Paper Review of Factors, Surveillance and Burden of Food Borne Disease Outbreak in Malaysia

Sharifa Ezat Wan Puteh, Netty D, Gopinath Sangaran

Malaysian Journal of Public Health Medicine, 2013; 13(2): 98–105

Department of Community Health, Faculty of Medicine, National University of Malaysia Medical Centre

Last reviewed: March 2026

Background and Context

Foodborne diseases represent one of the most persistent public health challenges globally, causing an estimated 600 million illnesses and 420,000 deaths annually according to World Health Organization estimates. In Malaysia, foodborne illnesses encompass a range of conditions resulting from the ingestion of foodstuffs contaminated with microorganisms or chemical substances, including cholera, typhoid fever, hepatitis A, dysentery, and food poisoning.

Malaysia’s tropical climate, with year-round high temperatures and humidity, creates an environment highly conducive to the growth and proliferation of foodborne pathogens. Coupled with the country’s vibrant street food culture and a food service industry that ranges from highly regulated establishments to informal hawker stalls, the challenge of maintaining food safety standards is substantial.

This review paper, published in the Malaysian Journal of Public Health Medicine, synthesises data from previous journal publications, Ministry of Health Malaysia statistics, and WHO databases to provide a comprehensive overview of factors contributing to foodborne disease, surveillance mechanisms, and the economic burden of food borne disease outbreaks in Malaysia.

Epidemiology of Foodborne Disease in Malaysia

The authors identified that the true incidence of foodborne disease in Malaysia remains difficult to determine due to underreporting. Notifiable foodborne diseases including cholera, typhoid fever, and hepatitis A had relatively low reported incidence rates, ranging from 0.14 to 1.56 cases per 100,000 population. However, food poisoning cases told a different story: the incident rate reached 62.47 per 100,000 population in 2008 and 36.17 per 100,000 in 2009, representing a significant public health burden.

More recent surveillance data has confirmed this continuing trend. By 2023, the Malaysian Ministry of Health reported a food poisoning incidence rate of 53.67 per 100,000 population, indicating that foodborne disease remains a persistent challenge despite ongoing prevention efforts.

Contributing Factors

The review identified multiple interconnected factors driving the rising trend in foodborne diseases in Malaysia. Rapid population growth and demographic shifts toward an ageing population increased the number of vulnerable individuals. Changing dietary habits were identified as particularly significant: increasing consumption of raw or lightly cooked food, extended storage times for perishable items, and growing reliance on food prepared outside the home all contributed to increased exposure risk.

Inadequate education on basic rules of hygienic food preparation was flagged as a fundamental problem. Food trading without appropriate microbiological safety procedures, particularly among informal food vendors, created pathways for contamination. Approximately half of all foodborne disease outbreaks from the early 1990s onward were associated with institutional and school settings, predominantly attributable to unhygienic food handling procedures.

Surveillance Mechanisms

Malaysia’s foodborne disease surveillance system is primarily physician-based, relying on notifications from government health facilities including health centres, outpatient departments, and hospitals, as well as from private hospitals and general medical practitioners. Notifications are received by the Communicable Diseases Surveillance Section of the Disease Control Division, Ministry of Health.

The review noted important limitations in this surveillance approach. Without mandatory laboratory-based reporting, the system may miss cases that do not present to healthcare facilities or are not correctly diagnosed. The Infectious Disease Act 1988 governs notification requirements, but compliance remains variable. The authors recommended strengthening surveillance capacity through laboratory-based reporting systems and the development of PulseNet-style molecular subtyping networks for rapid outbreak identification.

Economic Burden

The economic impact of foodborne diseases was identified as a growing concern. The review highlighted that direct costs (treatment, hospitalisation) and indirect costs (lost productivity, long-term disability) of managing foodborne disease constitute a substantial economic burden. Limited cost-of-illness studies specific to Malaysia had been conducted at the time of publication, but international comparisons indicated that similar middle-income countries incur billions in foodborne disease-related costs annually.

Implications for Policy and Practice

The findings underscore the need for a multi-pronged approach to foodborne disease prevention in Malaysia. HACCP (Hazard Analysis Critical Control Point) implementation at food service establishments, enhanced food handler training programmes, strengthened surveillance systems, and public education campaigns on food safety are all essential components. The Food Safety and Quality Act and associated regulations provide a legal framework, but enforcement and compliance remain ongoing challenges.

Limitations

This review relied on published literature and publicly available government statistics. The true burden of foodborne disease in Malaysia is almost certainly underestimated due to underreporting, as many mild cases do not present to healthcare facilities. The economic burden analysis was largely based on international comparisons rather than Malaysian-specific cost data.