Key Figures

1 Overview

This report provides a global overview of the mpox¹ epidemiological situation as reported to WHO as of 14 August 2023. The report focuses on 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. This report should be considered in the context of other WHO information products associated with the 2022-23 mpox outbreak, and mpox in general:

The biweekly 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, replacing the previous Disease Outbreak News format;
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).

Links to these products can be see in more detail at the end of the report.

Since 1 January 2022, cases of mpox have been reported to WHO from 113 Member States across all 6 WHO regions. As of 14 August 2023 at 17h CEST, a total of 89,391 laboratory confirmed cases and 662 probable cases, including 153 deaths, have been reported to WHO. Since 13 May 2022, a high proportion of these cases have been reported from countries without previously documented mpox transmission. This is the first time that cases and sustained chains of transmission have been reported in countries without direct or immediate epidemiological links to areas of West or Central Africa.

With the exception of countries^3,4 in West and Central Africa, 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. The unexpected appearance of mpox in several regions in the initial absence of epidemiological links to areas in West and Central Africa, suggests that there may have been undetected transmission for some time.

WHO assesses the global risk as Moderate. Regionally, WHO assesses the risk in the Moderate in the African Region, Eastern Mediterranean Region, European Region and Region of the Americas, and Low in the South-East Asia Region and Western Pacific Region. The IHR Emergency Committee on the multi-country outbreak of mpox held its fifth meeting on 10 May 2023. Having considered the views of committee members and advisors as well as other factors in line with the International Health Regulations (2005), the WHO Director-General determined that this outbreak no longer constitutes a public health emergency of international concern and issued revised temporary recommendations for a transitionary period towards a long-term mpox control strategy.

It should be noted that at the present stage of the 2022-23 global mpox outbreak, where reported cases are low, frequency of reporting of cases has decreased substantially. 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.

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.
For the WHO European region, both confirmed and probable cases are included within confirmed case counts and detailed case data.
Throughout this document, any use of the word country should be considered shorthand for a country, area, or territory
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

The number of weekly¹ reported new cases globally has increased by 1443.2% in week 32 (07 Aug - 13 Aug) (n = 571 cases) compared to week 31 (31 Jul - 06 Aug) (n = 37 cases). The majority of cases reported in the past 4 weeks were notified from the Western Pacific Region (64.3%) and the Region of the Americas (16%).

The 10 most affected countries globally are: United States of America (n = 30,446), Brazil (n = 10,967), Spain (n = 7,565), France (n = 4,150), Colombia (n = 4,090), Mexico (n = 4,045), Peru (n = 3,812), The United Kingdom (n = 3,771), Germany (n = 3,694), and Canada (n = 1,496). Together, these countries account for 82.8% of the cases reported globally.

In the most recent week of full reporting, 9 countries reported an increase in the weekly number of cases, with the highest increase reported in China. In the past 21 days, 16 countries have reported cases.

Global data are data collected by public sources. These data are largely aggregated cases that have been reported from official country sources. The below epidemic curve shows the aggregated number of cases by week according to the date of case reporting.

2.1 Epidemic curves

2.1.1 Global (cases)

Epidemic curve shown for cases reported up to 13 Aug 2023 to avoid showing incomplete weeks of data.

2.1.2 Global (deaths)

Epidemic curve shown for deaths reported up to 13 Aug 2023 to avoid showing incomplete weeks of data.

2.1.3 By WHO Region (cases)

Epidemic curve shown for cases reported up to 13 Aug 2023 to avoid showing incomplete weeks of data. Note different y-axis scales.

2.1.4 By WHO Region (deaths)

Epidemic curve shown for deaths reported up to 13 Aug 2023 to avoid showing incomplete weeks of data. Note different y-axis scales.

2.1.5 Top 10 countries (cases)

Epidemic curve shown for cases reported up to 13 Aug 2023 to avoid showing incomplete weeks of data. Note different y-axis scales.

2.2 Recent trends

In recent months, the number of cases reported weekly has declined substantially from the global peak of 7,576 cases observed in the week of 08 Aug 2022. In the last twelve weeks (22 May 2023 - 13 Aug 2023):

On average, at the global level, 146 cases have been observed weekly.
The most affected region was the Western Pacific Region, where 904 cases and 0 deaths have been reported. This is followed by the Region of the Americas (368 cases, 9 deaths), and the African Region (205 cases, 0 deaths)

2.2.1 Global (cases)

Epidemic curve shown for cases reported up to 13 Aug 2023 to avoid showing incomplete weeks of data.

2.2.2 Global (deaths)

Epidemic curve shown for deaths reported up to 13 Aug 2023 to avoid showing incomplete weeks of data.

2.2.3 By WHO Region (cases)

Epidemic curve shown for cases reported up to 13 Aug 2023 to avoid showing incomplete weeks of data. Note different y-axis scales.

2.2.4 Top 10 countries (cases)

Epidemic curve shown for cases reported up to 13 Aug 2023 to avoid showing incomplete weeks of data. Note different y-axis scales.

2.3 Maps

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

2.3.1 Cumulative cases

2.3.2 Cases in the past 3 weeks

2.3.3 Three-week change in cases

2.4 Tables

2.4.1 Cumulative cases and deaths by WHO Region

	Total Confirmed Cases	Total Probable Cases	Total Deaths	^1,2">Cases in the last 3 weeks^1,2	^1,3">Cases in the preceding 3 weeks^1,3	^1,4">3-Week % change in cases^1,4
Total mpox cases, by WHO region
From 1 Jan 2022. Data as of 14 Aug 2023
Region of the Americas	59,738	662	123	100	84	19%
European Region	26,000	0	7	65	23	183%
African Region	1,902	0	20	0	100	–
Western Pacific Region	1,444	0	0	533	70	661%
South-East Asia Region	217	0	2	0	63	–
Eastern Mediterranean Region	90	0	1	0	0	–
Total	89,391	662	153	698	340	105%
¹ Using most recently complete international standard week (Monday - Sunday)
² 24 Jul 2023 to 13 Aug 2023
³ 03 Jul 2023 to 23 Jul 2023
⁴ 03 Jul 2023 to 13 Aug 2023

2.4.2 Cumulative cases and deaths by country

	Total Confirmed Cases	Total Probable Cases	Total Deaths
Total Mpox cases, by WHO region
From 1 Jan 2022. Data as of 14 Aug 2023
Region of the Americas
United States of America	30,446	0	46
Brazil	10,967	349	16
Colombia	4,090	0	0
Mexico	4,045	52	30
Peru	3,812	0	20
Canada	1,496	78	0
Chile	1,442	26	3
Argentina	1,129	0	2
Ecuador	557	1	3
Guatemala	405	5	1
Bolivia (Plurinational State of)	265	0	0
Panama	237	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
Aruba	3	0	0
Curaçao	3	0	0
Trinidad and Tobago	3	0	0
Bahamas	3	0	0
Guyana	2	0	0
Guadeloupe	1	0	0
Saint Martin	1	0	0
Barbados	1	0	0
Bermuda	1	0	0
European Region
Spain	7,565	0	3
France	4,150	0	0
The United Kingdom	3,771	0	0
Germany	3,694	0	0
Netherlands	1,266	0	0
Portugal	1,005	0	1
Italy	958	0	0
Belgium	795	0	2
Switzerland	554	0	0
Austria	328	0	0
Israel	263	0	0
Sweden	260	0	0
Ireland	229	0	0
Poland	217	0	0
Denmark	196	0	0
Norway	96	0	0
Greece	88	0	0
Hungary	80	0	0
Czechia	71	0	1
Luxembourg	58	0	0
Romania	47	0	0
Slovenia	47	0	0
Finland	42	0	0
Serbia	40	0	0
Malta	34	0	0
Croatia	33	0	0
Iceland	16	0	0
Slovakia	14	0	0
Türkiye	12	0	0
Estonia	11	0	0
Bosnia and Herzegovina	9	0	0
Gibraltar	6	0	0
Latvia	6	0	0
Bulgaria	6	0	0
Lithuania	5	0	0
Ukraine	5	0	0
Cyprus	5	0	0
Andorra	4	0	0
Monaco	3	0	0
Georgia	2	0	0
Greenland	2	0	0
Montenegro	2	0	0
Republic of Moldova	2	0	0
Russian Federation	2	0	0
San Marino	1	0	0
Western Pacific Region
China¹	892	0	0
Japan	194	0	0
Australia	147	0	0
Republic of Korea	134	0	0
New Zealand	41	0	0
Singapore	26	0	0
Philippines	5	0	0
Viet Nam	3	0	0
Guam	1	0	0
New Caledonia	1	0	0
African Region
Nigeria	843	0	9
Democratic Republic of the Congo	834	0	2
Ghana	127	0	4
Cameroon	41	0	3
Central African Republic	30	0	1
Liberia	13	0	0
Congo	5	0	0
South Africa	5	0	0
Benin	3	0	0
Mozambique	1	0	1
South-East Asia Region
Thailand	189	0	1
India	22	0	1
Sri Lanka	4	0	0
Indonesia	1	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
Qatar	5	0	0
Pakistan	5	0	0
Morocco	3	0	0
Egypt	3	0	0
Bahrain	2	0	0
Jordan	1	0	0
Iran (Islamic Republic of)	1	0	0
-
Total	89,391	662	153
¹ Cases shown include those in mainland China (601), Hong Kong SAR (35) and Taipei (256)

2.4.3 Recent trends - African Region

Country	^1,2">Cases in past twelve weeks^1,2	Total number of cases	Total cases per 1M inhabitants	^1,3">Cases in past 3 weeks^1,3	^1,4">Cases in preceding 3 weeks^1,4	3 week % change in cases	Date case last reported
Democratic Republic of the Congo	193	834	9.3	0	75	–	14 Jul 2023
Cameroon	11	41	1.5	0	0	–	23 Jun 2023
Nigeria	1	843	4.1	0	0	–	09 Jun 2023
Benin	0	3	0.2	0	0	–	24 Jun 2022
Central African Republic	0	30	6.2	0	0	–	24 Mar 2023
Congo	0	5	0.9	0	0	–	09 Sep 2022
Ghana	0	127	4.1	0	0	–	12 May 2023
Liberia	0	13	2.6	0	0	–	12 May 2023
Mozambique	0	1	0.0	0	0	–	07 Oct 2022
South Africa	0	5	0.1	0	0	–	26 Aug 2022
¹ Using international standard weeks (Monday - Sunday). Weeks are only included when complete.
² 22 May 2023 to 13 Aug 2023
³ 24 Jul 2023 to 13 Aug 2023
⁴ 03 Jul 2023 to 23 Jul 2023

2.4.4 Recent trends - Region of the Americas

Country	^1,2">Cases in past twelve weeks^1,2	Total number of cases	Total cases per 1M inhabitants	^1,3">Cases in past 3 weeks^1,3	^1,4">Cases in preceding 3 weeks^1,4	3 week % change in cases	Date case last reported
United States of America	252	30,446	92.0	93	29	220.0%	08 Aug 2023
Mexico	28	4,045	31.4	6	8	−25.0%	01 Aug 2023
Brazil	26	10,967	51.6	0	6	–	19 Jul 2023
Ecuador	24	557	31.6	0	24	–	19 Jul 2023
Canada	12	1,496	39.6	0	0	–	24 May 2023
Peru	12	3,812	115.6	0	0	–	28 Jun 2023
Panama	5	237	54.9	0	0	–	21 Jun 2023
Costa Rica	3	225	44.2	0	0	–	07 Jun 2023
Trinidad and Tobago	3	3	2.1	1	2	−50.0%	25 Jul 2023
Bahamas	1	3	7.6	0	0	–	21 Jun 2023
Chile	1	1,442	75.4	0	1	–	12 Jul 2023
Paraguay	1	126	17.7	0	0	–	07 Jun 2023
Argentina	0	1,129	25.0	0	0	–	03 May 2023
Aruba	0	3	28.1	0	0	–	14 Sep 2022
Barbados	0	1	3.5	0	0	–	20 Jul 2022
Bermuda	0	1	16.1	0	0	–	20 Jul 2022
Bolivia (Plurinational State of)	0	265	22.7	0	0	–	01 Mar 2023
Colombia	0	4,090	80.4	0	0	–	19 Apr 2023
Cuba	0	8	0.7	0	0	–	09 Nov 2022
Curaçao	0	3	18.3	0	0	–	21 Sep 2022
Dominican Republic	0	52	4.8	0	0	–	05 Oct 2022
El Salvador	0	104	16.0	0	0	–	05 Apr 2023
Guadeloupe	0	1	2.5	0	0	–	03 Aug 2022
Guatemala	0	405	22.6	0	0	–	10 May 2023
Guyana	0	2	2.5	0	0	–	31 Aug 2022
Honduras	0	44	4.4	0	0	–	10 May 2023
Jamaica	0	21	7.1	0	0	–	29 Mar 2023
Martinique	0	7	18.7	0	0	–	11 Jan 2023
Puerto Rico	0	211	73.8	0	0	–	08 Mar 2023
Saint Martin	0	1	25.9	0	0	–	03 Aug 2022
Uruguay	0	19	5.5	0	0	–	21 Dec 2022
Venezuela (Bolivarian Republic of)	0	12	0.4	0	0	–	21 Dec 2022
¹ Using international standard weeks (Monday - Sunday). Weeks are only included when complete.
² 22 May 2023 to 13 Aug 2023
³ 24 Jul 2023 to 13 Aug 2023
⁴ 03 Jul 2023 to 23 Jul 2023

2.4.5 Recent trends - Eastern Mediterranean Region

Country	^1,2">Cases in past twelve weeks^1,2	Total number of cases	Total cases per 1M inhabitants	^1,3">Cases in past 3 weeks^1,3	^1,4">Cases in preceding 3 weeks^1,4	3 week % change in cases	Date case last reported
Pakistan	2	5	0.0	0	0	–	25 May 2023
Bahrain	0	2	1.2	0	0	–	16 Apr 2023
Egypt	0	3	0.0	0	0	–	12 Dec 2022
Iran (Islamic Republic of)	0	1	0.0	0	0	–	18 Aug 2022
Jordan	0	1	0.1	0	0	–	08 Sep 2022
Lebanon	0	27	4.0	0	0	–	09 Mar 2023
Morocco	0	3	0.1	0	0	–	29 Aug 2022
Qatar	0	5	1.7	0	0	–	20 Sep 2022
Saudi Arabia	0	8	0.2	0	0	–	30 Aug 2022
Sudan	0	19	0.4	0	0	–	05 Apr 2023
United Arab Emirates	0	16	1.6	0	0	–	24 Jul 2022
¹ Using international standard weeks (Monday - Sunday). Weeks are only included when complete.
² 22 May 2023 to 13 Aug 2023
³ 24 Jul 2023 to 13 Aug 2023
⁴ 03 Jul 2023 to 23 Jul 2023

2.4.6 Recent trends - Table - European Region

Country	^1,2">Cases in past twelve weeks^1,2	Total number of cases	Total cases per 1M inhabitants	^1,3">Cases in past 3 weeks^1,3	^1,4">Cases in preceding 3 weeks^1,4	3 week % change in cases	Date case last reported
Portugal	52	1,005	97.6	40	10	300.0%	10 Aug 2023
The United Kingdom	29	3,771	55.5	10	8	25.0%	07 Aug 2023
Spain	14	7,565	159.8	6	0	–	10 Aug 2023
France	4	4,150	63.8	3	1	200.0%	07 Aug 2023
Germany	3	3,694	44.4	3	0	–	07 Aug 2023
Belgium	2	795	69.0	0	0	–	07 Jun 2023
Netherlands	2	1,266	72.7	1	0	–	10 Aug 2023
Switzerland	2	554	64.0	0	0	–	19 Jun 2023
Israel	1	263	30.4	0	0	–	26 Jun 2023
Italy	1	958	16.1	1	0	–	10 Aug 2023
Luxembourg	1	58	92.6	1	0	–	10 Aug 2023
Norway	1	96	17.9	0	1	–	05 Jul 2023
Andorra	0	4	51.8	0	0	–	05 Aug 2022
Austria	0	328	36.8	0	0	–	18 Apr 2023
Bosnia and Herzegovina	0	9	2.7	0	0	–	12 Oct 2022
Bulgaria	0	6	0.9	0	0	–	13 Sep 2022
Croatia	0	33	8.1	0	0	–	17 Jan 2023
Cyprus	0	5	5.6	0	0	–	29 Aug 2022
Czechia	0	71	6.6	0	0	–	02 Dec 2022
Denmark	0	196	33.7	0	0	–	31 Jan 2023
Estonia	0	11	8.3	0	0	–	13 Sep 2022
Finland	0	42	7.6	0	0	–	04 Nov 2022
Georgia	0	2	0.5	0	0	–	17 Aug 2022
Gibraltar	0	6	178.1	0	0	–	11 Aug 2022
Greece	0	88	8.2	0	0	–	03 May 2023
Greenland	0	2	35.2	0	0	–	10 Aug 2022
Hungary	0	80	8.2	0	0	–	25 Oct 2022
Iceland	0	16	43.9	0	0	–	05 Oct 2022
Ireland	0	229	46.1	0	0	–	03 May 2023
Latvia	0	6	3.1	0	0	–	05 Oct 2022
Lithuania	0	5	1.8	0	0	–	11 Aug 2022
Malta	0	34	66.1	0	0	–	28 Mar 2023
Monaco	0	3	76.4	0	0	–	12 Aug 2022
Montenegro	0	2	3.2	0	0	–	22 Aug 2022
Poland	0	217	5.7	0	0	–	11 Apr 2023
Republic of Moldova	0	2	0.5	0	0	–	17 Aug 2022
Romania	0	47	2.4	0	0	–	17 Jan 2023
Russian Federation	0	2	0.0	0	0	–	11 Sep 2022
San Marino	0	1	29.5	0	0	–	10 Oct 2022
Serbia	0	40	5.8	0	0	–	21 Sep 2022
Slovakia	0	14	2.6	0	0	–	04 Sep 2022
Slovenia	0	47	22.4	0	0	–	26 Sep 2022
Sweden	0	260	25.2	0	0	–	31 Jan 2023
Türkiye	0	12	0.1	0	0	–	05 Oct 2022
Ukraine	0	5	0.1	0	0	–	10 Oct 2022
¹ Using international standard weeks (Monday - Sunday). Weeks are only included when complete.
² 22 May 2023 to 13 Aug 2023
³ 24 Jul 2023 to 13 Aug 2023
⁴ 03 Jul 2023 to 23 Jul 2023

2.4.7 Recent trends - South-East Asia Region

Country	^1,2">Cases in past twelve weeks^1,2	Total number of cases	Total cases per 1M inhabitants	^1,3">Cases in past 3 weeks^1,3	^1,4">Cases in preceding 3 weeks^1,4	3 week % change in cases	Date case last reported
Thailand	163	189	2.7	0	63	–	14 Aug 2023
Sri Lanka	2	4	0.2	0	0	–	08 Jun 2023
Nepal	1	1	0.0	0	0	–	16 Jun 2023
India	0	22	0.0	0	0	–	20 Jan 2023
Indonesia	0	1	0.0	0	0	–	22 Aug 2022
¹ Using international standard weeks (Monday - Sunday). Weeks are only included when complete.
² 22 May 2023 to 13 Aug 2023
³ 24 Jul 2023 to 13 Aug 2023
⁴ 03 Jul 2023 to 23 Jul 2023

2.4.8 Recent trends - Western Pacific Region

Country	^1,2">Cases in past twelve weeks^1,2	Total number of cases	Total cases per 1M inhabitants	^1,3">Cases in past 3 weeks^1,3	^1,4">Cases in preceding 3 weeks^1,4	3 week % change in cases	Date case last reported
China	801	892	0.6	522	159	230.0%	11 Aug 2023
Republic of Korea	54	134	2.6	8	9	−11.0%	08 Aug 2023
Japan	45	194	1.5	1	7	−86.0%	31 Jul 2023
Australia	2	147	5.8	2	0	–	02 Aug 2023
Singapore	1	26	4.4	0	1	–	20 Jul 2023
Viet Nam	1	3	0.0	0	1	–	11 Jul 2023
Guam	0	1	5.9	0	0	–	12 Sep 2022
New Caledonia	0	1	3.5	0	0	–	12 Jul 2022
New Zealand	0	41	8.5	0	0	–	12 Jan 2023
Philippines	0	5	0.0	0	0	–	13 May 2023
¹ Using international standard weeks (Monday - Sunday). Weeks are only included when complete.
² 22 May 2023 to 13 Aug 2023
³ 24 Jul 2023 to 13 Aug 2023
⁴ 03 Jul 2023 to 23 Jul 2023

2.4.9 Countries reporting cases in the previous 21 days

	Last Reported Case	Days Elapsed
Days since last reported case
As of 14 Aug 2023
South-East Asia Region
Thailand	14 Aug 2023	0
Western Pacific Region
China	11 Aug 2023	3
Republic of Korea	8 Aug 2023	6
Australia	2 Aug 2023	12
Japan	31 Jul 2023	14
European Region
Italy	10 Aug 2023	4
Luxembourg	10 Aug 2023	4
Netherlands	10 Aug 2023	4
Portugal	10 Aug 2023	4
Spain	10 Aug 2023	4
France	7 Aug 2023	7
Germany	7 Aug 2023	7
The United Kingdom	7 Aug 2023	7
Region of the Americas
United States of America	8 Aug 2023	6
Mexico	1 Aug 2023	13
Trinidad and Tobago	25 Jul 2023	20

Weekly reported cases, and weekly cases shown in the epidemic curve are aggregated according to international standard weeks, running from Monday to Sunday.

3 Detailed case data

Detailed case data are acquired via direct reporting of case based data via WHO Member States. Data from cases are reported¹ according to the WHO minimum dataset under the International Health Regulations (IHR 2005) Article 6, and subsequently aggregated and presented below. Note that completeness of records is variable, meaning denominators for each output may be different from one another. All of the following is derived from the 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.

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 15 August 2023. As of this date, the total number of detailed confirmed cases reported is 87,006, representing 97.3% 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.

Note that for all tables below, in order to best align modes of reporting, total confirmed cases are shown as of:

The most recent Friday (11 August) for data in the Region of the Americas.
The most recent Tuesday (08 August) for data in the European Region.

Total cases shown fully as of 14 August are shown in the global trends section.

3.1.1 Table - Coverage by region

	Total Confirmed Cases	²">Total Detailed Confirmed Cases²	% Detailed Cases reported
Mpox reporting completeness
As of 14 Aug 2023¹
Region of the Americas	59,738	58,877	98.6%
European Region	25,989	25,853	99.5%
African Region	1,902	672	35.3%
Western Pacific Region	1,444	1,392	96.4%
South-East Asia Region	217	147	67.7%
Eastern Mediterranean Region	90	65	72.2%
¹ Total confirmed cases shown as of date of last detailed case report for the WHO Region of the Americas and WHO European Region.
² Note that in rare cases total detailed cases may exceed total confirmed cases due to ongoing data cleaning issues

3.2 Trends in cases

Trends in cases are shown for all submitted detailed cases. These are shown by:

Date of symptom onset
Date of lab or clinical diagnosis (if date of symptom onset is not available)
Date of reporting (if date of symptom onset and date of diagnosis are not available)

Note that reporting of detailed cases is subject to some delay. The epidemic curves shown are not right censored, and therefore trends in the most recent 1-3 weeks should be interpreted with caution. It should be additionally noted that date of report does not reflect the date of reporting to WHO, but rather reporting to national or regional authorities.

Delay between date of onset and date of report were calculated for all countries where reporting quality passed minimum quality checks. Delays were only shown when the time between onset and reporting was between -5 and 40 days.

Median delay between onset and reporting was 6 days
The interquartile range between onset and reporting was 4-9 days.

3.2.1 Overall by date of symptom onset

3.2.2 By date of onset and by WHO region

3.2.3 By date of onset and by country (top 10 total cases)

Note different y-axis scales per country.

3.2.4 By date of onset and by age group

Note different y-axis scales per age group

3.2.5 By date of onset and by sexual orientation

Note that reported sexual orientation does not necessarily reflect who the case has had recent sexual history with nor does it imply sexual activity. Other sexual orientations include heterosexual people, women who have sex with women, and other sexual orientations. Note different y-axis scales.

3.2.6 Proportion of MSM and proportion of males by date of report

Proportion of cases who are men who have sex with men, and proportion of cases who are male are used to monitor the spillover of cases from networks of men who have sex with men to the general population. In both plots below, the denominator is defined as all detailed cases where a sexual orientation (top) or sex (bottom) has been reported. Shaded areas represent 95% confidence intervals.

Note that reported sexual orientation does not necessarily reflect who the case has had recent sexual history with nor does it imply sexual activity.

3.3 Case profile (overall)

As shown below, and stated previously, the ongoing outbreak is largely developing in men who have sex with men (defined as homosexual or bisexual males in detailed case forms) networks. In the following analyses, we have re-coded men reported as bisexual as men who have sex with men. Note that reported sexual orientation 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 hospitalisations and deaths:

Key features of these cases are as follows:

96.3% (80,419/83,487) 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 79.3% of cases.
Of all cases with available data, 3.7% (3,068/83,487) are female:
- The majority of of these cases are reported from the Region of the Americas (2,294/3,068; 75%) and the European Region (433/3,068; 14%)
- Of the cases where sexual orientation is reported, the majority are Heterosexual (1,020/1,063; 96%).
- The most commonly reported exposure setting is in a household (65/135; 48%), and the most common form of transmission is via sexual encounters (262/511; 51%)
Of the 86,455 cases where age was available, there were 1137 (1.3%) cases reported aged 0-17, out of which 331 (0.4%) were aged 0-4:
- The majority of cases aged 0-17 are reported from the Region of the Americas (706 /1,137; 62%).
- Of the cases aged 0-17, 1 has reported exposure in a school setting.
62 female cases were reported to be pregnant or recently pregnant. Of these:
- 8, 12, and 11 cases were in their first, second, and third trimesters respectively. 31 were in an unknown trimester, and 0 were six weeks or less post partum.
- The median age was 28 years old (IQR: 23 - 31).
- 16 of these cases were known to be hospitalised. 0 were known to be admitted to ICU, and hospitalised. 0 were known to have died.
- The most common mode of transmission was sexual encounter (4/11 cases where route was known). The most common exposure setting was household (6/6 cases where setting was known).
Among cases with known data on sexual orientation, 82.8% (27,356/33,056) identified as men who have sex with men. Of those identified as men who have sex with men, 2,103/27,356 (7.7%) were identified as bisexual men.
Among those with known HIV status 52.5% (17,811/33,912) were HIV-positive. Note that information on HIV status is not available for the majority of cases, and for those for which it is available, it is likely to be skewed towards those reporting positive HIV results.
1,319 cases were reported to be health workers. However, most were exposed in the community and further investigation is ongoing to determine whether the remaining infection was due to occupational exposure.
Of all reported types of transmission, a sexual encounter was reported most commonly, with 17,923 of 21,739 (82.4%) 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 4,051 of 6,346 (63.8%) of all reported exposure events.

3.3.1 Demographic Information

Note that the proportions shown below should be interpreted with caution. When considering some variables, it is more likely that a yes response will be obtained when compared to a no response after consideration of true proportions of these factors. This is most likely to be true for variables where reported answers can only be yes or no, such as HIV status, health worker status, travel history, hospitalisation, ICU, and death.

	¹"> Reported values¹		Unknown or Missing Value
Case profiles
As of 15 Aug 2023
	Yes	No	Unknown or Missing Value
Men who have sex with men	27,356 (82.8%)	5,700 (17.2%)	53,938
HIV-Positive	17,808 (52.5%)	16,100 (47.5%)	53,086
Health worker	1,319 (4.6%)	27,619 (95.4%)	58,056
Travel History	3,752 (15.0%)	21,199 (85.0%)	62,043
Sexual Transmission	17,921 (82.4%)	3,816 (17.6%)	65,257
Hospitalised²	5,445 (10.9%)	44,686 (89.1%)	36,863
ICU	49 (0.3%)	14,460 (99.7%)	72,485
Died	127 (0.2%)	54,048 (99.8%)	32,819
¹ Note given true proportions of variables, yes reporting may be common than no reporting
² May be hospitalised for isolation or medical treatment

3.3.2 Age-sex pyramid

3.3.3 Age-sex pyramid by region

Note that only regions with 50 or more cases with age and sex information are shown. Note different x-axis scales.

3.3.4 Age-sex pyramid (Hospitalised cases)

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

3.3.5 Age-sex pyramid (ICU cases)

3.3.6 Sexual orientation by region

3.3.7 Transmission type

Transmission data were available for 21,739/87,006 (25.0%) of cases.

Note that 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, mpox virus has been isolated from semen samples and rectal swabs from confirmed cases. Note that person to person contact does not include known sexual, healthcare-associated, and mother to child transmission.

3.3.8 Exposure settings

Exposure setting data were available for 7,543/87,006 (8.7%) 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.

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

The following outputs apply to cases that are not men who have sex with men, and sexual orientation is known. Other categories of sexual orientation that are reportable are:

Heterosexual
Lesbian (women who have sex with women)
Other

As stated above, men who have sex with men in this case refers to those who have a reported sexual orientation of men who have sex with men, and men reported as bisexual. As above, note that reported sexual orientation 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 2022-23 multi-country mpox outbreak has been overwhelmingly concentrated in networks of men who have sex with men For this reason, understanding events in which individuals of other sexual orientation have acquired mpox is important to monitor potential of sustained spillover into the general population.

81.5% (4626/5674) of cases with available data are male; the median age is 33 years (IQR: 27-40).
Males between 18-44 years old account for 67.4% of cases.
Among those with known HIV status 33.9% (1490/4399) were HIV-positive. Note that information on HIV status is not available for the majority of cases, and for those for which it is available, it is likely to be skewed towards those reporting positive HIV results.
168 cases were reported to be health workers. However, most were exposed in the community and further investigation is ongoing to determine whether the remaining infection was due to occupational exposure.
Of all reported types of transmission, sexual encounter was reported most commonly, with 1,338 of 2,030 (65.9%) of all reported transmission events.
Of all settings in which cases were likely exposed, the most common was in households, with 248 of 516 (48.1%) of all likely exposure categories.

3.4.1 Demographic Information

Note that the proportions shown below should be interpreted with caution. When considering some variables, it is more likely that a yes response will be obtained when compared to a no response after consideration of true proportions of these factors. This is most likely to be true for variables where reported answers can only be yes or no, such as HIV status, health worker status, travel history, hospitalisation, ICU, and death.

	¹"> Reported values¹		Unknown or Missing Value
Case profiles (excluding men who have sex with men)
As of 15 Aug 2023
	Yes	No	Unknown or Missing Value
Men who have sex with men	0	5,700 (100.0%)	0
HIV-Positive	1,490 (33.9%)	2,909 (66.1%)	1,301
Health worker	168 (9.8%)	1,550 (90.2%)	3,982
Travel History	358 (10.6%)	3,032 (89.4%)	2,310
Sexual Transmission	1,338 (65.9%)	692 (34.1%)	3,670
Hospitalised²	551 (20.9%)	2,085 (79.1%)	3,064
ICU	13 (1.1%)	1,208 (98.9%)	4,479
Died	11 (0.4%)	2,834 (99.6%)	2,855
¹ Note given true proportions of variables, yes reporting may be common than no reporting
² May be hospitalised for isolation or medical treatment

3.4.2 Age-sex pyramid

3.4.3 Transmission type

Transmission data were available for 2,030/5,700 (35.6%) of cases.

Note that 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, mpox virus has been isolated from semen samples and rectal swabs from confirmed cases. Note that person to person contact does not include known sexual, healthcare-associated, and mother to child transmission.

All Genders

Male

Female

3.4.4 Exposure settings

Exposure setting data were available for 565/5,700 (9.9%) 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 Genders

Male

Female

3.5 Case profile (recent cases)

This section of the report pertains specifically to the most recent twelve weeks of the outbreak, and case report forms that were reported in that time period (22 May 2023 - 13 Aug 2023).

In the last twelve weeks:

Of all cases with available information in the recent period, 99% (1,020 / 1,026) of cases were male, and 96% (753 / 782) self identified as men who have sex with men.
Of all reported types of transmission, a sexual encounter was reported most commonly, with 631 of 649 (97.2%) of all reported transmission events.
Of all settings in which cases were likely exposed, the most common was in others, with 41 of 81 (100.0%) of all reported exposure events.

3.5.1 Demographic information

	¹"> Reported values¹		Unknown or Missing Value
Case profiles
From 22 May to 15 Aug 2023
	Yes	No	Unknown or Missing Value
Men who have sex with men	753 (96.3%)	29 (3.7%)	351
HIV-Positive	359 (51.4%)	340 (48.6%)	434
Health worker	7 (0.9%)	747 (99.1%)	379
Travel History	60 (8.2%)	668 (91.8%)	405
Sexual Transmission	631 (97.2%)	18 (2.8%)	484
Hospitalised²	571 (81.2%)	132 (18.8%)	430
ICU	0	34 (100.0%)	1,099
Died	0	106 (100.0%)	1,027
¹ Note given true proportions of variables, yes reporting may be common than no reporting
² May be hospitalised for isolation or medical treatment

3.5.2 Age-sex pyramid

3.5.3 Transmission type

Transmission data were available for 649/1,133 (57.3%) of cases.

Note that 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, mpox virus has been isolated from semen samples and rectal swabs from confirmed cases. Note that person to person contact does not include known sexual, healthcare-associated, and mother to child transmission.

3.5.4 Exposure settings

Exposure setting data were available for 81/1,133 (7.1%) 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.

3.6 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. Symptom information is shown for all cases where information was available reported from Jan 2022.

3.6.1 Bar chart - Symptoms

All cases

Male cases

Female cases

3.6.2 Table - Symptoms

	All	Male	Female
Summary of symptoms
As of 15 Aug 2023
Any rash	33,534 (90.4%)	31,736 (90.8%)	1,170 (84.6%)
Fever	21,585 (58.2%)	20,514 (58.7%)	696 (50.3%)
Systemic rash	20,905 (56.4%)	19,749 (56.5%)	982 (71.0%)
Genital rash	18,733 (50.5%)	17,870 (51.1%)	399 (28.9%)
Headache	11,537 (31.1%)	10,758 (30.8%)	529 (38.3%)
Any lymphadenopathy	11,003 (29.7%)	10,770 (30.8%)	229 (16.6%)
Muscle ache	10,528 (28.4%)	9,875 (28.3%)	412 (29.8%)
General lymphadenopathy	7,940 (21.4%)	7,794 (22.3%)	143 (10.3%)
Fatigue	7,129 (19.2%)	6,633 (19.0%)	153 (11.1%)
Local lymphadenopathy	7,126 (19.2%)	6,979 (20.0%)	147 (10.6%)
Sore throat	5,151 (13.9%)	4,762 (13.6%)	218 (15.8%)
Oral rash	3,456 (9.3%)	2,925 (8.4%)	85 (6.1%)
Chills	3,376 (9.1%)	2,940 (8.4%)	128 (9.3%)
Rash, unknown location	3,313 (8.9%)	3,289 (9.4%)	22 (1.6%)
Cough	997 (2.7%)	864 (2.5%)	61 (4.4%)
Vomiting	864 (2.3%)	809 (2.3%)	54 (3.9%)
Lymphadenopathy, location unknown	424 (1.1%)	409 (1.2%)	14 (1.0%)
Anogenital pain and/or bleeding	302 (0.8%)	296 (0.8%)	5 (0.4%)
Other	254 (0.7%)	249 (0.7%)	5 (0.4%)
Asymptomatic	241 (0.6%)	176 (0.5%)	16 (1.2%)
Conjunctivitis	216 (0.6%)	194 (0.6%)	14 (1.0%)
Diarrhea	70 (0.2%)	68 (0.2%)	2 (0.1%)
Genital oedema	21 (0.1%)	20 (0.1%)	0

4 Africa in Focus

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 14 August 2023, there have been 1,902 confirmed cases of mpox reported in the region and 20 deaths. These represent 2% of global cases and 13% of global deaths, respecitvely. In addition, 672 (35% 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 Epidemic curve by date of notification (cases)

Epidemic curve shown for cases reported up to 13 Aug 2023 to avoid showing incomplete weeks of data.

4.2 Epidemic curve by date of notification (deaths)

Epidemic curve shown for deaths reported up to 13 Aug 2023 to avoid showing incomplete weeks of data.

4.3 Age-sex pyramid

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 mpox 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 seen 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 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 however, 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 has 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 mpox.

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 current mpox outbreak and to support forecasting work, WHO has undertaken an effort to extract epidemiological parameters, such as incubation period and generation interval, from the literature. The initial literature screening is performed and maintained by the Public Health Agency of Canada (PHAC). The overall search strategy is 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
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 updated once per week on Fridays. Please note that some of these sources are still undergoing the peer-review process, therefore readers are advised to exercise care when interpreting findings.

6.1 Parameters

Reference	N	¹">Mean¹	¹">95% CrI (mean)¹	¹">95% CI (mean)¹	¹">SD¹	¹">Median¹	¹">95% CrI (median)¹	¹">IQR¹	¹">Range¹	Distribution
Incubation Period
As of 19 Jan 2023
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

Reference	N	¹">Mean¹	¹">95% CrI (mean)¹	¹">SD¹	¹">Median¹	¹">95% CrI (median)¹	Distribution
Serial Interval
As of 19 Jan 2023
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

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

6.2 Bibliography

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
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
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
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#
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#
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#
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
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#
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#
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#
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#
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#
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#
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
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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
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7 Disclaimers

7.1 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).

7.2 Copyright, Permissions, and Referencing

WHO supports open access to the published output of its activities as a fundamental part of its mission and a public benefit to be encouraged wherever possible. Permission from WHO is not required for the use of the WHO Monkeypox global trends report or data available for download.

The user shall not, in connection with use of the app, state or imply that WHO endorses or is affiliated with the user, its use of the app, or any content, output, or analysis resulting from or related to the app, or that WHO endorses any entity, organization, company, or product.

The use of the WHO emblem / logo by a user of the report in connection with its use is not permitted. For further information, please visit WHO Copyright, Licencing and Permissions.

Suggested citation: 2022-23 Mpox Outbreak: Global Trends. Geneva: World Health Organization, 2023. Available online: https://worldhealthorg.shinyapps.io/mpx_global/ (last cited: [date]).

8 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.

2022-23 Mpox (Monkeypox) Outbreak:Global Trends

World Health Organization

Produced on 16 August 2023

Key Figures

1 Overview

2 Global situation update

2.1 Epidemic curves

2.1.1 Global (cases)

2.1.2 Global (deaths)

2.1.3 By WHO Region (cases)

2.1.4 By WHO Region (deaths)

2.1.5 Top 10 countries (cases)

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

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

Latvia

Lebanon

Liberia

Lithuania

Luxembourg

Malta

Martinique

Mexico

2022-23 Mpox (Monkeypox) Outbreak:
Global Trends