INTRODUCTION:
Mpox (monkeypox) is a zoonotic infection caused by the mpox virus that has recently emerged as a global public health concern, with outbreaks reported in several non-endemic regions. Pakistan confirmed its first mpox cases in 2023, all linked to international travel. Until early 2025, no locally acquired transmission had been reported. This study presents the first detailed case series of mpox in Pakistan, describing its clinical features, transmission patterns, and public health response in Khyber Pakhtunkhwa (KP) province.

METHODS:
A descriptive case series was conducted, including all laboratory-confirmed mpox cases identified through airport screening and provincial surveillance in KP between September 2023 and April 2025. Epidemiological, demographic, and clinical data were obtained through structured interviews, medical record review, and laboratory confirmation by MPXV PCR testing of lesion samples. All confirmed patients were isolated per national infection control guidelines, and close contacts were traced and monitored for 21 days post-exposure.

RESULTS:
Eleven confirmed mpox cases were detected across nine districts of KP. The median age was 38 years (range: 5 months–51 years), and 81.8% were male. Most patients (9/11) had recently returned from Gulf countries—primarily Saudi Arabia, the United Arab Emirates, and Qatar. Two secondary household transmissions occurred, involving a spouse and an infant infected by returning travelers. Rash was present in all cases, fever in 81.8%, and genital lesions in 63.6%. Three patients (27.3%) were living with HIV, and all recovered without complications. More than 60 close contacts were traced; no further transmission occurred.

CONCLUSIONS:
International travel was the primary source of mpox introduction in Pakistan, with limited local spread. Strengthening border screening, diagnostic capacity, and community awareness is vital to prevent sustained transmission in non-endemic settings.