Monkeypox is a rare infection caused by the monkeypox virus that transmits from animals to humans. However, human-to-human direct contact with secretions or direct contact with secretions of rodents contaminated has also been shown.¹ This virus belongs to the family Poxviridae, a subfamily of Chordopoxvirinae and the genus Orthopoxvirus. The relevant virus was first identified in monkeys in 1958 at a Danish laboratory, although the first-ever human case diagnosed was in the Democratic Republic of Congo, Africa, in a 9-month-old baby in 1970. Since then, the disease has become endemic in other countries, especially in West and Central Africa.² It has also been indicated that monkeypox disease is related to smallpox disease.¹ Monkeypox disease can be characterized based on several symptoms, such as fever, headache, back pain, swollen lymph nodes, chills, and skin rashes.^{1, 3} According to some studies, it has been suggested that the monkeypox cases were observed outside of Africa in 2003 followed by recent investigations in 2019.^{1, 4} The World Health Organization settled a meeting on May 21, 2022, after 100 cases were reported in nine European countries, including the United Kingdom, Belgium, Italy, France, Germany, Netherlands, Sweden, Portugal, and Spain.⁵ Recent reports (May 26, 2022) claimed 237 cases of monkeypox virus in 18 countries outside Africa. Amongst them, the highest frequency was found in the UK with 71 cases, followed by 23 confirmed and suspected cases in Spain, five in Portugal, UAE, Czech Republic, Brazil, Slovenia US, as well as Australia confirmed their first cases in May, 2022.^{3, 6, 7}

As of May 23, 2022, Pakistan has confronted two rarely occurring cases of the zoonotic monkeypox infection that has spread over 12 countries around the globe. According to the doctors of Lahore Services Hospital, two cases of monkeypox were detected in Lahore Jinnah Hospital, Pakistan. The patients were isolated and properly treated in separate wards. After the detection of these cases, the National Institute of Health strongly warned the healthcare settings of the country to deal carefully with the disease.⁸ Bearing in mind the limited healthcare settings in developing countries, including Pakistan, proper addressing measures for emerging viruses are lagging in terms of the epidemiological situation and socioeconomic constraints. Due to inadequate diagnostic settings and the virus detection in a precise time frame, the virus can spread inexorably and can increase the number of cases. In line with the 2018–2019 economic survey, serious deficiencies in terms of scarce availability of the doctors and other fundamental settings are on record – more than 900 patients per doctor, 1608 patients per bed, and lower availability of intensive care units.^{9, 10} Before the emerging infectious diseases, COVID-19 has also affected the healthcare settings in Pakistan. Therefore, government and nongovernmental organizations must pay close attention to the control of monkeypox infection. Adequate monitoring of this disease must be carried out with great attention and awareness of the population of the imminent risk is necessary. The combination of all these measures can help to gain knowledge, de-escalate the emerging cases, and limit the spread of the virus in the developing world, including Pakistan.

AUTHOR CONTRIBUTIONS

Abdullah, Sher Ali, Fernando A. C. Q. Cançado, and Carlos A. F. de Oliveira have written and read the manuscript.

CONFLICT OF INTEREST

The authors declare no conflict of interest.