Has Malaysia Bent the Curve in the Fight Against Hepatitis B & C?

WORDS LIM TECK CHOON

FEATURED EXPERT
DR PHILIP PANG BOON CHEONG
Consultant Gastroenterologist and Hepatologist
Subang Jaya Medical Centre
A QUICK OVERVIEW OF HEPATITIS B & C
Hepatitis B
  • It’s a viral infection that attacks the liver.
  • It’s caused by the hepatitis B virus (HBV)
  • Can be acute (short-term) or chronic (long-term).
  • Transmitted through blood, semen, and other body fluids.
  • Currently, there is no cure available.
  • Vaccination provides a greater degree of protection against HBV infection.
Hepatitis C
  • It’s also a viral liver infection.
  • It’s caused by the hepatitis C virus (HCV).
  • It often becomes chronic or long-term.
  • Primarily transmitted through blood-to-blood contact.
  • No vaccine available, but treatable with direct-acting antiviral medications (97% cure rate).
WHY IS THERE A FIGHT AGAINST HEPATITIS B & C?

Dr Philip Pang reveals the following:

  • Hepatitis B and C are considered silent killers because they are often undiagnosed until health complications arise.
  • These diseases progress while undetected to cause severe liver damage and even cancer.

“Viral hepatitis is preventable and treatable. Thus, it is crucial that effective intervention measures are put in place,” Dr Pang shares.

HOW DO WE FIGHT AGAINST THESE TWO FORMS OF HEPATITIS?
  • 3 doses of the hepatitis B vaccine are administered to all newborns before they turn 1.
  • “The Ministry of Health (MOH) has also implemented targeted health screenings for high-risk populations including pregnant women and those with family history,” says Dr Pang.
  • Wider access to affordable direct-acting antivirals has led to a significant drop in chronic hepatitis C cases.
  • The Ministry of Health has also developed the National Strategic Plan for Hepatitis B and C (NSPHBC) 2019-2023 with the aim of eliminating hepatitis B and C by 2030. This comprehensive plan outlines a structured approach to prevention, diagnosis, treatment, and care to combat viral hepatitis.
HOW ARE WE DOING THUS FAR?
  • Statistics show that in Malaysia, an estimated 1.1% of the population is infected with hepatitis B virus in 2017, and 2.5% with hepatitis C virus in 2019.
  • Viral hepatitis is the seventh most common cause of mortality in our country.
  • 94% of deaths from chronic hepatitis B and C infections are caused by cirrhosis (severe scarring of the liver) and liver cancer.
THE DRIVE FOR GREATER PREVENTION OF HEPATITIS B

Hepatitis B is not treatable at the moment, although early diagnosis can allow for proper measures to be taken so that individuals with this disease can still lead a fairly active and productive life.

However, many individuals with hepatitis B are unaware of their status and often go undiagnosed.

“An individual with hepatitis B is like having a neighbour who lives together in harmony, but you don’t know when your neighbour would one day go crazy,” Dr Pang tells us.

He goes on to say: “If we can fight hepatitis B in this generation, we are well on our way to eliminating it by 2030. Yet, we are far from achieving this goal. More needs to be done to raise public awareness about hepatitis B transmission, prevention methods, and the importance of vaccination.”

Pregnant Moms

The lack of symptoms can lead to pregnant mothers being unaware that they have hepatitis B, which increases the risk of mother-to-child transmission.

Routine blood tests during pregnancy can help identify these cases.

“Early detection allows for proper management, Pregnant mothers may be given antivirals and newborns given an immunoglobulin injection, specifically hepatitis B immunoglobulin, within 24 hours after birth” Dr Pang says.

For the newborn, the immunoglobulin injection provides a temporary protection against hepatitis B infection until the baby’s own immune system can develop immunity through vaccination.

People Living with Hepatitis B

Dr Pang recommends that individuals with hepatitis B should see their doctors once a year and undergo a routine blood test, which monitors their viral load.

Those who are 40 years old and above and present with symptoms should see their doctors more often, every six months, and undergo liver cancer surveillance.

Consider Hepatitis Vaccination and Stay Safe
  • Vaccination is key for improving our protection against hepatitis A and B.
  • Practice safe sex and good hygiene are vital.
  • Avoid sharing needles and personal care items.
  • Ensure safe practices during procedures that involve needles, such acupuncture or tattooing.

Let’s Talk about HPV with a Doctor

WORDS DR RAHIMAH RAHIM

FEATURED EXPERT
DR RAHIMAH RAHIM
Medical Doctor
Klinik Amaya
Question 1
WHAT IS HPV?

The human papilloma virus or HPV is a very common virus transmitted through skin-to-skin contact, including sexual activity.

Most HPV infections do not cause any symptoms and can clear up on their own.

However, some strains can lead to serious health issues like genital warts and cancers, particularly cervical cancer.

The risk of HPV infection increases with certain behaviors such as having multiple sexual partners, engaging in unprotected sex, and smoking.

How HPV infects human cells. Click on the image for a larger, clearer version.

Question 2
IF HPV INFECTION CAN SHOW NO SYMPTOMS, WHAT CAN WE DO TO FIND OUT WHETHER WE HAVE BEEN INFECTED?

Screening for HPV is vital because it helps detect abnormal cell changes early, before they have the chance to progress into cancer.

Cervical screening, which includes HPV testing, is essential for identifying high-risk HPV strains.

High-risk HPV strains can lead to abnormal cell changes in the cervix, which, if left untreated, may progress to cancer. Hence, early detection through HPV testing allows for close monitoring and timely intervention, preventing the development of cervical cancer. This proactive approach is essential in maintaining women’s health and well-being.

Question 3
CAN YOU TELL US ABOUT THE HPV VACCINE?

The HPV vaccine is the most effective way to prevent HPV infections and the associated cancers.

It is safe, effective, and recommended for both males and females starting at age 9.

The vaccine is administered as a series of shots and provides protection against several high-risk HPV strains.

Vaccination, combined with safe sex practices, using condoms or dental dams, and limiting the number of sexual partners, greatly reduces the risk of HPV transmission.

Question 4
WHAT ARE THE TREATMENT OPTIONS AVAILABLE FOR PEOPLE WITH HPV?

Healthcare providers can offer comprehensive guidance on screening, diagnosis, and treatment options for those affected by HPV infections.

This includes regular monitoring for abnormal cell changes, treatment for genital warts, and appropriate interventions for any pre-cancerous conditions.

Digital health solutions can be leveraged to enhance our approach in managing HPV. These solutions facilitate seamless patient-doctor interactions, enabling us to schedule and conduct HPV screenings efficiently. Patients can conveniently access consultations and receive timely reminders for screenings, which are crucial for early detection. This technology not only streamlines our workflow but also empowers patients to take proactive steps in their healthcare journey.

For further information, individuals can consult with healthcare professionals. Our goal is to provide comprehensive care and support to those affected by or at risk of HPV.

 

Why Is the Dengue Vaccine Needed? An Associate Professor Answers More Questions About the Vaccine

WORDS ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN

FEATURED EXPERT
ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN
Family Medicine Specialist
IMU Healthcare
WHY IS THE QDENGA VACCINE NECESSARY? WE ALREADY HAVE PREVENTIVE MEASURES SUCH AS FOGGING TO PREVENT THE AEDES MOSQUITO FROM BREEDING.

Fogging is effective in killing the Aedes mosquitoes. Its effect is immediate, extending to an average of 72 hours.

Fogging Works, but There Are Some Drawbacks

While fogging has been the main means to mitigate dengue infection in Malaysia, however, health offices are usually informed after the infection have been notified. As a result, fogging by itself does not reduce severe dengue infection that requires hospitalizations.

Furthermore, the resistance of the Aedes mosquitoes to insecticides is increasing. This decreases the effectiveness of fogging to control the population of these mosquitoes.

The Role of Dengue Vaccines

On the other hand, dengue vaccines have been proven to be effective in reducing the numbers of severe dengue infection requiring hospitalizations.

THERE WAS SOME CONTROVERSY WITH REGARDS TO THE SAFETY PROFILE OF THE PREVIOUS DENGUE VACCINE. SHOULD WE BE CONCERNED ABOUT THE QDENGA VACCINE?

Just like any new drug or new medical technology, there is very limited data from clinical practice in the early days. There would be many concerns.

Dengvaxia, the First Dengue Vaccine

The first dengue vaccine, Dengvaxia, was approved in April 2018.

It is safe in persons who have had dengue virus infection in the past (seropositive individuals), but it also increases the risk of severe dengue in those who experience their first natural dengue infection after receiving their vaccination (seronegative individuals).

Hence, pre-vaccination screening for past dengue infection is recommended before one receives the Dengvaxia vaccine. Only people with evidence of past dengue infection—indicated by the presence of dengue IgG antibody in their blood—would receive this vaccination.

About the Newest Vaccine, Qdenga

A second vaccine for dengue, Qdenga, received prequalification from the World Health Organization (WHO) on 10 May 2024.

Is it safe?

  • Overall, during the clinical trials, the vaccine was well tolerated. The most frequent reported vaccine-related adverse events were injection site itchiness, bruising, and fever.
  • An excess of hospitalized dengue virus serotype 3 (DENV3) infections was reported among baseline seronegative children, but it was not statistically significant.
  • There was also an excess of cases of severe dengue among seronegative vaccinees, all of which were caused by DENV3, but, again, the difference was not statistically significant.
  • An increase in the risk of dengue infection requiring hospitalization or severe dengue due to DENV3 in vaccinated seronegative subjects cannot be conclusively ruled out. We probably need to wait for more data.

How about allergy reactions?

During the clinical trial, no cases of severe allergy reaction or anaphylaxis were observed.

However, cases of anaphylaxis associated with this new vaccine occurred following the vaccine’s introduction to children between the age of 10 and 14 years in Brazil since February 2024, with 16 cases were reported (4.4/100,000 doses administered), including 3 cases of anaphylactic shock (0.8/100,000 doses administered).

The currently approved package insert for the vaccine describes precautionary measures to mitigate the risk of anaphylaxis. A full assessment of the national immunization programme is underway.

THE QDENGA VACCINE IS SAID TO BE ABLE TO IMMUNIZE AGAINST ALL FOUR SEROTYPES OF DENGUE VIRUS. WHY IS THIS A GOOD THING?

Dengue viruses belong to the genus Flavivirus.

The dengue virus. Click on the image for a larger, clearer version.

Flaviviruses are lipid-enveloped, single-stranded RNA viruses. The structural pre-membrane (prM) and envelope (E) proteins are embedded in the lipid envelope and are displayed on the surface of virions.

There are 4 dengue virus serotypes (DENV1, DENV2, DENV3, and DENV4); the serotypes share structural proteins (prM and E) but are genetically and serologically distinct.

Infection with 1 serotype induces sustained protection against the same serotype only. Although uncommon, an individual without a vaccine can be infected by each serotype for a total of 4 infections during their lifetime.

Serotypes and Infections

People who acquire a second dengue infection caused by a different serotype are at a higher risk for severe dengue once cross-protection induced by the first infection wanes.

Potential mechanisms for increased risk of severe dengue caused by a second infection include:

  • Cross-reactive antibodies binding to a different DENV serotype, which then enable uptake in inflammatory cells. This leads to higher and more prolonged virus count in the blood circulation (higher temperature and prolonged fever) that induces imbalanced pro-inflammatory and anti-inflammatory responses often referred to as antibody-dependent enhancement.
  • The action of the non-structural protein 1 (NS1) on the blood vessel wall or endothelium can trigger the release of active chemicals from immune cells.
  • Both the above will result in endothelial hyperpermeability and vascular leak (leading to hypovolemic shock and bleeding).

How the Vaccine Is Beneficial

Both dengue vaccines are tetravalent live-attenuated vaccines.

The new vaccine, Qdenga, induces a broad spectrum of immune responses which include:

  • Neutralizing antibodies with a 50% reduction against all 4 dengue virus serotypes.
  • Cross-reactive antibodies that block the activity of the NS1 protein.
  • Type-specific memory B cells to all four serotypes.

This means the vaccine can protect us from severe dengue infection by all the 4 serotypes. This is a good thing.

Expert Answers All the Important Questions You Have about the New Dengue Vaccine

WORDS LIM TECK CHOON

With the Qdenga® dengue vaccine officially launched by pharmaceutical company Takeda Malaysia in Malaysia on 11 June 2024, we manage to get some important answers from Dr Goh Choo Beng about dengue and this vaccine.

FEATURED EXPERT
DR GOH CHOO BENG
Head of Medical Affairs
Takeda India & Southeast Asia
What does it do?

Prevention of dengue caused by any of the 4 dengue serotypes.

The clinical trial of the vaccine found that it can:

  • Prevent 80.2% of symptomatic dengue cases at 12 months after receiving the vaccination.
  • Prevent 90.4% of hospitalizations at 18 months after vaccination.
Who can receive the vaccine?

Qdenga® can be administered to individuals 4 years old and above.

How many doses do I need?

Two doses. The second dose will be given three months after the first dose.

Where can I get it?

Currently it’s available at general practitioner or GP clinics as well as private hospitals.

How much is the vaccine?

The price will be set by the clinic or the hospital, so it’s best to consult them about the price.

How does this vaccine work?

Dr Goh explains that the Qdenga® vaccine has a backbone that is based on the live-attenuated DENV2 serotype of the dengue virus, with recombinant strains expressing surface proteins for DENV1, DENV3 and DENV4.

This way, the vaccine will protect an individual from all 4 dengue serotypes.

Is it safe for individuals that have not contracted dengue before?

Yes. People that have no history of dengue fever as well as people that have had dengue can safely receive the vaccine.

No blood tests are necessary before receiving the vaccine.

What are the side effects?

Short term side effects are common ones associated with vaccination, such as redness and soreness at site of injection. These side effects are mild and temporary.

At the time of writing, there is an ongoing clinical trial that is monitoring and closely following selected individuals that have received the vaccine since about 4.5 years ago. So far, the investigators have found that:

  • The protection afforded by the vaccine persists 4.5 years after receiving the vaccine.
  • There is no long-term serious side effect seen so far.

Ever Wondered Why Vaccines Still Need to Be Injected into Your Body? Get the Answer from a Paediatrician!

WORDS DR DATIN CLARENCE KAVETHA A/P S.S. DANIEL

FEATURED EXPERT
DR DATIN CLARENCE KAVETHA A/P S. S. DANIEL
Consultant Paediatrician, IMU Healthcare
and Lecturer, School of Medicine, International Medical University

Injections can be scary for both adults and children population in general. So why do we still do it?

WHY ARE THE MAJORITY OF VACCINES STILL GIVEN VIA INJECTIONS?

This is mainly because, by injecting directly into the muscle, the vaccines produce a good immune response and certainly provide adequate protection.

Many studies on needle-based vaccinations have demonstrated that these vaccines have good efficacy and high safety levels.

Furthermore, the World Health Organization (WHO) have set standards for vaccine administration, and needle-based vaccination is accepted by most countries and has become a standard practice.

INJECTIONS DON’T HAVE TO HURT (MUCH)!

There are certain vaccines that can be given into the skin instead of the muscle, hence they can be less painful.

This method uses a shorter and thinner needle, so it can also be less intimidating as well to some people.

ARE THERE ANY NEEDLE-FREE ALTERNATIVES TO RECEIVING VACCINES?

There are a few alternative vaccines that do not involve needles. All said, the choice of vaccine delivery still depends on the vaccine characteristics and the targeted disease.

Some needle-free alternatives include oral vaccines in the form of liquid or tablet for diseases like polio and cholera. However, some vaccines are not stable when given orally, mainly because the digestive enzymes in our stomach make it very challenging for most vaccines to work.

Nasal vaccines are also available for certain infections such as the flu—these vaccines are sprayed into the nose.

Having said all of these, I should point out that there is still ongoing research and development to produce alternative vaccine delivery methods that would be less painful and easier to administer.

SCARED OF NEEDLES? DON’T LET YOUR FEAR KEEP YOU FROM GETTING YOUR SHOTS
  • Bring a close friend or family member along with you.
  • Tell the staff that will administer the shot that you’re afraid of needles. Most of them will understand and do their best to soothe your anxiety.
  • Don’t look at the needle going into your arm. Distract yourself by looking at something else or chatting with the staff or your companion.
  •  If your nerves are getting the better of you, take deep breaths and slowly count to 10.

Michelle Yeoh Joins Local Healthcare NGOs in Rallying Malaysians Against COVID-19

WORDS LIM TECK CHOON

On 17 August 2023, the Malaysian Society of Infection Control and Infectious Disease (MyICID), the National Cancer Society of Malaysia (NCSM), and the Malaysian Red Crescent (MRCS), in collaboration with Pfizer Malaysia, launched the MyPELINDUNG campaign.

WHAT’S MyPELINDUNG?

It’s a public educational campaign aimed at mitigating the threat of COVID-19 in Malaysia by increasing the awareness levels of Malaysians on the importance of up-to-date vaccination and seeking of prompt COVID-19-specific treatment.

Among the luminaries gracing the launch were:

  • Her Highness Dato’ Seri DiRaja Tan Sri Tunku Puteri Intan Safinaz binti Almarhum Sultan Abdul Halim Mu’adzam Shah, Tunku Temenggong Kedah, who is the National Chairperson of the Malaysian Red Crescent
  • Datuk Dr Norhayati Rusli, Deputy Director-General of Public Health, Ministry of Health
  • Yang Berbahagia Tan Sri Dato’ Seri Michelle Yeoh, Oscar-winning actress
  • Dr Shaharudeen Bin Kamaludeen, the President of MyICID
  • Dato Dr. Saunthari Somasundaram, the President of NCSM
  • Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life
  • Madam Luksanawan Thangpaibool, the Country Cluster Lead of Pfizer Malaysia, Pakistan and Brunei
A PRINCESS’S WORD OF WISDOM

“Just as it takes many drops to form an ocean, our shared actions—however small they may seem —can create significant impact in the fight against COVID-19,” says Yang Teramat Mulia Dato’ Seri Diraja Tan Sri Tunku Puteri Intan Safinaz.

She adds: “It’s through initiatives like MyPELINDUNG that we can harness our collective strength to navigate this health issue. Together, with the strength of unity and shared responsibility, we can contribute to a healthier, safer nation for all Malaysians.”

WAIT, ISN’T COVID-19 OLD NEWS?

Not so! Yes, Malaysia has made significant strides but the virus responsible for COVID-19 continues to circulate in our communities and can still lead to hospitalizations and even death, especially among high-risk groups.

Hence, the experts driving MyPELINDUNG advocates constant vigilance, updating of COVID-19 vaccinations, adherence to recommended health measures, and prompt seeking of COVID-19-specific treatment if one is tested positive.

VACCINATION IS KEY, EXPERTS SAY

MyPELINDUNG aims to reduce public hesitancy around the COVID-19 booster doses by disseminating scientifically-accurate information and addressing common concerns held by Malaysians about these boosters.

The campaign’s efforts will particularly focus on high-risk groups, as up-to-date vaccination (including booster doses) can reduce their risk of severe illness, hospitalization, and death.

Dr Shaharudeen Kamaludeen, President of MyICID, tells us: “It’s paramount that we understand the critical role vaccinations play in mitigating the severity of COVID-19. Vaccinations, including recommended booster doses, are our primary line of defence against this virus.”

He also adds that prompt medical consultation and treatment after a positive test for COVID-19 are equally vital.

Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life, further emphasizes the importance of maintaining one’s up-to-date vaccination status.

“Full vaccination significantly reduces the risk of severe disease outcomes,” he says. “We urge everyone, particularly those in high-risk groups, to consider vaccinations as their personal shield against the virus, and to remember that this shield is most robust when all recommended doses, including boosters, have been administered.”

THE ACTRESS ADVOCATES

Tan Sri Dato’ Seri Michelle Yeoh concurs with the experts, adding that she herself had 2 brushes with the COVID-19 vaccine.

She participated in an educational video for MyPELINDUNG, a video that she is very proud of, and will continue to commit to encouraging Malaysians to remain vigilant and take the appropriate protective steps against COVID-19.

“Trust the science,” she urges.

PROMPT & QUICK TREATMENT CAN SAVE LIVES

“The most important thing to remember about treatment for COVID-19 is that it should be started as soon as possible after diagnosis to be effective,” states Dato Dr Saunthari Somasundram. “If you test positive for COVID-19, treatments are available that can reduce the likelihood of severe illness, hospitalization, and death. Please don’t delay because COVID-19 specific treatment must be started within days after you first develop symptoms to be effective.”

Tan Sri Michelle Yeoh concurs. “On screen, I’ve navigated flying stunts and leapt off moving vehicles, but life isn’t an action film, and we can’t afford to wait for the dramatic last-minute rescue. If you’re showing any symptoms, act fast, seek help at once.”

For more information about the MyPELINDUNG initiative and its efforts to combat COVID-19, please visit https://www.facebook.com/MyPELINDUNG (link opens in a new tab).

Great News! Now More Children Are Eligible for Free Pneumococcal Vaccination!

WORDS LIM TECK CHOON

In conjunction with World Immunization Week from 24 to 30 April, the Ministry of Health held a National Immunisation Day 2023 on 31 May 2023.

The event was a collaboration between various divisions in the Ministry of Health’s Public Health Programme and Immunise4Life (link opens in a new tab).

THE BIG CATCH-UP

The theme of National Immunisation Day this year is ‘Tingkatkan liputan, kurangkan keciciran’ or ‘The Big Catch-up’.

Dr Zaliha Mustafa, our Minister of Health, revealed that this theme is in line with the expansion of Malaysia’s free pneumococcal vaccination programme to those born between 2018 and 2019. This expansion will commence from June 1.

Pneumococcal vaccine was included in the National Immunisation Programme (link opens in new tab) to initially cover children born from January 1 in 2020.

With this expansion, our Ministry of Health hopes to target 70% or 700,000 of the 1 million children aged 4 to 5 under the two-year programme.

“The nationwide pneumococcal vaccination programme will start on June 1 until May 31 next year and it will involve the ministry’s primary healthcare facilities,” she explained.

Interested parents can set an appointment for their children’s vaccination using the MySejahtera app.

WHY KIDS SHOULD GET THE PNEUMOCOCCAL VACCINE

Pneumococcal disease, an infection caused by bacteria called Streptococcus pneumoniae is contagious and may cause severe illness, so early diagnosis and treatment is important.

Children 2 years old or younger are vulnerable to such infection.

Hence, these children are also at risk of developing serious, potentially life-threatening complications such as:

  • Pneumonia, which is the infection and inflammation of the air sacs in our lungs
  • Ear infections
  • Meningitis, which is the inflammation of a membrane called meninges in the spinal cord and brain
  • Bacteraemia, or infection of the bloodstream
Pneumococcal pneumonia is a lung infection caused by the bacteria responsible for pneumococcal disease. Click on the image for a larger, clearer version.

Once the bacteria infect the bloodstream, they can find their way to parts of the body that are normally sterile, such as the peritoneum—that’s the membrane lining our abdominal cavity—as well as our joints and heart. This can lead to many more invasive diseases, such as peritonitis, arthritis, and endocarditis (inflammation of the inner layer of the heart) respectively.

Hence, parents with children that are eligible for the free vaccination should consider taking advantage of the expansion of Malaysia’s free pneumococcal vaccine programme. They can consult a doctor should they have any doubts and concerns about the vaccine.

Is Tuberculosis Still a Disease That We Should Be Worried About?

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR JAMES KOH KWEE CHOY
Head of Division of Medicine
School of Medicine
International Medical University (IMU)

Tuberculosis, often abbreviated as TB, has been around for a long time. In fact, it was known as “consumption” back in the 1800s.

Perhaps this is what many of us rarely spare this disease a thought unlike, say, dengue and COVID-19.

WHAT CAUSES TUBERCULOSIS

It is caused by the bacteria Mycobacterium tuberculosis.

TUBERCULOSIS CAN ATTACK DIFFERENT PARTS OF THE BODY

“It can attack different parts of the body, with the lungs–referred to as pulmonary tuberculosis– being the most common,” says Professor Dr James Koh Kwee Choy,

These different parts of the body include the lymph nodes and bones (usually the spine), in rare cases in the gut. The bacteria can also attack the brains of people with suppressed immune system, such as those living with HIV. Such cases of tuberculosis are called extrapulmonary tuberculosis (EPTB for short).

Symptoms and prevention of tuberculosis. Click on the image to view a larger, clearer version.
WHO IS AT RISK OF CATCHING THIS DISEASE?

According to Prof James, the most susceptible groups of people are:

  • The elderly
  • People with lowered immunity, including young children whose immune system is still developing
  • People with suppressed immune system, such as those on chronic steroid therapy and people living with HIV
  • People living in overcrowded living spaces, such as the poor and migrant workers, as this close proximity makes it easy for the bacteria to be passed on from person to person
HOW EASILY DOES TUBERCULOSIS SPREAD?

Similarly to all respiratory diseases, it is spread by water droplets that come from coughing or spitting.

However, the bacteria responsible for this disease need to be in significant amount in water droplets for the disease to spread.

“You have to be in quite close contact and in a situation where there’s prolonged exposure. Generally, more than eight hours a day,” says Prof James.

It is also worth noting that the bacteria can become dormant in the body of the host, and someone with dormant bacteria will not pass the bacteria on to others.

Similarly, people with only extrapulmonary tuberculosis—the infection doesn’t affect their lungs—will not spread the bacteria to other people.

THE SYMPTOMS OF TUBERCULOSIS

Detecting tuberculosis at its early stage can be challenging because the symptoms may not show immediately.

“You could have been exposed long ago, and the bacteria will stay latent or dormant in the body and hibernate. Symptoms can come up months or even years later,” says Prof James.

SYMPTOMS OF PULMONARY TUBERCULOSIS (TUBERCULOSIS IN THE LUNGS)
  • Chronic cough
  • Profuse sweating at night
  • Unexplained weight loss
  • Recurrent rise in body temperature in the evenings
SYMPTOMS OF EXTRAPULMONARY TUBERCULOSIS (TUBERCULOSIS IN OTHER PARTS OF THE BODY)
  • Swollen lymph nodes
  • Chronic back pain and fragile bones
  • A sensitive gut and
  • Seizures, headaches, confusion and even alterations in personality if the brain is infected
WHAT TO DO IF YOU BELIEVE THAT YOU HAVE TUBERCULOSIS

“Don’t wait to cough up blood,” says Prof James. “See a doctor if you have had a persistent cough for two weeks!”

Also see a doctor if you have unexplained night sweats and weight loss together with swollen lymph nodes or chronic back pain.

“If you are aware that you’ve been exposed to someone with TB, someone you share a working or living space with, then you might also want to see a doctor to be screened,” Prof James adds.

HOW IS THIS DISEASE TREATED?

Treatment is straightforward, but can take place over a long period of time.

Once the treatment is started, a person will be non-infective in ten to 14 days. In hospitals, a patient will be put in isolation but there is no prescribed quarantine period. “The most important thing is to wear a mask and wash your hands frequently,” Prof James says.

Antibiotics to overcome tuberculosis

“A combination of 4 antibiotics will be prescribed for a period of 6 months to a year, depending on which part of the body is affected,” explains Prof James.

There are newer medications can potentially treat tuberculosis within 3 months, but Prof James shares that, unfortunately, they are not yet available in Malaysia. “At the moment, we’re still using the old regime,” he says.

It is crucial to take these antibiotics on time and as prescribed by the doctor

Otherwise, the bacteria can become resistant to the antibiotics. “This can escalate into extensively drug-resistant TB (XDR TB) and multidrug-resistant TB (MDR TB) – or what is commonly known as superbugs!” Prof James warns.

“Those with MDR/XDR TB can spread it to others and unfortunately for that someone, because the bacteria is already resistant, it becomes very hard to treat. These cases will need a lot of alternative medications involving injections and much longer therapy for up to 2 years. It gets very, very complicated,” he further explains.

WHY ARE WE STILL CONCERNED ABOUT TUBERCULOSIS? WE ALREADY HAVE THE BCG VACCINE TO PROTECT US FROM IT

The Bacille Calmette-Guerin (BCG for short) vaccine is given to Malaysians when they are babies and at primary school.

While the vaccine confers protection against tuberculosis, its effectiveness decreases over the years,

“By the time we are adults, many of us no longer have immunity against the disease,” says Prof James.

Tuberculosis cases in Malaysia are on the rise

Malaysia is still considered a country with a high incidence rate, estimated at 92 per 100,000 population. Prof James reveals that we have about 20,000 to 25,000 new cases every year, with an average of 1,500 to 2,000 resulting deaths.

Interestingly, the number of cases went down during the lock down, when we were wearing masks and practicing social distancing as well as movement control orders. It is when the SOPs are relaxed that the number of cases is up again.

CAN’T WE JUST GET A BOOSTER SHOT?

Sadly, there is no such booster shot currently in existence!

Prof James advises that the best way to keep tuberculosis at bay is to ensure a healthy lifestyle. “Generally, a person who is healthy with a good immune system should be able to fight off TB on their own.”

It is also important to be aware of the symptoms and seek early treatment. “If left for too long, even after recovery, tuberculosis can leave scarring on the lungs that will forever curb a person’s lung capacity,” Prof James states.

Also, it is equally important to stay healthy after recovering from tuberculosis. “Maintain a good diet, exercise, don’t smoke. You can get re-infected with TB and that can be quite bad,” says Prof James.

How Blockchain Technology Can Improve Malaysian Healthcare

WORDS ASSOCIATE PROFESSOR TS DR AFIZAN AZMAN

FEATURED EXPERT
ASSOCIATE PROFESSOR TS DR AFIZAN AZMAN
School of Computer Science
Faculty of Innovation and Technology
Taylor’s University
BLOCKCHAIN TECHNOLOGY UNBLOCKS LIMITATIONS IN MANY INDUSTRIES

Created in 2008, blockchain technology is a decentralized ledger that can be used to verify and trace multi-step transactions in healthcare, retail, supply chain, financial industries, and more.

Having reduced compliance costs and speed-up data transfer processing, users can also confirm secured transactions using this technology without the requirement for a central clearing authority.

Closer to home, Malaysia started its efforts in blockchain technology in 2015, with the Securities Commission (SC) and Bank Negara Malaysia (BNM) as important parties in the movement.

Moving forward, the Malaysian Industry-Government Group for High Technology (MIGHT) has said that Malaysia would be adopting blockchain by 2025 and many banking institutions are requested to explore and adopt this technology into their financial systems.

CURRENT PROBLEMS IN THE POST-COVID-19 HEALTHCARE SECTOR 

Privacy issues when it comes to medical data

From a healthcare perspective, every healthcare institution treats medical data as a highly privacy-sensitive element. The thought of giving patients control of access to their records and the exchange of health data between institutions raises the risks of data exposure and opens up issues around trust and security.

However, currently the problems of the medical record system include a lack of security, difficulty in transferring medical records between multiple healthcare institutions due to system complications, human errors when recording, storing, and transferring patients’ data, and unwanted tampering of data.

Indeed, post-COVID-19, Malaysia for one has been dealing with issues related to the healthcare system. MySejahtera turned into a national scandal after the Public Accounts Committee (PAC) revealed that the COVID-19 contact tracing mobile application had been developed for the government without a contract with the application developers.

Inefficiencies of an outdated medical record system

When medical records are mixed-up, not up to date or stored incorrectly, this can severely endanger the well-being and health of a patient.

Hence, the inefficiency of an antiquated medical record system will surely jeopardize the patient’s transfer process between different medical institutes due to complications with the patient’s medical data exchange.

These issues can lead to more serious issues down the line

These issues can become a stumbling block that contributes greatly to even bigger, unfavourable problems such as heavy monetary losses to healthcare institutions due to complications with patient’s medical data, which can lead to legal consequences.

HOW BLOCKCHAIN TECHNOLOGY CAN ADDRESS THESE ISSUES

Ensures medical data integrity and privacy 

Blockchain’s distributed ledger technology in healthcare makes it easier to:

  • Transfer patient medical records securely
  • Improve healthcare data security
  • Control the medication supply chain
  • Aid genetic code study in the medical field

It is known that the MySejahtera application had infused blockchain technology into its system during its conceptualization. The application could have functioned better had it covered the whole process ranging from user registration, vaccines supply-chain, contact to Pusat Pemberian Vaksin (PPV), medical officers, and more.

Help address major shortages in medications

The private general practitioner (GP) clinics, pharmacies, and hospitals in Malaysia suffered major shortages of various prescription and over-the-counter medications since last May, due to COVID-19 lockdowns in Shanghai, China, and Russia’s war in Ukraine.

More than an acute problem, the extraordinarily severe drug shortage in Malaysia this year revealed the need to boost the country’s medicine security for future international issues in the global pharmaceutical supply chain, as Malaysia is a net importer of pharmaceutical products.

Blockchain technology can help with medicine shortages through proper analysis at hospitals. Through this data analysis with untampered data, it can help to solve the issue in the pharmaceutical supply chain by establishing proof of ownership. Before reaching patients, drug ownership changes from the manufacturer to the distributor, and then to the pharmacist by easily cloning Radio Frequency Identification (RFID) tags. Using blockchain’s ability, more features can be periodically added to the chain.

Aid in improving overwork and toxic working culture in hospitals

The issue on the over workload and toxic working culture in public hospitals also can be solved if the Ministry of Health integrates digital innovation into its systems. Many manual processes can be automated and data transfer from one doctor to another can be updated timely at their fingertips, fostering a favourable environment between patients and doctors.

LOOKING AHEAD

There are several processes and new regulatory procedures related to blockchain that need to be standardized and coordinated.

As a catalyst for change, Malaysia should look into this as a core pillar to move the needle forward. Blockchain technology is ready, and so are we.

Thinking of Traveling? Get These Tips to Keep Yourself Flu-free!

WORDS LIM TECK CHOON

FEATURED EXPERT
DATUK DR CHRISTOPHER LEE KWOK CHOONG 
Consultant Infectious Diseases Physician
Member of the Malaysian Influenza Working Group
FLU FACTS THAT ARE NOTHING TO SNEEZE AT
  1. On board the plane, you have an 80% chance of getting the flu if there is an infected person–who may or may not have symptoms–sitting one row in front or behind you, within 2 seats to either side.
  2. Flu viruses can survive for up to 48 hours on certain surfaces, including your overhead compartment handle, seat-belt buckle, video screen, food tray, arm-rest, and control panel.
  3. You can try disinfecting the items mentioned in the above point, but it would be impractical to disinfect everything you will touch when you land, such as your luggage bag, trolley, the toilet flush, car door handle and so on.
TRAVELING SOON? HERE ARE 2 SIMPLE TIPS

Tip 1: Follow the COVID-19 SOPs when possible
Masking, although no longer promoted in most countries, may help reduce the chances of catching the flu.

However, it is less effective when those around you are not masked. This is where the next tip comes in.

Tip 2: Get the flu shot
The additional protection conferred by the annual flu vaccination is therefore recommended to prevent the disease.

When injected, the vaccine introduces inactivated flu viruses into the body. These have been killed and are unable to cause disease.

Instead, they stimulate your body to produce antibodies that will spring to your defense if you happen to be exposed to the flu.

Allow 2 weeks to reach the desired level of immunity before flying off.

MORE ABOUT THE FLU VACCINE
It gives you a better shot at beating the flu and reducing your risks of heart problems 

Flu vaccination helps prevent severe flu-related infection, hospitalization, and death . It is also associated with a 34% lower risk of major adverse cardiovascular events . There was also an 18% reduced risk of death reported in patients with heart failure .

In people with type 2 diabetes, flu vaccination has been associated with a reduced risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15% .

With the COVID-19, flu, & RSV triple threat in the northern hemisphere, the flu shot is a good bet 

Noting that flu viruses mutate constantly, Datuk Dr Christopher Lee explains that currently available flu vaccines have been updated to effectively fight virus sub-types that are circulating in the northern hemisphere at this time.

“This will help reduce your risk of contracting the disease. The flu vaccination is recommended for those travelling abroad, especially high-risk groups as the importation of flu cases through air travel can result in the spread of flu within the community,” he adds. “So, if you have not been vaccinated against the flu, now is a good time to get it done. The annual flu vaccination is your passport to healthy holidays. Don’t leave home without it.”