MPOX – Malawi Situation.
by
Moses Nyambalo Phiri in collaboration with Grace Funsani, Noel Khunga, Chriswell Nkoloma and Settie Kanyanda.
Malawi has recorded another confirmed case of Mpox, bringing the total number of laboratory-confirmed cases to 60 – The latest case, confirmed on July 24, 2025, is a 7-year-old male school learner from the Karonga district.
According to the Mpox Spot Report (Issue: 33) published by the Public Health Institute of Malawi (PHIM) on July 25, 2025, the young patient reported to Kaporo rural hospital on July 22, 2025. He presented with symptoms including muscle pain, headache, and a skin rash, with no reported underlying conditions.
Samples were collected on the same day, and laboratory testing confirmed Mpox infection two days later. The case has no travel history outside of Malawi. In response to the new case, district authorities have taken immediate action. Samples (swabs from blisters) were collected and sent for laboratory testing. The District Rapid Response Team (DRRT) has also initiated plans to conduct contact tracing, case follow-up, and further investigation.
From April 17 up to mid July…
Current Status and Geographic Spread:
The latest situation report, released by the Public Health Institute of Malawi (PHIM) under the Ministry of Health, indicates three new cases have been recorded since July 7, 2025. Of the 50 confirmed cases, 32 are males and 18 are females, with ages ranging from 2 to 57 years.
Lilongwe remains the most affected district with 40 confirmed cases, followed by Blantyre (3), Mangochi (2), Salima (2), Ntcheu (1), Likoma (1), and Nkhatabay (1). While 28 out of 29 districts have reported at least one suspected Mpox case, confirmed cases are concentrated in these seven areas.
Patient Outcomes and Contact Tracing:
Encouragingly, 36 individuals have been discharged from care after recovering, including 29 from Lilongwe, two each from Salima and Mangochi, and one each from Ntcheu, Likoma, and Blantyre.
Currently, 12 confirmed cases remain under clinical care: two in hospital isolation in Lilongwe, and ten under home isolation (seven in Lilongwe, two in Blantyre, and one in Nkhatabay). Two cases from Lilongwe have been classified as lost-to-follow-up due to difficulties in tracing.
Extensive contact tracing efforts by Rapid Response Teams (RRT) have identified 643 contacts. Of these, 637 have successfully completed their 21-day monitoring period without developing symptoms and have been discharged. Six contacts (four in Lilongwe and two in Blantyre) are still under active monitoring. Notably, five of the total traced contacts later tested positive for Mpox.
“One Health Approach” – Comprehensive Public Health Response:
The Ministry of Health, through PHIM, has implemented a multi-faceted response strategy, including:
Coordination: Activation of the Incident Management System (IMS) and development of a costed Mpox Incident Action Plan (IAP).
Laboratory: PCR testing of samples, genomic sequencing of MPXV, training of lab personnel, establishment of a molecular lab in Mzuzu Central Hospital, and distribution of viral transport media (VTM).
WASH & IPC: Development of training materials and IPC guidelines, IPC orientation in high-risk districts, adaptation of WHO rapid IPC/WASH assessment checklist, and construction of temporary latrines and bathing shelters at holding areas.
Risk Communication, Community Engagement & Social Mobilization (RCCE): Dissemination of messages in local languages (Chichewa, Tumbuka, Swahili, English) through various media, orientation of Chipatala Cha Pa Foni staff, and community engagements in affected areas.
Training: Extensive training of healthcare workers (297 trained across all 29 districts and 4 Central Hospitals), orientation of non-human health technical staff, and cascaded training down to health facility levels.
Surveillance: Deployment of RRTs for detailed investigations and contact tracing, enhanced surveillance at community, facility, and Points of Entry (PoE) levels, daily contact follow-up, and dissemination of case definitions and reporting tools.
Case Management: Development and distribution of case management guidelines, identification of isolation facilities, training of health workers, and development of home-based care protocols.
Logistics: Distribution of essential medicines and PPEs, and setup of treatment units at Kamuzu Central Hospital and Bwaila Hospital.
Points of Entry (PoE): Intensified surveillance and awareness campaigns for travelers at all PoEs.
Vaccination: The PMRA has approved the use of the MVA-BN vaccine, following MAITAG’s recommendation. Country vaccine request and budget development are underway.
Challenges and Recommendations:
Despite these efforts, challenges persist, including difficulties in contact tracing due to client non-disclosure, movement of suspected cases before lab results, suboptimal active case search, incomplete data capturing, inadequate laboratory and IPC supplies, and low global stockpiles of Mpox vaccines.
PHIM recommends continued resource mobilization, cascaded training for healthcare workers, orientation of coordination structures, surveillance data reviews, engagement of key stakeholders in contact tracing, continued screening at Dzaleka refugee camp, fast-tracking lab reagent orders, and rapid IPC/WASH assessments in remaining health facilities and private clinics.
“The first case was recorded in Lilongwe district on April 16, 2025. Later additional cases were registered. All the cases are males within the age range of 2 to 38 years: a 30-year-old from Phwetekere- Area 36, a 33-year-old from Kawale 2, 38 year-old from Chilinde, a 35 year-old from Area 36, Kandikole, an 18 year-old from Area 36, Tumbwe, Traditional Authority (TA) Tsabango, Lilongwe district, and a two year-old child from Michesi 1 village, TA Mponda, Mangochi district.Three cases from Lilongwe have recovered and have been discharged from clinical care, while the other three are still under clinical care . No death has been reported.”
Grace Fusani – Mpox Incident Manager, PHIM.
Vincent Kamforzi, Data Manager – “The affected districts are Lilongwe, Mangochi, Ntcheu, Salima, Likoma, and NkhataBay.”
What response activities have so far been undertaken ?
PHIM has activated its Incident Management System (IMS) for Mpox and is working with various sectors, including animal health, civic education, and disaster management, using One Health Approach
1. Surveillance.
Rapid Response Teams (RRTs) have been deployed to conduct contact tracing and investigate cases. Surveillance systems have been enhanced at the community level, health facilities, and points of entry (PoEs).
The district team are being trained on Mpox through a collaborative effort involving Amref Health Africa, the US CDC, and the World Bank, which have provided the necessary resources. Initial training, supported by Amref Health Africa, has been conducted in the Chitipa and Karonga districts. This district level training will be extended to all districts to ensure comprehensive staff preparedness covering critical areas such as Mpox Etiology and Virology, Transmission Pathways, Prevention and Control Measures, and Clinical Management etc.
2. Case Management.
Case management guidelines have been developed and distributed, and isolation facilities have been identified.
3. Labolatory.
Samples from suspected cases are being tested using PCR, and genomic sequencing of the Mpox virus is underway.
Essential medicines and PPEs have been distributed to districts and Messages about Mpox prevention are being disseminated in local languages through various channels, including posters, social media, leaflets, and audio recordings. PHIM is working to address these challenges and will continue to provide updates on the situation.
