Nepal has confirmed its third case of mpox.

According to officials at the Epidemiology and Disease Control Division, a 44-year-old migrant worker from Sindhuli district who returned from Saudi Arabia tested positive for the potentially deadly disease on Sunday.

“The infected person sought treatment upon his arrival on Saturday,” said Dr Yadu Chandra Ghimire, director at the division. “The test result confirmed that the man is infected with mpox virus.”

This is the second mpox-positive case among Saudi Arabia returnee migrant workers in the past 10 days. Earlier, on December 20, a 36-year-old man from Tanahun district also tested positive for the virus.

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

So far, all three positive cases of the mpox virus have been detected in migrant workers or travellers returning from disease-hit countries.

Experts warned of the risk of the deadly virus spilling over into communities, as hundreds of international travellers, including migrant workers, return to the country every day.

“The incubation period for the virus is 5 to 21 days, and not all infected persons show symptoms,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit of the Sukraraj Tropical and Infectious Disease Hospital. “Asymptomatic but infected persons can easily pass the virus to their spouse and other family members. What we should not forget is that only those with symptoms seek care. Others go home directly.”

Along with sexual transmission, the deadly disease can be transmitted through respiratory droplets, to children through skin-to-skin contact with caregivers, as well as through needle injuries and occupational exposures due to a lack of personal protective measures.

“We are aware of the risk of spillover of the virus into communities,” said Ghimire, the director of the disease control body. “We have already stepped up surveillance at health desks at international airports. We are also in discussions with partner agencies to implement further measures to reduce the risk of disease spillover into communities.”

Public health experts in Nepal say that screening 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 to appear, and not all cases can be detected at health desks.

Mpox is a rare disease caused by infection with the mpox virus. 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.

Since 2022, 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, sore throat, muscle aches, back pain, exhaustion, and itchy rashes on the face, hands, and feet.

The UN health body said that mpox is treated with supportive care for symptoms such as pain and fever, with close attention to nutrition, hydration, skin care, prevention of secondary infections, and treatment of co-infections.

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