ETIDIOH - NEW

  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...

  {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...

{Summary) KEY FIGURES   {Area - Number of reported confirmed cases - Number of deaths among confirmed cases - Number of reporting countries} -- Global (1 Jan – 31 May 2025)* - 24 672 - 82 - 75  Key countries (01 Jan – 22 June 2025) - Democratic Republic of the Congo - 12 208 - 22 - ... - Uganda - 5636 - 31  - ... - Sierra Leone - 4294 - 28 - ... - Burundi - 1079 - 0 - ... {*} Most recent global surveillance data available. Highlights • In May 2025, a total of 6823 confirmed mpox cases and 16 deaths (Case Fatality Ratio: 0.2%) were reported from 49 countries across all WHO regions. • The majority of mpox cases continue to be reported from the WHO African Region , with 18 countries currently experiencing active ongoing transmission. • Since the last report, Ethiopia and Italy have reported their first cases of mpox due to clade Ib monkeypox virus (MPXV). In addition, North Macedonia, the Republic of the Congo, and Togo have reported their first cases of mpox clade IIb MPXV ...

Abstract Emerging as a major global health threat, Mpox previously known as Monkeypox has drawn attention due to a worrying surge in cases . This zoonotic disease , native to Central and West Africa , is marked by fever, rash, and lymphadenopathy and is primarily spread through direct contact with infected animals or people and indirectly through contaminated objects. Recent studies have indicated possible sexual transmission , underscoring how human behavior and environmental changes are increasing its prevalence, even though human-to-human transmission is less efficient than that of smallpox . Mpox is endemic in several African countries , and currently, the infection has spread in non-endemic countries, including Rwanda, Uganda, and Kenya . Democratic Republic of Congo is the epicenter of the current Mpox outbreak. From January 1, 2022, to August 6, 2024, sixteen African countries reported Mpox outbreak. Several factors, including population immunity deficiencies and changes to the ...

Fourth meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024 – Temporary recommendations The Director-General of the World Health Organization (WHO), following the fourth meeting of the International Health Regulations (2005) (IHR)   Emergency Committee regarding the upsurge of mpox 2024 , held on 5 June 2025, from 12:00 to 17:00 CEST, concurs with its advice that the event continues to meet the criteria of a public health emergency of international concern and, considering the advice of the Committee, he is hereby issuing a revised set of temporary recommendations. The WHO Director-General expresses his most sincere gratitude to the Chair, Members, and Advisors of the Committee. The proceeding of the fourth meeting of the Committee will be shared with States Parties to the IHR and published in the coming days. Temporary recommendations These temporary recommendations   are issued to  States Parties   experienci...

Abstract Mpox clade Ib is significant as it is associated with human cases and plays a key role in understanding the transmission and public health implications of mpox outbreaks. Here we present a case report of the first confirmed human infection of clade Ib in China , which occurred in December 2025 in Zhejiang Province. The case was a 28-year-old woman from South Africa who had sexual contact with an asymptomatic man from the Democratic Republic of the Congo . She presented with disseminated vesicular lesions on the extremities, face, buttocks, trunk, palms, and dorsum of the hands, but lesions were absent from the oral cavity, perineum, and anus. By the 18th day post-onset (DPO), only vesicles remained on the dorsum of the right foot and in the finger web spaces, with complete resolution by the 24th DPO. Among 59 consecutive samples collected, 55 tested positive for mpox virus . Oropharyngeal swabs turned negative by the 16th DPO, while skin lesion samples, urine samples, and scab...

Summary Background The JYNNEOS modified vaccinia virus Ankara vaccine is effective in preventing clade IIb mpox disease . However, vaccine effects on mpox severity are poorly understood. We aimed to assess associations between reported clinical characteristics and vaccination status among individuals with laboratory-confirmed mpox. Methods We conducted a case–control study using data collected from public health surveillance interviews of people with mpox in California . Eligible participants for primary analyses were men who were cisgender and participated in telephone interviews with complete responses recorded about anatomical sites where they had lesions. We estimated JYNNEOS vaccine effectiveness against progression to disease involving disseminated lesions via the adjusted odds ratio of vaccination, comparing participants who reported lesions disseminated across multiple anatomical regions (cases) with participants who reported lesions contained to a single anatomical region (con...

Summary Background Mpox, caused by the monkeypox virus, is a serious public health threat in Africa , especially in DR Congo . Previously limited to endemic areas with clade 1a, monkeypox virus has recently spread to non-endemic regions, where clade 1b has emerged . This study provides a clinical comparison of mpox cases in DR Congo regions where clade 1a and clade 1b are prevalent. Methods We conducted a retrospective observational study , analysing PCR-confirmed mpox cases reported from sentinel health zones in seven provinces between Oct 1, 2023, and Sept 31, 2024. Cases from the newly affected provinces (South-Kivu and Kinshasa) were described along with those from four endemic provinces (Mai-Ndombe, Tshuapa, Tshopo, South-Ubangi, and Équateur). Surveillance data, including type of exposure, demographic details, clinical presentation, complications, and outcomes were collected from national surveillance systems and local health facilities, with laboratory confirmation using quantit...