Mpox threat

Sindh's growing mpox caseload requires a more visible and organised public-health response before sporadic infections become harder to contain. The province has recorded 93 confirmed cases this year and 11 deaths, while the recent rise is particularly concerning. Twenty cases were reported in September and another six have already emerged in October. Karachi has recorded the highest number, followed by Khairpur and Sukkur.

The numbers remain relatively small compared with those of some other infectious diseases, but that is precisely why containment must begin early. Sindh's immediate priority must be stronger case detection. Doctors at public and private hospitals and emergency departments should be able to recognise suspected cases quickly and report them through the provincial surveillance system without delay. Laboratories must have sufficient capacity to return results promptly. Every confirmed infection should trigger careful contact tracing so that exposed individuals can be monitored and advised before another chain of transmission develops.

Isolation guidance also needs to reach households clearly. Pakistan's national guidelines call for infected people to remain separated from others until their rash has healed, the scabs have fallen off and a fresh layer of skin has formed. Vaccination should also form part of the preparedness strategy, but it must be targeted. WHO does not recommend indiscriminate mass vaccination. It advises prioritising people at greater risk of exposure, including close contacts of confirmed patients and healthcare personnel handling cases. Pakistan should assess available stocks and access to international supply mechanisms before a larger outbreak creates an urgent scramble for doses.

Mpox is containable. What turns a manageable outbreak into a wider public-health problem is delayed diagnosis and weak surveillance coupled with complacency between individual cases. Sindh still has the opportunity to interrupt transmission while the numbers remain limited. It should use it.