Mpox Surveillance Fails: Patient Evades Detection at Islamabad airport, Found Later In Peshawar

M. Waqar Bhatti

Islamabad: Mpox surveillance at Islamabad International Airport miserably failed when a 35-year-old labourer, visibly infected with the virus, arrived on September 7, 2024, and left the airport without any detection or intervention, exposing serious deficiencies in the country’s health security measures at critical entry points, federal health authorities revealed on Wednesday.

Despite exhibiting clear symptoms of Mpox, the man passed through health screenings at Islamabad International Airport without being flagged, raising serious concerns about the competence of BHS officials. He was later tested positive for Mpox in Peshawar, marking the first confirmed case to have arrived at Islamabad but detected elsewhere.

So far, six people have tested positive for Mpox in Pakistan, five of whom were detected after the World Health Organization (WHO) declared Mpox a Public Health Emergency of International Concern (PHEIC) on August 14, 2024. All of the cases involved patients who contracted the virus in two Middle Eastern countries.

The labourer, who contracted the virus while working in a Middle Eastern country, chose to return to Pakistan rather than seek treatment abroad to avoid deportation. Upon arrival at Islamabad airport on September 7, he was neither questioned nor examined by BHS staff, despite showing visible symptoms, officials from the Ministry of National Health Services, Regulations, and Coordination (NHS, R&C) confirmed.

“He knew he was infected and flew back to Pakistan to avoid deportation, but the authorities at Islamabad airport failed to detect his condition. It was only after he traveled to Peshawar and consulted a dermatologist that the infection was confirmed,” an NHS,R&C official revealed to The News.

After reaching Peshawar, the man sought medical attention at Khyber Medical University, where a National Institute of Health (NIH)-designated lab confirmed he was infected with Mpox. This marks the sixth confirmed Mpox case in Pakistan this year, and the first since WHO declared Mpox a PHEIC.

Previous Mpox cases were all detected at Peshawar Airport, sparking concerns about the effectiveness of screening protocols at Islamabad, Karachi, and Lahore—the country’s three busiest airports, which handle most flights from Mpox-affected regions. Public health experts and officials have criticized the inconsistent performance of BHS, which has failed to detect a single case at these major entry points.

The labourer’s decision to avoid testing in the Middle East to escape deportation, and his unchecked entry into Pakistan, highlights the urgent need for a more vigilant screening process. The man could have spread the virus during his journey, both on the plane and after arriving in the country. Authorities are now tracing passengers who were seated near him on the flight, while warning of potential further infections.

“This incident exposes major gaps in our health surveillance system. It’s unacceptable that someone with such visible symptoms could walk out of one of the country’s busiest airports without any checks. Border Health Services at Islamabad and other major airports need urgent reforms to prevent similar failures in the future,” a member of the Technical Working Group (TWG) on Mpox said.

Both the TWG and the National Command and Operation Center (NCOC) have raised concerns about the lax attitude at Islamabad and other airports, noting that Peshawar International Airport has been the only entry point where Mpox cases were detected. This inconsistency in BHS performance suggests dangerous gaps in surveillance, especially as most passengers from Mpox-affected regions enter through Karachi, Lahore, and Islamabad.

Mpox has re-emerged as a public health threat in Pakistan, with six confirmed cases so far this year. The virus, primarily transmitted through close contact, causes painful rashes and can lead to severe complications, particularly in immunocompromised individuals. Although the current outbreak is being closely monitored, health authorities are rushing to tighten screening processes at entry points to prevent further spread.

The failure to detect the labourer at Islamabad airport has raised fresh concerns about the BHS staff’s ability to handle infectious diseases. Health experts warn that gaps in surveillance could allow more cases to slip through, and pressure is mounting on authorities to reform airport health checks and better equip staff to identify and manage infectious diseases like Mpox.