Mpox worldwide overview
Situation update, 16 December 2025
Monkeypox virus (MPXV) clades I and clade II are circulating in multiple countries across the globe. Since 2022, mpox clade II has been circulating outside the African continent, particularly among men who have sex with men. The epidemiological profile of mpox clade II cases reported outside Africa since 2022 remains similar to previous weeks. With regards to clade I, cases have been reported by several countries outside Africa without travel history to countries with ongoing clade I transmission. For both clade I and II, sexual contacts have been described as drivers of transmission (Multi-country outbreak of mpox, External situation report #59 - 30 October 2025).
A summary of the recently observed global trends of clades I and II is provided below along with the classification of countries based on the clade I transmission.
Overview:
Mpox clade II has been circulating globally since 2022. Following the spread and increases outside endemic areas in Africa in 2022, in 2025, clade II cases have been reported mostly in west African countries (e.g., Ghana, Guinea, Sierra Leone, Liberia) (Multi-country outbreak of mpox, External situation report #60 - 8 December 2025). 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 11 December 2025, data until 7 December 2025). In African countries with recent increases of clade II, cases have been reported among young adults males and females and sexual contact has been described as a driver of spread (Multi-country outbreak of mpox, External situation report #60 -8 December 2025)
Mpox clade I summary and transmission patterns classification
Overall, in Africa, in 2025 as of December, the five countries that have reported most confirmed and suspected clade I cases are DRC, Uganda and Burundi followed by Kenya, Zambia. The past six week and as of 7 December 2025, according to WHO most cases of clade I were reported by DRC and Kenya (366 and 140 cases, respectively). Fewer than 100 cases were reported for the same period by each of Uganda, Burundi, Zambia, South Sudan and Tanzania. In DRC, the country that reported most mpox cases in 2025, clades Ia and Ib are co-circulating. Cases due to clade IIb have also been reported. In recent weeks, and as of 7 December, the decreasing trend with week-to-week fluctuations in confirmed and suspected cases continued according WHO (Global Mpox Trends published 11 December 2025, data as of 7 December 2025). However, this trend should be interpreted with caution. Overall, a decreasing trend in clade I mpox cases has been reported in Africa the past weeks.
In EU/EEA, travel-associated cases or sporadic cases reporting epidemiological links with travel-associated cases of mpox 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) and Romania (December 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, Australia, Türkiye, and Japan (Global Mpox Trends published 11 December 2025, data as of 7 December 2025). Notably, 7 December 2025, it was reported that one case with travel history to Asia previously reported as clade I by the United Kingdom, was found to be an inter-clade recombinant of clade I and clade II (Inter-Clade Recombinant Mpox Virus Detected in England in a Traveller Recently Returned from Asia - MPXV - Virological and UK Health Security Agency Mpox outbreak: epidemiological overview, 11 December 2025).
Most travel-associated cases reported outside African countries had links to affected countries in Africa. Imported cases with a travel history to Lebanon, Malaysia, Nepal, Thailand and China have also been reported (Global Mpox Trends published 11 December 2025, data as of 7 December 2025). In 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. In addition, the United States reported three unlinked 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). Confirmed limited secondary transmission of mpox due to MPXV clade I outside of Africa was reported in the EU/EEA since 2024 by Germany, Belgium, and Ireland. Outside the EU/EEA, secondary transmission has been reported in the UK, China, Qatar, and Australia. The number of secondary cases reported in these events outside Africa has been low (range: 1–6 cases per event; Global Mpox Trends published 11 December 2025, data as of 7 December 2025). Based on the information available, all transmission events were due to close contact and no deaths were reported.
Transmission patterns of mpox due to monkeypox virus clade I
Update 16 November 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, France, Germany, Greece, India, Ireland, Japan, Namibia, Oman, Pakistan, Romania, Qatar, Senegal, South Africa, South Sudan, Sweden, Switzerland, Thailand, Türkiye, the United Kingdom, the United States, and Zimbabwe;
- Clusters of cases or limited transmission: China, Italy, Malaysia, the Netherlands, Portugal, Spain, the United Arab Emirates, and the United States;
- Community transmission: Burundi, Central African Republic, Congo, DRC, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, and Zambia.
The extend of ongoing undetected transmission of mpox clade I cannot be quantified with certainty. 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 11 December 2025, data as of 7 December 2025), For example, Viet Nam, Nepal 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 Malaysia, Thailand and China have also been reported but a small number of mostly travel associated cases has been reported by each of these countries (Global Mpox Trends published 11 December 2025, data as of 7 December 2025).
The categorisation was last updated on 16 December 2025. The epidemiological situation is continuously being monitored and the classification is reviewed and adjusted depending on a qualitative assessment of reported trends.
Mali also reported mpox cases for the first time recently however, the clade has not yet been determined (Global Mpox Trends published 11 December 2025, data as of 7 December 2025).
On 13 August 2024, Africa CDC declared mpox a Public Health Emergency of Continental Security, and this decision remains valid (Mpox Still a Continental Emergency, Africa CDC Advisory Group Recommends – Africa CDC). On 14 August 2024, WHO also declared the outbreak of mpox due to MPXV clade I to be a public health emergency of international concern (PHEIC), which was declared over on 5 September 2025 (WHO Director-General's opening remarks at the media briefing – 5 September 2025).
Actions:
ECDC is closely monitoring and assessing the evolving epidemiological situation related to mpox on a global basis. The Centre's recommendations are available here.
Reporting through the Communicable Disease Threats Report is monthly. As the global epidemiological situation is monitored continuously, ad hoc epidemiological updates may be published.
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, inThe epidemiological situation regarding mpox due to MPXV clade I remains similar to previous weeks. The sporadic cases of clade I that have been reported outside of Africa, including secondary transmission, are not unexpected. However, a new pattern of transmission is emerging in countries outside Africa, including in the EU/EEA, among men who have sex with men.
The risk for EU/EEA residents travelling to or living in the affected areas is considered moderate if they have close contact with affected individuals, including sexual contact, 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. Imported mpox cases due to MPXV clade I are likely to continue being reported by the EU/EEA and other countries.
EU/EEA countries should 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. Clade identification and virus sequencing should also be prioritised.
Please see the latest ECDC 'Risk assessment for the EU/EEA of the mpox epidemic caused by monkeypox virus clade I in affected African countries' and the Threat Assessment Brief Detection of autochthonous transmission of monkeypox virus clade Ib in the EU/EEA.