Mpox worldwide overview

Mpox clade II summary

Mpox clade II has been circulating globally since 2022. In African countries with recent mpox clade II outbreaks (e.g. Ghana, Guinea, Sierra Leone, Liberia), cases have been reported among young adults, affecting both males and females. Sexual contact has been described as a main driver of spread (Multi-country outbreak of mpox, External situation report #60 - 8 December 2025, Multi-country outbreak of mpox, External situation report #62-23 January 2026). Outside Africa, cases were mostly reported in adults (99%) and males (97%), the majority of whom reported having had sex with men (89%) (Global Mpox Trends published 3 February 2026).

Mpox clade I summary and transmission patterns classification

In Africa, in 2025, the five countries that reported most confirmed and suspected clade I cases are DRC, Uganda and Burundi, followed by Kenya and Zambia. According to WHO, in the past six weeks, and as of 1 February 2026, most confirmed cases of clade I were reported by DRC and Madagascar (253 and 196 cases, respectively). In DRC, clades Ia and Ib are co-circulating. Cases due to clade IIb have also been reported. Madagascar reported confirmed mpox clade Ib cases for the first time in December 2025. Since the first reports, confirmed cases have been reported from eight regions and suspected cases from 20 of 24 regions (Multi-country outbreak of mpox, External situation report #62 - 23 January 2026). Comoros also reported four clade Ib cases imported from Madagascar in January 2026. All other countries in Africa reported fewer than 50 cases during the last six weeks. Overall, a decreasing trend in clade I mpox cases has been reported in Africa since May 2025 (Global Mpox Trends published 3 February 2026).

In EU/EEA travel-associated cases of mpox clade I, or locally-acquired cases of clade I have been reported by Sweden (in 2024), Germany (in 2024 and 2025), Belgium (in 2024 and 2025), France, Ireland, Italy, and Spain (in 2025), as well as by Greece (in October 2025), Romania (December 2025) and Czechia (January 2026). In addition to Africa and the EU/EEA, since August 2024 clade I cases have been reported by Thailand, India, Türkiye, the United Kingdom, the United States, Canada, Pakistan, Oman, China, the United Arab Emirates, Qatar, Brazil, Switzerland, Australia, and Japan (Global Mpox Trends published 3 February 2026). Since December 2025, imported cases were also reported by Israel, Mexico and Nepal. Most travel-associated cases reported outside African countries had links to affected countries in Africa. Imported cases with a travel history to China, Germany, Lebanon, Malaysia, Nepal, Netherlands, Oman, Pakistan, Russia, Thailand, United Arab Emirates, and VietNam have also been reported (Global Mpox Trends published 3 February 2026).

Since October 2025, Italy, the Netherlands, Portugal and Spain reported mpox clade I in men without travel history. In the Netherlands and Spain, these were men who reported having sexual contact with another male. Additionally, the United States reported three cases of clade I in California without travel history with the investigation indicating that person-to-person transmission among gay, bisexual and other men who have sex with men and their social networks may be ongoing in the state (Community Spread of New Mpox Type (Clade I) in California Has Been Identified; Risk to General Public Remains Low). These three cases were considered unlinked following interviews. However, phylogenetic analysis showed that the sequences cluster with the sequence of a previously reported travel-associated case (Detection of Community Transmission of Clade Ib Mpox Virus in the United States | NEJM Evidence).

In addition, confirmed limited secondary transmission of clade I within households has been reported in the EU/EEA mainly among household contacts since 2024 by Germany, Belgium, and Ireland. Outside the EU/EEA and Africa, secondary transmission has also been reported in the UK, China, Qatar, and Australia. The number of secondary cases reported in these events has been low (range: 1–6 cases per event; Global Mpox Trends published 3 February 2026). Based on the information available, all transmission events were due to close contact and no deaths were reported.

Transmission patterns of mpox due to MPXV clade I - update 3 February 2026

Since September 2024, following an analysis of the patterns of MPXV transmission observed at the national level and given the limitations and uncertainties, ECDC has used official epidemiological information to classify countries that have reported MPXV clade I cases since 2024.

The definitions of the categories have been revised to account for context and availability of epidemiological data (see note below). The classification is as follows:

• Community transmission: Burundi, Central African Republic, Congo, DRC, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Rwanda, the United Arab Emirates, Tanzania, Uganda, and Zambia.
• Countries with travel-associated cases or limited transmission: Angola, Australia, Belgium, Brazil, Canada, China, Comoros, Czechia, France, Germany, Greece, India, Ireland, Israel, Italy, Japan, Malaysia, Mexico, Namibia, Nepal, the Netherlands, Oman, Pakistan, Portugal, Romania, Qatar, Senegal, Spain, South Africa, South Sudan, Sweden, Switzerland, Thailand, Türkiye, the United Kingdom, the United States, and Zimbabwe;

Note:

Community transmission is defined as follows:

When there are adequate epidemiological data and the following apply:

• cases without links to travel-associated cases are reported,
• multiple age groups are affected,
• cases are reported outside specific risk groups/settings,
• there is wide geographical spread.

If epidemiological data and/or testing are known to be limited and at least one of the following apply:

• there is a large number of suspected cases,
• there are multiple (suspected or confirmed) cases with limited data on transmission chains,
• multiple cases likely infected in the country are reported from other areas/countries.

Countries are classified as with travel-associated cases or limited transmission when the following apply:

• only travel-associated cases have been reported
• sporadic cases have been reported having epidemiological links with travel-associated cases
• there is only a small number of cases for which epidemiological links to travel-associated cases have not been reported or are unclear.
• transmission chains are mostly contained within specific groups or settings (e.g., groups with high rates of sexual partners, camps with internally displaced populations, prisons)
• there is limited spillover to other groups (e.g., children)
• zoonotic spillover and small clusters of cases reported in endemic countries
• there is no evidence of wider community transmission (e.g., clade I following patterns similar to clade II in countries where clade II has been reported since 2022 and has been circulating continuously at low levels and in groups with high rates of sexual contacts)

There are several limitations and caveats in the classification of community transmission of mpox clade I as the extend of ongoing undetected transmission cannot be quantified with certainty. Moreover, a number of countries have reported cases with travel history to regions/countries with limited number of clade I cases or no clade I cases and further information on transmission chains is not available (Global Mpox Trends published 3 February 2026), For example, VietNam, Mali, Russia and Lebanon have not reported any mpox clade I detection and they have been reported as places of travel of known cases elsewhere. Imported cases with a travel history to countries that have reported a small number of mostly travel associated cases have also been reported e.g., Malaysia, Nepal, Thailand, Oman and China (Global Mpox Trends published 3 February 2026). Countries that have been categorised as having community transmission for fulfilling the definitions may be reporting currently smaller number of cases (e.g., Kenya) or decreasing case trends. All the above, should be taken into account when interpreting the classification.