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. 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 of 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 and Angola (Global Mpox Trends published 14 May 2025, data as of 11 May 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 14 May 2025, data as of 11 May 2025). Mpox clade IIa and IIb cases have also been reported in Africa and in recent weeks Sierra Leone has reported a notable increase in clade II cases (Mpox : multi-country outbreak of mpox, External situation report no. 52, 14 May 2025).

Overall, in Africa, until the beginning of May 2025, most confirmed and suspected clade I cases were reported from the DRC, Uganda and Burundi (Mpox: multi-country outbreak of mpox, External situation report no. 52, 14 May 2025). However, different trends have recently been observed in each country.

In DRC, clade Ia and Ib are co-circulating to different degrees. The epidemiological trends remain similar to that reported in the previous update. The number of confirmed cases has levelled off over the last two months. However, epidemiological trends should be interpreted with caution. Testing coverage remained low during the same period (Africa CDC Special Briefing on Mpox and other Health Emergencies, 10 April 2025, Mpox: multi-country external situation report no. 50, 11 April 2025, Mpox: multi-country external situation report no. 51, 29 April 2025, Mpox: multi-country outbreak of mpox, External situation report no. 52, 14 May 2025). In Kinshasa, both clades Ia and Ib are co-circulating. Epidemiological data and sequencing suggest there is human-to-human transmission of clade Ia with high rates of APOBEC3-driven mutations. Similar signals have not been reported in provinces outside of Kinshasa, where clade Ia is circulating in DRC. However, the number of samples sequenced and analysed varies if different provinces of DRC (Mpox: multi-country external situation report no. 51, 29 April 2025). APOBEC3 mutations have also been noted in clade Ib. According to WHO, based on the available information on clade Ia circulation in Kinshasa there is currently no evidence that the strain is inherently more transmissible than other clade Ia strains or clade Ib  (Mpox: multi-country external situation report no. 51, 29 April 2025).

Uganda is currently the African country reporting most mpox clade Ib cases after DRC (Global Mpox Trends published 14 May 2025, data as of 11 May 2025). The total number of mpox cases reported in the country since 2024 is over 6 000. Following an increase earlier this year, there has been a decline since mid-April. Widespread transmission is ongoing in the country however testing rates have decreased, according to the National Mpox Situation Report of 15 May 2025 (Uganda National Mpox Situation Report, 14 May 2025).  

In Burundi, the decreasing trend observed in the number of reported mpox cases in recent weeks has continued for the first two weeks of May and only clade Ib has been detected (Mpox: multi-country outbreak of mpox, External situation report no. 52, 14 May 2025). In the past few weeks, the average number of confirmed cases reported by Burundi has been below 50 Mpox: multi-country outbreak of mpox, External situation report no. 52, 14 May 2025).

Detailed information on the mpox clade I case numbers can be found in the WHO Global Report (including data until 11 May 2025). In general, and as of 19 May 2025, no major changes have been noted in the epidemiological trends of mpox clade I in Africa.

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 and Ireland (in 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 and Switzerland. On 16 May 2025, Australia reported its first mpox clade Ib case which was travel-associated (First mpox clade Ib confirmed in Australia | Australian Centre for Disease Control).

In the United States, in 2025, positive MPXV clade Ib samples have now also been reported from Iowa (U.S. Mpox Wastewater Data | National Wastewater Surveillance System | CDC). Previously, MPXV clade I had been detected in wastewater samples in North Carolina in March and April 2025 during routine testing (Mpox Found in Wastewater in North Carolina, NCDHHS Urges Public and Providers to Be on Alert | NCDHHS) and in California (Detection of mpox clade Ib nucleic-acids in wastewater solids at 147 wastewater treatment plants across the United States | medRxiv).

Most travel-associated cases involving travel to non-African countries had links to affected countries in Africa. However, China, India, Oman, Pakistan and Thailand have reported at least one case each with travel links to the United Arab Emirates (WHO external situation reports). 

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.

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.

Transmission patterns of mpox due to monkeypox virus clade I – update 19 May 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, China, Germany, France, India, Ireland, Oman, Pakistan, Qatar, South Africa, South Sudan, Sweden, Switzerland, Thailand, the United Kingdom, the United States, and Zimbabwe;
• Clusters of cases or limited transmission: the United Arab Emirates;
• Community transmission: Burundi, Central African Republic, Congo, the DRC, Kenya, Malawi, Rwanda, Tanzania, Uganda and Zambia.

The categorisation was last updated on 19 May 2025 to include Australia (category of countries reporting only travel-associated cases or cases with a clear link to travel-associated cases) and Malawi (category of countries with community transmission).

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

• Malawi reported its first mpox clade Ib cases in April. In total, ten cases have been reported, most of which do not have any travel history, according to WHO and the Public Health Institute of Malawi (Mpox: multi-country external situation report no. 51, 29 April 2025,  Mpox: multi-country outbreak of mpox, External situation report no. 52, 14 May 2025 and Africa CDC Epidemic Intelligence Weekly Report, April 2025 – Africa CDC, Malawi NPHI Mpox Situation Report 18 May 2025). Given the number of cases reported without travel links, Malawi has been included in the category of countries with community transmission.
• Tanzania has reported a total of 43 cases in 2025, with 12 of these having occurred in the past six weeks and as of 11 May 2025 in Tanzania (2022-25 Mpox (Monkeypox) Outbreak: Global Trends (data as of 11 May 2025)). Previously, Tanzania was included in the classification as it was presumed that undetected transmission may be ongoing, given that mpox clade Ib cases with travel links to Tanzania have been reported elsewhere.
• South Sudan and South Africa are currently in the first (travel-associated) category, given the small number of confirmed cases. South Sudan has reported six cases in the past six weeks and a total of 14 cases, according to WHO, and as of 11 May 2025. In South Africa, no new cases have been reported the past six weeks and as of 11 May 2025. No additional information on suspected cases is available and there are no indications of wider community transmission in either country.
• 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 2024). 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.