Global Expansion of Mpox: Addressing the Threat to Maternal Health and Healthcare Systems in Pakistan

Mpox, formerly known as monkeypox, is a zoonotic disease caused by the monkeypox virus (MPXV) of the Orthopoxvirus genus. Once confined to Central and West Africa, it has rapidly evolved into a global public health concern, with outbreaks reported in over 120 countries since 2022. The virus comprises two main clades: Clade I, associated with higher severity, increased complications, and poor maternal and fetal outcomes, and Clade II, particularly subclade IIb, which drove recent international transmission and is generally linked to milder disease. In August 2024, the World Health Organization re-declared mpox a Public Health Emergency of International Concern following the emergence of a new Clade Ib lineage in the Democratic Republic of Congo, which has demonstrated higher transmissibility and disproportionate effects on pediatric and pregnant populations. Pregnant individuals remain especially vulnerable, as Clade I infections carry heightened risks of miscarriage, intrauterine fetal demise, and vertical transmission, while data on Clade II remain limited. In resource-limited settings like Pakistan, the mpox threat is compounded by systemic healthcare challenges, including low health expenditure, inadequate infrastructure, and limited access to vaccines and antivirals. Addressing these challenges requires strengthened surveillance, equitable vaccine distribution, targeted maternal care strategies, and global collaboration to mitigate risks and safeguard maternal and neonatal health.