Mpox and Neglected Tropical Diseases in Pakistan: A Growing Planetary Health Concern

Aug 14, 2024, was the day the World Health Organization (WHO) announced, mpox (previously known asmonkeypox) as a Public Health Emergency of International Concern (PHEIC-2024).1 While mpox undoubtedlyremains a global public health problem, neglected tropical diseases (NTDs) such as dengue, chikungunya,rabies, snake bite, and leishmaniasis, listed among the 20 NTDs by WHO, predominate in Pakistan. The fragilehealth system of Pakistan, overwhelmed for the past decades by infectious diseases such as tuberculosis andmalaria, further worsened due to the COVID-19 pandemic. The synchronal rise of mpox, dengue, andchikungunya infections is posing increasing concerns for the population and healthcare system further straining the economy's capacity to respond effectively. Mpox is a zoonotic infection caused by the monkeypox virus (MPVX), an orthopoxvirus in the same genus as thevariola virus, which is the causative agent of smallpox and, vaccinia virus (the virus used in the smallpoxvaccine).1 Mpox has two clades, Clade I (Central Africa) and Clade II (West Africa). Clade I, which was recentlyreported from Sweden, is more contagious and has a higher fatality rate (10%), raising global health concerns.The figures show that the global mpox count in 2024 surpassed last year's with 15,600 cases and 537 deaths.1Integrated Disease Surveillance & Response (IDSR), NIH, Islamabad, Pakistan has recorded a total of 14 travelrelated cases including one death (co-infection of HIV). All confirmed cases in Pakistan have been identified asthe Clade IIb strain, and no evidence of local transmission has been documented. A worrying aspect of mpox isthat no antiviral treatment is currently available for mpox and the initial clinical trials of the antiviral'Tecovirimat' are not very promising against Clade Ib.1 Moreover, controlling mpox infections in the younger age groups is particularly challenging as vaccination is not recommended for individuals that are 15 and under. This poses a grace concern as mpox infection is known to cause higher mortality in children younger than 15 as was reported in the Democratic Republic of Congo. Pakistan currently doesn't have the availability of the mpoxvaccine, making it inaccessible for those in need. Another endemic NTD that accounts for a huge burden of disease in Pakistan is rabies. Human infections aremostly due to dog bites and cases are diagnosed on clinical grounds only. Pakistan ranks in the top five countries globally in rabies-related mortality, with an estimated 2700-5000 deaths attributed to rabies in Pakistan. Dengue fever is yet another daunting health threat in Pakistan. About half of the world's population is at risk ofdengue with an estimated 100–400 million infections annually.2 In 2024, dengue cases surged globally, with theWHO reporting over 7.6 million cases by April, including 3.4 million confirmed cases, 16,000 severe cases, andmore than 3,000 deaths. Re-infection with a different dengue serotype increases the risk of severe illness,adding to the complexity of the outbreak.2 Pakistan faces a critical public health emergency, with 2,800 newdengue cases reported in September 2024, mostly in Baluchistan. Since May 2024, Karachi has experienced asurge in mosquito-borne infections, including dengue and chikungunya. The situation is being exacerbated byinadequate sanitation, optimal monsoon weather for mosquito breeding, prolonged heat waves, inadequatevector control measures, as well as contributing factors such as climate change, increased vector abundance(primarily Aedes aegypti and Aedes albopictus mosquitoes), and population movements.2,3 Both diseases aretransmitted by Aedes mosquitoes, also vectors for Zika and yellow fever. Thankfully, despite the presence of thevector, Pakistan remains free of yellow fever and Zika cases. Strengthening surveillance systems and training healthcare workers to ensure timely identification and management of mpox and other NTDs are crucial. The interconnected efforts for healthy ecosystems andcommunities are essential for resilience in the face of environmental challenges. By actively addressing climatechange, we can enhance planetary health and ensure a sustainable future for all. Collaborative initiatives thatinvolve governments, communities, and individuals will be crucial in achieving these goals. Strong advocacyand resource mobilization at national and global levels are essential to secure funding for outbreakpreparedness, support the stockpiling of medical supplies, and reinforce public health measures. Amultisectoral approach is required to tackle the rise in mpox and NTDs which remains a persistent challenge not only for Pakistan but also for planetary health. Despite the grim circumstances, there are positivebreakthroughs, such as the recent success in eliminating trachoma, a long-standing NTD in Pakistan. This is apromising development for Pakistan, the 19th country to reach this milestone. The trachoma eliminationreflects the government's commitment, WHO's support, and the contributions of partners and communities.Eliminating one disease is an achievement that reinforces our optimism in working towards controlling NTDs inthe future for the well-being of our planet and all its inhabitants. Editor-in-Chief How to cite this: Alamgir W, Shan H. Mpox and Neglected Tropical Diseases in Pakistan: A Growing Planetary Health Concern. Life and Science. 2024; 5(4): 431-432. doi: http://doi.org/10.37185/LnS.1.1.835