Monkeypox Disease Awareness in Pakistan

The global healthcare sector has recently grappled with the challenge of controlling the resurgent coronavirus disease 2019 (COVID-19). Adding to this burden is the recent outbreak of the monkeypox virus (MPXV), which has further strained the economic and healthcare systems of various countries. Monkeypox is a zoonotic viral disease caused by MPXV, an orthopoxvirus belonging to the Poxviridae family. While MPXV was first identified in 1958 in laboratory monkeys, sporadic human cases were not reported until the 1970s in several African countries. The virus can enter the human body through multiple routes, including oropharyngeal, nasopharyngeal, or intradermal pathways. The onset of classic monkeypox is marked by a prodrome of fever, fatigue, and lymphadenopathy, followed by a predominantly facial skin eruption.

The first significant outbreak of monkeypox outside Africa occurred in the United States in 2003. The current multinational outbreak began in Europe on May 6, 2022, and has presented with atypical symptoms such as mucocutaneous lesions, sore throat, rectal pain, and penile edema. Recognizing the surge in monkeypox cases worldwide, the World Health Organization (WHO) declared the monkeypox epidemic a global public health emergency in June 2022. As of September 26, 2023, over 90,618 laboratory-confirmed cases of monkeypox had been reported globally, resulting in 157 fatalities across 115 countries, spanning all six WHO regions. The most affected countries include the United States, Brazil, and Spain, which together account for a significant proportion of the cases reported globally.

In Pakistan, the first officially confirmed case of monkeypox was recorded on April 21, 2023, in Islamabad. The virus was detected in a 25-year-old Pakistani man who had recently returned from Saudi Arabia. Following the diagnosis, the patient and a fellow passenger who exhibited symptoms were promptly isolated and hospitalized. In response, Pakistani health authorities, led by the National Institute of Health (NIH), established a multidisciplinary team in collaboration with provincial health departments, border health services, and district health authorities to prevent further spread. This team implemented vigilant surveillance measures, including laboratory diagnostics, contact tracing, and isolation of suspected cases.

The clinical presentation of monkeypox closely resembles that of other diseases such as smallpox, chickenpox, measles, bacterial skin infections, scabies, medication allergies, and syphilis. Early differential diagnosis is crucial to curbing the spread of the virus in the community. While PCR is the preferred diagnostic test due to its high accuracy and sensitivity, other diagnostic methods include viral culture, electron microscopy, immunohistochemistry, and serology tests that detect anti-orthopoxvirus IgG and IgM antibodies. The availability of diagnostic facilities remains a critical challenge in Pakistan, where, despite having PCR machines in most major laboratories, there is a lack of testing kits and other necessary reagents. It is imperative that the Pakistani government urgently procure these materials to prevent a potential viral epidemic.

Given Pakistan's current economic challenges and insufficient healthcare infrastructure, the country is ill-prepared to manage a new endemic outbreak, especially in the aftermath of COVID-19. The experience of the COVID-19 pandemic highlighted the importance of timely measures and strict control in preventing widespread transmission. The increased frequency of monkeypox outbreaks over the past four decades can be attributed to several factors, including higher population density, ease of travel, and certain ecological and environmental factors. Asymptomatic transmission of the virus also contributes to its spread, making it essential to implement mandatory testing before flights and impose travel restrictions on suspected cases.

The response to the current monkeypox outbreak in Pakistan has involved close collaboration with the WHO and other international organizations. Efforts have been made to prevent the virus's spread and provide the best clinical care to those infected. WHO has supported Pakistan by providing laboratory testing kits, technical assistance, and guidelines for surveillance and management. Pakistani authorities have been instructed to implement laboratory diagnostics, contact tracing, and early identification of suspected cases to ensure effective surveillance.

Preventing a monkeypox outbreak in Pakistan requires a comprehensive approach that includes increased surveillance, public awareness, and healthcare preparedness. The Pakistani government has directed national and provincial health authorities to remain on high alert and has implemented strict monitoring at all points of entry, particularly for passengers arriving from countries with reported cases. Screening of incoming passengers, especially those from African countries, is being conducted at border health services.

Public awareness campaigns are crucial in educating the population about the risks of monkeypox and the measures that can be taken to prevent its spread. These campaigns should focus on avoiding contact with wild animals, practicing good hygiene, and promptly reporting any symptoms to healthcare authorities. Furthermore, healthcare facilities must be prepared to identify, isolate, and treat cases of monkeypox to prevent severe disease and reduce transmission.

The current monkeypox outbreak poses a significant threat to global public health, necessitating a coordinated response from healthcare providers, government organizations, and the general public. Early detection through rapid diagnostic testing, prompt treatment, and comprehensive prevention strategies are essential in curbing the transmission of MPXV and minimizing its impact on society. Continued research is needed to better understand the virus, its transmission pathways, and to develop effective therapeutic and prophylactic interventions to prevent future outbreaks.

By adopting a systemic, coordinated, and standardized approach, Pakistan can effectively manage the threat of monkeypox and protect its population from the potential consequences of this viral disease. The experience gained from managing COVID-19 should be leveraged to strengthen the country's preparedness and response to emerging infectious diseases, ensuring a healthier and safer future for all.

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