Mpox worldwide overview

Overview:

Monkeypox virus (MPXV) clade I and clade II are circulating in multiple countries across the globe. Since 2022, MPXV clade II has mainly been circulating outside of the African continent among men who have sex with men. The epidemiological profile of cases reported outside Africa since 2022 remains largely unchanged.

In 2024, an increase in MPXV clade Ia and Ib was reported in the Democratic Republic of the Congo (DRC), while clade Ia cases continued to be reported by the Central African Republic and the Republic of the Congo (Congo), where it is endemic. Since August 2024, a number of countries outside Africa have also reported mostly travel-related cases of mpox clade I, with limited onward transmission.

The countries in Africa that have reported clade I detection (Ia and/or Ib) in 2025, are: DRC, Uganda, Burundi, Kenya, Zambia, Tanzania, Rwanda, Congo, South Sudan, the Central African Republic, South Africa, Malawi, Angola and Ethiopia (Global Mpox Trends published 11 July 2025, data as of 6 July 2025). In 2024, Zimbabwe reported cases of clade Ib and Gabon reported mpox cases for which clade information was not available (Global Mpox Trends published 11 July 2025, data as of 6 July 2025).

In general, and as of 18 July 2025, no major changes have been noted in the epidemiological trends of mpox clade I in Africa.

Mpox clade IIa and IIb cases are also continuously being reported in Africa, with notable increases reported at the end of May in Sierra Leone. Recently, increases have been noted in Guinea, Liberia and Togo where clade IIb circulates.

Besides the countries mentioned above, Mozambique reported three confirmed cases of mpox (Africa CDC Special Briefing on Mpox and other Health Emergencies, 17 July 2025).

Mpox clade I summary and transmission patterns classification

Overall, in Africa, as of the beginning of July 2025, most confirmed and suspected clade I cases were reported from the DRC, Uganda and Burundi.

• In DRC, clade Ia and Ib are co-circulating. In recent weeks and as of week 26 (end of June), a decreasing trend in confirmed cases has been noted, according to Africa CDC (Special Briefing on Mpox and other Health Emergencies, 10 July 2025). However, this trend should be interpreted with caution as testing coverage remains low.
• Uganda is still currently the African country reporting most mpox clade Ib cases after DRC (Global Mpox Trends published 11 July 2025, data as of 6 July 2025; Uganda National Mpox Situation Report, 8 July 2025). Over 7 400 cases have been reported since 2024, including 46 deaths. The last four weeks an increase in confirmed weekly cases has been reported from 104 cases in week 23 to 233 cases in week 26. Most cases overall have been reported in Kampala district and among young adults (aged 25 to 29 years old). A resurgence has been noted in Wakiso and Masaka City (Africa CDC Special Briefing on Mpox and other Health Emergencies, 17 July 2025).
• In Burundi, a slight increase in the number of confirmed cases has been reported since end of June. However the total number of weekly cases remains at low levels (<50 confirmed cases per week) (Africa CDC Special Briefing on Mpox and other Health Emergencies, 10 July 2025)

Kenya and Zambia have reported over 50 confirmed cases the past six weeks, as of 6 July, according to WHO. Malawi and Ethiopia also reported 35 and 20 cases, respectively, in the same period, and South Sudan and Rwanda reported two cases each (Global Mpox Trends published 11 July 2025, data as of 6 July 2025).

At the end of May, Ethiopia reported its first mpox cases and detection of clade Ib. The first cases were reported in Oromia region, near the border with Kenya (Africa CDC Epidemic Intelligence Weekly Report, June 2025) As of week 27 2025, 27 cases have been confirmed (Africa CDC Special Briefing on Mpox and other Health Emergencies, 17 July 2025).

Outside of the African continent, travel-associated cases or sporadic cases reporting epidemiological links with travel-associated cases of MPXV clade I, have been reported in the EU/EEA by Sweden (in 2024), Germany, (in 2024 and 2025), Belgium (in 2024 and 2025), France, Ireland and Italy (in 2025).

Türkiye reported recently a clade Ia case that had been detected in October 2024 (Global Mpox Trends published 11 July 2025, data as of 6 July 2025). In addition to Africa and the EU/EEA, since August 2024, clade I cases have been reported by Thailand, India, the United Kingdom, the United States, Canada, Pakistan, Oman, China, the United Arab Emirates, Qatar, Brazil, Switzerland and Australia. In the United States, in 2025, positive MPXV clade I wastewater samples have now also been reported from Iowa, North Carolina and California (ECDC Communicable disease threats report, 17-23 May 2025).

Most travel-associated cases involving travel to non-African countries had links to affected countries in Africa. China, India, Oman, Pakistan and Thailand have reported at least one case each with travel links to the United Arab Emirates. One mpox clade I case reported from India had a travel history to Oman and the case reported by Australia had a travel history to Thailand (Global Mpox Trends published 11 July 2025, data as of 6 July 2025).

Confirmed secondary transmission of mpox due to MPXV clade Ib outside of Africa was reported for the first time in 2024 in the EU/EEA by Germany and Belgium, and outside of the EU/EEA by the UK and China. The number of secondary cases reported in these events outside of Africa has been low.

Based on the information available, all transmission events were due to close contact, secondary cases presented with mild symptoms and no deaths have been reported.

Transmission patterns of mpox due to monkeypox virus clade I 

Update 17 July 2025

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 according to whether MPXV clade I is endemic or was reported for the first time since 2024. The categories are as follows:

• Countries reporting only travel-associated cases or cases with a clear link to travel-associated cases: Angola, Australia, Belgium, Brazil, Canada, Germany, France, India, Ireland, Italy, Oman, Pakistan, Qatar, South Africa, South Sudan, Sweden, Switzerland, Thailand, Türkiye, the United Kingdom, the United States, and Zimbabwe;
• Clusters of cases or limited transmission: China, the United Arab Emirates;
• Community transmission: Burundi, Central African Republic, Congo, the DRC, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda and Zambia.

The categorisation was last updated on 18 June 2025 to include Türkiye in the category of countries with travel-associated cases and to include China in the category of countries with clusters of cases or limited transmission.

Below you can find some notes on the interpretation of the different trends reported in countries included:

• China has been included in the category of countries with clusters of cases or limited transmission. According to WHO, nine cases were recently reported of which four were liked to a cluster, three involve recent travel, one had travel history and one had exposure to a symptomatic individual that had not been previously diagnosed. The total number of clade Ib cases in China is 23 (Mpox: Multicountry external situation report 55, 11 July 2025). Given the recently reported cases, the unknowns on the exact transmission chains as epidemiological investigations are pending China has included in the category of countries reporting clusters or limited transmission.
• The United Arab Emirates has reported cases with travel history to Uganda, however a number of other countries have reported cases with travel history to the United Arab Emirates. Although there is no evidence of wider community transmission in the United Arab Emirates, it is presumed that undetected transmission is ongoing (Mpox: multi-country external situation report no. 50, 11 April 2025). The United Arab Emirates are therefore classified as having 'clusters of cases or limited transmission'.

The epidemiological situation is continuously being monitored and the classification is reviewed and adjusted depending on a qualitative assessment of reported trends.

Mpox clade II focus in selected countries in Africa reporting recent increases

Sierra Leone: The first cases of mpox in Sierra Leone were reported at the beginning of the year. Clade II was detected. As of week 27, over 4 600 confirmed cases had been reported, including 32 deaths for all 16 districts of the country according to Africa CDC ( Africa CDC Special Briefing on Mpox and other Health Emergencies, 17 July 2025). Of the confirmed cases, 5.4% are aged under 15 years and 51% are males. A sharp increase in cases since May 2025 has been followed by a decline and a stable trend in the last two weeks (and as of week 27). The testing positivity rate has also decreased but it is 81% on week 27( Africa CDC Special Briefing on Mpox and other Health Emergencies, 17 July 2025.

Guinea: Guinea has reported 87 confirmed mpox clade II cases in 2025 all of which were reported the last six weeks and as of 6 July 2025. Most cases are from the Conakry and the Kindia regions (Mpox: Multicountry external situation report 55, 11 July 2025, Africa CDC Special Briefing on Mpoxand other Health Emergencies, 17 July 2025).

Liberia: Mpox cases due to clade IIa and IIb have been reported in Liberia since 2024. In recent weeks another increase has been noted with 27 confirmed cases reported on week 26 compared to 11 cases reported on week 25. The majority of the cases continue to be are in males (86%) and 31% are under 15 years (Special Briefing on Mpox and other Health Emergencies, 10 July 2025). Overall, and until 3 July 2025, 271 confirmed cases have been reported (National Public HealthInstitute of Liberia, 4 July 2025 (Facebook)).

Ghana: A resurgence of mpox cases has been reported in Ghana in recent weeks. Previously the country had reported mostly sporadic cases (Special Briefing on Mpox and other Health Emergencies, 12 June 2025). Clade IIb has been detected in the country. The first confirmed cases in 2025 were reported on 15 May 2025 in Accra and as of 6 July 2025, the total number of confirmed cases is 170 (Ghana Health Services, 15 May 2025 (Facebook) and Ghana Health Services, 9 July 2025 (Facebook)).

Togo: The first cases of mpox in Togo were reported in May 2025 and clade II has been detected. Until 6 July, 45 confirmed cases have been reported from different districts (Mpox: Multicountryexternal situation report 55, 11 July 2025).

On 13 August 2024, Africa CDC declared mpox a Public Health Emergency of Continental Security. On 14 August 2024, WHO convened a meeting of the IHR Emergency Committee to discuss the mpox upsurge and declared the current outbreak of mpox due to MPXV clade I to be a public health emergency of international concern. On 5 June 2025, the WHO IHR Emergency Committee convened for the fourth time, advised that the event continues to meet the criterial for a public health emergency of international concern and revised the set of temporary recommendations which are now valid until 20 August 2025 (Fourth meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024 – Temporary recommendations).

ECDC assessment:

The epidemiological situation regarding mpox due to MPXV clade Ib remains similar to previous weeks. The sporadic cases of mpox clade I that have been reported outside Africa, including secondary transmission, are not unexpected.

The risk for EU/EEA citizens travelling to or living in the affected areas is considered to be moderate if they have close contact with affected individuals, and low if they do not have contact with affected individuals. The overall risk to the general population in the EU/EEA is currently assessed as low.

However, more imported mpox cases due to MPXV clade I are likely to be reported by the EU/EEA and other countries.

EU/EEA countries may consider raising awareness in travellers to/from areas with ongoing MPXV transmission and among primary and other healthcare providers who may be consulted by such patients. If mpox is detected, contact tracing, partner notification and post-exposure preventive vaccination of eligible contacts are the main public health response measures.