In January 2026, India notified the WHO of a mpox case involving an inter-clade recombinant strain — one of only two such cases confirmed globally. Airports across Asia quietly stepped up screening. Just weeks later, the same country that battled Nipah in West Bengal found itself monitoring another emerging pathogen. For most Indians, mpox (formerly called monkeypox) remains unfamiliar — something seen in foreign news headlines, not something that reaches Bengaluru, Delhi, or Kerala. But India has now confirmed cases across multiple years, and the 2026 recombinant strain has placed the country firmly on the global mpox map.
This guide explains what mpox is, how it spreads, what the symptoms and tests look like in the Indian context, and what you can realistically do to protect your family.
What is Mpox?
Mpox (formerly monkeypox, renamed by WHO in 2022 to reduce stigma) is a viral infection caused by monkeypox virus (MPXV), a member of the Orthopoxviridae family — the same family as the smallpox virus. Despite the old name, it was first identified not in monkeys but in lab research monkeys in 1958. Its natural reservoir is believed to be small rodents and squirrels in Central and West African forests, not primates.
Mpox was considered a rare, geographically confined disease until 2022, when it suddenly appeared in over 100 non-endemic countries in a matter of months — including India. Since then, two clades (genetic variants) have drawn attention:
- Clade IIb — the strain behind the 2022 global outbreak, generally associated with milder disease and sexual transmission networks
- Clade Ib — a newer, more concerning variant that emerged in the Democratic Republic of Congo in 2024, with a higher fatality rate (~3%) and greater ability to spread in households and communities
In January 2026, India detected the world's second case of a recombinant strain combining genetic elements of both Clade Ib and Clade IIb — a development that prompted WHO monitoring and underscores why mpox is no longer just a distant concern.
India's Mpox Timeline
India's encounter with mpox began quietly in 2022, escalated in 2024, and has continued evolving into 2026.
2022–2023: The First Wave
India's first confirmed mpox cases appeared in July 2022, during the global Clade IIb outbreak that swept through Europe, North America, and eventually Asia. By March 2024, India had confirmed 30 laboratory-confirmed cases — split between Kerala (15 cases) and Delhi (15 cases). All cases involved individuals from specific high-risk groups, and there was no sustained community transmission.
2024: Clade Ib Arrives
In September 2024, India confirmed its first Clade Ib case — a traveller returning from Dubai to Kerala. Genomic analysis by ICMR-NIV (National Institute of Virology), Pune confirmed it was the more dangerous Ib strain. By early 2025, Kerala reported at least 10 Clade Ib cases, all linked to travel from the UAE and Oman. The Ministry of Health issued advisories for travellers from affected regions.
January 2026: The Recombinant Strain
India's most recent mpox development came in January 2026, when ICMR-NIV confirmed a case carrying an inter-clade recombinant MPXV — a virus with genomic segments from both Clade Ib and Clade IIb. This patient had a recent travel history and did not experience severe illness, but the finding placed India among only two countries worldwide (alongside the United Kingdom) to detect this emerging variant. Onward transmission was not confirmed.
How Mpox Spreads: What Indians Need to Know
Mpox does not spread easily — but understanding the routes is critical, especially given the evolving strain landscape.
Close Physical Contact (Primary Route)
Mpox spreads primarily through direct skin-to-skin or mucous membrane contact with an infected person's rash, lesions, or scabs. This includes:
- Sexual contact (the dominant route in the 2022 Clade IIb outbreak)
- Hugging or prolonged touching of rash/lesions
- Household contact — contact with infected clothing, bedding, or towels (Clade Ib shows higher household transmission than earlier strains)
- Handling lesion crusts or fluid
Respiratory Droplets (Close, Prolonged Contact)
Mpox can spread through respiratory secretions, but only during close, face-to-face interaction with someone who has mouth or throat lesions. It is not airborne in the way COVID-19 or measles is — casual conversation across a room poses negligible risk.
Animal-to-Human (Less Relevant in India)
In Africa, mpox spreads from infected rodents and small animals through bites, scratches, or handling. India does not have endemic mpox in wildlife, so this route is currently not a concern domestically — though it remains the original evolutionary source.
Healthcare Settings
Healthcare workers who treat mpox patients without adequate PPE are at elevated risk — particularly during lesion care, respiratory support, or specimen collection. India's 2026 cases and prior Kerala cases all involved travel-linked infections rather than healthcare exposure.
Mpox Symptoms: A Stage-by-Stage Guide
Mpox symptoms follow a characteristic incubation period of 5–21 days — longer than many common infections. The illness typically progresses in recognisable stages.
Prodromal Stage (Days 1–5 after onset)
Before any rash appears, mpox often begins with:
- Fever — usually 38–39°C, sometimes higher
- Intense headache
- Severe backache — often described as one of the most distinctive early features
- Muscle pain and fatigue
- Swollen lymph nodes (lymphadenopathy) — this distinguishes mpox from chickenpox and many other rash illnesses; look for swollen glands in the neck, armpit, or groin
Rash Stage (Days 3–7 after fever onset)
The hallmark of mpox is its sequential rash progression, typically appearing 1–4 days after fever:
| Stage | Appearance | Duration |
|---|---|---|
| Macules | Flat, discoloured patches | 1–2 days |
| Papules | Raised, firm bumps | 1–2 days |
| Vesicles | Fluid-filled blisters | 1–2 days |
| Pustules | Pus-filled, painful lesions | 5–7 days |
| Crusts/Scabs | Dry, hardened lesions | Until healing |
The rash commonly begins on the face and mouth, then spreads to the rest of the body — palms and soles are frequently involved, which is unusual compared to chickenpox. In Clade IIb cases, the rash sometimes begins in the genital or anal region.
Importantly, mpox lesions all tend to progress together (at the same stage at the same time), unlike chickenpox where crops of lesions appear at different stages simultaneously.
Duration and Recovery
Most mpox illness lasts 2–4 weeks. Lesions heal completely when all crusts fall off. The person is infectious from the onset of symptoms until all scabs have healed.
Who is at Risk in India?
Based on India's case history, the following groups face elevated risk:
- International travellers to mpox-endemic countries (Central/East Africa, parts of Southeast Asia)
- Healthcare workers who may be exposed to undiagnosed cases
- People living with HIV or other immunocompromising conditions — they are more likely to develop severe mpox
- Close household contacts of confirmed cases, particularly with Clade Ib variants
- Individuals with multiple sexual partners, particularly in networks where Clade IIb circulates
Testing for Mpox in India
India has established a functional mpox testing network through ICMR.
Primary Diagnostic Test: PCR
The gold standard for mpox diagnosis is PCR (Polymerase Chain Reaction) testing of samples collected from:
- Lesion swabs — the most reliable sample type; material is swabbed directly from a pustule or crust
- Throat/oropharyngeal swabs (if no skin lesions are present)
- Whole blood (in very early or atypical presentations)
Where to Get Tested in India
ICMR has authorised 36 laboratories across India to perform mpox PCR testing. Key centres include:
- ICMR-NIV, Pune — the national nodal centre for mpox confirmation and genomic analysis
- NIV Field Unit, Kerala — handles Kerala-specific surveillance
- NCDC Lab, New Delhi
- IPGMER, Kolkata
- AIIMS New Delhi and Nagpur
- Multiple ICMR-approved private labs (using three PCR kits validated by ICMR and approved by CDSCO)
Suspect a case? If you or a contact develops fever, swollen lymph nodes, and a progressive rash — especially with recent international travel — contact your state health department or visit a government medical college for assessment. Do not simply walk into a general pathology lab, as sample collection requires precautionary protocols.
Treatment: What's Available in India
There is no specific approved antiviral treatment for mpox available in India's mainstream healthcare system. Management is primarily supportive.
Supportive Care
- Antipyretics (paracetamol) for fever
- Pain management for lesion pain and backache
- Wound care — keeping lesions clean and dry; antibiotic ointment if secondary infection develops
- Adequate fluid and nutrition
- Isolation to prevent transmission during active illness
Antiviral Options (Severe/High-Risk Cases)
Tecovirimat (brand name: TPOXX) is the only antiviral specifically approved for orthopoxvirus infections in some countries. In India, it is not routinely available, but can be accessed through emergency use protocols in consultation with the Ministry of Health for severe cases — particularly in immunocompromised patients.
Intravenous immunoglobulin (IVIG) has been used experimentally in severe cases. Remdesivir, used in some Kerala Nipah cases, has no established role in mpox.
Recovery and Isolation
Patients should remain isolated at home or in a hospital until all lesion crusts have completely fallen off and the skin has healed — typically 2–4 weeks. During this period, all clothing, bedding, towels, and utensils should be washed separately. Close contacts should be monitored for symptoms for 21 days.
Vaccines for Mpox: The India Situation
Three mpox vaccines exist globally:
| Vaccine | Type | Status |
|---|---|---|
| MVA-BN (JYNNEOS) | Modified vaccinia Ankara | Approved in the US, EU, Canada |
| LC16-KMB | Live attenuated | Japan |
| OrthopoxVac | Live vaccinia | Russia |
In India, no mpox vaccine is currently available for general use. The Ministry of Health has not issued a national vaccination programme or recommended pre-exposure vaccination. Historical smallpox vaccination (which India stopped after eradication in the 1970s) would have provided cross-protection — but anyone born after ~1978 has not received it.
ICMR is actively monitoring the situation, and WHO has called for equitable vaccine distribution to affected countries. If you belong to a high-risk group and plan travel to endemic regions, discuss the option of MVA-BN vaccination with a travel medicine specialist — it is not available in India domestically but may be obtainable through international travel health clinics.
Prevention: Practical Steps for Indian Families
The good news is that mpox — unlike COVID-19 — is not easily transmitted through casual contact. Practical prevention is achievable.
For Travellers
- Avoid close contact with sick individuals showing rash or fever during travel to mpox-affected regions
- Avoid contact with live or dead animals (rodents, primates) in endemic regions
- Avoid eating bushmeat or products that may be contaminated
- Report any fever or rash illness to a doctor immediately after return to India, mentioning travel history
- Maintain hand hygiene throughout travel
For Healthcare Workers
- Use appropriate PPE (gloves, gown, N95 mask, eye protection) when examining any patient with an undiagnosed febrile rash illness
- Follow ICMR and Ministry of Health isolation protocols for suspected mpox cases
- Report suspected cases immediately to the state surveillance unit
For General Public
- Hand hygiene — wash hands frequently with soap and water or alcohol-based sanitiser
- Avoid contact with lesions or body fluids of anyone suspected of mpox infection
- If a household member is ill, use separate utensils and do not share towels or clothing
- Stay updated through ICMR and Ministry of Health advisories, particularly during travel
Tracking any illness after potential exposure is simple with tools like MedicalVault's report tracking feature, where you can log symptoms, share reports with family members, and monitor recovery.
When to Seek Medical Help
Seek medical attention immediately if you experience:
- Fever accompanied by progressive rash starting on the face or mouth
- Swollen lymph nodes in the neck, armpits, or groin combined with fever
- Fever, rash, and recent travel to an mpox-endemic region
- Close contact with a confirmed mpox case in the past 21 days
Early reporting is essential — both for your care and for preventing community spread. Your state health department has dedicated surveillance teams that can coordinate testing without requiring you to navigate the general healthcare system.
How to Store and Share Your Medical Records
If you are assessed for or diagnosed with mpox, keeping clear records helps with monitoring recovery and sharing information with specialist doctors. You can upload and track your medical reports using MedicalVault, and if you are managing a family member's health, the family sharing feature allows a caregiver to access reports and timelines remotely — particularly useful when coordinating care across cities.
For more on managing health records during infectious illness, see our family health records guide.
Key Takeaways
- India has confirmed mpox cases since 2022, including Clade Ib in 2024 and a recombinant strain in 2026 — this is no longer a purely foreign disease
- Mpox spreads through close physical contact with lesions, and household transmission (especially with Clade Ib) is a real risk
- The hallmark symptom is a progressive rash — macules to pustules — combined with fever and swollen lymph nodes; the simultaneous-stage rash distinguishes it from chickenpox
- ICMR has authorised 36 labs including NIV Pune for PCR testing; sample collection requires proper precautions
- No mpox vaccine is currently available for general use in India; no specific antiviral is available through routine channels; treatment is supportive
- High-risk groups — travellers, healthcare workers, immunocompromised individuals — should stay informed and consult a doctor at the first sign of fever + rash
- Consult your doctor before taking any self-treatment; mpox requires proper medical evaluation and isolation protocols