Mpox in Pakistan: What Do We Know About the Situation in the Pakistan?

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Updated September 2024

Key takeaways:

• Pakistan has reported a few cases of mpox as of 3 September.

• So far, there’s no case reported for the newer, more lethal strain.

• The Federal Ministry of Health has released guidelines for international airports to prevent the spread of mpox.

What is Mpox?

Mpox, also known as Monkeypox, is a viral zoonotic disease that can be transmitted between animals and humans. For the past 50 years, it has been endemic in Central and West Africa, with occasional cases reported in other regions. The infection usually presents with fever, rash, and swollen lymph nodes and can lead to various medical complications.

There are two classifications of mpox:

• Clade I: This is the more severe form, with a fatality rate of about 10% among those infected. However, recent outbreaks have seen a decrease in the number of deaths.
• Clade II: This variant is less severe and has a 99.9% survival rate. It was responsible for the 2022 outbreak.

Mpox cases in Pakistan

Pakistan has confirmed four cases of mpox after WHO declared mpox as a global health emergency, all of which are unrelated to the new strain. According to the Minister for Health of Khyber Pakhtunkhwa, Syed Qasim Ali Shah, the latest case of mpox in Pakistan was detected in Khyber Pakhtunkhwa province, Peshawar city.

Two passengers were found to have symptoms of mpox during screening at the Bacha Khan International Airport. Only one of the passengers has been confirmed to be infected by mpox. The individual is a 51-year-old man from Orakzai district. He is reportedly stable and has been transferred to Police and Services Hospital Peshawar for treatment.

As the number of mpox cases in Pakistan continues to rise, the city of Peshawar is becoming an epicenter for the disease. A total of 20,901 screenings were conducted at Bacha Khan International Airport, and 21,040 screenings took place at the Torkham location to prevent the spread of the disease.

The detection of these cases underscores the importance of continued vigilance and adherence to preventive measures to curb the spread of mpox. Health authorities closely monitor the situation and take necessary steps to contain the virus.

Mpox health and travel guidelines in Pakistan

The Federal Ministry of Health in Pakistan has released detailed guidelines for international airports to prevent the spread of mpox. This move comes in response to the confirmation of a new mpox variant in Sweden, which has been linked to a growing outbreak in Africa.

Border Health Services (BHS) has been designated as the primary agency responsible for preventing the spread of mpox at international airports in Pakistan. The Civil Aviation Authority (CAA) provides oversight and coordination, while the Airport Security Force (ASF) ensures security while implementing health measures.

Key measures include:

• Health declarations: Airlines must submit health declarations and passengers must complete health forms disclosing any Mpox-related symptoms
• Screening measures: Thermal scanning and visual inspections are conducted at all entry points to identify potential cases
• Isolation and quarantine: Suspected mpox cases are isolated at the airport, and quarantine measures are enforced for close contacts
• Disinfection protocols: BHS oversees the disinfection of aircraft and high-traffic areas within the airport
• Coordination: CAA ensures that all airport agencies are aligned with health protocols
• Crew instructions: Airline crews receive training on symptom recognition and the use of PPE
• Passenger communication: Passengers are informed about mpox symptoms and provided with PPE
• Case reporting and contact tracing: BHS ensures immediate reporting of cases and initiates contact tracing for those exposed
• Public health surveillance: Continuous monitoring of passengers, especially from affected regions, is conducted, with data shared in real-time
• Training and simulation: Regular training and simulation exercises are conducted to ensure preparedness
• Communication strategy: BHS maintains clear communication with stakeholders and provides public updates on mpox prevention
• Review and monitoring: Guidelines are regularly reviewed and updated based on the latest public health recommendations

What causes Mpox?

Mpox is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as clothing, bedding, or other items used in healthcare settings.

What are the symptoms of mpox?

Mpox has an incubation period of seven to 14 days. The initial symptoms of mpox are similar to influenza, with fever, chills, exhaustion, headache, muscle weakness and swelling in lymph nodes.

The widespread rash all over the infected bodies includes the inside of the mouth, palms of the hands, and feet. Moreover, it has been reported that the rashes are mainly in the genital area for the early stages of the illness.

The most distinguished ways of transmission of the mpox infection from one person to another are typically through contact with body fluids and respiratory droplets, contact with skin lesions of an infected person and contact with contaminated surfaces.

What is the treatment for Mpox?

According to the Centers for Disease Control and Prevention (CDC), USA, no treatments are specifically for mpox virus infections. However, mpox and smallpox viruses are genetically similar, so antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat mpox virus infections.

WHO currently recommends two vaccines, the Modified Vaccinia Ankara (MVA) and the replication-competent smallpox vaccine (ACAM2000), available globally for mpox but designated only for certain high-risk cases. Mass vaccination is not advised, and travelers at risk may consider vaccination based on individual risk assessments with healthcare providers.

Mpox prevention

The Pakistan government is currently taking steps to vaccinate healthcare workers involved in screening, ICU management, and laboratory testing as part of its strategy to combat mpox. To support this movement, they have requested mpox vaccines from the World Health Organization (WHO) and GAVI to support this effort, ensuring that frontline workers are protected as they manage the outbreak.

In addition to the government prevention protocols, individuals intending to travel to Pakistan must observe personal preventative measures. The following measures are recommended to mitigate the spread of mpox:

• Keep your hands clean by washing them for at least 20 seconds with soap and water or alcohol-based hand sanitizers
• Prevent animal-to-human transmission
• Avoid any contact with wild animals
• Cook meat properly
• Avoid any objects that have been in contact with a sick animal
• Prevent human-to-human transmission
• Avoid contact with any person who has a rash
• Avoid contact with any object that has been in contact with a sick person