Islamabad: Pakistan is among countries reporting community transmission of clade Ib mpox, including transmission within sexual networks of men who have sex with men (MSM), while Sindh is also facing a healthcare-associated outbreak involving neonates, infants and adults, the World Health Organisation (WHO) has said in its latest situation report.
The WHO said the virus is no longer confined to imported cases and is now circulating locally in Pakistan, including within MSM networks, while a separate outbreak linked to healthcare settings has also been detected.
Argentina, Denmark, Germany, Pakistan, Portugal, Singapore, Spain and the United Kingdom have all reported community transmission of clade Ib MPXV, “including among men who have sex with men,” signalling sustained human to human spread in these countries, the report said.
Health experts say the classification of community transmission is significant as it indicates infections are occurring without travel history or known epidemiological links, making containment more difficult.
The WHO noted that mpox transmission globally continues largely within sexual networks, particularly among MSM, but is increasingly followed by household transmission, exposing women, children and other close contacts.
In Pakistan, the situation is compounded by a healthcare-associated outbreak in Sindh province. From March 14 to April 20, a total of 249 suspected cases were reported across nine districts, of which 29 were laboratory confirmed, including eight deaths, with a case fatality ratio of 28 percent. One additional death was reported in a suspected case.
About half of the confirmed cases, and all reported deaths, occurred in infants younger than six months, highlighting serious gaps in infection prevention and control in healthcare facilities.
According to the WHO investigation, the outbreak was traced to healthcare facilities in Khairpur district, where transmission occurred due to suboptimal infection prevention practices, including shared incubators, contaminated surfaces and oxygen equipment. The outbreak initially involved a newborn, likely infected through contact with one or both caregivers, before spreading within neonatal intensive care units.
By April 20, Khairpur alone had reported 20 confirmed cases, including seven deaths, with most cases and all deaths occurring among infants. Genomic sequencing confirmed the presence of clade Ib MPXV.
Additional confirmed cases in Karachi and Sukkur among adults and caregivers suggest concurrent community transmission, including through close physical and sexual contact, raising concerns about wider spread.
Globally, the WHO reported 58,214 confirmed mpox cases and 238 deaths across 100 countries between January 2025 and March 2026. In March 2026 alone, 48 countries reported 1,235 cases and five deaths, with more than 70 percent of cases reported from the African region.
While several WHO regions have reported a decline in cases, increases in the Eastern Mediterranean and Western Pacific regions indicate shifting transmission patterns.
Public health experts warn that Pakistan’s inclusion among countries with community transmission of clade Ib mpox, particularly within MSM networks, reflects gaps in surveillance and targeted risk communication for high-risk groups.
They warned that weak infection prevention practices in healthcare facilities, combined with ongoing community transmission, could lead to further spread if not contained.
The WHO has called for rapid containment measures, including strengthened surveillance, early case detection, contact tracing, strict infection prevention protocols in hospitals and targeted vaccination strategies for at-risk populations.
Officials say response measures in Pakistan include closure and decontamination of affected facilities, enhanced surveillance and contact tracing, and technical support from WHO, but sustained efforts will be required to prevent wider community transmission of the virus.
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