Editor’s Note:
This article was originally contributed by International SOS in response to concerns about tuberculosis among expatriates living and working in Indonesia. Medical knowledge, diagnostic methods, and tuberculosis statistics have evolved considerably since the article was first published. This updated version retains the original educational style while revising medical information and statistics to reflect current guidance from the World Health Organization (WHO) and modern tuberculosis control practices as of date of publishing.
Tuberculosis (TB) remains one of the world’s leading infectious disease killers and continues to be a major public health challenge. Despite significant advances in diagnosis and treatment, tuberculosis continues to affect millions of people worldwide each year.
Tuberculosis (TB) is a serious bacterial disease caused by Mycobacterium tuberculosis. The bacteria are airborne and can be spread when an infected person coughs, sneezes, speaks, or sings. Most people who contract TB have had prolonged, close exposure to an infected person. This means they have spent days or weeks—not just a few hours—sharing the same air space with someone who has infectious pulmonary TB. People who work or live in institutions such as nursing homes, correctional facilities, shelters, and crowded workplaces may also be at increased risk.
Not everyone infected with TB becomes ill. In many people, the infection remains inactive (latent TB infection) and causes no symptoms. However, latent TB can become active later in life, particularly if a person’s immune system becomes weakened. Active TB disease can affect the lungs or other parts of the body and requires medical treatment. With appropriate treatment, most cases can be cured.
Incidence of Tuberculosis in Indonesia
The World Health Organization (WHO) continues to classify Indonesia as one of the countries with the highest tuberculosis burdens globally. Indonesia records more than one million estimated TB cases annually, making it one of the countries most affected by the disease.
Expatriates and frequent travellers who spend significant periods of time in countries with a high TB burden may wish to discuss tuberculosis screening with their healthcare provider. Some countries also recommend BCG vaccination for infants and children who may be exposed to higher-risk environments.
Globally, approximately 10 million people develop tuberculosis each year, and more than one million people die from the disease. While these numbers remain significant, improvements in diagnosis, treatment, and public health programs have reduced mortality rates compared to previous generations.
Symptoms and Diagnosis of Tuberculosis
Active TB can cause a variety of symptoms, including:
- Persistent cough lasting more than two to three weeks
- Fever
- Night sweats
- Unexplained weight loss
- Fatigue and weakness
- Chest pain
- Coughing up blood in some cases
Latent TB infection causes no symptoms and can only be detected through screening tests.
Modern diagnosis increasingly relies on rapid molecular testing, such as GeneXpert MTB/RIF, which can identify TB bacteria and detect certain forms of drug resistance within hours. Sputum microscopy and laboratory culture continue to play important roles, particularly in confirming diagnoses and determining drug sensitivity.
Individuals who have had a persistent cough for more than two weeks should seek medical evaluation, particularly in countries where tuberculosis is common.
Treatment of Tuberculosis
No matter the treatment regimen used, the following basic rules remain important:
- Medication should be taken exactly as prescribed.
- Treatment must continue for the full duration recommended by the physician.
- An uninterrupted supply of medication is essential to prevent drug resistance.
- Follow-up appointments and monitoring are critical to ensure successful treatment.
Drug-resistant forms of TB continue to be a major global concern.
Multidrug-resistant tuberculosis (MDR-TB) occurs when the bacteria become resistant to at least isoniazid and rifampicin, two of the most important first-line anti-TB medications.
Extensively drug-resistant tuberculosis (XDR-TB) refers to MDR-TB with additional resistance to important second-line medications, making treatment considerably more difficult.
Drug-resistant TB may develop when treatment is incomplete, medication is taken incorrectly, or resistant strains are transmitted directly from one person to another.
Prevention of Tuberculosis
Travellers and expatriates may reduce their risk of contracting TB by limiting prolonged exposure to crowded and poorly ventilated environments where tuberculosis transmission is more likely to occur.
Avoiding close contact with individuals who have untreated active TB can significantly reduce risk. Families employing domestic staff who live in the household may wish to discuss routine health screening with their physician, particularly when young children or immunocompromised individuals are present.
Good ventilation, access to sunlight, and prompt medical evaluation of persistent respiratory symptoms remain important preventive measures.
The BCG Vaccine
The Bacillus Calmette-Guérin (BCG) vaccine has been used worldwide for more than a century and remains part of the routine childhood immunization schedule in many countries, including Indonesia.
The vaccine provides protection against severe forms of tuberculosis in children, such as TB meningitis and disseminated TB. Protection against adult pulmonary tuberculosis is more variable and may differ between populations and geographic regions.
Because vaccination policies vary between countries, expatriate families should discuss vaccination recommendations with their healthcare provider before relocating.
Tuberculosis Screening
The two most commonly used screening methods today are:
A. Mantoux (Tuberculin Skin Test)
A small amount of purified protein derivative (PPD) is injected under the skin of the forearm. The injection site is examined after 48–72 hours to determine whether a reaction has occurred.
B. Interferon Gamma Release Assays (IGRAs)
These blood tests measure the immune system’s response to TB bacteria and are increasingly used because they are not affected by prior BCG vaccination.
Medical Prevention of Tuberculosis
Organizations operating in countries where tuberculosis is common may include TB screening as part of occupational health programs, particularly for employees working in healthcare settings or environments where exposure risk is elevated.
The decision regarding when an employee can safely return to work should always be made by the treating physician and local public health authorities. Factors considered include treatment response, laboratory results, symptoms, and the nature of the individual’s work environment.
Most patients receiving effective treatment become significantly less infectious within a few weeks, although treatment itself typically continues for several months.
Although properly treated pulmonary tuberculosis is usually curable, certain drug-resistant strains may require prolonged treatment and close specialist supervision.
Additional information on Tuberculosis is available from the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
We trust this information will assist you in making informed decisions regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.
Our appreciation to International SOS, an AEA Company, which contributed the original article and helped raise awareness of an important health concern for expatriates living and working in Indonesia.
