ETIDIOH - NEW

  {Summary} Highlights     • All clades of the monkeypox virus (MPXV) continue to circulate.  - When mpox outbreaks are not rapidly contained and human-to-human transmission is not interrupted, there is a risk of sustained community transmission .   • In October 2025, 44 countries , across all WHO regions, reported a total of 2501 new confirmed mpox cases , including 12 deaths (case fatality ratio [CFR] 0.5%).  - About 75% of these cases were reported in the African Region .  - All regions, apart from the South-East Asia Region observed a decline in confirmed cases in October, compared to September 2025.      • Twenty-one countries in Africa have reported active transmission of mpox in the last six weeks (12 October – 23 November 2025), with 1734 confirmed cases , including 10 deaths (CFR 0.6%) reported during this period.  - Countries reporting the highest number of cases in this period are the Democratic Republic of the Congo...

  Latest update The UK Health Security Agency (UKHSA) has identified a new recombinant mpox virus in England in an individual who had recently travelled to Asia .   -- Genomic sequencing showed that the mpox genome contained elements of clade Ib and IIb mpox .  -- This is not unexpected as both clades are circulating , but highlights the continued potential for mpox virus to evolve and the importance of continued genomic surveillance.     -- UKHSA continues to assess the significance of the strain.   Dr Katy Sinka, Head of Sexually Transmitted Infections at UKHSA, said:    '' Our genomic testing has enabled us to detect this new mpox strain . It’s normal for viruses to evolve, and further analysis will help us understand more about how mpox is changing.   '' Although mpox infection is mild for many, it can be severe . Getting vaccinated is a proven effective way to protect yourself against severe disease, so please make su...

  Situation at a glance The purpose of this report is to raise awareness about the local transmission of clade Ib monkeypox virus (MPXV) among men who have sex with men (MSM) in countries previously unaffected or to date reporting only cases linked to travel.  This report summarizes recent epidemiological developments , response activities, and the associated global public health risk .  The second declaration of a public health emergency of international concern (PHEIC) for mpox was lifted on 5 September 2025.  As both MPXV clades I and II and their subclades continue to circulate globally, leading to substantial outbreaks in African countries , WHO continues to advise emergency preparedness and response activities .  Multiple modes of transmission underlie ongoing virus circulation , with sexual contact remaining the primary amplifier of transmission in most settings.  Since 5 September 2025, several countries across four of six WHO regions have confirmed...

  Summary Background Given the continued global circulation of monkeypox virus (MPXV), we aimed to assess the long-term clinical consequences of MPXV infection and the continued presence of the virus in saliva, semen, and the anorectum . We also aimed to compare long-term antibody dynamics after MPXV infection with modified vaccinia Ankara–Bavarian Nordic (MVA-BN) vaccination. Methods In this mixed retrospective and prospective cohort study, adults with acute MPXV infection at the Institute of Tropical Medicine (Antwerp, Belgium) were enrolled in a clinical registry (MPX-COHORT) from May 13, 2022, with follow-up at 1 month after infection. On Oct 3, 2022, we initiated a long-term follow-up study (POQS-FU-PLUS) to extend follow-up of people with mpox and to establish a parallel cohort of adults who received MVA-BN vaccination between Aug 3, 2022, and Jan 4, 2023. Participants were eligible for the second cohort if they received two doses of MVA-BN, unless they had previous smallpox ...

  Highlights     • This Situation report will now be published monthly.  • All clades of the monkeypox virus (MPXV) continue to circulate. When mpox outbreaks are not rapidly contained and human-to-human transmission is not interrupted, there is a risk of sustained community transmission.   • In September 2025, 42 countries , across all WHO regions, reported a total of 3135 confirmed cases , including 12 deaths (case fatality ratio [CFR] 0.4%). More than 80% of these cases were reported in the African Region . Four regions (African Region, Eastern Mediterranean Region, Region of the Americas, and the Western Pacific) observed a declining trend in confirmed cases reported per month, while the European and South-East Asian regions observed an increase in cases in September 2025. • Seventeen countries in Africa have experienced ongoing active transmission of mpox in the last six weeks (14 Sep – 19 Oct 2025), with 2862 confirmed cases, including 17 deaths (CFR ...

  Last updated 27 October 2025 Latest update UKHSA is aware of small numbers of locally-acquired cases of clade Ib mpox in the USA , Spain, Italy , the Netherlands and Portugal which have no connection to countries with known clade Ib mpox transmission.   This suggests there is now community transmission of clade Ib mpox globally . Most of the new cases identified in Europe and the USA have been in gay, bisexual and other men who have sex with men , a population in which clade Ib mpox transmission has not previously been observed.   Mpox is usually a mild infection , and clade Ia and Ib mpox are no longer classified as a high-consequence infectious disease (HCID). However, it can be severe in some cases.  The UK has a routine mpox vaccination programme in place for eligible groups, including those who:   -- have multiple sexual partners   -- have group sex   -- visit sex-on-premises venues   Studies show that the vacc...

  Abstract Global efforts to eradicate smallpox—an Orthopoxvirus infection—began in the mid-20th century, with the last naturally occurring case reported in 1977. This was achieved through global solidarity efforts that expanded the smallpox eradication vaccination program . Approximately 50 years following the cessation of mass smallpox vaccination and in the absence of access to a sustainable boosting program , the population immunologically naïve to Orthopoxviruses has increased significantly. With increasing global movements and travels, we argue that the emergence of two back-to-back yet distinct mpox epidemics in the 21st century is a sign of humanity’s lost herd immunity to Orthopoxviruses. This needs concerted efforts to restore. Source: Viruses,  https://www.mdpi.com/1999-4915/17/9/1257 ____

  Abstract Monkeypox virus (MPXV) experienced an unprecedented global outbreak in 2022, characterized by a significant departure from historical patterns: a rapid spread of the epidemic to more than 110 non-traditional endemic countries , with more than 90,000 confirmed cases; a fundamental shift in the mode of transmission , with human-to-human transmission (especially among men who have sex with men (MSM)) becoming the dominant route (95.2%); and genetic sequencing revealing a key adaptive mutation in a novel evolutionary branch ( Clade IIb ) that triggered the outbreak. These features highlight the significant evolution of MPXV in terms of host adaptation, transmission efficiency, and immune escape ability . The aim of this paper is to provide insights into the viral adaptive evolutionary mechanisms driving this global outbreak, with a particular focus on the role of immune escape (e.g., novel mechanisms of M2 proteins targeting the T cell co-stimulatory pathway) in enhancing vi...

  Abstract During infectious disease outbreaks, acquiring genetic data across various kingdoms offers essential information to tailor precise treatment methodologies and bolster clinical, epidemiological, and public health awareness. Metagenomics sequencing has paved the way for personalized treatment approaches and streamlined the monitoring process for both co-infections and opportunistic infections. In this study, we conducted long-read metagenomic DNA sequencing on mpox-like lesion pustules from six suspected patients who were positive and confirmed to be infected with MPXV during the MPXV subclade Ib outbreak in the Eastern Democratic Republic of the Congo. The sequenced data were taxonomically classified as bacterial, fungal, and viral in composition . Our results show a wide spectrum of microorganisms present in the lesions . Bacteria such as Corynebacterium amycolatum, Gardnerella vaginalis, Enterococcus faecium, Enterobacter clocae, Staphylococcus epidermidis, and Stenotro...

  Highlights     • All clades of monkeypox virus (MPXV) continue to circulate in several countries.  - When mpox outbreaks are not rapidly contained and human-to-human transmission is not interrupted, they continue to pose a risk of sustained community transmission .  - Since the last edition of this report , one country, Senegal , has reported mpox for the first time . Efforts to identify the clade are underway.  • Furthermore, Türkiye has reported cases of mpox due to clade Ib MPXV for the first time and the Democratic Republic of Congo has reported its first cases of mpox due to clade IIb MPXV.   • In July 2025, 47 countries in five (out of six) WHO regions reported a total of 3924 confirmed cases , including 30 deaths (case fatality ratio [CFR] 0.8% ).  - The South-East Asian and Western Pacific regions reported an increase in cases in July 2025, while the African Region, European Region and the Region of the Americas reported a decrease....

  Abstract Mpox poses a heightened risk of severe disease and mortality among individuals with HIV , yet the molecular mechanisms and immunopathology underlying multi-organ damage caused by the mpox virus (MPXV), particularly in the context of HIV co-infection, remain poorly understood. Here, we observe increased MPXV replication, more extensive skin lesions, and impaired humoral and cellular immune responses in SIV-MPXV co-infected rhesus macaques compared to those infected with MPXV alone. Multi-organ proteomic and phosphoproteomic analyses reveals upregulation of proteins involved in immune and inflammatory pathways in skin lesions and across multiple organs, especially in immune-related tissues. Abnormal activation of DNA replication and cell cycle signaling pathways , which may contribute to enhanced viral replication, is evident in both MPXV and SIV-MPXV co-infected groups. CDK4/6 may present a potential therapeutic target to suppress MPXV replication. These comprehensive pro...

  ABSTRACT Mpox, caused by monkeypox virus (MPXV) infection, has emerged as a significant global health threat . The World Health Organization (WHO) has twice declared a Public Health Emergency of International Concern for mpox: first for the 2022–2023 global outbreak and subsequently for concurrent outbreaks in Africa. Beyond MPXV, other members of the Orthopoxvirus genus also pose growing risks of zoonotic spillover , with the potential to jump from animal reservoirs to humans . Clinically, mpox is distinguished from other Orthopoxvirus infections by its propensity to cause severe systemic manifestations alongside localized skin lesions , disproportionately affecting vulnerable groups such as children, pregnant women, and immunocompromised individuals . Although vaccines are available, effective therapeutics are equally essential in combating the mpox crisis. Current antiviral agents , including tecovirimat and brincidofovir , have demonstrated uncertain or disappointing efficacy...

Abstract Monkeypox virus (MPXV) has re-emerged globally since May 2022, posing a significant public health threat . To address this, we develop two multivalent mRNA vaccine candidates —AAL, encoding three MPXV antigens, and AALI, which combines AAL with an immune-enhancing IFN-α protein. Both vaccines are delivered via mannose-modified lipid nanoparticles to target dendritic cells . Here we show that these vaccines elicit strong antibody responses against vaccinia virus and multiple MPXV clades , induce robust memory B-cell and T-cell responses, and promote dendritic cell maturation . In mouse challenge models , both vaccines provide protection against clade IIb MPXV and vaccinia virus , significantly reducing viral loads and preventing lung damage. Immune profiling reveals enhanced B- and T-cell receptor diversity and distinct CDR3 motifs post-vaccination. These findings demonstrate the potential of using mRNA-based multivalent vaccines as an effective strategy for preventing mpox and...

  {Excerpt} Highlights -- All clades of monkeypox virus (MPXV) continue to circulate in several countries.  - When mpox outbreaks are not rapidly contained and human-to-human transmission is not interrupted, they continue to pose a risk of sustained community transmission .   -- Since the last edition of this report, one new country, the Gambia , has reported an mpox case for the first time.  - Genomic sequencing analysis has identified clade IIb MPXV.  -- Furthermore, Mozambique, has reported cases of mpox due to clade Ib MPXV for the first time.   -- Twenty-one countries in Africa have reported ongoing mpox transmission in the past six weeks.  - Clade IIb MPXV continues to be reported in West Africa, while Central African countries report both clade Ia and clade Ib MPXV, and East African countries report clade Ib MPXV.  -- The recent overall downward trend of confirmed cases across the continent is driven by the decline in cases in Sie...

Abstract Mpox was first identified against the backdrop of the smallpox eradication campaign. Monkeypox virus (MPXV), the causative agent of mpox, has been maintained in animal reservoirs in the forested regions of West and Central Africa as 2 distinct clades ; clade I has historically caused more severe infection in Central Africa than clade II , historically found in West Africa . However, rapid reemergence and spread of both MPXV clades through novel routes of transmission have challenged the known characteristics of mpox. We summarize mpox demographic distribution , clinical severity , and case-fatality rates attributed to genetically distinct MPXV subclades and focus on MPXV clade Ib, the more recently identified subclade. Broad worldwide assistance will be necessary to halt the spread of both MPXV clades within mpox endemic and nonendemic regions to prevent future outbreaks. Source: US Centers for Disease Control and Prevention,  https://wwwnc.cdc.gov/eid/article/31/8/24-1551...

  Highlights • All clades of monkeypox virus (MPXV) continue to circulate in several countries. When mpox outbreaks are not rapidly contained and human-to-human transmission is not interrupted , they continue to pose a risk of sustained community transmission .   • Since the last edition of this report, no new countries have reported cases of clade Ib MPXV for the first time.   • Nineteen countries in Africa have reported ongoing mpox transmission in the past six weeks. Clade IIb MPXV continues to be reported in West Africa , while Central African countries report both clade Ia and clade Ib MPXV, and East African countries report clade Ib MPXV .  • The recent overall downward trend of confirmed cases across the continent is driven by the decrease in cases in Sierra Leone , the Democratic Republic of the Congo , and some reporting delays. Challenges with access to testing continue in the Democratic Republic of the Congo.   • An upward trend has bee...

  {Summary} The Director-General of the World Health Organization (WHO) is hereby transmitting the report of the fourth meeting of the International Health Regulations (2005) (IHR) Emergency Committee (Committee) regarding the upsurge of mpox 2024 , held on Thursday, 5 June 2025, from 12:00 to 17:00 CEST. Concurring with the advice unanimously expressed by the Committee during the meeting, the WHO Director-General determined that the upsurge of mpox 2024 continues to meet the criteria of a public health emergency of international concern (PHEIC) and, accordingly, on 9 June 2025, issued temporary recommendations to States Parties, available here.   The WHO Director-General expresses his most sincere gratitude to the Chair, Members, and Advisors of the Committee. (...) Source: World Health Organization,  https://www.who.int/news/item/10-07-2025-fourth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-upsurge-of-mpox-2024 ____

Summary Background Clade I monkeypox virus is endemic in DR Congo. We aim to describe the epidemiological trends of the cocirculating subclades Ia and Ib mpox outbreaks in Kinshasa, DR Congo. Methods This retrospective observational study included suspected and laboratory-confirmed mpox cases reported between Jan 1, 2023, and Oct 31, 2024, in Kinshasa. Skin lesion swabs or blood samples were collected as part of a routine countrywide mpox surveillance programme. To confirm the diagnosis of mpox, all samples were tested at the Institut National de Recherche Biomédicale (INRB) using real-time PCR. Whole-genome sequencing was conducted for phylogenomic analysis and assessment of APOBEC3 type mutations. Samples that remained unassigned to subclade Ia or Ib after whole-genome sequencing and real-time PCR were labelled as an unknown subclade. Findings As part of routine disease surveillance, 1479 suspected mpox cases were reported in Kinshasa. Samples were collected from 1314 suspected mpox ...

Abstract Zoonotic diseases pose global public health threats, prompting various interventions to limit their emergence and spread . One increasingly common response by governments has been to ban wildlife hunting , trade and consumption. However, there is limited evidence of the effectiveness of wildlife trade bans . Here we assess compliance with Nigeria’s wildlife trade ban—enacted to curb the spread of mpox (formerly monkeypox)—by analysing approximately 4.5 years of wild meat sales data from 19 vendors in southeast Nigeria (988 vendor-months) alongside interviews with vendors and law enforcement officials. After matching the sales data by time of year, we found no significant differences before and after the ban in the number of vendors selling wild meat per week, the weekly mass of wild meat sold, or the weekly price per kilogram of wild meat; however, the total weekly sales price was higher post-ban. These findings, supported by interview insights, indicate widespread non-complia...

Abstract In 2022-23, the world witnessed the largest recorded outbreak of monkeypox virus (MPXV). Neurological manifestations were reported alongside the detection of MPXV DNA and MPXV-specific antibodies in the cerebrospinal fluid of patients. Here, we analyze the susceptibility of neural tissue to MPXV using human neural organoids (hNOs) exposed to a clade IIb isolate . We report susceptibility of several cell types to the virus, including neural progenitor cells and neurons . The virus efficiently replicates in hNOs, as indicated by the exponential increase of infectious viral titers and establishment of viral factories . Our findings reveal focal enrichment of viral antigen alongside accumulation of cell-associated infectious virus , suggesting viral cell-to-cell spread . Using an mNeonGreen-expressing recombinant MPXV, we confirm cell-associated virus transmission . We furthermore show the formation of beads in infected neurites, a phenomenon associated with neurodegenerative diso...