At least 15 nations that are not endemic to the monkeypox virus have reported cases of the viral infection in their countries.

A majority of the countries that have reported monkeypox cases are in Europe and North America from where people frequently travel to Nepal.

Public health experts have stressed precautions saying every disease seen in any corner of the world has the possibility to come to Nepal due to high mobility.

However, authorities concerned have yet to take the issue seriously.

“We have not received any instruction from any agency about the risk of infection of monkeypox,” a health worker at the health desk set up at the Tribhuvan International Airport, told the Post, asking not to be named. “We have been only checking Covid-19 vaccine cards of everyone, proof of vaccination against yellow fever of those returning from Africa, and proof of polio vaccination of people coming from Afghanistan and Pakistan.”

Monkeypox is most common in remote parts of central and west Africa. But the viral infection has been reported in countries including Belgium, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, the United Kingdom, the United States, Canada, Australia, Argentina and Israel.

Public health experts say that even if the rare viral infection is usually mild and from which most people recover in a few weeks, authorities concerned should not underestimate the risks.

“The cases should be contained before they spill over into communities,” said Dr Prabhat Adhikari, an infectious disease and critical care expert. “For that, active surveillance is needed, All agencies concerned should be alerted and necessary preparation should be made.”

Officials at the Ministry of Health and Population concede that no agency has been alerted so far about the risk of infection of monkeypox virus in the country.

“We are in constant touch with the agencies of the World Health Organisation but have not received any instructions,” said Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry. “If we get any instruction from the UN health body, we will alert our health agencies.”

The UN health agency said that it expects to identify more cases of monkeypox as it expands surveillance in the countries where the disease is not typically found.

Experts say that the lackadaisical approach of the authorities concerned shows that no lesson has been learnt from the Covid-19 pandemic, which killed thousands of people and infected hundreds of thousands throughout the country.

Before the Covid-19 pandemic hit the country, officials including then minister and the prime minister had ruled out the chance of the spread of the infection in the country.

When the virus entered the country, they had said that the number of the infected would not cross double digits.

“We all know what has happened,” said Adhikari, an infectious disease and critical care expert. “What we do shows how serious we are towards the health of people and the country.”

When the second wave of infection hit the country in April 2021, all health facilities designated for the treatment of Covid-19 were overwhelmed. Hundreds of people died without getting treatment. Officials at the Health ministry urged the public to visit the hospital only after being unconscious.

Agencies under the Health Ministry had been testing swab samples of the infected people, whose S-gene targets were found negative before the third wave of the pandemic hit the country.

But when the authorities realised that those having S-gene target positive could be infected with the Omicron variant of the SARS-CoV-2, it was already late. Until then the virus variant had spread rampantly throughout the country.

Authorities could not do anything to contain the spread.

Experts say that hundreds of thousands of people would have died had the virus variant been as severe as the Delta variant, which killed around 8,000 people in the second wave of the infection.

Doctors say that it is the duty and responsibility of the agencies concerned to proactively follow the diseases seen in any parts of the world, analyse the risks and start preparations accordingly for a possible outbreak.

“Necessary preparation should be started, agencies concerned should be alerted about the risks, and preparations should be made accordingly,” said Dr Biraj Karmacharya, an infectious disease expert. “It is the basic duty of the agencies concerned.”

Doctors say that health workers should be trained on the risks, symptoms, and treatment procedures among other things. If the country lacks reagents for testing, that should be secured.

“Chances of misdiagnosis will be high in the infection of the monkeypox virus as symptoms are similar to chickenpox or smallpox,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at the Sukraraj Tropical and Infectious Disease Hospital, Kathmandu. “If we wait until the disease enters the country to alert the health workers and start preparations, it will be very late. Our own experience during the Omicron outbreak shows that monkeypox could enter the country long before we know about it.”

Patients infected with the Omicron variant of the SARS-CoV-2 had entered Nepal before the World Health Organisation declared it as a variant of concern.

Fever, headache, swelling, body pains, exhaustion, itchy rash on the face, hands and feet are some of the symptoms of the monkeypox virus. Upto one in 10 persons infected with monkeypox virus can die from the infection.

As the disease spreads through close contact, it can be contained through self-isolation and good hygiene, doctors say.