Karachi: The World Health Organization (WHO) is ready to provide vaccines to contain the rapidly evolving Mpox outbreak in Sindh, as Pakistan faces what senior experts term an unprecedented neonatal cluster that has already claimed seven lives in Khairpur, exposing serious infection control failures and raising alarm over lack of transparency and coordination with federal health authorities.
The offer comes as leading pediatric infectious disease experts including Dr Khalid Shafi, Dr Ali Faisal Saleem and Dr Fatima Mir, presenting their findings at an emergency session of the Pakistan Pediatric Association (PPA), warned that the outbreak reflects a dangerous shift in the epidemiology of Mpox in Pakistan, from imported cases to localized transmission within healthcare settings, particularly neonatal units.
They warned that while vaccines are available globally, their use in Pakistan would be restricted to targeted groups such as healthcare workers and close contacts, as the outbreak remains in an early phase, but stressed that immediate containment measures were being undermined by systemic lapses.
According to the latest data, Khairpur has emerged as the epicentre, where seven confirmed infections among newborns and infants were reported within 24 hours, all of whom died.
While provincial authorities maintain that the deaths were due to prematurity, low birth weight and malnutrition, four of the deceased infants tested positive for Mpox, raising serious questions about the role of the infection in worsening outcomes.
Presenting clinical and epidemiological insights, Dr Ali Faisal Saleem highlighted that Mpox transmission in children is not limited to close contact but can occur through contaminated materials and hospital environments, warning that fomites such as bedding, linens and medical equipment can sustain the virus and facilitate rapid spread among vulnerable patients.
Dr Khalid Shafi, in his presentation, described the Khairpur outbreak as a “neonatal crisis” driven by healthcare associated transmission, pointing to unsterilised incubators as the likely source of infection, a failure he said echoes past outbreaks in Sindh linked to weak infection prevention systems.
Dr Fatima Mir and other experts also warned that the clustering of cases among newborns signals a highly vulnerable population being exposed within healthcare facilities, rather than through traditional community or sexual transmission routes.
Investigations suggest that infected newborns were placed in incubators later used for other infants without proper sterilisation, allowing the virus to spread across neonatal units. Experts termed this a critical breakdown of infection prevention and control protocols, warning that hospitals themselves may have become amplifiers of the outbreak.
Beyond Khairpur, the virus appears to be spreading. Two cases have been confirmed in Karachi in 2026, including one in a returning traveler and another locally detected infection, indicating early domestic transmission. More than 16 suspected “chickenpox like” cases are under investigation in Sukkur and Khairpur, with additional reports from Hyderabad and Mirpurkhas.
At the national level, Pakistan has already reported 26 cases in Khyber Pakhtunkhwa this year, compared to 53 cases in 2025, while earlier years saw only sporadic travel related infections, underscoring a clear epidemiological shift.
Experts warned that the situation is being further complicated by diagnostic confusion. With over 13,000 suspected measles cases reported in 2026, many in children under five, early Mpox infections presenting as atypical rashes may have been misdiagnosed, delaying detection and enabling silent spread.
In a strongly worded call, pediatricians urged immediate HIV screening of all suspected neonatal Mpox cases, warning that immunocompromised infants face significantly higher risks, a critical step they said is still not being implemented by provincial authorities.
At the same time, experts expressed serious concern over the apparent sidelining of the National Institute of Health in Islamabad from the outbreak response.
They warned that withholding data and limiting federal involvement could have global implications, as Mpox is a notifiable disease requiring coordinated surveillance and reporting.
“The absence of transparent data sharing and federal coordination is alarming. This is not just a provincial issue anymore,” one of the experts said, adding that failure to involve national institutions could weaken both containment and international confidence.
Experts stressed that while the WHO vaccine offer provides an important tool, it cannot compensate for systemic failures.
“Vaccination will follow a ring strategy, but the real battle is in hospitals. If infection control is not fixed, the outbreak will continue to spread,” they warned.
Despite provincial claims that the situation is under control following disinfection of affected facilities and enhanced surveillance, experts cautioned that the outbreak has already revealed deep structural weaknesses.
They described the Khairpur cluster as the “new face of Mpox” in Pakistan, driven by pediatric vulnerability, healthcare associated transmission and gaps in surveillance.
The emergence of Mpox among newborns, they said, is not merely an outbreak but a warning that without urgent reforms in infection control, reporting and coordination, Pakistan risks a wider and more dangerous public health crisis.
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