Mpox in South Asia: A Narrative Review on Epidemiology, Preparedness, and Preventive Strategies

Background and Aims: Monkeypox (Mpox), due to its growing global concern, was declared a public health emergency of worldwide concern by the World Health Organization in August 2024. The monkeypox virus (MPXV), once limited to African regions, has now spread to South Asia, including Pakistan, India, Nepal, and Sri Lanka, and there have been over 109,699 cases and 234 deaths reported globally till now. This review aims to provide an overview of the spread of Mpox in South Asia, the preparedness of the South Asian countries, and the preventive and control measures. Methods: This narrative review was conducted through a comprehensive literature search of online databases including PubMed, Google Scholar, World Health Organization (WHO) resources, World Bank Open Data, and relevant public health reports from South Asian countries. Published literature was reviewed to extract information on mpox transmission, pathogenesis, epidemiology, preventive measures, healthcare preparedness, and regional impact. Results: Currently there is no clinical treatment for Mpox. Several antiviral agents are undergoing investigation, including cidofovir, brincidofovir, and so forth. In vitro potency of cidofovir for Mpox was found to be highest among other antivirals in a study. Tecovirimat did not significantly reduce the time required to heal Mpox lesions in two separate studies. In a different investigation involving trifluridine, tecovirimat, when used in combination, showed a substantially additive effect in dermal fibroblast cells (DF) and immortalized human conjunctival epithelial cells HConEpic. Alteration of biological traits, human behavior and clinical manifestations of Mpox mandates a need for surveillance of transmission. Regional outbreak patterns were identified through this study. Control measures include vaccination of susceptible individuals and avoiding contact with infected animals and humans. Conclusion: Mpox poses a growing public health threat in South Asia due to population density, limited healthcare infrastructure, and underreporting. Strengthening vaccination, antiviral management, and diagnostic capacity is crucial to control transmission. Tailored region-specific strategies, including surveillance and stigma reduction, are essential.