At least five newborns have died in an mpox outbreak in Pakistan, raising concerns over undetected transmission and lapses in infection control inside the country’s hospitals.

So far this year, health officials in the southeastern Sindh province have reported 122 suspected mpox cases, according to local media. Of these, 25 infections have been laboratory confirmed. Nine people have died, including at least five newborns in neonatal units.

The deadly outbreak is concentrated in two densely-packed cities, Khairpur and Karachi, and has raised concerns that the virus has gained a foothold in Pakistan. Until now, only sporadic imported infections had been detected, mainly among people with travel links to the Middle East.

It has also resurfaced long-standing unease around infection prevention and control measures inside the South Asian country’s hospitals, with officials investigating how the five dead newborns contracted the virus while in neonatal wards.

“This is another sign of how poor infection prevention and control within the country is leading to transmission of infections,” said Prof Faisal Mahmood, head of the Infectious Diseases department at Aga Khan University in Karachi.

This week, undercover filming from the BBC revealed rampant re-use of syringes and the limited use of personal protective equipment including sterile gloves at a hospital in Punjab. The facility has been linked to at least 331 HIV infections in children between November 2024 and October 2025.

This is not an isolated incident – roughly 1,000 people, including some 800 children, contracted HIV after visiting doctors in Sindh in 2019. By 2021, it was estimated that 1,500 children had been affected. Hospital-acquired outbreaks of other diseases, including hepatitis, and have also been reported.

“This problem is much bigger than just one outbreak, it’s a symptom of a failure in our healthcare system,” said Dr Rana Jawad Asghar, the chief executive of the Pakistan-based health system consultancy, Global Health Strategists and Implementers.

“Still, somehow, we’re not learning lessons – pretty much every hospital in Pakistan just hasn’t prioritised infection prevention and control.”

In response to the mpox outbreak in Sindh, a province home to roughly 55 million people, health officials have sealed the neonatal units at two hospitals in Khairpur where the five newborns died. The mortality rate seems unusually high – but officials told local media that the overall number of cases is unclear and that the children affected were malnourished.

Dr Akira Endo, an assistant professor at the NUS Saw Swee Hock School of Public Health in Singapore, said this had probably weakened their immune systems, leaving them more susceptible to severe disease. Mpox, which is spread through close physical contact or contaminated materials like bedding, is rarely deadly in healthy individuals.

“So far, the globally circulating mpox clades have not shown very high fatality… however, the disease can sometimes be challenging for particularly vulnerable people, including infants with existing health conditions or immunocompromised individuals,” he said.

In Sindh, close contacts of known patients are also being monitored for signs of the disease. Isolation wards have been set up in major and district hospitals, while people have been told to seek medical care if they develop a rash, fever or throat irritation. The World Health Organisation has also offered vaccines for targeted use among high-risk groups.

An official, who asked to remain anonymous, told the Telegraph that investigations into the responsible strain remain ongoing. Pakistan has reported cases of clade 1a, but there are fears the more virulent clade 1b could be driving the outbreak.

“If clade 1b is proven [to be] driving the infections, it would carry wider implications for transmission and mortality, particularly in densely populated areas where weaknesses in surveillance and infection control could allow the virus to spread,” he said.

Last year Pakistan reported 53 cases of mpox, but most were linked to international travel. Prof Mahmood said the emergence of local transmission chains means Pakistan needs to alter its response to be “more inward-looking” – especially in densely packed areas where surveillance is limited.

“We are at a moment where awareness can make the difference between containment and spread. People including physicians need to know the signs, act early, and not wait,” he said.

He warned that malnourishment, poverty and poor sanitation could also provide the ideal conditions for the virus to take off.

“Poverty and malnutrition in itself can lead to obviously severe disease, but can also aid in the transmission because people live in close quarters,” he said, adding that these “close quarters” could also be hospitals with poor infection prevention protocols.

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