The Ministry of National Health Science has issued guidelines regarding mpox — a viral zoonotic disease — to all airports in Pakistan following the detection of a case at the Islamabad airport, the ministry’s spokesperson Sajid Shah said on Tuesday.

The spokesperson confirmed that it was the first case of mpox — previously called monkeypox — detected in the country.

In this disease, patients commonly show symptoms such as a rash, fever, sore throat, headache, muscle aches, back pain, low energy and swollen lymph nodes.

According to the World Health Organisation (WHO), “mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure.

“Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.”

Mpox cases have been on the rise across the world since last year, with 87,113 confirmed cases reported to the WHO between January 1, 2022 and April 24, 2023.

Shah told Dawn.com that after confirming the first case in Pakistan, the National Institute of Health (NIH) had established two teams that were conducting contact tracing at Islamabad International Airport, the Pakistan Institute of Medical Sciences and other places where the patient could have possibly been a source of the disease’s transmission.

He added that airports across the country had been directed to provide information about passengers exhibiting mpox symptoms.

Meanwhile, the Border and Health Services of Pakistan had been keeping an eye on every person entering the country, he said, assuring that “all necessary steps have been taken to ensure the safety and health of Pakistanis”.

NCOC establishes control room; airports provided PPE

Following the development, the National Command and Operation Center set up a control room to deal with mpox cases across the country, Federal Joint Secretary Health Mustafa Jamal Kazi told Dawn.com.

He said the control room would update information about mpox cases on a daily basis to avoid misinformation and panic among the public.

The official further said that representatives of all provinces and 31 divisions and departments had decided during a virtual meeting today that personal protective equipment (PPE) would be provided to all airports and isolation wards for suspected mpox patients would be set up in hospitals in major cities.

“As many as 50,000 face masks, 10,000 gowns, 100,000 surgical gloves, 1,000 bottles of disinfectants, 2000 hand sanitisers and 20,000 shoe covers have been dispatched to international airports across the country,” he said.

He added that wearing masks and using gloves had been made mandatory for all porters at airports, as well as staff providing assistance for pushing wheelchairs, handling luggage or coming in direct contact with passengers by any other means.

Kazi said passengers suspected to have been infected with mpox could avail the option of home quarantine and in that case, they would be provided PPE.

The official also refuted media reports about two mpox cases having been detected in the country and clarified that just one case had been reported so far.

High alert issued to Sindh hospitals

Meanwhile, the Sindh health services director general issued a high alert to multiple hospitals in the province, directing them to take proactive measures for dealing with mpox cases.

The alert was issued to Jinnah Postgraduate Medical Centre, the National Institute of Child Health, Dr Ruth Pfau Civil Hospital and Sindh Government Lyari General Hospital in Karachi, Liaquat University Hospital in Hyderabad, Peoples Medical University Hospital in Shaheed Benazirabad, Ghulam Muhammad Mehar Medical College in Sukkur, Chandka Medical College Hospital in Larkana, Civil Hospital and the Gambat Institute of Medical Sciences in Khairpur, the Syed Abdullah Ahah Institute of Medical Sciences in Sehwan and the Jacobbabad Institute of Medical Sciences.

The alert, a copy of which is available with Dawn.com, said: “In light of the emergent threat of monkeypox, it is imperative that hospitals take proactive steps for the management of suspected or confirmed cases.

“This includes the establishment of an isolation ward to provide safe and effective care for patients.

“Therefore, hospital administrations are required to establish designated separate areas with separate five to ten rooms for the isolation of monkeypox cases with appropriate infection control measures, including negative pressure, hand hygiene facilities, and personal protective equipment within 24 hours.

“Further, you are advised to nominate the focal person and share the contact details to this office.”

The notification said the matter should be treated as a “top priority”.

In another notification issued to multiple hospitals, the provincial health services director general said: “It is imperative to be vigilant for the detection of any suspected cases and ensure preparedness to launch response activities for curtailing the transmission of monkeypox disease in Sindh.”

He instructed the hospitals to immediately share information with relevant authorities “if anyone presents with acute illness with fever >38.3⁰C (101⁰F), intense headache, lymphadenopathy, back pain, myalgia and intense asthenia followed one to three days later by a progressively developing rash often beginning on the face (most dense) and then spreading elsewhere on the body, including the soles of feet and palms of hands and along with travel history of epidemic countries where monkey cases are reported”.

What is mpox?

WHO describes mpox as zoonosis — “a disease that is transmitted from animals to humans, with cases often found close to tropical rainforests where there are animals that carry the virus”.

The WHO says that the disease can also spread from humans to humans.

“It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects.”

According to a health advisory issued by the WHO last year, “People who closely interact with someone who is infectious are at greater risk for infection; this includes household members, sexual partners, commercial sex workers and health workers.”

The disease was first identified in monkeys kept for research in Denmark in 1958 and hence, was named monkeypox. But last year, the WHO announced that the disease would be renamed to mpox to avoid stigmatisation stemming from the disease’s then-name.

The disease was first discovered in humans in 1970 in the Democratic Republic of Congo, with the spread among humans since then mainly limited to certain West and Central African nations.

But in May 2022, cases of the disease, which causes fever, muscular aches, and large boil-like skin lesions, began spreading rapidly around the world.

The WHO triggered its highest level of alarm on July 24, 2022, classifying it as a public health emergency of international concern, alongside Covid-19.

Dr Javaid Usman, a microbiologist, told Dawn.com that “there is no specific anti-viral treatment for it nor any approved vaccine as of now”.

However, he said, the disease was not usually fatal but could be so in rare cases when a person developed complications like pneumonia or an infection of the brain called encephalitis.

Dr Usman said a mpox “patient has to be kept in isolation and the health care provider should wear gloves and mask to avoid the chances of infection” But, he again stressed, the disease was not usually fatal and people should not panic following its detection.