It often begins quietly. A lingering cough, a mild fever that comes and goes, a child who seems more tired than usual.
For many families, these symptoms may appear harmless at first, easily mistaken for a common infection.
But in some cases, they can signal something far more serious: tuberculosis (TB).
For parents, the possibility can be frightening, not only because of the disease itself but because children are especially vulnerable to its most severe complications.
In Sarawak, the concern is real as the state has reported 257 cases in just five weeks into 2026, with several active clusters identified.
This highlights the need for greater awareness, early detection and strong community cooperation to prevent further spread.
Consultant paediatrician, Dr Tan Jiunn Liang, of Normah Medical Specialist Centre said paediatric TB often reflects transmission within the household, usually from an infected adult, making family screening critical when a child is diagnosed.
“Paediatric TB is due to contact with a diseased adult. Hence, a positive paediatric case in a household will require screening among the adults who have close contact with the children,” he told Sarawak Tribune.
He explained that children are more prone to developing disseminated TB infections, where the bacteria spread beyond the lungs to other parts of the body, including the brain.
He warned that when TB affects the brain, the consequences can be life-long.
“Paediatric population has higher tendency for disseminated TB infection. Hence early detection, ideally at latent phase, will help to prevent disseminated infection,” he said.
“Damage to a growing brain can have a permanent negative impact on the child and caregiver’s quality of life in the long run.”
Beyond clinical risks, Dr Tan said broader systemic challenges continue to hinder TB control efforts, including under detection among households with known TB contacts.
“I have concern about under detection among households with positive TB contact. Unfortunately, the Ministry of Health (MOH) is understaffed, and active detection will require manpower to reach out to rural areas where most TB cases occur,” he lamented.
He noted that treatment compliance also remains a concern, particularly because TB treatment requires months of medication and close monitoring.
He said in an ideal setting, newly diagnosed patients should undergo the initial phase of treatment in facilities equipped with proper isolation.
“Poor compliance can be an issue, attributed to long treatment duration, multiple pills and lack of understanding on the severity of untreated TB disease,” he explained.
“In an ideal setting, positive TB cases should complete the first two weeks of treatment in medical facility with proper isolation and negative pressure room which sadly we are lacking.”
He also pointed out that crowded living environments with poor sanitation can increase transmission risks, especially among populations with limited access to healthcare services.
“I am concerned the trend is a result of MOH’s resources being stretched thin and general population awareness of the severity of TB disease or infection is also lacking,” he added.
For families, Dr Tan stressed that awareness is one of the most powerful tools in preventing severe outcomes.
He stressed the importance of ensuring that household members undergoing TB treatment remain compliant with their medication and follow-up appointments.
“Active screening especially high-risk households, parents to improve their understanding of TB symptoms and to seek healthcare advice if present,” Drt Tan advised.
“Ensure household members who are receiving TB medications to be compliant to treatment regime and follow-up.”
He also urged families to cooperate with health authorities during screening exercises, noting that stigma or embarrassment can sometimes lead to missed opportunities for early detection.
One of the most effective protections against severe TB in children remains vaccination.
Dr Tan said the Bacillus Calmette–Guérin (BCG) vaccine provides significant protection against serious forms of the disease.
“BCG can be protective for disseminated TB and brain TB up to 80 per cent and 52 per cent respectively,” he elaborated.
However, he noted that challenges remain, including vaccine hesitancy and a small number of children who do not develop sufficient immunity after the first dose.
“For those who did not respond to the first BCG vaccine, a repeat BCG vaccine can be obtained prior to the age of seven years old. However, vaccination after seven years old has not been proven to be protective,” he shared.
Ultimately, he said early medical assessment is crucial if TB is suspected in a child, as prompt intervention can prevent complications and further transmission.
“My advice is to bring the child for assessment by healthcare personnel. If screened positive, ensure close contact family members to be screened along.
“It is advisable for the steps to be done as soon as possible to prevent further spread among close contact and prevent disease progression.”
