2022-23 Mpox (Monkeypox) Outbreak:
Global Trends

World Health Organization

Produced on 20 March 2024

logo

Key Figures

February 2024

Overall

1 Overview

This report is now produced on a monthly basis. At the present stage of the 2022-23 global mpox1 outbreak, frequency of reporting of cases to WHO has decreased substantially. Furthermore, we currently do not factor in zero reporting. For this reason, there are often significant delays between case detection and reporting at the global level, and data should be interpreted in light of this. The present report only includes those countries which reported their data by the publication date above.

Here, we provide a global overview of mpox epidemiological situation as reported to WHO as of the end of February 2024. The report mainly focuses laboratory confirmed cases2 as defined by the WHO’s working case definition published in the Surveillance, case investigation and contact tracing for monkeypox interim guidance. Note that countries may use their own case definitions separate from those outlined in the above document.

Since 1 January 2022, cases of mpox have been reported to WHO from 117 Member States across all 6 WHO regions. As of 29 February 2024 , a total of 94 707 laboratory confirmed cases and 662 probable cases, including 181 deaths, have been reported to WHO.

With the exception of countries3,4 in West and Central Africa, amongst those countries for whom mpox cases’ exposures have been reported, the ongoing outbreak of mpox continues to primarily affect men who have sex with men (MSM). At present there is no signal suggesting sustained transmission beyond these networks. Confirmation of one case of mpox, in a country, is considered an outbreak.

WHO conducted the latest global mpox risk assessment at the end of July 2023, in preparation for the meeting of the Review Committee regarding Standing Recommendations for mpox.

The mpox long-term risk was assessed as follows:

  • For the general population in countries newly affected in 2022-23 or not affected mpox risk is assessed as low.
  • For the general population in countries with historical mpox transmission and their neighboring countries mpox risk is assessed as moderate.
  • The overall global risk for men who have sex with men and sex workers is assessed as moderate.

This report should be considered in the context of other WHO information products associated with the 2022-23 mpox outbreak, and mpox in general. Links to these products can be found at the end of the report.

  • The monthly situation report provides a comprehensive update of the mpox situation and response activities across a variety of domains such as epidemiology, clinical management and communications ;

  • This global epidemiological report provides in-depth epidemiological information about the mpox situation, based primarily on case report forms provided by Member States to WHO under Article 6 of the International Health Regulations (IHR 2005), and the Standing Recommendations for mpox.

 


  1. On of 28 November 2022, WHO recommended using the name mpox as a new name for monkeypox. The words will be used synonymously for one year while the term monkeypox is phased out.

  2. For the WHO European region, both confirmed and probable cases are included within confirmed case counts and detailed case data.

  3. Throughout this document, any use of the word country should be considered shorthand for a country, area, or territory.

  4. All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).


2 Global situation update

As of February 2024, the number of monthly reported new cases has increased by 1.6%, compared to the previous month. The majority of cases reported in the past month were notified from the Region of the Americas (31.9%) and the African Region (31.2%).

The 10 most affected countries globally since 1 January 2022 are: United States of America (n = 31 800), Brazil (n = 10 967), Spain (n = 7 898), France (n = 4 195), Colombia (n = 4 090), Mexico (n = 4 081), The United Kingdom (n = 3 892), Germany (n = 3 816), Peru (n = 3 812), and China (n = 2 031). Together, these countries account for 80.9% of the cases reported globally.

In the most recent month of reporting, 18 countries reported an increase in the monthly number of cases. In the past month, 29 countries have reported cases.

In the past month, 1 country reported their first case. The country(ies) which reported their first case(s) in the past month are: Cambodia.

Global aggregated data are collected collected through direct reporting from Member States to WHO and its partners or from official country sources. The below epidemic curve shows the aggregated number of cases by month according to the date of case reporting.

2.1 Epidemic curves

2.1.1 Global (cases)

Epidemic curve shown by month for cases reported up to 29 Feb 2024 to avoid showing incomplete months of data.

2.1.2 Global (deaths)

Epidemic curve shown by month for deaths reported up to 29 Feb 2024 to avoid showing incomplete months of data.

2.1.3 By WHO Region (cases)

Epidemic curve shown by month for cases reported up to 29 Feb 2024 to avoid showing incomplete months of data. Note different y-axis scales.

2.1.4 By WHO Region (deaths)

Epidemic curve shown by month for deaths reported up to 29 Feb 2024 to avoid showing incomplete months of data. Note different y-axis scales.

2.1.5 Top 10 countries (cases)

Epidemic curve shown by month for cases reported up to 29 Feb 2024 to avoid showing incomplete months of data. Note different y-axis scales.

2.1.6 By country

Andorra

Argentina

Aruba

Australia

Austria

Bahamas

Bahrain

Barbados

Belgium

Benin

Bermuda

Bolivia (Plurinational State of)

Bosnia and Herzegovina

Brazil

Bulgaria

Cambodia

Cameroon

Canada

Central African Republic

Chile

China

Colombia

Congo

Costa Rica

Croatia

Cuba

Curaçao

Cyprus

Czechia

Democratic Republic of the Congo

Denmark

Dominican Republic

Ecuador

Egypt

El Salvador

Estonia

Finland

France

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Guadeloupe

Guam

Guatemala

Guyana

Honduras

Hungary

Iceland

India

Indonesia

Iran (Islamic Republic of)

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Lao People’s Democratic Republic

Latvia

Lebanon

Liberia

Lithuania

Luxembourg

Malaysia

Malta

Martinique

Mexico

Monaco

Montenegro

Morocco

Mozambique

Nepal

Netherlands

New Caledonia

New Zealand

Nigeria

Norway

Oman

Pakistan

Panama

Paraguay

Peru

Philippines

Poland

Portugal

Puerto Rico

Qatar

Republic of Korea

Republic of Moldova

Romania

Russian Federation

Saint Martin

San Marino

Saudi Arabia

Serbia

Singapore

Slovakia

Slovenia

South Africa

Spain

Sri Lanka

Sudan

Sweden

Switzerland

Thailand

The United Kingdom

Trinidad and Tobago

Türkiye

Ukraine

United Arab Emirates

United States of America

Uruguay

Venezuela (Bolivarian Republic of)

Viet Nam

2.3 Maps

Note: Maps can be clicked to view on a larger scale

2.3.1 Cumulative cases

2.3.2 Cumulative deaths

2.3.3 Cases in the past month

2.3.4 Monthly change in cases

2.4 Tables

2.4.1 Cumulative cases and deaths by WHO Region

Total mpox cases, by WHO region
Data as of February 2024
WHO Region Total cases1 Total deaths1 Cases in Jan 2024 Cases in Feb 2024 Monthly % change in cases Month most recent cases reported
Region of the Americas 61,115 138 333 228 −32.0% Feb 2024
European Region 27,056 10 140 213 52.0% Feb 2024
Western Pacific Region 2,865 8 37 25 −32.0% Feb 2024
African Region 2,717 22 151 223 48.0% Feb 2024
South-East Asia Region 859 2 43 26 −40.0% Feb 2024
Eastern Mediterranean Region 95 1 0 0 Oct 2023
1 From Jan 2022


2.4.2 Cumulative cases and deaths by country

Total Mpox cases, by WHO region
From 1 Jan 2022. Data as of 29 Feb 2024
Total Confirmed Cases Total Probable Cases Total Deaths
Region of the Americas
United States of America 31,800 0 57
Brazil 10,967 349 16
Colombia 4,090 0 0
Mexico 4,081 52 34
Peru 3,812 0 20
Canada1 1,467 77 0
Chile 1,449 26 3
Argentina 1,136 0 2
Ecuador 557 1 3
Guatemala 405 5 1
Bolivia (Plurinational State of) 265 0 0
Panama 239 0 1
Costa Rica 225 0 0
Puerto Rico 211 150 0
Paraguay 126 0 0
El Salvador 104 0 0
Dominican Republic 52 1 0
Honduras 44 0 0
Jamaica 21 0 0
Uruguay 19 0 0
Venezuela (Bolivarian Republic of) 12 0 0
Cuba 8 0 1
Martinique 7 0 0
Bahamas 3 0 0
Aruba 3 0 0
Curaçao 3 0 0
Trinidad and Tobago 3 0 0
Guyana 2 0 0
Bermuda 1 0 0
Barbados 1 0 0
Guadeloupe 1 0 0
Saint Martin 1 0 0
European Region
Spain 7,898 0 3
France 4,195 0 0
The United Kingdom 3,892 0 0
Germany 3,816 0 0
Netherlands 1,299 0 0
Portugal 1,190 0 3
Italy 1,028 0 0
Belgium 805 0 2
Switzerland 579 0 0
Austria 345 0 1
Israel 293 0 0
Sweden 272 0 0
Ireland 245 0 0
Poland 220 0 0
Denmark 198 0 0
Norway 105 0 0
Greece 91 0 0
Hungary 83 0 0
Czechia 78 0 1
Luxembourg 61 0 0
Romania 47 0 0
Slovenia 47 0 0
Finland 43 0 0
Serbia 40 0 0
Malta 35 0 0
Croatia 33 0 0
Iceland 17 0 0
Slovakia 16 0 0
Türkiye 12 0 0
Estonia 11 0 0
Bosnia and Herzegovina 9 0 0
Bulgaria 6 0 0
Gibraltar 6 0 0
Latvia 6 0 0
Cyprus 5 0 0
Lithuania 5 0 0
Ukraine 5 0 0
Andorra 4 0 0
Russian Federation 4 0 0
Monaco 3 0 0
Georgia 2 0 0
Greenland 2 0 0
Republic of Moldova 2 0 0
Montenegro 2 0 0
San Marino 1 0 0
Western Pacific Region
China2 2,031 0 1
Japan 240 0 1
Australia 156 0 0
Republic of Korea 155 0 0
Viet Nam 147 0 6
Singapore 52 0 0
New Zealand 50 1 0
Cambodia 13 0 0
Malaysia 9 0 0
Philippines 9 0 0
Guam 1 0 0
New Caledonia 1 0 0
Lao People's Democratic Republic 1 0 0
African Region
Democratic Republic of the Congo 1,605 0 2
Nigeria 843 0 9
Ghana 127 0 4
Cameroon 45 0 3
Congo 37 0 2
Central African Republic 30 0 1
Liberia 21 0 0
South Africa 5 0 0
Benin 3 0 0
Mozambique 1 0 1
South-East Asia Region
Thailand 743 0 1
Indonesia 84 0 0
India 27 0 1
Sri Lanka 4 0 0
Nepal 1 0 0
Eastern Mediterranean Region
Lebanon 27 0 0
Sudan 19 0 1
United Arab Emirates 16 0 0
Saudi Arabia 8 0 0
Pakistan 7 0 0
Qatar 5 0 0
Morocco 3 0 0
Egypt 3 0 0
Oman 3 0 0
Bahrain 2 0 0
Iran (Islamic Republic of) 1 0 0
Jordan 1 0 0
-
Total 94,707 662 181
1 Date information is unavailable for 45 cases in Canada
2 Cases shown include those in mainland China (1611), Hong Kong SAR (83), Taipei (335), and Macao (2)


2.4.9 Countries reporting cases in the previous month

Countries reporting cases in February
Country New cases New deaths
Region of the Americas
United States of America 224 0
Mexico 2 0
Panama 2 0
African Region
Democratic Republic of the Congo 214 0
Congo 7 0
Liberia 2 0
European Region
Spain 112 0
Israel 18 0
France 16 0
Italy 13 0
The United Kingdom 10 0
Germany 9 0
Netherlands 7 0
Switzerland 7 0
Czechia 6 0
Austria 4 1
Portugal 4 1
Belgium 2 0
Sweden 2 0
Finland 1 0
Ireland 1 0
Luxembourg 1 0
South-East Asia Region
Thailand 22 0
Indonesia 4 0
Western Pacific Region
Cambodia 10 0
Japan 6 0
Viet Nam 5 0
China 3 0
Singapore 1 0


 


3 Detailed case data

Detailed case data are acquired via direct reporting of case-based data from Member States to WHO. Data from cases are reported1 according to the WHO minimum dataset under the International Health Regulations (IHR 2005) Article 6. Completeness of records is variable, meaning denominators for variables may be different from one another. All of the following is derived from detailed case data, and as a result, overall numbers may not be reflective of figures shown with aggregate case numbers. All detailed cases shown are confirmed cases, where the reporting date occurred after 01 January 2022.


  1. Note that a small number of detailed case reports are constructed from official public reports about individual cases.

3.1 Reporting coverage

The detailed case dataset was last updated on February 2024. As of this date, the total number of detailed confirmed cases reported is 90 649, representing 95.7% of all aggregated cases reported.

The table below indicates the reporting coverage between reported aggregated confirmed cases and detailed confirmed cases by countries and per region.

3.1.1 Table - Coverage by region

Mpox reporting completeness
As of 29 Feb 2024
Total Confirmed Cases Total Detailed Confirmed Cases1 % Detailed Cases reported
Region of the Americas 61,115 59,378 97.2%
European Region 27,056 26,819 99.1%
Western Pacific Region 2,865 2,847 99.4%
African Region 2,717 672 24.7%
South-East Asia Region 859 863 100.5%
Eastern Mediterranean Region 95 70 73.7%
1 Note that in rare cases total detailed cases may exceed total confirmed cases due to ongoing data cleaning issues



3.3 Case profile (overall)

As shown below, and stated previously, the ongoing outbreak is largely occurring in networks of men who have sex with men. Note that reported sexual behaviour does not necessarily reflect who the case has had recent sexual history with nor does it imply sexual activity. Generally, severity has been low, with few reported hospitalizations and deaths:

Key features of these cases are as follows:

  • 96.4% (84 735/87 899) of cases with available data are male, the median age is 34 years (IQR: 29 - 41).

  • Males between 18-44 years old continue to be disproportionately affected by this outbreak as they account for 79.4% of reported cases.

  • Of all cases with available data, 3.6% (3 164/87 899) are female:

    • The majority of these cases are reported from the Region of the Americas (2 353/3 164; 74%) and the European Region (442/3 164; 14%)

    • The most commonly reported form of transmission is via sexual encounters (262/510; 51%)

  • Of the 90 308 cases where age was available, there were 1 154 (1.3%) cases reported aged 0-17, out of which 333 (0.4%) were aged 0-4:

    • The majority of cases aged 0-17 are reported from the Region of the Americas (705 /1 154; 61%).
  • 55 cases were reported to be pregnant or recently pregnant. Of these:

    • 5, 12, and 10 cases were in their first, second, and third trimesters respectively. 28 were in an unknown trimester, and 0 were six weeks or less post-partum.

    • The median age was 28 years old (IQR: 22.5 - 31).

    • 12 of these cases were known to be hospitalized. 0 were known to be admitted to ICU and 0 were known to have died.

    • The most common mode of transmission was sexual encounter (4/8 cases where route was known).

  • Among cases with known data on sexual behaviour, 85.4% (29 244/34 240) identified as men who have sex with men.

  • Among those with known HIV status, 52.0% (18 275/35 122) were people living with HIV. Note that information on HIV status is not available for the majority of cases.

  • 1 263 cases were reported to be health workers. However, most were exposed in the community and further investigation is ongoing to determine which were due to occupational exposure.

  • Of all reported types of transmission, a sexual encounter was reported most commonly, with 18 273 of 21 935 (83.3%) of all reported transmission events.

  • Of all settings in which cases were likely exposed, the most common was in party setting with sexual contacts, with 4 285 of 6 493 (66.0%) of all reported exposure events.

As of 6 October 2023, the updated case reporting form no longer requires collection of exposure setting as an aspect of the case-based data. While we longer receive this information, we continue to present these data for the historical record.



3.3.1 Demographic Information

Note that the proportions shown below should be interpreted with caution. In some cases, a variable may be more likely to be filled in if the answer is yes than if the answer is no. This is most likely to be true for variables such as HIV status, health worker status, travel history, hospitalization, ICU, and death.

Case profiles
As of 29 Feb 2024
Reported values Unknown or Missing Value
Yes No
Men who have sex with men 29,244 (85.4%) 4,996 (14.6%) 56,402
Persons living with HIV 18,275 (52.0%) 16,847 (48.0%) 55,520
Health worker 1,263 (4.1%) 29,920 (95.9%) 59,459
Travel History 3,925 (15.2%) 21,849 (84.8%) 64,868
Sexual Transmission 18,272 (83.3%) 3,662 (16.7%) 68,708
Hospitalized1 5,744 (10.9%) 46,855 (89.1%) 38,043
ICU 48 (0.3%) 14,908 (99.7%) 75,686
Died 143 (0.3%) 54,792 (99.7%) 35,707
1 May be hospitalized for isolation or medical treatment



3.3.2 Age-sex pyramid



3.3.3 Age-sex pyramid by region

Note different x-axis scales.



3.3.4 Age-sex pyramid (Hospitalized cases)

Note that some cases represented below may be hospitalized for isolation rather than treatment purposes.



3.3.5 Age-sex pyramid (ICU cases)



3.3.6 Sexual behaviour by region



3.3.7 Transmission type

Transmission data were available for 21 935/90 649 (24.2%) of cases.

Transmission can occur during sex via skin-to-skin contact as well as via bodily fluids. While skin-to-skin contact with lesions remains an important transmission route, monkeypox virus has been isolated from semen samples and rectal swabs from confirmed cases. Note that person to person contact excludes known sexual, healthcare-associated, and mother to child transmission.



3.3.8 Exposure settings

Exposure setting data were available for 7 708/90 649 (8.5%) of cases.

Note that multiple exposure settings can be attributed to a single case. Here, differentiation between party settings and large events is determined by size of the event, although there is no formal size threshold to distinguish the two.



3.3.9 Transmission by exposure type

3.4 Case profile (excluding men who have sex with men)

The following outputs apply to cases with sexual behaviour reported as other than men who have sex with men. As above, note that reported sexual behaviour does not necessarily reflect persons who the case has had recent sexual history with nor does it imply sexual activity. Up until this point in time, the multi-country mpox outbreak has been overwhelmingly concentrated in sexual networks of men who have sex with men. For this reason, understanding events in which individuals having other sexual behaviours have acquired mpox is important to monitor potential of sustained spillover into the general population.

  • 79.0% (3 935/4 978) of cases with available data are male; the median age is 33 years (IQR: 27-41).

  • Males between 18-44 years old account for 64.4% of cases.

  • Among those with known HIV status 29.1% (1 125/3 872) were people living with HIV. Note that information on HIV status is not available for the majority of cases.

  • 128 cases were reported to be health workers. However, most were exposed in the community.

  • Of all reported types of transmission, sexual encounter was reported most commonly, with 979 of 1 551 (63.1%) of all reported transmission events.

  • Of all settings in which cases were likely exposed, the most common was in households, with 157 of 424 (37.0%) of all likely exposure categories.

3.4.1 Demographic Information

Note that the proportions shown below should be interpreted with caution. In some cases, a variable may be more likely to be filled in if the answer is yes than if the answer is no. This is most likely to be true for variables such as HIV status, health worker status, travel history, hospitalization, ICU, and death.

Case profiles (excluding men who have sex with men)
As of 29 Feb 2024
Reported values Unknown or Missing Value
Yes No
Men who have sex with men 0 4,996 (100.0%) 0
Persons living with HIV 1,125 (29.1%) 2,747 (70.9%) 1,124
Health worker 128 (7.6%) 1,550 (92.4%) 3,318
Travel History 312 (11.6%) 2,386 (88.4%) 2,298
Sexual Transmission 979 (63.1%) 572 (36.9%) 3,445
Hospitalized1 405 (16.2%) 2,091 (83.8%) 2,500
ICU 13 (1.1%) 1,206 (98.9%) 3,777
Died 10 (0.4%) 2,738 (99.6%) 2,248
1 May be hospitalized for isolation or medical treatment



3.4.2 Age-sex pyramid excluding men who have sex with men



3.4.3 Transmission type

Transmission data were available for 1 551/4 996 (31.0%) of cases.

Transmission can occur during sex via skin-to-skin contact as well as via bodily fluids. While skin-to-skin contact with lesions remains an important transmission route, monkeypox virus has been isolated from semen samples and rectal swabs from confirmed cases. Note that person to person contact excludes known sexual, healthcare-associated, and mother to child transmission.

All Genders



Male



Female



3.4.4 Exposure settings

Exposure setting data were available for 473/4 996 (9.5%) of cases that were not men who have sex with men.

Note that multiple exposure settings can be attributed to a single case. Here, differentiation between party settings and large events is determined by size of the event, although there is no formal size threshold to distinguish the two.

All Sexes



Male



Female



3.5 Case profile (recent cases)

This section of the report pertains specifically to the most recent six months of the outbreak, and case report forms that were reported in that time period (01 Sep 2023 - 29 Feb 2024).

In the last six months:

  • Of all cases with available information, 99% (2 066 / 2 090) of cases were male, and 96% (1 391 / 1 444) reported being as men who have sex with men.

  • Of all reported types of transmission, a sexual encounter was reported most commonly, with 881 of 906 (97.2%) of all reported transmission events.

3.5.1 Demographic information

Note that the proportions shown below should be interpreted with caution. In some cases, a variable may be more likely to be filled in if the answer is yes than if the answer is no. This is most likely to be true for variables such as HIV status, health worker status, travel history, hospitalization, ICU, and death.

Case profiles
From 01 Sep to 18 Mar 2024
Reported values Unknown or Missing Value
Yes No
Men who have sex with men 1,391 (96.3%) 53 (3.7%) 675
Persons living with HIV 674 (51.6%) 632 (48.4%) 813
Health worker 16 (1.7%) 920 (98.3%) 1,183
Travel History 174 (14.3%) 1,039 (85.7%) 906
Sexual Transmission 881 (97.2%) 25 (2.8%) 1,213
Hospitalized1 256 (27.4%) 677 (72.6%) 1,186
ICU 0 320 (100.0%) 1,799
Died 3 (0.5%) 580 (99.5%) 1,536
1 May be hospitalized for isolation or medical treatment



3.5.2 Age-sex pyramid, recent cases



3.5.3 Transmission type

Transmission data were available for 906/2 119 (42.8%) of cases.

Transmission can occur during sex via skin-to-skin contact as well as via bodily fluids. While skin-to-skin contact with lesions remains an important transmission route, monkeypox virus has been isolated from semen samples and rectal swabs from confirmed cases. Note that person to person contact excludes known sexual, healthcare-associated, and mother to child transmission.



3.6 Symptomatology

Although most cases in current outbreaks have presented with mild disease symptoms, monkeypox virus (MPXV) may cause severe disease in certain population groups (young children, pregnant women, immunosuppressed persons).

Among the cases who reported at least one symptom, the most common symptom is any rash and is reported in 90% of cases with at least one reported symptom. Note that identifying true denominators for symptomatology is difficult due to a general lack of negative reporting and symptom definitions that may vary between countries’ reporting systems.

A bar chart and table showing symptoms is shown below. Here any rash refers to one or more rash symptoms (systemic, oral, genital, or unknown location), and any lymphadenopathy refers to either general or local lymphadenopathy. Systemic rash included rash on the body, excluding mucosal and genital rash. Symptom information is shown for all cases where information was available reported from January 2022.

3.6.1 Bar chart - Symptoms

All cases

Male cases

Female cases

3.6.2 Table - Symptoms

Summary of symptoms
As of 29 Feb 2024
All Male Female
Any rash 32,150 (89.8%) 30,834 (90.3%) 1,149 (84.2%)
Fever 20,862 (58.3%) 20,005 (58.6%) 687 (50.3%)
Systemic rash 19,575 (54.7%) 18,584 (54.4%) 957 (70.2%)
Genital rash 17,715 (49.5%) 17,193 (50.3%) 387 (28.4%)
Any lymphadenopathy 10,708 (29.9%) 10,424 (30.5%) 224 (16.4%)
Headache 10,421 (29.1%) 9,858 (28.9%) 513 (37.6%)
Muscle ache 9,373 (26.2%) 8,964 (26.2%) 397 (29.1%)
General lymphadenopathy 8,209 (22.9%) 8,007 (23.4%) 143 (10.5%)
Fatigue 6,407 (17.9%) 6,251 (18.3%) 150 (11.0%)
Local lymphadenopathy 5,813 (16.2%) 5,680 (16.6%) 132 (9.7%)
Sore throat 4,715 (13.2%) 4,448 (13.0%) 216 (15.8%)
Rash, unknown location 3,428 (9.6%) 3,403 (10.0%) 23 (1.7%)
Oral rash 2,846 (8.0%) 2,751 (8.1%) 83 (6.1%)
Chills 2,679 (7.5%) 2,525 (7.4%) 121 (8.9%)
Cough 869 (2.4%) 798 (2.3%) 56 (4.2%)
Vomiting 766 (2.1%) 711 (2.1%) 52 (3.8%)
Lymphadenopathy, location unknown 459 (1.3%) 445 (1.3%) 14 (1.0%)
Anogenital pain and/or bleeding 368 (1.0%) 363 (1.1%) 5 (0.4%)
Other 253 (0.7%) 249 (0.7%) 5 (0.4%)
Asymptomatic 245 (0.7%) 222 (0.7%) 17 (1.2%)
Conjunctivitis 202 (0.6%) 186 (0.5%) 14 (1.0%)
Diarrhea 113 (0.3%) 91 (0.3%) 2 (0.1%)
Genital oedema 41 (0.1%) 40 (0.1%) 0

 


4 Africa in Focus

4.1 Overview

This section specifically focuses on countries in the WHO African region, in order to highlight any differences in epidemiology between this region and others regarding the ongoing 2022-23 mpox outbreak. Historically, the sexual component of transmission in the region has been thought to contribute less to human to human transmission of mpox than has been observed in the ongoing global outbreak. It should also be noted that there is limited testing capacity for mpox in much of the region, which has led to underascertainment of mpox cases.

As of 29 February 2024, there have been 2,717 confirmed cases of mpox reported in the region and 22 deaths. These represent 3% of global cases and 12% of global deaths, respectively. In addition, 672 (25% of all cases) detailed cases have been reported to WHO.

Of those cases with detailed data:

  • 359 male cases (53.4%) and 313 female cases (46.6%) have been reported

  • The median age is 17 (IQR: 7 - 32).

  • Of the 672 cases where age was available, there were 339 (50.4% of total) cases reported aged 0-17, out of which 119 (17.7% of total) were aged 0-4.

  • There are currently no case based data for which transmission or exposure setting details are available

Regional trends are shown below:

4.1.1 Epidemic curve by date of notification (cases)

Epidemic curve shown by month for cases from the African region reported up to 29 Feb 2024 to avoid showing incomplete months of data.

4.1.2 Epidemic curve by date of notification (deaths)

Epidemic curve shown by month for deaths from the African region reported up to 29 Feb 2024 to avoid showing incomplete months of data.

4.1.3 Age-sex pyramid

 

4.2 Situation in The Democratic Republic of the Congo

The Democratic Republic of the Congo reported the first ever mpox cases in humans in 19701. Since then, the country has continued to report mpox cases over time2. In 2023, there has been a significant increase in the number of mpox cases and deaths with a wider geographical spread, though the reasons behind this remain unclear3. Historically, the country has only reported MPXV clade I; there have been no confirmed cases of MPXV clade IIb, which is dominant in the current global outbreak. In April 2023 transmission through sexual contact of MPXV clade I was documented for the first time in the Democratic Republic of the Congo3.

Due to limited testing capacities, only approximately 15% of suspected cases in 2024 have been tested by PCR; the test positivity rate at the national level was around 75%. The remaining cases remain classified as suspected cases based on signs and symptoms compatible with mpox.

In this section, WHO presents a recent update on suspected mpox cases and related deaths in the Democratic Republic of the Congo. From 1 January 2022 through the end of February 2024, the country reported 23 941 suspected mpox cases and 1165 suspected mpox deaths (only 2024: 3576 suspected cases and 264 suspected deaths). Among the 2024 cases, 389 were laboratory-confirmed. During this period, more than 65% of suspected cases and around 85% of suspected deaths in the country are among children under 15 years of age. These data underscore the need for enhanced surveillance and support in the country to better understand and manage the outbreak.

 


  1. Breman JG, Kalisa-Ruti, Steniowski M V., Zanotto E, Gromyko AI, Arita I. Human monkeypox, 1970-79. Bull World Health Organ 1980; 58: 165

  2. World Health Organization (WHO). Epidemiology of human monkeypox (‎mpox)‎ – worldwide, 2018–2021 – Épidémiologie de la variole simienne chez l’humain – dans le monde, 2018-2021. 2023.

  3. World Health Organization (WHO). (2023, November 23). Mpox (monkeypox)- Democratic Republic of the Congo.


5 Genomic epidemiology

Sequence alignment and visualisation of sequences available on NCBI Genbank is regularly carried out by Nextstrain, using both historical sequences and sequences associated with the 2022-23 multi-country mpox outbreak. On 12 August 2022, after reaching consensus among scientists from different fields and from different countries, WHO decided to rename the MPXV clades from the Congo Basin clade as Clade one (I) and the West African clade as Clade two (II). Additionally, it was agreed that the Clade II consists of two subclades, Clade IIa and Clade IIb.

The following visualisations are derived from Nextstrain alignments of Genbank data under the mpxv dataset. Further details on methods and interactive visualisation can be found on the Nextclade website and GitHub. Phylogenetic trees were visualised in R with the ggtree and treeio packages. As of 26 Jul 2023, a total of 749 sequences were visualised. Note that these data do not include data submitted to GISAID, the other major platform for sharing mpox genomic data.

At present, all sequences in the ongoing 2022-23 global mpox outbreak are associated with Clade IIb. Among these, the vast majority have been associated with the B.1 lineage of Clade IIb. Despite this, a number of sequences have been associated with the related A.2 lineage. Currently, the similarities between the sequences uploaded from different areas of the world suggest that the ongoing outbreak does not involve multiple zoonotic spillover events, and transmission is sustained through human-to-human transmission. In order to understand when sustained human to human transmission started, it is critical to analyse the diversity of sequences from the period prior to the current outbreak in countries that experienced continuous circulation of monkeypox virus.

5.1 Phylogeny focused on 2022-23 outbreak

Click on image to expand

5.2 Phylogeny prior to 2022-23 outbreak

Click on image to expand

 

6 Literature summary & epidemic parameters

In order to promote a better understanding of the dynamics of the mpox outbreak and to support forecasting work, in 2022, WHO undertook an effort to extract epidemiological parameters (incubation period, serival interval and generation interval) from the literature. The initial literature screening was performed and maintained by the Public Health Agency of Canada (PHAC). The overall search strategy was as follows:

  • Inclusion criteria: monkeypox and monkeypox virus
  • Study design:
    • Any study design including primary and secondary studies (both animal and human)
    • Guidelines and commentaries are not excluded but are not searched systematically.
  • Publication language: no restriction for peer-reviewed articles, grey literature is focused on English
  • Publication date: from April 14, 2022 – January 19, 2023
  • Bibliographic databases and other sources searched:
    • PubMed Scopus
    • Pre-print servers: Europe PMC, arXiv and SSRN
    • WHO, PHAC, CDC, ECDC, UKHSA

The tables below provide an overview of the most relevant estimates for incubation period and generation interval extracted from the literature where the following criteria are met:

  • Studies with a sample size greater than 5
  • Clear estimate of the specific parameter

The epidemic parameter tables are no longer updated, as the literature screening is no longer carried out.

6.1 Parameters

Incubation Period
As of 19 Jan 2023
Reference N Mean1 95% CrI (mean)1 95% CI (mean)1 SD1 Median1 95% CrI (median)1 IQR1 Range1 Distribution
Miura et al. [1] 18 8.5 6.6 - 10.9 - - - - - - Log-normal
Charniga et al. [2] 40 7.6 6.2 - 9.7 - 1.8 6.4 5.1 - 7.9 - - Log-normal
Rodríguez et al. [3] 45 - - - - - - - - -
Thornhill et al. [4] 23 - - - - 7.0 - - 3 - 20 -
Català et al. [5] 77 - - - - 6.0 - - 4 - 9 -
Tarín-Vicente et al. [6] 144 - - - - 7.0 - 5 - 10 1 - 19 -
Guzzetta et al. [7] 30 9.1 - 6.5 - 10.9 - - - - - Gamma
Mailhe et al. [8] 112 - - - - 6.0 - 3 - 8 - -
Moschese et al. [9] 16 - - - - 11.0 - 11 - 16 - -
Gomez-Garberi et al. [10] 14 - - - - 13.0 - - 3 - 30 -
O'Laughlin et al. [11] 527 7.0 - - - - - 4 - 9 - -
Angelo et al. [12] 78 - - - - 8.0 - 5 - 11 2 - 40 -
Madewell et al. [14] 35 5.6 4.3 - 7.8 - - - - - - -
Ward et al. [15] 54 7.8 6.6 - 9.2 - - - - - - Weibull
Besombes et al. [16] 29 - - - - 7.0 - 1 - 13 0 - 17 -
Kröger et al. [17] 209 8.2 - - 4.7 - - - - Log-normal
Source: PHAC
1 Units are in days




Serial Interval
As of 19 Jan 2023
Reference N Mean1 95% CrI (mean)1 SD1 Median1 95% CrI (median)1 Distribution
Guo et al. [13] 21 5.6 1.7 - 10.4 1.5 5.5 1.4 - 10.4 -
Madewell et al. [14] 57 8.5 7.3 - 9.9 - - - Gamma
Ward et al. [15] 79 9.5 7.4 - 12.3 - - - Gamma
Miura et al. [18] 34 9.4 - 6.2 - - Normal
Source: PHAC
1 Units are in days




Generation Interval
As of 19 Jan 2023
Reference N Mean1 95% CrI1 Distribution
Guzzetta et al. [7] 16 12.5 7.5 - 17.3 Gamma
Source: PHAC
1 Units are in days


6.2 Bibliography

  1. The incubation period for monkeypox cases confirmed in the Netherlands, May 2022 ( 658) medRxiv . Miura, Fuminari, van Ewijk, Catharina Else, Backer, Jantien A., Xiridou, Maria, Franz, Eelco, de Coul, Eline Op, Brandwagt, Diederik, van Cleef, Brigitte, van Rijckevorsel, Gini, Swaan, Corien, van den Hof, Susan, Wallinga, Jacco. #volume# (2022): 2022.06.09.22276068–> 10.1101/2022.06.09.22276068 ; http://medrxiv.org/content/early/2022/06/13/2022.06.09.22276068.abstract

  2. Estimating the incubation period of monkeypox virus during the 2022 multi-national outbreak ( 722) medRxiv . Charniga, Kelly, Masters, Nina B., Slayton, Rachel B., Gosdin, Lucas, Minhaj, Faisal S., Philpott, David, Smith, Dallas, Gearhart, Shannon, Alvarado-Ramy, Francisco, Brown, Clive, Waltenburg, Michelle A., Hughes, Christine M., Nakazawa, Yoshinori. #volume# (2022): 2022.06.22.22276713–> 10.1101/2022.06.22.22276713 ; http://medrxiv.org/content/early/2022/06/23/2022.06.22.22276713.abstract

  3. Epidemiologic Features and Control Measures during Monkeypox Outbreak, Spain, June 2022 ( 888) Emerg Infect Dis . Rodríguez, B. S., Herrador, B. R. G., Franco, A. D., Fariñas, M. P. S., Del Amo Valero, J., Llorente, A. H. A., de Agreda, Jpap, Malonda, R. C., Castrillejo, D., Chirlaque López, M. D., Chong, E. J., Balbuena, S. F., García, V. G., García-Cenoz, M., Hernández, L. G., Montalbán, E. G., Carril, F. G., Cortijo, T. G., Bueno, S. J., Sánchez, A. L., Linares Dópido, J. A., Lorusso, N., Martins, M. M., Martínez Ochoa, E. M., Mateo, A. M., Peña, J. M., Antón, A. I. N., Otero Barrós, M. T., Martinez, Mdcp, Jiménez, P. P., Martín, O. P., Rivas Pérez, A. I., García, M. S., Soria, F. S., Sierra Moros, M. J.. 28,2022/07/13 (2022): #pages#–> 10.3201/eid2809.221051 ; https://wwwnc.cdc.gov/eid/article/28/9/22-1051_article

  4. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022 ( 933) N Engl J Med . Thornhill, J. P., Barkati, S., Walmsley, S., Rockstroh, J., Antinori, A., Harrison, L. B., Palich, R., Nori, A., Reeves, I., Habibi, M. S., Apea, V., Boesecke, C., Vandekerckhove, L., Yakubovsky, M., Sendagorta, E., Blanco, J. L., Florence, E., Moschese, D., Maltez, F. M., Goorhuis, A., Pourcher, V., Migaud, P., Noe, S., Pintado, C., Maggi, F., Hansen, A. E., Hoffmann, C., Lezama, J. I., Mussini, C., Cattelan, A., Makofane, K., Tan, D., Nozza, S., Nemeth, J., Klein, M. B., Orkin, C. M.. 2022/07/23 (2022): #pages#–> 10.1056/NEJMoa2207323 ; #URL#

  5. Monkeypox outbreak in Spain: clinical and epidemiological findings in a prospective cross-sectional study of 185 cases ( 1008) Br J Dermatol . Català, A., Clavo Escribano, P., Riera, J., Martín-Ezquerra, G., Fernandez-Gonzalez, P., Revelles Peñas, L., Simón Gozalbo, A., Rodríguez-Cuadrado, F. J., Guilera Castells, V., De la Torre Gomar, F. J., Comunión Artieda, A., Fuertes de Vega, L., Blanco, J. L., Puig, S., García Miñarro Á, M., Fiz Benito, E., Muñoz-Santos, C., Repiso-Jiménez, J. B., Ceballos-Rodriguez, C., García Rodríguez, V., Castaño Fernández, J. L., Sánchez-Gutiérrez, I., Calvo López, R., Berna-Rico, E., de Nicolás-Ruanes, B., Corella Vicente, F., Tarín Vicente, E. J., Fernández de la Fuente, L., Riera-Martí, N., Descalzo-Gallego, M., Grau-Perez, M., García-Doval, I., Fuertes, I.. 2022/08/03 (2022): #pages#–> 10.1111/bjd.21790 ; #URL#

  6. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study ( 1074) Lancet . Tarín-Vicente, E. J., Alemany, A., Agud-Dios, M., Ubals, M., Suñer, C., Antón, A., Arando, M., Arroyo-Andrés, J., Calderón-Lozano, L., Casañ, C., Cabrera, J. M., Coll, P., Descalzo, V., Folgueira, M. D., García-Pérez, J. N., Gil-Cruz, E., González-Rodríguez, B., Gutiérrez-Collar, C., Hernández-Rodríguez, Á., López-Roa, P., de Los Ángeles Meléndez, M., Montero-Menárguez, J., Muñoz-Gallego, I., Palencia-Pérez, S. I., Paredes, R., Pérez-Rivilla, A., Piñana, M., Prat, N., Ramirez, A., Rivero, Á., Rubio-Muñiz, C. A., Vall, M., Acosta-Velásquez, K. S., Wang, A., Galván-Casas, C., Marks, M., Ortiz-Romero, P., Mitjà, O.. 2022/08/12 (2022): #pages#–> 10.1016/s0140-6736(22)01436-2 ; #URL#

  7. Early Estimates of Monkeypox Incubation Period, Generation Time, and Reproduction Number, Italy, May-June 2022 ( 1189) Emerg Infect Dis . Guzzetta, G., Mammone, A., Ferraro, F., Caraglia, A., Rapiti, A., Marziano, V., Poletti, P., Cereda, D., Vairo, F., Mattei, G., Maraglino, F., Rezza, G., Merler, S.. 28,2022/08/23 (2022): #pages#–> 10.3201/eid2810.221126 ; https://wwwnc.cdc.gov/eid/article/28/10/22-1126_article

  8. Clinical characteristics of ambulatory and hospitalised patients with monkeypox virus infection: an observational cohort study ( 1238) Clin Microbiol Infect . Mailhe, M., Beaumont, A. L., Thy, M., Le Pluart, D., Perrineau, S., Houhou-Fidouh, N., Deconinck, L., Bertin, C., Ferré, V. M., Cortier, M., C.,De La Porte Des Vaux,, Phung, B. C., Mollo, B., Cresta, M., Bouscarat, F., Choquet, C., Descamps, D., Ghosn, J., Lescure, F. X., Yazdanpanah, Y., Joly, V., Peiffer-Smadja, N.. 2022/08/27 (2022): #pages#–> 10.1016/j.cmi.2022.08.012 ; #URL#

  9. Natural history of Human Monkeypox in individuals attending a sexual health clinic in Milan, Italy ( 1262) J Infect . Moschese, D., Pozza, G., Giacomelli, A., Mileto, D., Cossu, M. V., Beltrami, M., Rizzo, A., Gismondo, M. R., Rizzardini, G., Antinori, S.. 2022/08/26 (2022): #pages#–> 10.1016/j.jinf.2022.08.019 ; #URL#

  10. Genitourinary Lesions Due to Monkeypox ( 1440) Eur Urol . Gomez-Garberi, M., Sarrio-Sanz, P., Martinez-Cayuelas, L., Delgado-Sanchez, E., Bernabeu-Cabezas, S., Peris-Garcia, J., Sanchez-Caballero, L., Nakdali-Kassab, B., Egea-Sancho, C., Olarte-Barragan, E., Ortiz-Gorraiz, M.. 2022/09/13 (2022): #pages#–> 10.1016/j.eururo.2022.08.034 ; #URL#

  11. Clinical Use of Tecovirimat (Tpoxx) for Treatment of Monkeypox Under an Investigational New Drug Protocol - United States, May-August 2022 ( 1486) MMWR Morb Mortal Wkly Rep . O’Laughlin, K., Tobolowsky, F. A., Elmor, R., Overton, R., O’Connor, S. M., Damon, I. K., Petersen, B. W., Rao, A. K., Chatham-Stephens, K., Yu, P., Yu, Y.. 71,2022/09/16 (2022): 1190–> 10.15585/mmwr.mm7137e1 ; #URL#

  12. Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study ( 1748) Lancet Infect Dis . Angelo, K. M., Smith, T., Camprubí-Ferrer, D., Balerdi-Sarasola, L., Díaz Menéndez, M., Servera-Negre, G., Barkati, S., Duvignaud, A., Huber, K. L. B., Chakravarti, A., Bottieau, E., Greenaway, C., Grobusch, M. P., Mendes Pedro, D., Asgeirsson, H., Popescu, C. P., Martin, C., Licitra, C., de Frey, A., Schwartz, E., Beadsworth, M., Lloveras, S., Larsen, C. S., Guagliardo, S. A. J., Whitehill, F., Huits, R., Hamer, D. H., Kozarsky, P., Libman, M.. 2022/10/11 (2022): #pages#–> 10.1016/s1473-3099(22)00651-x ; #URL#

  13. Estimation of the serial interval of monkeypox during the early outbreak in 2022 ( 1895) J Med Virol . Guo, Z., Zhao, S., Sun, S., He, D., Chong, K. C., Yeoh, E. K.. 2022/10/23 (2022): #pages#–> 10.1002/jmv.28248 ; #URL#

  14. Serial interval and incubation period estimates of monkeypox virus infection in 12 U.S. jurisdictions, May - August 2022 ( 2007) medRxiv . Madewell, Zachary, Charniga, Kelly, Masters, Nina, Asher, Jason, Fahrenwald, Lily, Still, William, Chen, Judy, Kipperman, Naama, Bui, David, Shea, Meghan, Saathoff-Huber, Lori, Johnson, Shannon, Harbi, Khalil, Berns, Abby, Perez, Taidy, Gateley, Emily, Spicknall, Ian, Nakazawa, Yoshinori, Gift, Thomas. #volume# (2022): #pages#–> 10.1101/2022.10.26.22281516 ; http://europepmc.org/abstract/PPR/PPR564657 https://doi.org/10.1101/2022.10.26.22281516

  15. Transmission dynamics of monkeypox in the United Kingdom: contact tracing study ( 2069) Bmj . Ward, T., Christie, R., Paton, R. S., Cumming, F., Overton, C. E.. 379,2022/11/03 (2022): e073153–> 10.1136/bmj-2022-073153 ; #URL#

  16. National Monkeypox Surveillance, Central African Republic, 2001-2021 ( 2104) Emerg Infect Dis . Besombes, C., Mbrenga, F., Schaeffer, L., Malaka, C., Gonofio, E., Landier, J., Vickos, U., Konamna, X., Selekon, B., Dankpea, J. N., Von Platen, C., Houndjahoue, F. G., Ouaïmon, D. S., Hassanin, A., Berthet, N., Manuguerra, J. C., Gessain, A., Fontanet, A., Yandoko, E. N.. 28,2022/11/04 (2022): #pages#–> 10.3201/eid2812.220897 ; https://wwwnc.cdc.gov/eid/article/28/12/22-0897_article

  17. Monkeypox outbreak 2022 – an overview of all cases reported to the Cologne Health Department ( 2181) Research Square . Kröger, Sophia Toya, Lehmann, Max Christian, Treutlein, Melanie, Fiethe, Achim, Kossow, Annelene, Küfer-Weiß, Annika, Nießen, Johannes, Grüne, Barbara. #volume# (2022): #pages#–> 10.21203/rs.3.rs-2251751/v1 ; http://europepmc.org/abstract/PPR/PPR570380 https://doi.org/10.21203/rs.3.rs-2251751/v1

  18. Time scales of human monkeypox transmission in the Netherlands ( 2405) medRxiv . Miura, Fuminari, Backer, Jantien, van Rijckevorsel, Gini, Bavalia, Roisin, Raven, Stijn, Petrignani, Mariska, Ainslie, Kylie E. C., Wallinga, Jacco. #volume# (2022): #pages#–> 10.1101/2022.12.03.22283056 ; http://europepmc.org/abstract/PPR/PPR579534 https://doi.org/10.1101/2022.12.03.22283056

 


7 Archive: acute outbreak phase

With reporting frequencies declining, and with new WHO guidance specifying monthly reporting intervals, it is no longer reliable to present cases by week of report. However, in an effort to retain data availability, we present a record of the acute phase of the 2022-2023 outbreak by reporting week. While the end of the acute phase of the outbreak is not explicitly defined, we present data from 1 January 2022 to 14 April 2023, which corresponds to the week when mpox was no longer considered to be a public health emergency of international concern.

Regional trends are shown below:

7.1 Epidemic curve by date of notification (cases)

Epidemic curve shown by month for cases reported up to 14 April 2023.

7.2 Epidemic curve by date of notification (deaths)

Epidemic curve shown by month for deaths reported up to 14 April 2023.

7.3 Epidemic curve by WHO region (cases)

Epidemic curve shown by month for cases reported up to 14 April 2023. Note different y-axis scales.

 


8 Disclaimers

8.1 Data Overview and Visualizations

The WHO 2022-23 mpox global trends report aims to provide frequently updated data visualizations. Caution must be taken when interpreting all data presented, and differences between information products published by WHO, national public health authorities, and other sources using different inclusion criteria and different data cut-off times are to be expected. While steps are taken to ensure accuracy and reliability, all data are subject to continuous verification and change. All counts are subject to variations in case detection, definitions, laboratory testing, and reporting strategies between countries, states and territories.

WHO makes no warranties or representations regarding the contents, appearance, completeness, technical specifications, or accuracy of the report. WHO disclaims all responsibility relating to, and shall not be liable for, any use of the report, the results of such use, or the reliance thereon.

WHO reserves the right to make updates and changes to the report without notice, and accepts no liability for any errors or omissions in this regard.

The user of the report is responsible for the interpretation and use of the analysis and outputs performed by the report. The submission of content to the report does not imply WHO’s approval or endorsement of that content, or that the content is appropriate for any purpose or meets any established standard or requirement

Any designations employed or presentation by the user in its use of the app, including tables and maps, do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries.

All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).

A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).

9 Acknowledgements

We gratefully acknowledge the input of national public health staff involved in surveillance activities and data submission to WHO, the European Centre for Disease Prevention and Control (ECDC) for the provision of surveillance data collected via the TESSy platform, as well as external partners who contributed additional insights and contextual information on the data.