In a bid to determine the clade of the mpox (monkeypox) virus, the Ministry of Health and Population is preparing to send specimens from infected persons to the World Health Organisation’s collaborating centre in Thailand.

A clade is a subtype, genotype or group of viruses that originates from a common ancestor. So far, three clades of mpox viruses—clade I, clade IIa and cladeIIb—have been identified.

Officials say clade identification tells the virus’s virulence and transmissibility of the virus, which is necessary to curb the further spread of deadly disease. As the country lacks a system to carry out virus sub-typing, it sought help from the UN health body.

“We will probably send the specimen taken directly from the rash—skin fluid or crusts collected from the infected person—to the World Health Organisation’s collaborating centre in Thailand for clade identification,” said Dr Hemanta Chandra Ojha, an official at the Epidemiology and Disease Control Division.

“Identification of the virus’ clade will help us to figure out what extra measures are needed to mitigate the risks of further spread.”

Mpox is a rare disease caused by infection with the mpox virus. Last week, Nepal confirmed its second mpox case. A 36-year-old man from Tanahun, who returned from Saudi Arabia on December 19, tested positive for the disease.

The country confirmed its first case of mpox infection in June last year when a 60-year-old foreign national tested positive.

Experts say clade I, which is present in the Congo basin, causes up to 10 percent human mortality and is transmitted by rodents, although human-to-human transmission has also been recorded. Clade IIa, which exists in West Africa, has a low mortality rate, but clade IIb is currently spreading globally through human transmission. Clade IIb was responsible for infection in the first mpox case in Nepal.

According to Ojha, the health condition of the infected person is normal, and he could be discharged from the hospital in a few days.

With the confirmation of the second mpox case in Nepal, health authorities have stepped up surveillance measures to prevent a possible outbreak of the deadly viral disease.

Along with stepping up screening of passengers entering the country via the Tribhuvan International Airport, health authorities have requested dermatologists throughout the country to refer suspected cases for testing.

“We have also deployed health workers at the health desk at Pokhara International Airport and screened passengers who arrived from China for the dragon boat festival,” said Ojha. “We also conducted an orientation for health workers serving in strategic locations.”

Public health experts in Nepal say that screening suspects at health desks at international airports and land crossings is not sufficient to prevent outbreaks, as the first symptoms of mpox can take between five and 21 days for the first symptoms of mpox to appear, and not all cases can be detected at health desks.

Monkeypox cases have been reported in neighbouring India, with which Nepal shares a long, porous border. India has recorded at least 30 mpox infections since 2022.

Health experts say that even though mpox is usually mild and most people recover within weeks, the risks should not be underestimated. They stress the importance of precautions, saying that any disease seen in any corner of the world can reach Nepal due to the high mobility of people.

Mpox has been a neglected public health problem in parts of Africa for decades. The disease came to widespread attention after May 2022, when countries outside Africa began reporting new cases.

Since then, mpox has spread globally. More than 100,000 people from 122 countries have already tested positive for the disease.

Its symptoms include fever, headache, swelling, body aches, exhaustion, and itchy rashes on the face, hands, and feet.

As the disease primarily spreads through close person-to-person contact, public health experts recommend self-isolation and good hygiene to prevent transmission.