff will place it in a secure bin for safe disposal.

For more information on the Do It Right programme, you can visit their website (link opens in a new tab).

An Infection Called Listeriosis

An Infection Called Listeriosis

May 8, 2022   Return

Words Lim Teck Choon


Bad Bacteria

The bacteria responsible for listeriosis is Listeria monocytogenes. People get infected by eating food contaminated with these bacteria.

What are the Symptoms to Watch Out For? 

This is the tricky part, as symptoms may vary from one person to another.

Most people experience mild symptoms. Those who are most vulnerable to the more serious consequences are listed below – people in these groups should see a doctor for proper diagnosis and treatment as soon as possible if they suspect that they have a case of listeriosis.


Be Very Careful if You Are: 

  • Pregnant, as listeriosis may lead to miscarriage, stillbirth, premature birth and potentially life- threatening infection in the newborn.
  • Newborn or over 65 years old and/or have weakened immune system, as listeriosis may lead to severe infections of the blood and the brain, with potentially life-threatening consequences.

Careful with These Foods!

Raw milk

  • Raw milk may contain not only L monocytogenes – other types of potentially harmful microorganisms may be present as well!
  • Drink only pasteurized milk – check label on milk to be sure.
  • Refrigerate milk at 5°C or below.

Cheese, yoghurts and ice creams made from raw milk

  • Always check the label to make sure that the product uses pasteurized milk.


  • The recent Australian outbreak is caused by eating contaminated melons.
  • After cutting a melon, eat or refrigerate right away. Don’t leave it in room temperature to be contaminated!
  • When refrigerating, make sure that the temperature is below 5°C. Don’t keep for more than a week.

Raw sprouts (alfalfa, clover, radish, bean sprouts, etc)

  • Cook sprouts thoroughly; avoid eating raw or lightly cooked ones.
  • Note that rinsing alone will not remove harmful bacteria.

Processed meats (hot dogs, burger patties, pâtés, cold cuts, etc)

  • Cook until the internal temperature is 75°C or higher before eating.
  • Refrigerate opened packages for not more than one week, while unopened packages should not be kept longer than two weeks.


Keep these “high risk” foods refrigerated separately from other foods to avoid contamination. Also, always check to make sure that the fridge is 5°C or below while the freezer should be 0°C or below.

What Determines Our Fertility?

What Determines Our Fertility?

May 8, 2022   Return


Dr Eeson Sinthamoney


Obstetrical and Gynaecological Society of Malaysia (OGSM)


The most accurate gauge of a woman’s fertility is the anti-Müllerian hormone (AMH) levels in the body and not her age, says fertility expert Dr Eeson Sinthamoney.

The AMH test is a simple blood test which determines a woman’s fertility as it is a marker for ovarian reserve—an important consideration for women who are planning their pregnancy or struggling with infertility.

For women planning to delay motherhood, the AMH test is also helpful as they can determine their fertility and gauge how many fertile years they have ahead of them and be well- informed in decisions involving parenthood.

AMH testing is also important in those seeking fertility treatment as it is a good gauge of a woman’s response to ovarian stimulation, which is the first step towards in vitro fertilization (IVF). “If AMH levels are within the normal range, the ovaries are more likely to react more positively to stimulating drugs and more eggs are likely to be retrieved, often resulting in a higher IVF success rate,” Dr Eeson explains.

“We used to have to send our samples overseas to test for AMH levels, hence the reason we didn’t use it very often,” he adds. He goes on to explain that nowadays, the AMH test is available locally and at a relatively cheaper cost.


Dr Eeson said Malaysia’s national fertility rate has dropped to an all-time low, as reported by the 2017 Vital Statistics Report of the Department of Statistics (DOSM).

“It is widely believed by the professional community that the infertility rates have also increased. Women are born with around two million eggs and these continue to decrease throughout their lives,” says Dr Eeson.

The risk of egg abnormality also increases with age and above the age of 45, there is 100 percent certainty of egg abnormality.

Dr Eeson points out that it was common for women to have their first child at the age of 17 or 18 a few decades ago. Now, more women are delaying childbirth to focus on establishing their careers, thus more and more are starting families in their late 20s and well into their 30s.

“Over the past 5 years, I have seen more and more women in their early 30s come to me to find out about how they can plan ahead so that if they decide to delay parenthood, their chances are not diminished. Whatever the reason for the delay, they may still want to experience motherhood, and the AMH test helps them match their career and parenthood goals,” he elaborates. HT

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Protect Them Against Pneumonia

Protect Them Against Pneumonia

May 8, 2022   Return

Words Hannah May-Lee Wong

Datuk Dr Zulkifli Ismail

Consultant Paediatrician & Paediatric Cardiologist


Dr Aminah Bee Mohd Kassim

Public Health Physician


Dr Hishamshah Mohd Ibrahim



World Pneumonia Day falls on the 12th of November every year. In November 2018, Immunise4Life hosted an educational programme to raise awareness on the importance of vaccination as prevention against pneumonia.

Consultant paediatrician Datuk Dr Zulkifli describes pneumonia as a serious lung disease whereby the alveoli in the lungs become filled with fluid or pus, which would cause difficulty in breathing. “Pneumonia is an infection that affects the parenchymal (the functional) part of the lungs. It affects the little globules at the end of the respiratory tract called the alveoli. When there is infection, inflammation occurs and when that happens, the cells swell up causing fluid build-up. Fluid in the lungs will hamper the transfer of oxygen from the air that we breathe to the capillaries around the alveoli, and this causes difficulty in breathing,” he explains. Common signs and symptoms of pneumonia include cough, difficulty breathing, rapid heartbeat, fever, shivers and chest pain.1

Public health physician, Dr Aminah adds that pneumonia is spread through air-borne droplets emitted by infected people when they cough or sneeze.



Other than suffering an infection, it is not uncommon for those struck with pneumonia to spend weeks at the hospital. Not only do parents have to deal with sky high medical bills, if a child gets pneumonia, his or her parents would have to take time off work. Furthermore, if the child is admitted to the ICU (intensive care unit), he also runs the risk of getting another infection from spending time at the ICU.

The cost of the vaccine depends on where you go to get it. On average, it is RM250 to RM300 per dose, and a child (depending on age) will need up to four doses. “In total, the vaccines would have cost just above RM1000 for four doses that a child typically needs. It is the most effective way of preventing pneumonia.” Dr Zulkifli adds, “When the vaccine was introduced in Malaysia in 2007, 3% of the birth cohort were vaccinated. The good news is that numbers have been increasing. Now 15% to 18% of children are vaccinated.”


Dr Zulkifli explains that anybody is prone to get infected if they are exposed to a high enough dose of bacteria or virus. That said, there are a few groups of people who are more susceptible to contracting pneumonia, namely:

  • Those who have underlying medical conditions like having congenital or acquired immunodeficiency, sickle cell disease, pulmonary disease, chronic heart disease, chronic renal disease, diabetes and more.
  • Children younger than the age of two and the elderly older than 65.
  • Certain ethnic groups are more predisposed to getting pneumonia. These include Asian, Black, Hispanic and Native American people.
  • Children who are looked after outside home (at a nursery or day care) for at least four hours a week and are in the presence of at least two children other than siblings.



“Pneumonia is mostly caused by viruses. The common ones are: influenza virus, respiratory syncytial virus (RSV), measles virus and chicken pox virus. Bacterial causes include Streptococcus pneumoniae and Haemophilus influenzae type B (Hib). But in terms of pneumonia-associated mortality (death) rates, the numbers are higher with those cases caused by bacteria. This means, vaccines against pneumococcus is important,” Dr Zulkifli explains.

“Across the world, most deaths associated with pneumonia occur in the Southeast Asian region (where Malaysia is) and Western Pacific Region. But you’ll find that deaths caused by pneumonia has been decreasing from the year 2015.” Dr Zulkifli continues, “Compared with other Asian countries such as Indonesia, the death toll in Malaysia is low. This is not because we don’t see a lot of cases of pneumonia. Malaysia has been seeing good survival rates due to the health seeking behaviour of Malaysians and the good accessibility of health centres across Malaysia, from where patients can be referred to a tertiary health centre.”

Pneumonia is a health issue not to be taken lightly. It is the third leading cause of death among children under five in Malaysia, just behind deaths cause by delivery complications and congenital malformation.


“Exclusive breast feeding for the first six months would give some protection to the child. Taking care of the environment where the child spends time is important too,” says Dr Zulkifli. Haze, indoor pollution and indoor smoking aggravate pneumonia.

He adds, “The practice of hand washing with soap and water prevents spread of disease. If possible, limit your child’s exposure to other children. This doesn’t mean your child should not play with other children. But be careful and watch who they play with. Make sure they play with kids who do not have a cough or running nose. Adequate nutrition is also important to ensure good health of a child.”

Vaccines are among the most effective means of preventing disease, disabilities and death in infants and children. Measles, pertussis and invasive Hib disease for example, had a reduction of 99-100% after vaccinations for those diseases were introduced.

Dr Zulkifli explains, “the pneumococcal vaccine is now being used in 142 countries in the world. In the US, when the vaccine was introduced in the year 2000, there was a 94% reduction of contracting pneumonia in children under 5 who received the vaccine. At the same time, what was not expected was that there was a 65% reduction of invasive pneumococcal disease in the elderly (older than 65 years) who were not vaccinated. This is the indirect effect of vaccination known as herd immunity. When you vaccinate the children, the elderly get protected because there are less circulating bacteria around.”


Younger children are particularly more vulnerable to complications of pneumonia. Paediatrician Dr Hishamshah remarks: “Treating pneumonia in young children can be complex. The disease can progress rapidly, and patients may require oxygen, intravenous therapy to deliver strong antibiotics and possibly surgery to drain their lungs. If lungs failure occurs, we will need to put them on a ventilator machine to enable them to breathe.”

He adds, “A small percentage may end up with chronic lung disease, which requires long term management and may impact quality of life down the road. The impact and burden not only falls on the child who is infected with pneumonia, it affects the parents and the hospital where the child is admitted. All of this can be prevented.”



There are conjugate and polysaccharide type vaccines for pneumonia. The polysaccharide vaccines will protect a person from 23 types of pneumococcal bacteria, while the conjugate will cover 10 or 13 serotypes. The conjugate vaccines can be given to children less than two years of age, while the polysaccharide is suitable for those older than two years old.

Dr Zulkifli adds “The polysaccharide vaccine will not prevent carriage, which means you may still carry the bacteria in your nasopharynx and you can transmit it. Whereas the conjugate vaccine does prevent carriage, which is why we see that indirect effect in the elderly when the children are vaccinated.” He continues, “The pneumococcal conjugate vaccine (PCV) confers life-long protection from the Streptococcus pneumoniae bacterium, which is the leading cause of severe pneumonia in children under five years old, accounting for one-third of deaths due to pneumonia, globally.”

Dr Aminah says the Hib, MMR and DTaP vaccines are already part of Malaysia’s National Immunisation Programme and are free of charge for infants. These vaccines protect against Hib, measles and pertussis. However, she encourages parents to talk to their doctors and consider vaccinating their children against influenza, chicken pox and pneumococcus. These would optimize their protection against vaccine-preventable pneumonia. HT

Reference: www.nhs.uk/conditions/pneumonia/

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When Chikungunya Rears Its Head

When Chikungunya Rears Its Head

May 8, 2022   Return


During the first few weeks of 2019, Thailand experienced a sustained increase in chikungunya infection rate in the southern part of the country. According to Thai health officials, the outbreak was a continuation from 2018. More than 700 cases have been reported for this year mainly from the provinces of Songkhla, Pattani and Phuket.

Chikungunya is an infection caused by Chikungunya virus that is transmitted by Aedes aegypti and Aedes albopictus mosquitos. The chikungunya virus is passed to humans when a bite from an infected mosquito breaks the skin and introduces the virus into the body. In other words, the virus spreads from an already infected human to a mosquito, and then to another human. These mosquitoes feed mainly during daytime and can be found both indoors and outdoors. The mosquitos can also potentially transmit dengue and Zika virus.

The chikungunya disease was first described in southern Tanzania in 1952 where the name ‘Chikungunya,’ derived from the Makonde language that means ‘to become contorted,’ was used to describe the clinical appearances of patients who suffer terrible joint pains.

The disease mainly affects people living in Africa, Asia and the Indian subcontinent where outbreaks occur from time to time. Malaysia and Thailand are no exception.  

Signs & Symptoms

Not all infected individuals will exhibit signs and symptoms of the disease. According to the U.S. Centers for Disease Control and Prevention (CDC), 3% to 28% of people remain asymptomatic. On the other hand, patients who develop symptoms of the disease will first undergo a period of incubation that typically lasts three to seven days.

Two symptoms characterise the disease: the sudden onset of high fever, where the temperature ranges above 39ºC, and joint pains. Typically, fevers will last for several days (up to one week). Some patients may experience what is called a ‘biphasic fever’ where the initial temperature surge lasts for several days, subsides, and then spikes for the second time.

Joint pains are generally severe and sometimes can be debilitating. Multiple joints from both sides, commonly those in the hands and feet, are involved and pain usually occurs symmetrically. Chikungunya patients may also experience other symptoms such as headache, muscle pain, nausea and vomiting, or develop rashes on their body.

These signs and symptoms are not unique to chikungunya, unfortunately. In endemic areas with concomitant dengue or Zika outbreaks, chikungunya may be indistinguishable with others. According to a recent systematic review – a type of rigorous scientific methodology that aggregates all available results from the literature to summarise the findings and possibly conclude on the strength of the evidence – showed that clinicians tend not to confirm their diagnosis through laboratory testing. Most commonly, dengue infection would be assumed when a patient exhibited these signs and symptoms.

The high likelihood of being misdiagnosed have some adverse consequences to the patients. The prescription of pain killer to alleviate joint pain may be withheld unnecessarily in patients misdiagnosed as having dengue, thus denying the patients an appropriate treatment to relieve pain.

Chikungunya patients may also suffer joint pain for a considerable period even after the infection has subsided. A 3-year study produced by the Pasteur Institute in France demonstrated that as many as 60% of patients would still suffer joint pains that were highly debilitating from time to time. Pains were mostly reported to affect fingers, wrists, knees and ankles.



Chikungunya infection does not evoke as much fear as other similar diseases, but the lack of the fear factor should not mask the underlying possibility of severe complications no matter how remote the chances are.

In addition, not all infected patients share the same risk to develop adverse complications from the disease. Several groups have been identified as having increased risk for severe clinical outcomes, including newborn children who are exposed to the infection during childbirth, adults who are aged 65 years and above, and individuals who have concomitant chronic medical conditions such as high blood pressure, diabetes or heart diseases.

Death occurs rarely and is mainly confined to older individuals who are relatively frail at disease onset. The fatality rate of chikungunya has been reported to range between 0.02% and 0.1% and is generally considered as a non-fatal disease.

Several complications that involved the skin or the mucous membrane, such as lesions or hyperpigmentation (the darkening of the skin colour in a mottled fashion), has been reported as the atypical manifestations of the virus infection. Other uncommon complications that affect the nerves, eyes, kidney and the cardiovascular system have been reported.

Pregnancy does not directly increase the risk of suffering a severe illness, and pregnant women do not transmit the virus to their baby directly in the womb. However, the risk of transmission becomes elevated during the process of childbirth, where such a risk peaks if the women are symptomatic during the delivery (defined as 2 days before or after delivery). Furthermore, analysis of previous outbreaks indicated that chikungunya fever may increase the risk of abortion in the first trimester.



Thus far there is no effective treatment or vaccine that can be used against the chikungunya virus, unfortunately. Conventional clinical management mainly revolves around alleviating the symptoms, including maintaining enough hydration and controlling fever with medicine.

Joint pain is typically managed by the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), a class of painkiller that can also reduce inflammation around the joints. Doctors do tests to rule out the possibility of dengue infection, however, as NSAIDs could cause severe complications in these individuals.

Research is currently underway to identify compounds that can cure chikungunya. A recent discovery from the University of São Paulo revealed that sofosbuvir, an antiviral used to treat hepatitis C, could also eliminate the chikungunya virus. More research will be needed to ascertain its safety and efficacy for widespread use in the country.

Until these new drugs can be readily deployed in endemic areas, prevention of mosquito bites is still the best prophylactic measure against chikungunya. Research has shown the mosquito vectors bite both during the day and night, and are active indoor and outdoor, thus round-the-clock prevention is needed when travelling to endemic areas.


Insect repellents are effective against mosquito and are safe for use by pregnant or breastfeeding mothers. CDC has published a list of active ingredients that could be used, including DEET, picaridin, and the oil of lemon eucalyptus. Travelers may need to consider avoiding places with ongoing outbreaks. If travel is unavoidable, protective measures should be prioritised. HT



1. Herriman R. Thailand: Chikungunya, dengue and measles during the first 3 weeks of 2019. Retrieved from http://outbreaknewstoday.com/thailand-chikungunya-dengue-measles-first-3-weeks-2019/.

2. Staples JE, et alChikungunya. Retrieved from https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/chikungunya.

3. Lumsden WH. (1955). An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. II. General description and epidemiology. Trans R Soc Trop Med Hyg;49:33–57.

4. Mohan A, et al. (2010). Epidemiology, clinical manifestations, and diagnosis of Chikungunya fever: Lessons learned from the re-emerging epidemic. Indian J Dermatol;55:54–63.        

5. Furuya-Kanamori L, et al. (2016). Co-distribution and co-infection of chikungunya and dengue viruses. BMC Infect Dis;16:84.

6. Schilte C, et al. (2013). Chikungunya virus-associated long-term arthralgia: A 36-month prospective longitudinal study. PLoS Negl Trop Dis 2013;7:e2137.

7. European Centre for Disease Prevention and Control. Factsheet about chikungunya. Retrieved from https://ecdc.europa.eu/en/chikungunya/facts/factsheet.

8. CDC. Chikungunya – Atypical and severe disease manifestations. Retrieved from https://www.cdc.gov/chikungunya/pdfs/Chikungunya-atypical-severe-disease_Healthcare-provider-factsheet-10-07-2014.pdf.

9. Bonotto RM, et al. (2018). Evaluation of broad-spectrum antiviral compounds against chikungunya infection using a phenotypic screening strategy. F1000Research;7:1730.

10. CDC. Chikungunya Virus – Prevention. Retrieved from https://www.cdc.gov/chikungunya/prevention/index.html.

Is Tb Making A Comeback?

Is Tb Making A Comeback?

May 8, 2022   Return


Every year March 24th is recognized as World TB Day to commemorate the discovery of Mycobacterium tuberculosis, the bacteria that causes TB. It was on this date in the year 1882 Dr. Robert Koch announced this discovery. In conjunction with World TB Day and having reviewed the statistics and facts, let’s understand this condition better and spread the knowledge around to others.

Tuberculosis, also commonly known as TB was a major cause of morbidity and mortality in the yesteryears and is slowly feared to be making a comeback. Let’s take a peek into some alarming statistics on TB, as stated by the World Health Organization (WHO):

  • TB is one of the top 10 causes of death worldwide.
  • In 2017, 10 million people fell ill with TB, and 1.6 million died from the disease (including 0.3 million among those with HIV).
  • In 2017, an estimated 1 million children became ill with TB and 230,000 children died of TB.
  • About one-quarter of the world’s population has latent TB, which means people have the TB bacteria within their body, but the bacteria are present in very small numbers, are kept under control by the body’s immune system and do not cause any symptoms.
  • People infected with TB bacteria have a 5-15% lifetime risk of falling ill with TB. (including children with HIV associated TB).
  • People with active TB can infect 10-15 other people through close contact over the course of a year (ie, via inhalation of infectious droplets from cough, sneeze, spit, etc.).
  • TB is a leading cause of death among those with HIV. Without proper treatment, TB has a 10-year case fatality or death rate of around 70% among HIV negative and around 83% among HIV positive persons.
  • Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. WHO estimates that there were 558,000 new cases with resistance to rifampicin – the most effective first-line drug – of which 82% had MDR-TB.
  • Globally, TB incidence is falling at about 2% per year. This needs to accelerate to a 4-5% annual decline to reach the 2020 milestones of the End TB Strategy.
  • An estimated 54 million lives were saved through diagnosis and treatment between 2000 and 2017.
  • TB can occur in every part of the world. In 2017, the largest number of new TB cases occurred in the Southeast Asia and Western Pacific regions, with 62% of new cases, followed by the African region with 25% of new cases.
  • In 2017, 87% of new TB cases occurred in 30 high TB burden countries. Eight countries accounted for two thirds of the new TB cases, namely India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh and South Africa.


TB in Malaysia

  • Every year more people die of TB than from dengue- and HIV-related complications. In 2016, there were 1,945 deaths from 25,739 cases which is a 14.7% increase compared to 2015 (1,696 deaths from 24,220 cases).
  • TB cases reduced from more than 30,000 in 1960 to less than 6,000 in the mid-1980s.
  • But cases have been increasing since 2008. 
  • New TB cases registered in 2017 was 26,168.

The hike in the number of cases from the above statistics leaves us with the question “Is TB making a comeback?”

Here are some additional fast facts about this highly dreaded disease.

  • TB is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.
  • TB is curable and preventable. Most cases are cured with antibiotics for a duration of about 6 to 9 months.
  • TB is spread via droplet transfer. When people with lung TB cough, sneeze or spit, they propel the TB bacteria into the air. A person needs to inhale only a few of these bacteria to become infected.
  • Drinking unpasteurized milk products from cows infected with Mycobacterium bovis may also cause TB.
  • People with compromised immune systems, such as people living with HIV, malnutrition diabetes, or people who smoke, have a much higher risk of falling ill due to infection by TB.
  • When a person develops active TB disease, the symptoms (such as cough, fever, night sweats, or weight loss) may be mild for many months. This can lead to delays in seeking medical attention, thereby resulting in worsening of the infectious condition and also transmission of the infection to others.
  • TB can also affect other parts of the body like the brain, bone, lymph nodes and heart.
  • The death rate due to TB is the highest among all infectious diseases including dengue, HIV and malaria.

Here are the answers to a few pertinent questions on TB:

How is TB spread?

TB is contagious, but it is not easy to contract. The bacteria grow and multiply slowly. You usually have to spend a lot of time around a person who has TB before you become infected. That is why it is often spread among co-workers, friends, and family members. The TB bacteria does not thrive on surfaces. You cannot contract the disease from just shaking of hands with someone who has it, or by sharing their food or drink.

What are the types of TB?

There are two common forms of the disease:

Latent TBYou have the bacteria in your body, but your immune system stops them from spreading. That means you don’t have any symptoms and the infection is not contagious. However, the latent bacteria are still alive in your body and can one day become active.

Active TB diseaseThis means the bacteria multiplied and can make you sick. You can spread the disease to others. Of all the adult cases of active TB, 90% are from the reactivation of a latent TB infection.

What are the Symptoms of TB?

There are no symptoms for latent TB. Only a skin or blood test can confirm the presence of any latent infection.

On the contrary, active TB manifests itself with a wide range of symptoms that include cough that lasts more than 3 weeks, chest pain during coughing, coughing out blood, fever, fatigue, lack of appetite, chills, night sweats, and weight loss.

Who is at Risk?

A healthy immune system fights TB bacteria. In general, young children and the elderly are at greater risk because young children’s immune system has not fully formed while the elderly’s is weakened.

If you have one or more of the following conditions, your immune system might not be able to fight TB infection:

  • HIV or AIDS
  • Diabetes
  • Severe kidney disease
  • Head and neck cancers
  • Cancer treatments, such as chemotherapy
  • Low body weight and malnutrition
  • Taking medications for organ transplants
  • Taking certain drugs to treat rheumatoid arthritis, Crohn’s disease, and psoriasis.


Can TB be prevented?

It may sound like a disease of the past, but TB, is still a real concern today. The best way to prevent TB is to avoid the infection in the first place.  Hence, doctors advise those who have active TB disease to stay home and away from other people as much as possible, until they’re no longer infectious.

If you’re found to have TB, follow these tips to help prevent others from getting TB during your first few weeks of treatment, or until your doctor says you’re no longer infectious:

  • Take all of your medicines as prescribed by your doctor.
  • Go for all your follow-up doctor appointments.
  • Always cover your mouth with a tissue when you cough or sneeze. Seal the tissue in a plastic bag, then throw it away.
  • Wash your hands after coughing or sneezing.
  • Avoid visiting other people and don’t invite others to visit you.
  • Stay home from work, school, or other public places.
  • Use a fan or open windows to move around fresh air.
  • Avoid use of public transportation.

In Malaysia, BCG vaccination is given to all children at birth. It helps to protect against childhood forms of TB such as TB meningitis and disseminated TB, hence there is a low incidence of these childhood forms in our country.

Can TB be treated?

With proper treatment, TB is almost always curable. Doctors prescribe antibiotics which must be taken for 6-9 months. The medications and the duration will depend on the severity and seriousness of the patient’s condition.

Sometimes, antibiotics don’t work and this form of the disease is known as drug-resistant TB. Those with drug-resistant TB may need to take stronger medications for a longer duration.

Depending on one’s risk factors, latent TB can reactivate and cause an active infection. So, doctors may prescribe antibiotics such as isoniazid and rifampicin as a precautionary measure. For active TB, doctors usually prescribe antibiotics such as ethambutol, isoniazid, pyrazinamide and rifampicin.

Your doctor may order a few tests to verify if the treatment is actually working against the TB infection. Based on the results and overall health condition, your dose of medications will be modified. You will probably start to feel better after a few weeks of treatment. But only a doctor can tell you if you’re still contagious and require treatment.

The Road Ahead

Having gained some knowledge about this dreaded disease that was thought to be on its way to extinction and is now making a comeback, let’s be wary of the symptoms, associated risks and treatment options. Please consult your doctor upon noticing any of the symptoms and diligently follow their advice.

We need to stand united in this battle against TB considering the rate at which TB incidence is rising. On this World TB Day, all of us including doctors, policy makers and the public need to aggressively take up the cause and pursue the challenges of controlling TB and move towards a TB-free Malaysia. Every effort counts! HT



1. World Health Organization. Retrieved from: www.who.int/news-room/fact-sheets/detail/tuberculosis.

2. The Star Online. Retrieved from: https://www.thestar.com.my/news/nation/2017/07/19/infectious-diseases-making-comeback-more-deaths-from-tuberculosis-than-dengue-and-hivrelated-complic/.

3. World Health Organization. Retrieved from: https://www.who.int/tb/country/data/profiles/en/.

4. Free Malaysia Today. Retrieved from: www.freemalaysiatoday.com/category/nation/2018/03/06/ministry-rise-in-tb-leprosy-cases-in-2017/.

5. U.S. Centers for Disease Control and Prevention (CDC). Retrieved from: www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a4.htm.