#Mpox, Multi-Country #Outbreak - Rapid #risk #assessment V7 (#WHO, August 25 '26)

{Summary}

    ° Date and version of current assessment: 18 August 2026, v7

    ° Overal Global Risk statement: 

        § This global rapid risk assessment (RRA) assessesthe current public health  risk associated with the 2024 upsurge of mpox in Africa, in the context of the  continuing global occurrence of mpox in all regions since 2022, with a focus on  updates since the previous RRA in February 2026. 

        § The overall public health risk  posed by mpox remains unchanged from the last RRA. 

Global overview

    As of 30 June 2026, the monkeypox virus (MPXV) continues to spread  globally, causing both localized and extended mpox outbreaks driven by multiple  MPXV clades (Ia, Ib, IIa, and IIb) in diverse settings. The recombination of MPXV clades has also been documented, with the two previously reported cases  of a recombinant clade Ib/IIb MPXV strain detected in the United Kingdom of Great Britain and Northern Ireland in late 2025 and India in January 2026,  and one additional case reported in Qatar since the last RRA.

    Globally, from 1 January 2022 to 30 June 2026, 145 countries and  territories across all WHO regions reported 188 847 confirmed cases of mpox,  with 521 deaths [case fatality ratio (CFR) – 0.3%] and including two  additional countries: Comoros and Guinea-Bissau. 

    Since the last RRA, an additional 10 908 confirmed cases, 44 deaths,  and an average of 420 new confirmed mpox cases per week have been reported  across all affected countries. 

    As with the previous version, this RRA assesses the risk for three population groups; 

        i) global risk for individuals with multiple sexual partners, 

        ii) risk for children in mpox historically endemic areas where risk of zoonotic  transmission continues, and 

        iii) global risk for all other individuals. Updates in understanding of mpox  epidemiology within these groups are described herein.

Individuals with multiple sexual partners – global risk

    Since the start of the global mpox outbreak in 2022, sexual activity in  linked sexual networks has been the primary driver of sustained transmission and  geographic spread, particularly in newly affected areas. The major and  predominant contribution of sexual transmission, whether linked to  heterosexual or same-sex contact, to the introduction, spread and  establishment of mpox in communities has been recognized across all affected  settings. 

    Outside the WHO African Region, over 87% of reported cases have been among men who have sex with men (MSM), with transmission driven by  spread among individuals with multiple sexual partners in a short time span  and/or frequent partner change. 

    Outbreaks are commonly linked to a sex-on-premises location or event.  In Africa, transmission has often been reported to involve sex workers and their  clients, long-distance drivers and other sexual networks where people have  multiple partners and/or frequent partner change. In Africa, most transmission  appears to be heterosexual.

    In networks characterized by multiple partners and/or frequent partner  change over short periods (days to a few weeks), the secondary attack rate for  sexual contact may be high (estimated at 73% in some settings), facilitating epidemic spread. This pattern was observed during the initial spread of  clade IIb MPXV among MSM communities and more recently clade Ib and IIb  MPXV outbreaks in Africa and elsewhere, with amplification in key populations  such as female sex workers and their clients as well as others with multiple  partners, often in different locations. The recently identified recombinant clade  Ib/IIb strain of MPXV has also been identified in this group with similar risk factors  related to sexual contact. This risk group therefore includes people with multiple or frequently changing sex partners, including those with higher-risk  sexual behaviours.

    Sexual contact transmission likely occurs during various stages of  infection, including pre-symptomatic or less apparent stages, the duration of  which can vary between individuals. People with few or mild genital lesions might not recognise the infection. Studies have shown that the virus can be  present in genital and anal mucosae, as well as in seminal and vaginal fluids  of symptomatic infected individuals. Emerging data suggests that viral  shedding from the genitals may occur up to four days before symptom onset,  potentially contributing to undetected sexual contact transmission. This could  explain the persistence of the virus in communities and the challenges  encountered in interrupting human-tohuman transmission, while the contribution  of asymptomatic viral carriage to transmission remains unclear.

    In most healthy adults of this group, mpox is often self-limiting.  However, severe disease, including disabling complications, secondary infections,  long-term sequelae and death, continues to occur most particularly but not exclusively in people living with advanced HIV disease or uncontrolled HIV  infection, as well as other immunocompromising conditions. While overall case  fatality has remained below 1% in most settings, up to 15-fold or higher fatality has been observed among individuals with immunosuppression, as well as in vulnerable infants, and particularly neonates  in some settings. Notably, recent data from the African setting support  observations elsewhere that people living with HIV who have suppressed viral loads and preserved CD4 counts experience mortality equivalent to HIV-negative individuals, indicating that the HIV-associated  mortality risk is largely modifiable and deaths are preventable through sustained  viral suppression and immune reconstitution. Although most people living with HIV globally are on antiretroviral therapy, significant and growing gaps in  diagnosis and treatment persist in several lowand middle-income settings, with  26.3 million people estimated to be living with HIV in Africa in 2025, of which over 20% either do not know their status, are not on antiretroviral therapy or are  not successfully virally suppressed, a situation exacerbated by recent funding cuts  to HIV control programmes in many countries. In many contexts, over half of mpox cases are reported among people living with HIV, adding  more complexity to the convergence of risks faced by this group (risk of infection,  risk of severe disease, and risk of poorer health service access).

    Most countries globally have activated outbreak responses, including  surveillance, case investigation, contact tracing, case management, and infection  prevention and control. However, control efforts have been impeded when sexual contact transmission or other risk factors are not adequately recognized, or  when risk communication and community engagement do not effectively reach  key populations and other individuals within sexual networks. Furthermore, countries are increasingly tasking HIV/STI control programmes –  themselves heavily constrained by recent funding cuts – with participating in or  leading the response, as well as activating immunization policies and programme  capacity.

    While targeted mpox vaccination has been implemented for groups at  higher risk of mpox exposure in many countries in high and low-income settings,  including administration of more than two million doses in Africa, coverage  remains uneven or partial and most individuals in this group remain susceptible to  MPXV infection, particularly in countries outside Europe and North America. In  addition, younger cohorts are continually entering sexually active age groups.

    The duration and level of protection conferred by prior infection and/or vaccination remains uncertain. 

    Overall, transmission in these groups at higher risk is ongoing and likely  to continue to spread geographically, which can be expected to lead to  severe outcomes among immunocompromised individuals, thus focusing  risk of spread among individuals with multiple partners in interconnected sexual  networks who may not be aware of risk, and the risk of complications and death  among vulnerable individuals. 

    The overall public health risk for individuals with  multiple sexual partners is, therefore, assessed as moderate.

Children in historically endemic areas – local risk

    In historically endemic areas in West and Central African countries,  where viruses continue to circulate in animal hosts and zoonotic spillover  continues to occur, particularly in the Democratic Republic of the Congo, the  highest number of mpox cases and incidence of deaths has been documented  among young children (<5 years). Surveillance and diagnostic capacities in these  settings remain suboptimal and have continued to decline in 2026, making the interpretation of available data challenging.

    Among individuals younger than 50 years in the Democratic Republic of the Congo, age-specific mpox incidence appears broadly comparable across age  groups, largely reflecting the underlying age distribution of the population.  However, case fatality among suspected mpox cases in children under five years of age (CFR 3.0%) is higher  than that observed among individuals aged  five to 15 years (CFR 1.9%), and almost twice that observed among  individuals aged 15 years and older (1.7%). Of note, the case fatality ratio in  historically endemic areas of the Democratic Republic of the Congo remains much  higher across all age groups than elsewhere (about 7 to 20-fold higher). This may  arise from specific vulnerabilitiesincluding delayed or limited access to appropriate  health care, compounded by concomitant health risks, such as  malaria, varicella, measles, malnutrition, and complications of mpox such as  dehydration and secondary infections. This higher fatality is particularly observed  in infants and young children, who are largely immunologically naïve. At present,  mortality data from this setting are largely drawn from syndromic surveillance  and multiple studies are underway to better describe the risks  associated with mpox in these settings.

    While targeted vaccination has supported outbreak response, in the  absence of established vaccination programmes against mpox and limited access  to early and appropriate healthcare, children and pregnant women in the affected  settings are likely to continue experiencing elevated health risks from  mpox and MPXV infection.

    The risk of geographic spread associated with non-sexual contact transmission is predominantly local. Available data indicate secondary attack  rates of less than 20% following non-sexual household contact, suggesting that  while children are vulnerable to more severe disease, and outbreaks in schools  have been documented , children generally appear to have a limited role in  driving viral spread. In addition, children have not often been reported as a source  of introduction of mpox in new areas, and their contribution to wider  geographic or cross-border spread remains negligible, compared to spread among adults exposed through sexual contact.

    Most historically endemic areas are rural forested territories, where  there is a risk of insufficient control capacities of outbreak response, particularly  now as countries transition from an acute outbreak response approach to a  longerterm disease control programme. Mpox programmes in these settings have  previously been greatly under-resourced and will increasingly need to rely on  preventive strategies and routine care capacity.

    Overall, in the absence of vaccination programmes for mpox in  historically endemic areas, and resources for national programmes conducting  outbreak response activities, the virus will likely continue to circulate,  disproportionately affecting younger children. 

    The overall public health risk for children in historically endemic areas is,  therefore, assessed as moderate.

All other individuals – global risk

    For individuals outside the above two risk groups, the overall risk of acquiring mpox is lower. While illness in the general population is typically mild  and self-limiting, with most cases requiring only supportive care and no  hospitalization, severe disease and death can also occur, albeit less commonly.  While the risk of severe outcomes is much higher among individuals with  underlying immunocompromising conditions, these persons generally represent a  small proportion of cases reported in recent outbreaks, and thus the majority of  cases with complications or deaths may actually occur in persons without immune  suppression in some settings. As noted above, case fatality in historically endemic  areas of the Democratic Republic of the Congo remains much higher across all age  groups than elsewhere (about 7 to 20-fold higher). More research is needed  to characterise less studied risk factors for severe disease. 

    Some data suggest that adults vaccinated before the cessation of routine smallpox vaccination worldwide , in 1980 or earlier in many  countries, are likely to retain partial cross-protective immunity and present with  lower disease severity.

    While breakthrough cases of mpox have been documented in some older  previously vaccinated persons, epidemiological data indicate that few mpox  deaths have been reported in this group. New cases of mpox with clade Ib  MPXV in various regions have predominantly been associated with sexual contact  in people with a history of travel to outbreak-affected areas who developed  symptoms just prior to or upon return. Spread through sexual networks from  some cases has ultimately led to the establishment of community transmission of  clade Ib MPXV in several countries outside Africa.

    Overall, the spread of clade Ib MPXV in newly affected areas has remained largely confined to groups at risk. Since the start of the global  outbreak in 2022, the general population has not been widely affected by ongoing  circulation of clade IIb MPXV in high income settings, nor has it been implicated in  mpox introduction or establishment in new geographic areas. Secondary  transmission to non-sexual contacts has remained limited. Thus, individuals in this  risk group (“all other individuals”) affected by clade IIb have mainly been  infected through household or occupational contact, characterized by low  secondary attack rates and limited onward transmission. Nonetheless, explosive  outbreaks in West Africa have demonstrated that all age groups can be  significantly affected such that continued vigilance is required for all mpox clade  outbreaks in different settings. Within this broad group which includes most  people, there are also other individuals in settings where there is a higher risk of  onward mpox transmission, such as those in internally displaced person (IDP) and  refugee camps and other congregate, overcrowded settings. Furthermore,  some more vulnerable individuals are considered to face a higher risk of severe  disease and poorer disease outcomes if they fall ill, particularly pregnant  individuals, neonates, and infants. Poor outcomes have been documented among  pregnant individuals and their unborn children, including spontaneous  abortions, missed abortions, still births, congenital mpox and early neonatal  death, with recent studies reporting these adverse outcomes in about half of  pregnant individuals followed up. The healthcare-associated clade Ib mpox outbreak among neonates and infants in Pakistan in early 2026 which  resulted in a CFR higher than 20% also demonstrated that mpox transmission can  lead to severe consequences in highly vulnerable populations. In this instance,  mpox in a neonatal intensive care setting resulted in rapid amplification and disproportionate impact in neonates and infants.

    Public health control measures such as laboratory confirmation, rapid  contact tracing and isolation have generally been sufficient to manage mpox in the  general population, notably in high-income settings. Nonetheless, partner  notification strategies should supplement classic contact-tracing to reach non- disclosed sexual partners. Vaccination has been prioritized for groups at higher  risk of exposure with the intent to prevent and stop transmission. Where vaccines  have, in some settings, been mainly offered to health workers for their individual  protection, this strategy builds confidence and quality of care but cannot be  expected to play a major role in stopping outbreaks.

    In all settings therefore, the general population largely remains  immunologically naïve to mpox, while the risk to health, contribution to  international spread and burden of insufficient response capacities, remains low.  Exceptions to this include where mpox is inadvertently introduced into high-risk  settings, such as newborn and infant care units. 

    The overall public health risk for all other individuals without multiple sexual partners is, therefore, assessed as low.

Overall public health risk

    Mpox continues to pose a public health risk across all WHO regions,  with the likelihood and impact varying by population group, transmission context,  and local response capacity. The African Region will most likely continue observing  sustained community transmission in several countries  outside historically endemic areas, as well as recurrent outbreaks in countries  where zoonotic transmission occurs. While all countries remain at risk of  importation and limited local transmission, recent outbreaks (starting from 2022- 2023) have confirmed observations that sustained transmission and geographic  spread are largely driven by sexual contact in specific population groups and  network dynamics, rather than in the general population, with some notable  exceptions such as health facility-based outbreaks.

    While most countries have established outbreak response mechanisms,  such as early detection and contact tracing that help in controlling  viral spread, the effectiveness of classic contact-tracing for a sexually  transmissible infection remains very limited. Other countries are less prepared and  at a higher risk of missing chains of local transmission, especially where low  index of suspicion, stigma, and discrimination create barriers to access diagnostic testing, clinical care services and implementation of infection prevention and  control measures, and where political and socio-cultural  contexts or other  circumstances preclude timely information-sharing with communities, health  sector partners and timely and complete reporting to WHO.

    While improvements in understanding mpox transmission and risk have  improved since the first mpox public health emergency of international  concern (PHEIC) was declared in 2022, important knowledge gaps remain. These  include uncertainties regarding the role of asymptomatic or pauci-symptomatic  infections, the duration and extent of immunity  following infection or vaccination  (e.g., for immunocompromised individuals), risk factors for severe disease beyond known immunocompromising conditions, and the contribution of zoonotic  spillover and potential human-to-animal transmission. Limited data regarding  animal reservoirs and transmission at the human–animal–environmental interface further limits risk characterization in endemic settings. The lack of  reporting by some countries further limits overall community awareness,  appreciation of risk, and visibility on continuing evolution of the epidemic.

    Several cases and larger outbreaks have been reported in humanitarian emergency settings such as IDP and refugee camps and other congregate,  overcrowded settings, but the risk of spread and modes of transmission in these  settings, including the role of living conditions among other factors, are still poorly  understood. Additionally, transmission between children outside of the  household setting is not fully understood, and its potential to sustain spread of the  virus in the community context has not been quantified.

    In recent years, access to diagnostics, vaccines, and response tools has  improved through coordinated efforts by WHO and partners, and 19 countries  in Africa have implemented vaccination for populations at highest risk.  However, funding constraints, competing public health priorities, and reliance on  limited resources for vaccine supply continue to challenge sustained response  efforts, particularly in low- and middle-income countries. Delays in vaccine  introduction and limited coverage reduce the potential impact of vaccination,  underscoring the importance of prioritization and timely vaccine deployment. In  addition, data on the effectiveness of available therapeutics for mpox remain  limited, particularly in settings reporting the highest burden of disease.

    The detection of a recombinant MPXV strain with genetic elements of  both clade Ib and IIb MPXV warrants continued monitoring. To date, one  additional case has been detected since the last RRA, bringing the cumulative case  count to three. The geographic areas where the recombination event first  occurred remain unknown. While the public health risk associated with this  recombinant strain is currently considered low, ongoing genomic surveillance is  essential given uncertainties related to viral evolution and recombination.

    Overall, MPXV continues to circulate in all WHO regions and pose distinct risks across different population groups and  settings. Sustained  transmission of this still emerging and evolving orthopoxvirus continues, posing  health risks for vulnerable individuals of all ages and in all settings. While  response capacity continued to improve during the second PHEIC, it remains  uneven with suboptimal reporting practices, and highly dependent on dwindling or  non-existent resources as priorities shift. Transition to longer term disease  prevention and control programmes and strategies is still in early stages in most  settings and resources remain extremely limited as interest in mpox response  wanes. Taken together, this context creates additional risk that the gains made  over the past few years may erode. 

    Thus, the overall public health risk at the global level is assessed as moderate.

(...)

Source: 

Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment-mpox--global-v.7

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#Orthopoxvirus #Antibodies in Feral #Mammals in #Mpox #Outbreak Areas, #Nigeria, 2021–2022

 

Abstract

We analyzed tissue and serum samples from 124 wild animals from communities with confirmed mpox cases in Nigeria. Tissue samples were PCR-negative, but serum samples from 8 animals (6.45%)—3 feral cats, 4 giant pouched rats, and 1 shrew—revealed Orthopoxvirus antibodies, suggesting these species as probable reservoirs.

Source: 

Link: https://wwwnc.cdc.gov/eid/article/32/5/25-1565_article

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#Mpox - cMulti-country external #situation #report no. 64, published 26 March 2026 (#WHO, summary)

 

{Excerpt}

Highlights

• Transmission of mpox continues mostly within sexual networks, affecting both women and men, followed by household transmission, and in some historically endemic areas, affecting all age groups. 

- All clades of monkeypox virus (MPXV) continue to circulate. 

- Unless mpox outbreaks are rapidly contained and human-to-human transmission is interrupted, there is a risk of sustained community transmission in all settings. 

• In February 2026, 46 countries across all WHO regions reported a total of 1184 confirmed mpox cases, including four deaths (case fatality ratio [CFR] 0.3%). 

- Of these cases, 58.6% were reported in the WHO African Region. 

• Four WHO regions – the Region of the Americas and the African, South-East Asian and Western Pacific regions – reported a decline in confirmed cases in February, compared to January 2026, while the European Region reported an increase in confirmed cases. 

- The Eastern Mediterranean Region reported the same monthly case count in January and February 2026.

• Seventeen countries in Africa reported active transmission of mpox in the last six weeks (1 February – 15 March 2026), with 907 confirmed cases, including seven deaths (CFR 0.8%). 

- Countries reporting the highest number of cases in this period are Madagascar, the Democratic Republic of the Congo, Kenya, Burundi, and Liberia. 

• Three countries, Argentina, Austria, and the Central African Republic, have reported mpox due to clade Ib MPXV for the first time. 

• Outside Africa, community transmission of clade Ib MPXV continues in the WHO European Region, with Austria, Belgium, Portugal, Spain, and the United Kingdom of Great Britain and Northern Ireland reporting community transmission, including in sexual networks of men who have sex with men.  

• This report provides an update on mpox outbreak transmission dynamics across different clades and settings. 

• On 7 April 2026, World Health Day, WHO will join a One Health summit convened by the Government of France. 

- The Summit will foster international and interdisciplinary dialogue to highlight the interdependence of human, animal, plant and ecosystem health, and the need for coordinated, science-based approaches to address shared health threats, including for emergency response. 

(...)

Source: 

Link: https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report--64---26-march-2026

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Immunogenicity and #safety of MVA-BN #vaccine administered 5 years after a two-dose primary series in #DRC: a prospective cohort study

 

Summary

Background

The expanding mpox outbreak in Africa and travel-associated cases in other continents have increased efforts to vaccinate populations at high risk. This study aimed to assess serological immune responses 5 years after individuals received a primary vaccination (two-dose series) with the smallpox and mpox vaccine modified vaccinia Ankara-Bavarian Nordic (MVA-BN), as well as to evaluate the safety and immunogenicity of a third dose (booster). To date, there are no data for immunological memory or third-dose-induced immunity for MVA-BN at these long-term timescales.

Methods

In this open-label, prospective cohort extension, we re-enrolled health-care workers from a 2017 vaccination study in Bokungu Health Zone, DR Congo, to receive a third dose of MVA-BN. All previous participants were offered the opportunity to re-enrol. Participants were grouped according to whether they had received a childhood smallpox vaccination with a replication-competent vaccine strain (historically vaccinated group) or had no history of smallpox vaccination (historically naive group). Participants were excluded from serological analyses if they had any history of mpox or mpox-like lesion-presenting illness, if their previous vaccination status during initial enrolment for the primary series was unknown, or if they had discordant vaccination information. The coprimary outcomes were sustained humoral immunity following primary vaccination with MVA-BN (5 years previously) and the immunogenicity and safety of the booster vaccination. Safety was analysed in patients with a completed immediate adverse event form or adverse event diary. Adverse events were assessed on days 0 (within 30 min of the booster), 7, and 14. Antibody responses were measured by ELISA, plaque reduction neutralisation tests, and endpoint titre at re-enrolment (day 0, before administration of the booster dose) and on days 7, 14, and 545 after the booster dose.

Findings

Between Sept 7 and 15, 2022, 170 (66·1%) of 257 Bokungu health-care personnel vaccinated in 2017 were re-enrolled to receive a third (booster) dose of MVA-BN. At re-enrolment, low levels of circulating antibody were observed, but 30 (61%) of 49 historically naive participants and 95 (96%) of 99 historically vaccinated participants with childhood smallpox vaccination remained seropositive 5 years after the primary MVA-BN two-dose series. After the third dose, there was a rapid and massive increase in anti-orthopoxvirus IgG but not IgM, and a 93-fold rise in orthopoxvirus neutralising antibody titres was observed by day 14 in historically naive participants, irrespective of participants' seropositivity at the time of booster vaccination. The third dose resulted in enhanced durability of circulating antibody concentrations, with endpoint titres on day 545 remaining more than six-fold higher than day 0 values. There was a greater risk of local reactogenicity after the booster dose than after the primary vaccination (relative risk 4·2, 95% CI 2·81–6·46), but there was no difference in the risk of systemic adverse events up to day 7 after vaccination. No grade 3 serious adverse events were recorded after booster dose administration.

Interpretation

These data show that primary MVA-BN vaccination induces sustained immunological memory up to 5 years after vaccination and that a booster dose strongly enhances circulating antibody levels and durability. Future studies should clarify the role of circulating antibody concentrations as a correlate of protection from monkeypox virus infection.

Funding

US Centers for Disease Control and Prevention and US Biomedical Advanced Research and Development Authority.

Translation

For the French translation of the abstract see Supplementary Materials section.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00001-0/fulltext?rss=yes

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Case presentation of #patients hospitalised with #mpox (subclade Ib/2023sh) including #children, #adolescents, and #adults in South Kivu, #DRC: an observational cohort study

 

Summary

Background

Mpox is a public health concern in eastern DR Congo. It continues to cause substantial numbers of hospital admissions, with changing demographics including children and adolescents, requiring comprehensive clinical and epidemiological investigation. In this study, we aim to describe the clinical characteristics of hospitalised participants infected with monkeypox virus (MPXV) subclade Ib/2023sh in the Kabare Territory in South Kivu, DR Congo.

Methods

This observational cohort study included patients admitted with suspected mpox to the reference centre of mpox treatment at Lwiro Hospital, South Kivu, DR Congo. Eligible participants must have had, at the time of inclusion, skin lesions compatible with the infection. Individuals who did not present lesions compatible with MPXV infection were also eligible if they had at least one of the following symptoms: fever, cervical lymphadenopathy, or pharyngitis, provided they had been in contact with someone with suspected mpox within the last 21 days. Data from hospital records and standardised clinical forms captured demographics, presenting symptoms and signs, outcomes, and general clinical characteristics. Descriptive analyses and statistics summarised the clinical and epidemiological profiles of participants with molecular confirmation of MPXV subclade Ib/2023sh.

Findings

Between Aug 3, 2024, and Feb 8, 2025, MPXV subclade Ib/2023sh was detected in 494 (77%) of 643 participants with a median age of 9 years (IQR 2–24). Participants who were positive for MPXV subclade Ib/2023sh infection were more often female (290 [59%]) and were generally older (median 16 years [4–25]) than male participants (204 [41%]; median age 4 years [1–14]). 300 (61%) of 494 participants were aged 15 years or younger. Fever (444 [90%]), skin lesions or rash (391 [79%]), and dysphagia (279 [56%]) were the most prevalent symptoms. Children aged 0–5 years had a higher frequency of lesions on the head (84 [41%] of 203), face (67 [33%]), neck (23 [11%]), back (27 [13%]), arm (35 [17%]), palm of hand (35 [17%]), chest (46 [23%]), posterior aspect of thighs (40 [20%]), legs (25 [12%]), dorsal foot (45 [22%]), and oral cavity (37 [18%]). 117 (24%) participants had lesions in the oral cavity. Oral cavity and oropharynx swabs were able to detect MPXV subclade Ib/2023sh in the absence of assayable skin lesions.

Interpretation

The high proportion of children and adolescents (aged ≤15 years) differentiates our cohort from other clinical descriptions of the novel MPXV subclade Ib/2023sh. Given that, we hypothesise a demographic shift in the target population that contributes to the community spread of mpox in the South Kivu region of DR Congo. Targeted public health measures should consider ways to reduce transmission among children and adolescents.

Funding

Canadian Institutes of Health Research (CIHR), Canadian Foundation for Innovation, Research Nova Scotia, Dalhousie Medical Foundation, Moderna, Li-Ka Shing Foundation, European & Developing Countries Clinical Trials Partnership (EDCTP).

Translations

For the French, Swahili and Mashi translations of the abstract see Supplementary Materials section.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00051-4/fulltext?rss=yes

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#Genomic Characterization of the Index Case of #Human #Monkeypox Virus Infection in #Mali, 2025

 

Abstract

Mpox is a zoonosis caused by the monkeypox virus. Here, we report Mali’s index Mpox case, which was clinically identified at the Mali–Guinea border by the national telemedicine center and confirmed by PCR. The library prepared with NextGenPCR™ MPXV Sequencing Library Prep and sequenced on Minion MK1C revealed a genome length of 197,122 bp with an average depth of 1284.4×. The strain belonged to Clade IIb G1 lineage and exhibited 85 mutations relative to NC_063383.1. To decipher genomic epidemiology, genomes ≥ 195 kb were retrieved from NCBI and aligned with MAFFT. Time-resolved phylogenetic reconstruction and ancestral trait inference were performed with TreeTime v0.11.4. A median joining network was built with Popart v1.7. Phylogeographic analysis revealed clustering with Clade IIb (G.1 lineage) linked to the May 2025 outbreak in Sierra Leone.

Source: 

Link: https://www.mdpi.com/1999-4915/18/3/294

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#Tecovirimat for the Treatment of #Mpox

 

Abstract

Background

Tecovirimat is approved for smallpox treatment under the Food and Drug Administration Animal Rule on the basis of efficacy in nonhuman primate models of mpox (previously known as monkeypox). However, the clinical efficacy of tecovirimat against human clade II mpox is unclear.

Methods

In a phase 3, international, double-blind, randomized, placebo-controlled trial, we evaluated the efficacy of oral tecovirimat in adults with laboratory-confirmed clade II mpox. Participants were randomly assigned in a 2:1 ratio to receive tecovirimat or placebo for 14 days. The primary outcome was clinical resolution, assessed in a time-to-event analysis in participants with active skin or mucosal lesions. Secondary outcomes included reduction in pain, assessed in all participants with laboratory-confirmed mpox and in those with severe pain at baseline (pain score, 7 to 10; scale, 0 [no pain] to 10 [worst pain imaginable]); complete lesion healing (assessed in a time-to-event analysis); viral DNA clearance; and safety.

Results

Of 412 participants who underwent randomization (275 to tecovirimat and 137 to placebo), 344 had laboratory-confirmed mpox, and 336 had active skin or mucosal lesions and were included in the primary analysis. By day 29, the estimated cumulative incidence of clinical resolution was 83% with tecovirimat and 84% with placebo; the competing-risks hazard ratio for clinical resolution was 0.98 (95% confidence interval [CI], 0.74 to 1.31; P=0.89). No substantial between-group differences were seen in pain reduction among participants with severe pain (difference, 0.1 point; 95% CI, −0.8 to 1.0), in complete lesion healing (competing-risks hazard ratio, 0.97; 95% CI, 0.75 to 1.26), or in viral DNA clearance. The incidence of adverse events of grade 3 or higher was similar in the two groups (4% with tecovirimat and 3% with placebo).

Conclusions

This trial showed no evidence that tecovirimat therapy shortened the time to clinical resolution, reduced pain, or increased viral clearance among adults with clade II mpox. (Funded by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; STOMP/A5418 ClinicalTrials.gov number, NCT05534984.)

Source: 

Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2506495?af=R&rss=currentIssue

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#Mpox Multi-country external #situation #report no. 63, published 24 February 2026 (#WHO, summary)

 

Highlights   

• Transmission of mpox continues in sexual networks, affecting both women and men, and in some historically endemic areas. 

- All clades of monkeypox virus (MPXV) continue to circulate. 

- Unless mpox outbreaks are rapidly contained and human-to-human transmission is interrupted, there is a risk of sustained community transmission. 

• In January 2026, 50 countries across all WHO regions reported a total of 1334 new confirmed mpox cases, including three deaths (case fatality ratio [CFR] 0.2%). 

- Of these cases, 66% were reported in the African Region. 

• Four regions observed a decline in confirmed cases in January, compared to December 2025, while the European Region reported an increase in confirmed cases.

• Twenty countries in Africa reported active transmission of mpox in the last six weeks (5 January – 15 February 2026), with 1142 confirmed cases, including four deaths (CFR 0.4%). 

- Countries reporting the highest number of cases in this period are the Democratic Republic of the Congo, Guinea, Madagascar, Liberia and Ghana. 

• One country, Comoros, and one territory, La Réunion (Overseas Department of France), have reported mpox due to clade Ib MPXV for the first time.   

• Outside Africa, reports of community transmission of clade Ib MPXV continue in France, Portugal and Spain, including in sexual networks of men who have sex with men.  

• WHO conducted a global mpox rapid risk assessment in February 2026; the overall global public health risk associated with the mpox multi-country outbreak was assessed as moderate. 

• India has reported a case of mpox with the clade Ib /IIb recombinant MPXV. 

- The strain sequenced is closely related to the first clade Ib / IIb recombinant strain reported by the United Kingdom of Great Britain and Northern Ireland in December 2025. 

- As both cases are travel-related, these case reports suggest wider transmission of the recombinant strain, implicating four countries in three WHO regions. 

(...)

Source: 

Link: https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report--63---24-february-2026

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#MPOX, Multi-Country: Rapid #risk #assessment, 7 February 2026, v6 (#WHO, Feb. 18 '26)

 

{Excerpt}

Overall Global Risk Statement  

-- This global rapid risk assessment (RRA) aims to assess the current public health risk associated with the 2024 upsurge of mpox in in Africa, in the context of the continuing global reporting of mpox cases in other regions since 2022, with a focus on updates since the previous RRA in September 2025.    

Global overview 

-- As of 28 January 2026, the monkeypox virus (MPXV) continues to spread globally, causing both localized and extended mpox outbreaks driven by various MPXV clades (Ia, Ib, IIa, and IIb) in diverse settings. 

-- Furthermore, recombination of MPXV clades has been documented, with two cases of a recombinant clade Ib/IIb MPXV strain reported in recent months.  

-- Globally, from 1 January 2022 to 31 December 2025 (latest global data available), 143 countries and territories across all WHO regions have reported 177 848 confirmed cases, including 477 deaths (case fatality ratio [CFR] – 0.3%). 

-- This marks an increase of five additional reporting countries (Kuwait, Mali, Madagascar, Namibia and Senegal), along with an additional 19 423 confirmed cases and 78 deaths since the last RRA in September 2025. 

-- Since the last RRA, an average of 616 new confirmed mpox cases per week have been reported across all affected countries.

-- In addition, in January 2026, the Comoros and the French departments of Mayotte and la Réunion have reported cases linked to travel to Madagascar.  

-- Previous versions of this RRA have categorized risk based on MPXV clade. However, in absence of substantial data suggesting differences in the mode of transmission between different MPXV clades, and with relatively limited data suggesting higher case fatality for clade Ia MPXV compared to other clades, this version of the RRA assesses the risk for three population groups:

- global risk for individuals with multiple sexual partners, 

- local risk for children in mpox historically endemic areas, and 

- global risk for all other individuals.   

Individuals with multiple sexual partners – global risk  

-- Since the start of the global mpox outbreak in 2022, sexual activity in linked sexual networks has been the primary driver of sustained transmission and geographic spread, particularly in newly affected areas. 

-- In Europe and the Americas, up to 96% of cases were among men who have sex with men driven by spread among individuals with multiple sexual partners in a short space of time and frequent partner change. 

-- While sexual behavior data for cases in newly affected African countries remain limited, the contribution of sexual transmission to the introduction, spread and establishment of mpox in communities has been recognized across all affected settings, as in the most recent outbreak in Madagascar. 

-- In several countries, transmission has involved sex workers and their clients, and sexual networks with frequent and multiple partner change.  

-- Sexual contact infection likely occurs during pre-symptomatic or less apparent stages of infection, the duration of which can vary between individuals. 

-- People with few or mild genital lesions might not even recognise the infection. 

-- Although the secondary attack rate for sexual contact is high (estimated at 16-73%), for the epidemic to spread it requires networks characterised by frequent partner change and high rates of partner turnover over short timeframe (days to few weeks). 

-- This pattern was observed during the initial spread of clade IIb among communities of men who have sex with men, as well as in more recent MPXV clade Ib oubtreaks driven – in part – by key populations such as female sex workers and their clients. 

-- We therefore consider within this group of multiple sexual partners, individuals with frequent partner change, and those who may engage in at-risk sexual behaviour, such as people who buy sex.  

(...)

Source: 

Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment---mpox--global-v.6

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#Mpox: #recombinant virus with genomic elements of clades Ib and IIb - Global (#WHO, Feb. 16 '26)

 

Situation at a glance

Recombination of monkeypox virus (MPXV) strains has been documented in recent months, with two cases of a recombinant strain comprising clade Ib and IIb MPXV reported. 

Recombination is a known natural process that can occur when two related viruses infecting the same individual exchange genetic material, producing a new virus. 

The first case was detected in the United Kingdom of Great Britain and Northern Ireland (hereafter “United Kingdom”), with travel history to a country in South-East Asia, and the second in India, with travel history to a country in the Arabian Peninsula. 

Detailed analysis of the virus genomes shows that the two individuals fell ill several weeks apart with the same recombinant strain, suggesting that there may be further cases than are currently reported. 

Both cases had similar clinical presentation to that observed for other clades. 

Neither patient experienced severe outcomes. 

Contact tracing for both cases in the reporting countries has been completed; no secondary cases were detected. 

Based on available information, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.

Description of the situation

In December 2025, the United Kingdom detected the first reported case of a clade Ib/IIb MPXV recombinant strain.​​ After classification of this case and posting in a public database as a novel MPXV recombinant strain, a case of mpox detected in India in September 2025 was retrospectively reclassified as a closely-related recombinant strain based on sequencing data. To date, these are the only known cases of this recombinant virus.  

Case detected in the United Kingdom of Great Britain and Northern Ireland 

The case was identified following testing of a vesicular swab from a traveler who had returned from a country in the Asia Pacific region in October 2025. 

During laboratory confirmation, the virus was initially typed as clade Ib MPXV by qPCR. 

Subsequent whole genome sequencing revealed that the MPXV strain identified was distinct from other known clade Ib MPXV strains with phylogenetic analysis indicating that the genome had regions similar to both clade Ib and clade IIb MPXV reference sequences, suggesting that it is an inter-clade recombinant. 

To confirm this unusual finding, sequencing was repeated on the original extract from the primary sample, a fresh extract from the same primary sample, a second swab collected from the patient at the same time, and a cultured isolate derived from the initial swab. 

This repeat sequencing yielded identical viral genome sequences from the two clinical swabs and the cultured isolate, supporting the initial findings of a new recombinant strain, and showing that it can replicate and presents potential for onward transmission. 

This strain is a recombinant MPXV, containing genetic elements from both clade Ib and clade IIb MPXV. 

A small number of contacts were identified and followed up in the United Kingdom; none developed any clinical features of mpox. 

Health worker contacts had worn full personal protective equipment (PPE) during provision of medical care to the patient. 

The authorities of the United Kingdom continue to investigate the significance of this recombinant MPXV strain through phenotypic characterization studies. 

Case detected in India

On 13 January 2026, the National IHR Focal Point (NFP) of India notified WHO of a mpox case with an inter‑clade recombinant MPXV which was, upon whole-genome sequencing, found to have genomic elements of clades Ib and IIb MPXV.

The recombinant virus was found in samples from a man with mpox who had presented for care in September 2025. The patient had reported recent travel from a country in the Arabian Peninsula, where he resides as an overseas worker.

He developed symptoms on 1 September 2025, while still abroad. After his return to India, real‑time PCR confirmed MPXV infection on 11 September 2025. 

Clade differentiation PCR performed on 15 September 2025 initially identified this virus as clade II MPXV. Initial genomic sequencing analysis suggested features consistent with clade IIb MPXV. However, following the update of the global Nextclade database on 16 December 2025, which included the recombinant clade Ib/IIb MPXV strain reported by the United Kingdom, the virus from the patient in India was reclassified as belonging to the recombinant strain. 

Recombination analysis demonstrated mosaic patterns containing genomic regions derived from both parent clades.

Following the initial diagnosis, the patient was hospitalized, did not experience any medical complications, and fully recovered, testing negative for MPXV on 29 September 2025. The case reported no close contacts in India, and no known secondary cases were identified following this introduction of the recombinant clade Ib/IIb MPXV in India.

Full or near‑full genome retrieval (>99%) from both the sample and a sample-derived virus isolate enabled phylogenetic analysis showing >99.9% similarity to the recombinant strain detected in the United Kingdom. 

A total of 34 recombinant tracts were observed in the sequence reported by India, while 28 recombinant tracts were observed in the sequence reported by the United Kingdom; 16 recombinant tracts were common to both strains.  

This case in India therefore represents the earliest known detection of this recombinant strain globally, having preceded the event reported in the United Kingdom.

Consistent with the case reported in the United Kingdom, clinical presentation was consistent with cases due to clade I or clade II MPXV (non-recombinant MPXV) infection.

Epidemiology

Mpox is an infectious disease caused by the MPXV, which is part of the genus Orthopoxvirus, that includes the variola virus, the causative agent for smallpox. 

There are two known clades of MPXV: clade I (previously called the Congo Basin clade), which includes subclades Ia and Ib; and clade II (previously called the West Africa clade), which includes subclades IIa and clade IIb. 

Subclades Ia and Ib were defined after the emergence of subclade Ib in the South Kivu province of the Democratic Republic of the Congo in 2023, and subclade Ia encompasses all other strains of clade I that are not Ib.

As reported here, there have also been two cases of the clade Ib/IIb recombinant strain, detected in the UK and in India.

Mpox spreads among humans through direct close physical contact with an infected person, including sexual contact. 

Transmission can also occur through indirect contact (with contaminated materials), through infectious respiratory particles in limited cases, and from mother to child (vertical transmission).

Historically mpox was primarily characterized by zoonotic transmission, with outbreaks occurring in tropical rainforest regions of East, Central and West Africa, and occasional exportation of cases to other areas. 

In the context of zoonotic transmission, which continues to occur in historically endemic areas, MPXV is transmitted to humans through direct contact with infected wild animals (e.g., through hunting, trapping, or petting), and possibly through processing and consuming infected wild game or their body parts and fluids. 

To date, animal-to-human transmission has always been documented in or linked to known endemic regions of Africa. 

All other outbreaks in Africa or in other parts of the world are to date presumed to be due to human-to-human transmission, until proven otherwise. 

Symptoms of mpox in humans include: 

- swollen lymph nodes, 

- fever, and 

- a skin rash and/or mucosal lesions that may initially resemble those of other illnesses such as chickenpox (caused by the varicella virus), or sexually transmitted infections such as herpes or syphilis if the rash or lesions appear in the genital or anal region. 

The ongoing  global outbreak has shown that mpox can also present with few lesions, and asymptomatic infection can occur.​ The contribution of pre- and asymptomatic infection to transmission remains poorly understood. 

Public health response

WHO Response:

WHO maintains global mpox surveillance and continues to provide response guidance and support for all countries, including access to diagnostics and vaccines through multi-partner coordination including through the Access and Allocation Mechanism for mpox. WHO and partners are establishing the longer-term International Coordinating Group for mpox vaccine provision (ICG) to further accelerate timely outbreak response and ensure sustainable support for the future. Furthermore, WHO continues to evaluate available rapid diagnostic tests for field use.

Response measures in the United Kingdom:

The United Kingdom Health Security Agency (UKHSA) continues to work closely with the National Health Service England, public health agencies in Scotland, Wales and Northern Ireland, and is monitoring the situation in the United Kingdom and undertaking public health actions in accordance with the Mpox control: UK strategy 2025 to 2026 .

Public health information was made available to health care providers and the public. Contact tracing was completed in line with national guidance. Contacts were given appropriate health advice, offered vaccination, and monitored for symptoms.

All suspected mpox cases in the UK are tested using Orthopoxvirus-generic, MPXV-generic, and MPXV-specific PCR as primary testing, with clade differentiation assays performed on any positive samples. All samples identified as clade Ib, and selected samples identified as clade IIb cases undergo whole genome sequencing through Illumina-based workflows.

Response measures in India:

Public health measures, including contact tracing and monitoring, were implemented to prevent onward transmission. No secondary case was detected.

All suspected mpox cases in India are tested using Orthopoxvirus‑generic and MPXV‑specific PCR with clade differentiation assays. Positive cases undergo whole genome sequencing through Illumina‑based workflows.

WHO risk assessment

Mpox outbreaks must be considered in their local context, with meaningful involvement of affected communities, to ensure an in-depth understanding of the epidemiology, modes of transmission, risk factors for severe disease, viral reservoir and evolution, and relevance of strategic approaches and countermeasures for prevention and control.   

Multiple strains of MPXV are circulating through interconnected sexual networks across many countries and settings. Co-infection with different strains, that could lead to emergence of recombinant virus strains, while rare, can be expected. The case in India was infected with the same recombinant Ib/IIb MPXV strain detected in the United Kingdom. 

Symptom onset in the case reported in India occurred more than two months earlier than the case in the United Kingdom, and the great degree of similarity between their sequences suggests a common evolutionary history. This information has two important implications: i) the origin of the recombinant strain remains unknown; and ii) transmission of this recombinant virus already involves at least four countries in three WHO regions, and is therefore likely to be more widespread than currently documented.

For the cases in the United Kingdom and India, the initial clade differentiation PCR results indicated clade Ib and IIb MPXV, respectively. Thus, clade differentiation PCR assays alone may not reliably identify recombinant MPXV strains, and genomic sequencing is likely to be required for their detection.   

Due to the small number of cases found to date, conclusions about transmissibility or clinical characterization of mpox due to recombinant strains would be premature, and it remains essential to maintain vigilance regarding this development.

In light of the limited information available on this recombinant MPXV strain, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.

All countries should remain alert to the possibility of MPXV genetic recombination. The public health risk posed by any newly detected recombinant strain should be assessed on a case-by-case basis, considering available epidemiological, clinical and genomic information.

WHO advice

Based on the information available, WHO recommends maintaining epidemiological surveillance, laboratory and genomic sequencing capacity for mpox, case management, infection prevention and control (IPC) measures, vaccination for people at risk, locally relevant risk communication and community engagement, and public health guidance for mpox.   

All recommendations are made in the context of ongoing transmission of clades Ib and IIb MPXV in key populations at risk in all WHO regions, including undetected or pre- and asymptomatic infections, as well as unreported cases. They additionally apply to settings where clades Ia and IIa MPXV continue to spread through a mix of zoonotic and human-to-human contact. There is likely to be wider circulation of this emerging recombinant strain of MPXV since at least September 2025 than reflected by the two cases documented and linked to four countries in three WHO regions. 

WHO advises Member States to:  

- maintain mpox surveillance and rapid reporting, including prompt IHR notification of any unusual events and imported cases in line with the WHO Standing Recommendations issued under the IHR (2005) and extended to August 2026; 

- continue to carry out genomic sequencing of all laboratory specimens from confirmed cases in early outbreak settings, and a representative sample of at least 10% of laboratory specimens from confirmed cases in settings experiencing community transmission, as per WHO guidance;  

- carry out targeted sample characterization for specific situations of interest, especially for cases who report recent travel to locations with clade I MPXV circulation or to locations which provide opportunities for sex tourism, prioritizing sequencing for cases in key populations at risk and for imported, unusual, or severe cases, and sharing sequences rapidly in public databases;  

- ensure quality case management and robust IPC practices and strengthen vaccination strategies, including ensuring access to mpox vaccines for key populations at risk;  

- continue to advance integration of HIV/STI and mpox health services to ensure early HIV testing and care for any person with suspected or confirmed mpox and rapid initiation or resumption of antiretroviral therapy in people living with HIV as needed for any person with mpox; 

- strive to eliminate human-to-human transmission of mpox where MPXV circulation remains low and ensure the maintenance of capacity for prompt outbreak response;  

- continue to provide information to travelers who may be at risk.

WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.  

Further information

1) World Health Organization. Mpox: fact sheet. 26 August 2024. Available from: http://www.who.int/news-room/fact-sheets/detail/monkeypox 

2) World Health Organization. Global mpox trends. Available from: https://worldhealthorg.shinyapps.io/mpx_global/ 

3) World Health Organization. Multi-country outbreak of mpox: external situation report no. 62. 23 January 2026. Available from: Multi-country outbreak of mpox, External situation report #62

4) World Health Organization. Fifth meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024. 30 October 2025. Available from: https://www.who.int/news/item/30-10-2025-fifth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-upsurge-of-mpox-2024

5) World Health Organization. Standing recommendations for mpox issued by the Director-General of the World Health Organization in accordance with the International Health Regulations (2005). 21 August 2023. Available from: https://www.who.int/publications/m/item/standing-recommendations-for-mpox-issued-by-the-director-general-of-the-world-health-organization-(who)-in-accordance-with-the-international-health-regulations-(2005)-(ihr) 

6) World Health Organization. Extension of standing recommendations for mpox to August 2026, by the Director-General of WHO. 21 August 2025. Available from: https://www.who.int/publications/m/item/extension-of-standing-recommendations-for-mpox-by-the-director-general-of-who 

7) World Health Organization. Clinical management and infection prevention and control for mpox: living guideline. May 2025. Available from: https://www.who.int/publications/i/item/B09434 

8) World Health Organization. WHO recommends rapid treatment initiation for people living with HIV and mpox. 16 July 2025. Available from: https://www.who.int/news/item/16-07-2025-who-recommends-rapid-treatment-initiation-for-people-living-with-hiv-and-mpox 

9) World Health Organization. WHO mpox multi-country rapid risk assessment, version 5. 13 October 2025. Available from: https://www.who.int/publications/m/item/who-rapid-risk-assessment---mpox--global-v.5 

10) World Health Organization. Strategic framework for enhancing prevention and control of mpox (2024–2027). 24 May 2024. Available from: https://www.who.int/publications/i/item/9789240092907 

11) World Health Organization. Guidance on use of Smallpox and mpox vaccines, including WHO Position paper on mpox vaccines and other resources to support countries. 23 August 2024 https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/smallpox-and-mpox  

12) World Health Organization. Frequently Asked Questions (FAQ) on use of fractional dosing with intradermal administration of mpox MVA-BN vaccine in the context of vaccine supply-constrained outbreak response. 19 June 2025. https://www.who.int/publications/m/item/frequently-asked-questions-(faq)-on-use-of-fractional-dosing-with-intradermal-administration-of-mpox-mva-bn-vaccine-in-the-context-of-vaccine-supply-constrained-outbreak-response  

13) World Health Organization. LC16m8 (live-attenuated freeze-dried vaccinia) smallpox and mpox vaccine. Interim guidance. 22 April 2025. Available from:  https://iris.who.int/server/api/core/bitstreams/9b10eb01-fbfd-4f9f-81b7-9c29ddbcc560/content

14) World Health Organization. Prequalification of Smallpox and Mpox vaccine (Live Modified Vaccinia Virus Ankara), 2024 September 13. Available from:  https://extranet.who.int/prequal/vaccines/p/imvanexr

15) World Health Organization. Emergency use listing of LC16m8. 2024 November 19. Available from: https://extranet.who.int/prequal/vaccines/lc16-kmb

16) UK Health Security Agency, Institute of Ecology and Evolution, University of Edinburgh; Inter-clade recombinant mpox virus detected in England in a traveller recently returned from Asia. 7 December 2025: https://virological.org/t/inter-clade-recombinant-mpox-virus-detected-in-england-in-a-traveller-recently-returned-from-asia/1015  

17) UK Health Security Agency, Mpox outbreak: epidemiological overview. 11 December 2025: https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiological-overview/mpox-outbreak-epidemiological-overview-11-december-2025   

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON595

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