A hospital-linked mpox outbreak in Pakistan is killing infants at a 28% case fatality rate
WHO's latest mpox report shows global case counts holding steady, but flags a Sindh province cluster where nearly all deaths were in babies under six months old.
The World Health Organization's latest mpox situation report, its 65th since the outbreak began, shows a global picture that has been largely stable for months — and one localized cluster that has not. In Sindh province, Pakistan, a healthcare-associated mpox outbreak concentrated in neonates and infants has killed eight of 29 confirmed cases in the past month, a 28% case fatality ratio, with roughly half of all cases and effectively all deaths occurring in infants younger than six months [s1].
The global count
WHO's global surveillance data, current through March 31, show 48 countries reporting 1,235 confirmed mpox cases in March, including five deaths — a case fatality ratio of 0.4% [s1]. Monthly case counts have stayed roughly stable since December 2025 [s1]. The African Region reported 70.4% of March's confirmed cases (870 of 1,235), and has been on an overall downward trend even as it remains the largest single contributor [s1]. Four WHO regions — the Americas, Africa, Europe, and South-East Asia — saw declines in March compared with February, while the Eastern Mediterranean and Western Pacific regions saw increases [s1].
Zooming into the most recent six weeks (March 9 to April 19), WHO counted 969 confirmed cases across 16 African countries reporting active transmission, with Madagascar (554 cases), the Democratic Republic of the Congo (224), Guinea (52), Kenya (32), and Burundi (28) reporting the highest numbers [s1].
The Pakistan cluster
The Sindh province outbreak is the report's most alarming specific finding. Over the past month, the province reported 29 confirmed cases and eight deaths among confirmed cases — a case fatality ratio of 28%, nearly seventy times the global average for March — plus one additional death in a suspected case that had not been laboratory-confirmed [s1]. WHO's report specifies that about half of all cases, and all of the deaths, occurred in infants younger than six months old, and that the cluster involves neonates, infants, and adults, consistent with healthcare-associated transmission within facilities rather than solely community spread [s1].
The report does not give a mechanism for how transmission entered or spread within the healthcare setting, nor does it specify the mpox clade involved in the Sindh cases. Case fatality ratios this high in infants are a known feature of severe mpox in immunologically vulnerable populations, but a cluster with a healthcare-associated transmission pattern and a case fatality ratio this far above the global baseline warrants continued monitoring rather than extrapolation to the broader outbreak.
New geography for clade Ib
Four countries — Colombia, Denmark, Ecuador, and Singapore — reported mpox due to clade Ib MPXV for the first time during the reporting period, while Poland and Slovakia reported clade I cases pending subclade identification [s1]. Outside Africa, WHO also documented community transmission of clade Ib in Argentina, Denmark, Germany, Pakistan, Portugal, Singapore, Spain, and the United Kingdom, including transmission among men who have sex with men [s1].
Separately, Qatar reported a travel-related case involving a clade Ib/IIb recombinant strain — a virus carrying genetic material from both clades, a phenomenon WHO first documented earlier this year in two other countries. WHO describes the Qatar case as the third such recombinant case reported globally, following earlier reports in India and the United Kingdom; the patient has recovered, and no secondary cases linked to it have been identified [s1].
A regional picture that cuts against a simple narrative
The divergence between regions in March complicates any single storyline about the outbreak's trajectory. Four regions posting declines while two posted increases in the same month suggests localized transmission dynamics — new introductions, changes in testing capacity, or shifts in which populations are most affected — rather than a single global trend that regional totals can flatten into. WHO's report does not offer a unified explanation for the divergence, and readers should treat month-to-month regional swings in a still-evolving, multi-clade outbreak as noisy rather than as firm evidence of an underlying shift in transmission risk.
What the report says about transmission generally
WHO's overall assessment continues to describe mpox transmission as occurring mostly within sexual networks, affecting both men and women, often followed by household transmission, with all clades of the virus continuing to circulate simultaneously in different settings [s1]. The agency's standing message — that rapid containment of outbreaks in any setting remains essential to prevent broader community transmission — is repeated in this report largely unchanged from prior updates, reflecting an outbreak that WHO characterizes as a persistent, multi-clade, geographically expanding problem rather than one trending toward resolution [s1].
This article is informational and is not medical advice.
Sources
- [s1] World Health Organization, "Multi-country outbreak of mpox, External situation report no. 65," published 30 April 2026. https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report--65---30-april-2026
Sources
- Multi-country outbreak of mpox, External situation report no. 65 — World Health Organization , April 30, 2026
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