Following confirmed local transmission of Mpox in Punjab, the National Institute of Health (NIH) Islamabad has issued a formal directive to all provinces, instructing them to ensure timely, complete, and accurate reporting of Mpox cases and related epidemiological data.
Although addressed to all provincial health departments, federal health officials said the directive is primarily aimed at Punjab, as all other provinces and federal territories are already sharing regular surveillance data with the NIH.
The directive, issued on December 30 by the National Command and Operation Centre and the CDC Wing of the NIH after the conclusion of the Public Health Emergency of International Concern for Mpox, calls for continued enhanced surveillance under the International Health Regulations (IHR) 2005 and national public health laws.
Federal officials said the step was taken due to Punjab’s continued failure to formally share Mpox case details, despite recording the highest number of infections in the country, many involving local transmission without recent travel history.
According to official figures, Pakistan reported 57 confirmed Mpox cases between April 18, 2023, and December 31, 2025, including one death.
Punjab accounted for 23 cases, followed by Khyber Pakhtunkhwa with 22 cases and one death, Islamabad with six cases, Sindh with three, Azad Jammu and Kashmir with two, and Balochistan with one case, while no cases have been reported from Gilgit-Baltistan.
However, federal officials said Punjab’s figures remain largely unverifiable, as the province has not submitted complete line lists, laboratory confirmations, exposure histories, or clinical outcomes to the NIH.
The NIH letter states that Mpox continues to warrant routine national surveillance due to its potential for re-emergence and international spread.
Provinces have been directed to report suspected, probable, and confirmed cases, along with epidemiological, demographic, and geographic data, clinical severity, outcomes, hospitalizations, laboratory results, and public health response measures, including contact tracing.
The letter also warns that under the IHR, any unusual events, clusters, or changes in transmission patterns posing a public health risk must be reported immediately through established national channels.
Federal officials said the lack of data from Punjab is especially concerning, as a significant number of cases involve local transmission, indicating that Mpox may be circulating within communities rather than remaining limited to imported cases.
They said available information suggests transmission among men who have sex with men, a group identified globally as being at higher risk during recent outbreaks.
Officials confirmed that two to four Mpox patients are currently under treatment at Mayo Hospital Lahore, but said Punjab has not officially shared their clinical details, laboratory findings, or exposure histories.
Despite this, Punjab’s Health Department has made informal requests for federal support, including testing kits, antiviral medication such as tecovirimat, and updated clinical guidelines, without submitting the required surveillance data.
“Mpox is a notifiable disease, and under national and international obligations, every confirmed case must be reported to the NIH,” a senior federal health official said, adding that Punjab often sends incomplete paper listings that do not meet surveillance standards.
Officials stressed that genetic sequencing of Mpox samples is critical to identify circulating clades, assess transmission dynamics, and fulfil World Health Organization reporting requirements.
“Without samples and detailed data from Punjab, we cannot conduct sequencing or present an accurate national picture to the WHO,” an official said.
Federal authorities said all other provinces and territories, including Sindh, Khyber Pakhtunkhwa, Balochistan, Azad Jammu and Kashmir, and Gilgit-Baltistan, are regularly sharing data, enabling timely risk assessment and coordinated response.
Repeated attempts to seek comments from senior officials at the Directorate General of Health Services, Punjab, regarding Mpox cases and treatment at Mayo Hospital, Lahore, received no response by the time of filing this report.
