Lilongwe has emerged as the epicentre of Malawi’s Mpox outbreak, accounting for 104 of the 126 confirmed cases nationwide as of October 3, according to Ministry of Health data.
The alarming concentration of cases in the capital has prompted health authorities to intensify surveillance and containment efforts.
The Public Health Institute of Malawi (PHIM) attributes the surge to several factors, including Lilongwe’s proximity to the Mchinji border and its high population density.
PHIM deputy director Joseph Bango said genomic sequencing revealed that the virus currently circulating in Malawi is imported, with some cases linked to sexual transmission.
“We conducted genomic analysis and confirmed that the Mpox strain is imported. Our teams are actively conducting contact tracing and rapid surveillance to contain the spread, especially in Lilongwe,” Bango said.
District health officials say the outbreak is concentrated in densely populated areas such as Kawale, Chilinde, Dzenza, Area 25, Chiwoza, Kang’oma, Nkhoma and Milamba.
Lilongwe District Health Office spokesperson Richard Mvula said the city’s status as a transit hub contributes to the rapid spread.
“Lilongwe is a busy place with constant movement of people,” Mvula said. “We are seeing cases from multiple locations, and we’ve ramped up surveillance to control the outbreak.”
WHO Recommends Wastewater Surveillance In response to the rising numbers, the World Health Organisation (WHO) has recommended wastewater and environmental surveillance (WES) as a complementary tool to traditional disease monitoring.
WHO country representative Dr. Neema Kimambo said WES has proven effective in tracking diseases like polio and Covid-19.
“WES can fill critical gaps in surveillance data and inform public health responses. Given Lilongwe’s sharp rise in cases, this method could be instrumental in curbing further spread,” Kimambo said.
WES involves testing sewage and other water sources impacted by human waste to detect viral presence and trends in transmission.
Malawi confirmed its first Mpox case on April 16 2025, a 30-year-old man in Lilongwe with no recent travel history, suggesting local transmission.
The Ministry of Health officially declared an outbreak the following day. Within a week, three additional cases were confirmed in Lilongwe and Mangochi.
As the outbreak continues to evolve, health experts warn that swift action is needed to prevent further escalation, especially in urban centres like Lilongwe where mobility and density pose heightened risks.
