KARACHI: Mpox cases are rapidly increasing worldwide, prompting the World Health Organization (WHO) to declare a global emergency for the second time in two years. Shortly after this alert, Pakistan’s health ministry confirmed its first mpox case in a traveler returning from a Gulf country.
The infected individual, a young man from Mardan, Khyber Pakhtunkhwa (K-P), was allowed to return to his hometown while the virus strain was still being sequenced. The patient had initially traveled to Dir, about 240 kilometers from Peshawar, but he is now quarantined at home.
A day before Pakistan’s alarm was raised, Sweden confirmed its first case of mpox clade I, a more dangerous variant, suggesting that the virus might have already spread from the Democratic Republic of Congo, where it has been causing significant fatalities.
The Centers for Disease Control and Prevention in Africa reported over 17,000 mpox cases across the continent in 2024, surpassing last year’s total. This surge and memories of the WHO’s previous global alert before the COVID-19 pandemic have sparked concerns. Medical experts suggest that death rates may vary depending on healthcare access and underlying health conditions, such as advanced HIV. The WHO data shows a fatality rate ranging from 0.1% to 10%.
Understanding the Global Mpox Alert
A public health emergency is declared when a disease spreads rapidly, as with mpox. More than 99,000 confirmed cases have been recorded globally since 2022. The previous WHO alert in 2022 led to the containment of the outbreak through behavior changes and vaccines. However, mpox has been a recurring issue in parts of Africa since 1970. The recent spread in Congo has been particularly severe, with over 1,100 deaths since January 2023, mainly among children.
Currently, two strains of mpox are circulating in Congo: the endemic clade I and a new variant, clade Ib. Clade Ib has spread to Rwanda, Uganda, Burundi, and Kenya, with Sweden being the first country outside Africa to report a case of this new variant. Pakistan has yet to confirm the strain of the virus. As the global community mobilizes resources for Congo, health experts emphasize the need for vigilant surveillance to prevent further spread and avoid a global pandemic.
Mpox in Pakistan: What You Need to Know
Pakistan’s first mpox case was confirmed on August 16, involving a traveler returning from the Middle East. Whether this case involves the new variant or the global strain spreading since 2022 is still unclear.
The federal and provincial governments have implemented strict screening measures at all entry points nationwide. Major airports are now screening all international passengers for symptoms.
Dr. Faisal Mahmood, an Aga Khan University Hospital infectious disease specialist, reassures that mpox is less contagious than Covid-19. He explained that during the 2022 WHO alert, Pakistan saw only a few cases, and a similar situation is expected this time. Most cases will likely come from returning travelers with limited local transmission. “The general public should not be overly alarmed,” he said.
According to the National Institutes of Health (NIH), 11 reported mpox cases have occurred in Pakistan since 2023, with one death as of August 15, 2024. The NIH’s “Revised National Guidelines for Mpox” confirms no evidence of local transmission.
Regarding Pakistan’s healthcare capacity, Mahmood believes the country is well-prepared. Mpox requires close contact for transmission, and patients don’t need special air handling in hospitals, making it easier to manage. However, Mahmood noted that Pakistan lacks medications and vaccines for mpox prevention, which are in short supply globally.
Temperature screenings for returning passengers are ineffective for detecting mpox since fever often precedes visible symptoms. Mahmood emphasized the need for visual inspections and PCR tests, which require trained staff to collect samples from skin lesions.
Pakistan’s Preparedness and Challenges
In the Global South, healthcare systems are often seen as under-resourced. During the Covid-19 pandemic, some governments struggled to respond effectively. In India, over 1.2 million deaths were recorded, and the healthcare system nearly collapsed. In contrast, Pakistan reported over 30,000 Covid-19 deaths. Given this history, there is heightened concern about the health infrastructure following the recent WHO mpox alert.
Dr. Faisal Mahmood believes that Pakistan is taking appropriate steps by screening at ports of entry, preparing hospitals, and training healthcare providers. However, improving surveillance and raising awareness in private hospitals would be beneficial. The timing of resource allocation is crucial to avoid overstretching the system too early or being underprepared.
Mpox Symptoms and Transmission
Mpox symptoms include a 2 to 4-week rash, fever, headache, muscle aches, back pain, and swollen lymph nodes. The rash can appear as blisters or sores on various body parts, including the face, hands, feet, and genital areas. Severe cases can lead to complications like secondary infections, encephalitis, and pneumonia, especially in high-risk groups such as newborns, children, pregnant individuals, and those with weakened immune systems.
The virus spreads primarily through close contact with an infected person, including skin-to-skin or face-to-face interactions. In the 2022 outbreak, sexual contact was the main transmission route. The virus can also persist on surfaces like clothing and bedding used by an infected person. Patients are considered infectious until all lesions have crusted over, and a new layer of skin has formed, typically taking 2 to 4 weeks.
Treatment and Misinformation
While understanding mpox is evolving, the World Health Organization acknowledges that treatment options remain limited. Vaccine access has been inequitable, especially in Africa. Three vaccines are available, but mass vaccination isn’t recommended due to the virus’s transmission method. High-risk individuals, such as those in close contact with mpox cases, should consider vaccination.
Supportive therapy—managing symptoms like pain and preventing secondary infections—is sufficient for most cases. Although trials for specific medications are ongoing, they are not currently available in Pakistan.
Misinformation about mpox, particularly on social media, has caused unnecessary fear. Some accounts have falsely reported multiple cases in Pakistan, leading to confusion. Dr. Mahmood emphasized the importance of staying calm and informed, as mpox is not highly transmissible.
The Potential for Mpox Spread
The WHO’s recent alert has put the world on notice. The virus has caused significant deaths in Africa, especially in Congo. The main concern is how far the virus might spread globally. During the last alert two years ago, nearly 100,000 people were affected worldwide. Health experts believe the current situation is manageable but warn that the outcome depends on the global response.
Dr. Mahmood noted that mpox could spread within close-contact networks, such as social or sexual groups, and urged continued monitoring to prevent more comprehensive transmission in Pakistan.
(Additional input by Tufail Ahmed, Wisal Yousafzai, and Muhammad Ilyas)
