Karachi: A highly virulent strain of Mpox, clade ‘1b’, has been detected in Pakistan through genetic sequencing, with cases now reported from Khairpur, Lahore and other parts of Punjab, as federal officials and public health experts accuse Sindh health authorities of misleading stakeholders and suppressing critical information even as children continued to fall ill and die.
Officials familiar with laboratory findings said genetic sequencing at Dow University of Health Sciences (DUHS) Karachi, Punjab and the National Institute of Health (NIH) confirmed the presence of the more transmissible clade 1b of the Mpox virus in samples from Khairpur, with similar findings linked to cases reported in Punjab.
“Clade 1b of mpox, a more severe sub-lineage of Clade I first seen in the Democratic Republic of the Congo, is linked to higher severity and sustained human transmission through close contact. The World Health Organization is monitoring it closely due to its greater outbreak potential compared to earlier strains,” an official in the federal health ministry said.
However, Dow varsity researchers were reportedly warned against widely sharing the findings with experts, federal authorities or even within sections of the provincial health system.
The outbreak, which surfaced in February this year, has so far resulted in at least nine officially acknowledged deaths and over two dozen confirmed cases, though experts believe the actual toll may be significantly higher.
Highlighting the alleged cover-up, officials said that despite growing clinical suspicion and emerging laboratory evidence, the Directorate General Health Services Sindh issued a notification on March 24 describing the situation as “Staphylococcal Scalded Skin Syndrome,” a bacterial condition, and advised routine infection control measures without any reference to Mpox.
Federal health officials and public health experts said the notification mischaracterised the outbreak at a critical stage. “This was not merely a diagnostic lapse, it amounted to misdirection at a time when early recognition was crucial,” said a senior official at the Ministry of National Health Services, requesting anonymity. “By then, there were strong clinical and laboratory indicators pointing towards Mpox.”
Images and videos of children with severe lesions began circulating by mid-March, raising alarm among clinicians at major institutions including Aga Khan University and Dow University. Samples from affected children were subsequently reported to have tested positive for Mpox at independent laboratories.
However, when experts approached provincial authorities and field epidemiology units, they were reportedly told the cases were routine skin infections and advised not to intervene.
Health officials say the delay in acknowledging the outbreak may have facilitated its spread beyond Khairpur. Cases linked to the cluster have now been identified in Rahim Yar Khan and other parts of southern Punjab, while additional suspected and confirmed infections have also been reported from Lahore.
“Movement of patients between districts without proper diagnosis and containment likely contributed to cross-district transmission,” a federal official said.
Experts believe the officially reported nine deaths do not reflect the true scale of the outbreak, pointing to gaps in surveillance and delayed reporting. “There are indications that both fatalities and infections may be underreported,” said another health ministry official.
Federal officials said cases are still being reported from Khairpur, while the index case remains untraced, raising concerns about the extent of community transmission.
Public health specialists have called for a comprehensive epidemiological investigation in line with recommendations of the World Health Organization, which has also offered technical support. Officials added that a team sent to the affected area on the directions of the prime minister and minister of state for health Dr Malik Mukhtar Bharath has yet to share its findings, delaying a coordinated response, while the National Institute of Health did not respond to queries.
Experts and officials criticised the lack of transparency, warning that withholding outbreak data can worsen public health emergencies, delay response and increase transmission. They said the Khairpur episode reflects broader weaknesses in disease surveillance and coordination, cautioning that delays in responding to infectious diseases could lead to avoidable deaths, particularly among children.
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