{{Short description|World public health emergency (May 2022 – May 2023)}} {{About|the 2022–2023 global outbreak|the subsequent epidemic|2023–2026 mpox epidemic|other uses|Mpox outbreak (disambiguation){{!}}Mpox outbreak}} {{Use dmy dates|date=August 2022}} {{Use British English|date=May 2022}} {{Infobox outbreak | image = Monkeypox By Country.svg | caption = {{Center|Spread of disease as of 14 October 2022}} {{Leftlegend|#8888FF|Endemic clade I<br>(formerly Congo Basin or Central African clade)<ref name=WHOvariants>{{cite web|url=https://www.who.int/news/item/12-08-2022-monkeypox--experts-give-virus-variants-new-names|title=Monkeypox: experts give virus variants new names|website=World Health Organization|date=2022-08-12|access-date=16 August 2022|archive-date=14 March 2023|archive-url=https://web.archive.org/web/20230314171402/https://www.who.int/news/item/12-08-2022-monkeypox--experts-give-virus-variants-new-names|url-status=live}}</ref> }}{{Leftlegend|#FF8888|Endemic clade II<br>(formerly West African clade)<ref name=WHOvariants/>}}{{Leftlegend|#AA44AA|Both clades recorded}}{{Leftlegend|#AA0000|Clade II<ref name=WHOvariants/> outbreak in 2022}}{{Leftlegend|#FFC6C6|Suspected cases}} | disease = Mpox | pathogen = ''Monkeypox virus'' (MPV), clade II,<ref name=WHOvariants/> 2017–2019 outbreak subclade<ref name="Rambaut_DIS">{{cite web |last1=Rambaut |first1=Andrew |title=Discussion of on-going MPXV genome sequencing |url=https://virological.org/t/discussion-of-on-going-mpxv-genome-sequencing/802 |website=Virological.org |access-date=21 May 2022 |language=en |date=21 May 2022 |archive-date=23 May 2022 |archive-url=https://web.archive.org/web/20220523234818/https://virological.org/t/discussion-of-on-going-mpxv-genome-sequencing/802 |url-status=live}}</ref> | location = 121 countries and territories<br>(119 with confirmed cases,<br/>2 with suspected cases only) | first_outbreak = London, United Kingdom<br/>(first outside of historically endemic African countries) | date = First international outbreak: 6 May 2022<br>Public health emergency of international concern: 23 July 2022 – 11 May 2023 ({{Age in years, months, weeks and days|month1=7|day1=23|year1=2022|month2=5|day2=11|year2=2023}}) | source = Travel from Nigeria (presumed/hypothesis)<ref>{{cite web |title=Monkeypox spreads in West, baffling African scientists |url=https://abcnews.go.com/Health/wireStory/monkeypox-spreads-west-baffling-african-scientists-84854464 |access-date=20 May 2022 |work=ABC News |language=en |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520142410/https://abcnews.go.com/Health/wireStory/monkeypox-spreads-west-baffling-african-scientists-84854464 |url-status=live }}</ref><ref>{{Cite news |last=Mandavilli |first=Apoorva |date=18 May 2022 |title=A Massachusetts Man Is Infected With Monkeypox |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/05/18/health/massachusetts-monkeypox.html |access-date=20 May 2022 |issn=0362-4331 |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520011140/https://www.nytimes.com/2022/05/18/health/massachusetts-monkeypox.html |url-status=live}}</ref> | confirmed_cases = 99,518 (since January 2022)<ref>{{Cite web |date=13 April 2023 |title=2022 monkeypox outbreak global map |url=https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html |access-date=13 April 2023 |website=cdc.gov |archive-date=21 June 2022 |archive-url=https://web.archive.org/web/20220621233330/https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html |url-status=live }} (Updated every two weeks since 1 February 2023) (Updated once per month since September 2023) (no longer updated, [https://archive.cdc.gov/#/details?url=https://www.cdc.gov/poxvirus/mpox/response/2022/world-map.html archived] on 6 September 2024 - added 26 February 2025)</ref> (6 August 2024) | deaths = 207 (since January 2022)<ref>{{Cite web |date=13 April 2023 |title=2022 monkeypox outbreak global map |url=https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html |access-date=13 April 2023 |website=cdc.gov |archive-date=21 June 2022 |archive-url=https://web.archive.org/web/20220621233330/https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html |url-status=live }} (Updated every two weeks since 1 February 2023) (Updated once per month since September 2023) (no longer updated, [https://archive.cdc.gov/#/details?url=https://www.cdc.gov/poxvirus/mpox/response/2022/world-map.html archived] on 6 September 2024 - added 26 February 2025)</ref> (6 August 2024) }}
In May 2022, the World Health Organization (WHO) made an emergency announcement of the existence of a multi-country outbreak of mpox, a viral disease then commonly known as "monkeypox".<ref name="WHO13">{{cite web |date=21 May 2022 |title=Multi-country monkeypox outbreak in non-endemic countries |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385 |url-status=live |archive-url=https://web.archive.org/web/20220522002241/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385 |archive-date=22 May 2022 |access-date=25 May 2022 |publisher=World Health Organization}}</ref> The initial cluster of cases was found in the United Kingdom,<ref name=":13">{{cite web | url=https://www.theatlantic.com/health/archive/2022/05/monkeypox-outbreak-covid-pandemic/629920/ | title=So, Have You Heard About Monkeypox? | website=The Atlantic | date=19 May 2022 | access-date=2 June 2022 | archive-date=23 June 2022 | archive-url=https://web.archive.org/web/20220623122621/https://www.theatlantic.com/health/archive/2022/05/monkeypox-outbreak-covid-pandemic/629920/ | url-status=live }}</ref> where the first case was detected in London on 6 May 2022<ref name="gov.uk">{{Cite web |title=Monkeypox cases confirmed in England – latest updates |url=https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates |access-date=2022-09-25 |website=GOV.UK |date=6 September 2022 |language=en |archive-date=16 May 2022 |archive-url=https://web.archive.org/web/20220516173645/https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates |url-status=live }}</ref> in a patient with a recent travel history from Nigeria where the disease has been endemic.<ref name="WHO12">{{cite web |date=16 May 2022 |title=Monkeypox – United Kingdom of Great Britain and Northern Ireland |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 |url-status=live |archive-url=https://web.archive.org/web/20220517223855/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 |archive-date=17 May 2022 |access-date=17 May 2022 |publisher=World Health Organization}}</ref> On 16 May, the UK Health Security Agency (<abbr>UKHSA</abbr>) confirmed four new cases with no link to travel to a country where mpox is endemic.<ref name="gov.uk"/> Subsequently, cases have been reported from many countries and regions.<ref>{{Cite web |date=2023-09-12 |title=2022 Mpox Outbreak Global Map {{!}} Mpox {{!}} Poxvirus {{!}} CDC |url=https://www.cdc.gov/poxvirus/mpox/response/2022/world-map.html |access-date=2023-12-01 |website=cdc.gov |language=en-us |archive-date=1 December 2023 |archive-url=https://web.archive.org/web/20231201062128/https://www.cdc.gov/poxvirus/mpox/response/2022/world-map.html |url-status=live }}</ref> The outbreak marked the first time mpox had spread widely outside Central and West Africa. The disease had been circulating and evolving in human hosts over several years before the outbreak and was caused by the clade IIb variant of the virus.<ref>{{Cite news |last=Sample |first=Ian |date=2 November 2023 |title=Mpox circulated for five years before global explosion in 2022, research finds |language=en-GB |work=The Guardian |url=https://www.theguardian.com/world/2023/nov/02/mpox-monkeypox-circulated-global-explosion-in-2022 |access-date=1 December 2023 |issn=0261-3077 |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701040812/https://www.theguardian.com/world/2023/nov/02/mpox-monkeypox-circulated-global-explosion-in-2022 |url-status=live }}</ref>
On 23 July 2022, the director-general of the WHO, Tedros Adhanom Ghebreyesus, declared the outbreak a public health emergency of international concern (PHEIC), stating that "we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little".<ref name="who-pheic">{{Cite web |title=WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern |url=https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern |access-date=2022-08-04 |date=2022-07-23 |website=World Health Organization (WHO) |language=en |archive-date=25 July 2022 |archive-url=https://web.archive.org/web/20220725054644/https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern |url-status=live }}</ref> A global response to the outbreak included public awareness campaigns in order to reduce spread of the disease, and repurposing of smallpox vaccines.<ref>{{Cite web |title=Monkeypox – Campaign details |url=https://campaignresources.dhsc.gov.uk/campaigns/monkeypox/ |url-status=live |archive-url=https://web.archive.org/web/20230528122209/https://campaignresources.dhsc.gov.uk/campaigns/monkeypox/ |archive-date=28 May 2023 |access-date=2023-05-28 |website=Department of Health and Social Care – Campaign Resource Centre |language=en-GB}}</ref><ref name="UK_Protect">{{Cite web |title=Protecting you from mpox (monkeypox): information on the smallpox vaccination |url=https://www.gov.uk/government/publications/monkeypox-vaccination-resources/protecting-you-from-monkeypox-information-on-the-smallpox-vaccination |url-status=live |archive-url=https://web.archive.org/web/20230528112802/https://www.gov.uk/government/publicationsMentioned/monkeypox-vaccination-resources/protecting-you-from-monkeypox-information-on-the-smallpox-vaccination |archive-date=28 May 2023 |access-date=2023-05-28 |website=GOV.UK |language=en}}</ref>
In May 2023, the World Health Organization declared an end to the PHEIC, citing steady progress in controlling the spread of the disease.<ref name="kimball511">{{Cite web |last=Kimball |first=Spencer |date=2023-05-11 |title=WHO says mpox outbreak, the largest in history, no longer global health emergency |url=https://www.cnbc.com/2023/05/11/mpox-who-says-outbreak-no-longer-global-health-emergency.html |access-date=2023-05-11 |website=CNBC |language=en |archive-date=11 May 2023 |archive-url=https://web.archive.org/web/20230511193947/https://www.cnbc.com/2023/05/11/mpox-who-says-outbreak-no-longer-global-health-emergency.html |url-status=live }}</ref> Relatively low levels of cases continued to occur, and as of 30 April 2026, there have been a total of 180,545 confirmed cases and 506 deaths in 144 countries.<ref name="OurWorldinData1">{{cite web |title=Monkeypox Data Explorer |url=https://ourworldindata.org/explorers/monkeypox?tab=table&time=2022-05-24..latest&facet=none&Metric=Confirmed+cases&Frequency=Cumulative&Shown+by=Date+of+confirmation&country=~OWID_WRL |access-date=27 May 2022 |website=OurWorldInData |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628125406/https://ourworldindata.org/explorers/monkeypox?tab=table&time=2022-05-24..latest&facet=none&Metric=Confirmed+cases&Frequency=Cumulative&Shown+by=Date+of+confirmation&country=~OWID_WRL |url-status=live }}</ref><ref>{{Cite journal |last=Kozlov |first=Max |date=25 July 2022 |title=Monkeypox declared a global emergency: will it help contain the outbreak? |url=https://www.nature.com/articles/d41586-022-02054-7 |journal=Nature |language=en |doi=10.1038/d41586-022-02054-7 |pmid=35879614 |s2cid=251067503 |access-date=1 August 2022 |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701040813/https://www.nature.com/articles/d41586-022-02054-7 |url-status=live |url-access=subscription }}</ref><ref>{{cite web |title=2022-23 Mpox (Monkeypox) Outbreak: Global Trends |url=https://worldhealthorg.shinyapps.io/mpx_global/ |website=worldhealthorg.shinyapps.io |publisher=World Health Organization |access-date=4 March 2024 |date=23 February 2024 |archive-date=2 September 2022 |archive-url=https://web.archive.org/web/20220902152401/https://worldhealthorg.shinyapps.io/mpx_global/ |url-status=live }}</ref>
Mpox is a viral infection that manifests a week or two after exposure with fever and other non-specific symptoms, and then produces a rash with lesions that usually last for 2–4 weeks before drying up, crusting and falling off.<ref name="WHO12" /> While mpox can cause large numbers of lesions, in this outbreak some patients experience only a single lesion in the mouth or on the genitals, making it more difficult to differentiate from other infections.<ref>{{cite web |last1=Soucheray |first1=Stephanie |title=Largest monkeypox study to date highlights new symptoms |url=https://www.cidrap.umn.edu/news-perspective/2022/07/largest-monkeypox-study-date-highlights-new-symptoms#:~:text=Many%20of%20the%20people%20infected,sexually%20transmitted%20infection%20(STI). |website=CIDRAP |date=22 July 2022 |publisher=University of MInnesota |access-date=26 July 2022 |archive-date=29 July 2022 |archive-url=https://web.archive.org/web/20220729060720/https://www.cidrap.umn.edu/news-perspective/2022/07/largest-monkeypox-study-date-highlights-new-symptoms#:~:text=Many%20of%20the%20people%20infected,sexually%20transmitted%20infection%20(STI). |url-status=live }}</ref> In previous outbreaks, 1–3 per cent of people with known infections had died (without treatment). In the 2022–2023 outbreak the rate of death was less than 0.2 percent. Cases in children and immunocompromised people are more likely to be severe.<ref name="who-statement-highest-alert">{{cite news |type=Statement |title=Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox |url=https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox |access-date=23 July 2022 |publisher=World Health Organization |date=23 July 2022 |archive-date=29 July 2022 |archive-url=https://web.archive.org/web/20220729192857/https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox |url-status=live }}</ref>
Mpox spreads through close, personal, often skin-to-skin contact. The disease can spread through direct contact with rashes, or body fluids from an infected person, by touching objects and fabrics that have been used by someone with mpox or through respiratory secretions.<ref name=":16">{{Cite web |last=CDC |date=29 July 2022 |title=Monkeypox in the U.S. |url=https://www.cdc.gov/poxvirus/monkeypox/transmission.html |access-date=1 August 2022 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=15 October 2017 |archive-url=https://web.archive.org/web/20171015202658/https://www.cdc.gov/poxvirus/monkeypox/transmission.html |url-status=live }}</ref> Given the unexpected and vast geographical spread of the disease, the actual number of cases is likely to be underestimated.<ref>{{Cite web |title=Multi-country monkeypox outbreak: situation update |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396 |access-date=2022-08-05 |website=who.int |language=en |archive-date=2 August 2022 |archive-url=https://web.archive.org/web/20220802114314/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396 |url-status=live }}</ref> While anyone can get mpox, the majority of confirmed cases outside of the endemic regions in Africa occurred in young or middle-aged men who have sex with men (MSM) who had recent sexual contact with new or multiple partners.<ref>{{cite web |title=Multi-country monkeypox outbreak: situation update |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396 |website=World Health Organization |access-date=5 August 2022 |date=27 June 2022 |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701040812/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396 |url-status=live }}</ref><ref name="who-press-briefing-20220727">{{cite press release |type=Press briefing transcript |date=27 July 2022 |title=Monkeypox, COVID-19 & Other Global Health Issues Virtual Press conference transcript - 27 July 2022 |url=https://www.who.int/publications/m/item/monkeypox--covid-19---other-global-health-issues-virtual-press-conference-transcript---27-july-2022 |publisher=World Health Organization |access-date=3 August 2022 |archive-date=3 August 2022 |archive-url=https://web.archive.org/web/20220803044627/https://www.who.int/publications/m/item/monkeypox--covid-19---other-global-health-issues-virtual-press-conference-transcript---27-july-2022 |url-status=live }}</ref> On 28 July 2022, the WHO Director-General advised MSM to limit exposure by reducing the number of sexual partners, reconsidering sex with new partners, and maintaining contact details to allow for epidemiological follow-up.<ref>{{cite news |title=WHO chief advises men who have sex with men to reduce partners to limit exposure to monkeypox |url=https://edition.cnn.com/2022/07/27/health/who-monkeypox-msm-sex-partners/index.html |access-date=3 August 2022 |work=CNN |date=28 July 2022 |archive-date=2 August 2022 |archive-url=https://web.archive.org/web/20220802201219/https://edition.cnn.com/2022/07/27/health/who-monkeypox-msm-sex-partners/index.html |url-status=live }}</ref> The Centers for Disease Control and Prevention has emphasized the importance of reducing stigma in communicating about the demographic aspects of mpox, specifically with regards to gay and bisexual men.<ref>{{cite web |date=12 July 2022 |title=Reducing Stigma in Monkeypox Communication and Community Engagement |url=https://www.cdc.gov/poxvirus/monkeypox/reducing-stigma.html |access-date=23 July 2022 |website=CDC |archive-date=23 July 2022 |archive-url=https://web.archive.org/web/20220723180257/https://www.cdc.gov/poxvirus/monkeypox/reducing-stigma.html |url-status=live }}</ref>
A new outbreak of a different variant of mpox began in 2023 and was declared a PHEIC in August 2024.
== Background == {{Excerpt|Mpox|only=paragraphs|paragraphs=1–3|this=These paragraphs are}}
=== Emergency preparedness prior to outbreak=== On 17 March 2021, the Nuclear Threat Initiative led a tabletop exercise at the Munich Security Conference simulating hypothetical public health responses to the intentional release of a genetically manipulated strain of monkeypox virus.<ref>{{cite web |last1=Yassif |first1=Jaime M. |last2=O'Prey |first2=Kevin P. |last3=Isaac |first3=Christopher R. |date=November 2021 |title=Strengthening Global Systems to Prevent and Respond to High-Consequence Biological Threats |url=https://www.nti.org/wp-content/uploads/2021/11/NTI_Paper_BIO-TTX_Final.pdf |url-status=live |archive-url=https://web.archive.org/web/20220527194423/https://www.nti.org/wp-content/uploads/2021/11/NTI_Paper_BIO-TTX_Final.pdf |archive-date=27 May 2022 |access-date=20 June 2022 |website=Nuclear Threat Initiative}}</ref><ref>{{Cite web |last=Rahman |first=Khaleda |date=2022-05-24 |title=Report Simulating Deadly Monkeypox Outbreak Was Released Six Months Ago |url=https://www.newsweek.com/report-simulating-monkeypox-outbreak-released-six-months-ago-1709520 |access-date=2023-02-25 |website=Newsweek |language=en |archive-date=25 February 2023 |archive-url=https://web.archive.org/web/20230225161701/https://www.newsweek.com/report-simulating-monkeypox-outbreak-released-six-months-ago-1709520 |url-status=live }}</ref> On 23 July 2022, the World Health Organization Director-General Tedros Adhanom Ghebreyesus declared the 2022 outbreak a public health emergency of international concern.<ref name="who-pheic"/> In May 2023, the emergency was declared over.<ref name=kimball511/>
=== Endemic mpox in Africa === Mpox is endemic to West and Central Africa.<ref name="Bunge2022">{{cite journal |last1=Bunge |first1=Eveline M. |last2=Hoet |first2=Bernard |last3=Chen |first3=Liddy |last4=Lienert |first4=Florian |last5=Weidenthaler |first5=Heinz |last6=Baer |first6=Lorraine R. |last7=Steffen |first7=Robert |date=11 February 2022 |title=The changing epidemiology of human monkeypox – A potential threat? A systematic review |journal=PLOS Neglected Tropical Diseases |language=en |volume=16 |issue=2 |article-number=e0010141 |doi=10.1371/journal.pntd.0010141 |issn=1935-2735 |pmc=8870502 |pmid=35148313 |doi-access=free }}</ref><ref>{{cite web |title=Monkeypox |url=https://www.who.int/news-room/fact-sheets/detail/monkeypox |access-date=20 May 2022 |publisher=World Health Organization |language=en |archive-date=21 April 2022 |archive-url=https://web.archive.org/web/20220421083742/https://www.who.int/news-room/fact-sheets/detail/monkeypox |url-status=live }}</ref>
In a 2021 article, Oyewale Tomori pointed out that the number of mpox infections in Nigeria through 2021 were likely to be under-reported, because many Nigerians had been avoiding healthcare facilities due to fear of contracting COVID-19.<ref name=":02">{{cite web |last=Tomori |first=Oyewale |title=Monkeypox in Nigeria: why the disease needs intense management |url=http://theconversation.com/monkeypox-in-nigeria-why-the-disease-needs-intense-management-165022 |access-date=25 May 2022 |website=The Conversation |date=25 July 2021 |language=en |archive-date=25 July 2021 |archive-url=https://web.archive.org/web/20210725083905/http://theconversation.com/monkeypox-in-nigeria-why-the-disease-needs-intense-management-165022 |url-status=live }}</ref> Nigeria's surveillance of various diseases, including mpox, had to focus on the global COVID-19 pandemic in 2020 and 2021, missing many cases and resulting in a drop in official statistics.<ref>{{cite web |last=Tomori |first=Oyewale |title=Monkeypox is endemic in Nigeria. But surveillance isn't what it should be |url=http://theconversation.com/monkeypox-is-endemic-in-nigeria-but-surveillance-isnt-what-it-should-be-183711 |access-date=25 May 2022 |website=The Conversation |date=25 May 2022 |language=en |archive-date=25 May 2022 |archive-url=https://web.archive.org/web/20220525090451/http://theconversation.com/monkeypox-is-endemic-in-nigeria-but-surveillance-isnt-what-it-should-be-183711 |url-status=live }}</ref>
As British health authorities reported the first case of mpox in the UK in May 2022, the Nigerian government released information and statistics on reported cases and deaths in the country: The report of 9 May 2022 stated that between 2017 and 2022 there were 230 confirmed cases across 20 states and the Federal Capital Territory. Rivers State was the most affected, followed by Bayelsa and Lagos. In the span from 2017 to 2022, the NCDC reported six deaths in six different states, making for a 3.3% case fatality ratio.<ref>{{Cite news |last=Ileyemi |first=Mariam |date=10 May 2022 |title=Monkeypox: Nigeria records 558 cases, eight deaths in five years |url=https://www.premiumtimesng.com/news/top-news/528825-monkeypox-nigeria-records-558-cases-eight-deaths-in-five-years.html |access-date=25 May 2022 |newspaper=Premium Times|language=en |archive-date=10 May 2022 |archive-url=https://web.archive.org/web/20220510142341/https://www.premiumtimesng.com/news/top-news/528825-monkeypox-nigeria-records-558-cases-eight-deaths-in-five-years.html |url-status=live }}</ref> On 30 May, the first death from mpox was reported in Nigeria during 2022; the last time a death was reported in the country from this disease was in 2019.<ref>{{Cite news |date=30 May 2022 |title=Nigeria records first monkeypox death in 2022 as cases rise to 21 |url=https://www.thecable.ng/nigeria-records-first-monkeypox-death-in-2022-as-cases-rise-to-21 |access-date=26 June 2022 |newspaper=TheCable|language=en-US |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530145527/https://www.thecable.ng/nigeria-records-first-monkeypox-death-in-2022-as-cases-rise-to-21 |url-status=live }}</ref>
In May 2022 the Africa Centres for Disease Control and Prevention alerted several members of the African Union about cases of mpox. The director of the Africa CDC, Ahmed Ogwell, said that Cameroon, Central African Republic, the Democratic Republic of Congo and Nigeria have reported 1,405 endemic cases with 62 deaths during the first five months of 2022. The case fatality rate in these four African countries combined was 4.4%.<ref>{{cite web |last=Kamsukom |first=Nana |date=27 May 2022 |title=African Centre For Disease Control Alerts Cameroon On Monkeypox |url=https://www.journalducameroun.com/en/african-centre-for-disease-control-alerts-cameroon-on-monkeypox/ |access-date=27 May 2022 |website=Journal du Cameroun |language=en |archive-date=27 May 2022 |archive-url=https://web.archive.org/web/20220527165842/https://www.journalducameroun.com/en/african-centre-for-disease-control-alerts-cameroon-on-monkeypox/ |url-status=live }}</ref>
== Outbreak characteristics == {{See also|Mpox#Epidemiology|2022–2023 mpox outbreak in the United Kingdom}}
Prior to the 2022 outbreak, the United Kingdom had recorded only seven previous cases of mpox,<ref name="bbc-scotland">{{cite news |date=14 May 2022 |title=Monkeypox contact tracing extended to Scotland |publisher=BBC News |url=https://www.bbc.co.uk/news/uk-scotland-61435476 |url-status=live |access-date=17 May 2022 |archive-url=https://web.archive.org/web/20220517232614/https://www.bbc.co.uk/news/uk-scotland-61435476 |archive-date=17 May 2022}}</ref> all of which were imported cases from Africa or healthcare workers involved in their treatment. The first three such cases were in 2018,<ref name="bbc-scotland" /> followed by a further case in 2019<ref name="PHE4Dec2019">{{cite web |date=4 December 2019 |title=Monkeypox case confirmed in England |url=https://www.gov.uk/government/news/monkeypox-case-confirmed-in-england |url-status=live |archive-url=https://web.archive.org/web/20191212092044/https://www.gov.uk/government/news/monkeypox-case-confirmed-in-england |archive-date=12 December 2019 |access-date=18 May 2022 |website=GOV.UK |publisher=Public Health England |language=en}}</ref> and three more in 2021.<ref name=":0">{{cite web |date=19 May 2022 |title=Australia's first confirmed monkeypox case recorded in Victoria |url=https://7news.com.au/news/public-health/warning-in-vic-for-rare-monkeypox-disease-c-6867171 |url-status=live |archive-url=https://web.archive.org/web/20220520082536/https://7news.com.au/news/public-health/warning-in-vic-for-rare-monkeypox-disease-c-6867171 |archive-date=20 May 2022 |access-date=20 May 2022 |website=7News |language=en}}</ref> The only major mpox outbreak to be recorded in a Western country prior to 2022 was the 2003 Midwest monkeypox outbreak in the United States, which did not feature community transmission.<ref>{{cite news |last1=Spice |first1=Linda |title=13 Sick After Prairie Dog Contact; Milwaukee Pet Store Employee, Two Others Remain Hospitalized |url=http://www.jsonline.com/news/State/jun03/146134.asp |access-date=31 May 2022 |work=Milwaukee Journal Sentinel |date=6 June 2003 |archive-url=https://web.archive.org/web/20031009135623/http://www.jsonline.com/news/State/jun03/146134.asp |archive-date=9 October 2003}} [https://www.everycrsreport.com/files/20030627_RS21557_7f686249a9b8eb61db84ad52bdfec245a199b472.pdf Cited Here] {{Webarchive|url=https://web.archive.org/web/20201017233309/https://www.everycrsreport.com/files/20030627_RS21557_7f686249a9b8eb61db84ad52bdfec245a199b472.pdf |date=17 October 2020 }} (PDF)</ref><ref>Todd Richmond. [https://www.theintelligencer.com/news/article/4-Get-Monkeypox-Virus-From-Prairie-Dogs-10510065.php "Four Get Monkeypox Virus from Prairie Dogs"] {{Webarchive|url=https://web.archive.org/web/20220523152342/https://www.theintelligencer.com/news/article/4-Get-Monkeypox-Virus-From-Prairie-Dogs-10510065.php |date=23 May 2022 }} Associated Press. 7 June 2003.</ref>
===Phylogenetics=== Phylogenomic characterization of the first monkeypox virus outbreak genome sequences, found the "presumably slow-evolving" DNA virus has evolved roughly 6–12-fold more mutations than one would expect and 15 SNP mutations since the beginning of the outbreak<!--which could indicate adaptation to humans such as increasing transmissibility-->.<ref>{{cite news |title=Monkeypox mutating 12 times faster than expected as daily UK cases 'could hit 60,000' |url=https://www.independent.co.uk/news/health/monkeypox-virus-uk-cases-mutating-b2111814.html |access-date=22 July 2022 |work=The Independent |date=29 June 2022 |language=en |archive-date=22 July 2022 |archive-url=https://web.archive.org/web/20220722145803/https://www.independent.co.uk/news/health/monkeypox-virus-uk-cases-mutating-b2111814.html |url-status=live }}</ref><ref>{{cite journal |last1=Isidro |first1=Joana |last2=Borges |first2=Vítor |last3=Pinto |first3=Miguel |last4=Sobral |first4=Daniel |last5=Santos |first5=João Dourado |last6=Nunes |first6=Alexandra |last7=Mixão |first7=Verónica |last8=Ferreira |first8=Rita |last9=Santos |first9=Daniela |last10=Duarte |first10=Silvia |last11=Vieira |first11=Luís |last12=Borrego |first12=Maria José |last13=Núncio |first13=Sofia |last14=de Carvalho |first14=Isabel Lopes |last15=Pelerito |first15=Ana |last16=Cordeiro |first16=Rita |last17=Gomes |first17=João Paulo |title=Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus |journal=Nature Medicine |date=24 June 2022 |volume=28 |issue=8 |pages=1569–1572 |doi=10.1038/s41591-022-01907-y |pmid=35750157 |pmc=9388373 |s2cid=250022488 |language=en |issn=1546-170X}} * News article: {{cite news |last1=Reardon |first1=Sara |title=Why is Monkeypox Evolving So Fast? |url=https://www.scientificamerican.com/article/why-is-monkeypox-evolving-so-fast/ |access-date=22 July 2022 |work=Scientific American |language=en |archive-date=22 July 2022 |archive-url=https://web.archive.org/web/20220722042642/https://www.scientificamerican.com/article/why-is-monkeypox-evolving-so-fast/ |url-status=live }}</ref> Examination of the mutations suggested they were the result of cytosine deamination by an APOBEC (apolipoprotein B mRNA editing enzyme, catalytic polypeptide) protein expressed in the human cells.<ref>{{Cite web |date=2022-05-30 |title= observations about putative APOBEC3 deaminase editing driving short-term evolution of MPXV since 2017 |url=https://virological.org/t/initial-observations-about-putative-apobec3-deaminase-editing-driving-short-term-evolution-of-mpxv-since-2017/830 |access-date=2025-08-28 |website=Virological |language=en}}</ref> Recombination has been reported in the natural transmission of monkeypox virus. Using Tandem repeat polymorphism, case FVGITA-01 (ON755039) in Italy, case VIDRL01(ON631963) in Australia, as well as six cases in Slovenia (ON838178, ON631241, ON609725, ON754985, ON754986, ON754987) were recombinant crossovers. Based on linkage disequilibrium (LD) between monkeypox virus variants with minor alleles in at least two MPXV isolates and to detect the possible recombination, two Germany cases (ON959149 and ON637939) and one Spain case (ON720849) already gained their mutations via recombination.<ref>{{cite journal |last1=Yeh |first1=Ting-Yu |last2=Hsieh |first2=Zih-Yu |last3=Feehley |first3=Michael C. |last4=Feehley |first4=Patrick J. |last5=Contreras |first5=Gregory P. |last6=Su |first6=Ying-Chieh |last7=Hsieh |first7=Shang-Lin |last8=Lewis |first8=Dylan A. |title=Recombination shapes the 2022 monkeypox (mpox) outbreak |journal=Med |date=9 December 2022 |volume=3 |issue=12 |pages=824–826 |doi=10.1016/j.medj.2022.11.003 |pmid=36495863 |pmc=9733179 |language=en |issn=2666-6359}}</ref> Scientists investigated circulating lineages (and potential variants) of the monkeypox virus and are comparing them against the African endemic lineages.<ref>{{cite journal |last1=Luna |first1=Nicolas |last2=Ramírez |first2=Angie L. |last3=Muñoz |first3=Marina |last4=Ballesteros |first4=Nathalia |last5=Patiño |first5=Luz H. |last6=Castañeda |first6=Sergio Andres |last7=Bonilla-Aldana |first7=D. Katterine |last8=Paniz-Mondolfi |first8=Alberto |last9=Ramírez |first9=Juan David |title=Phylogenomic analysis of the monkeypox virus (MPXV) 2022 outbreak: Emergence of a novel viral lineage? |journal=Travel Medicine and Infectious Disease |date=1 September 2022 |volume=49 |article-number=102402 |doi=10.1016/j.tmaid.2022.102402 |pmid=35840078 |pmc=9628808 |s2cid=250540323 |language=en |issn=1477-8939}} * News article: {{cite news |title=Researchers assess the evolution and diversity of monkeypox virus genomes using phylogenomic analysis |url=https://www.news-medical.net/news/20220718/Researchers-assess-the-evolution-and-diversity-of-monkeypox-virus-genomes-using-phylogenomic-analysis.aspx |access-date=22 July 2022 |work=News-Medical.net |date=18 July 2022 |language=en |archive-date=21 July 2022 |archive-url=https://web.archive.org/web/20220721114101/https://www.news-medical.net/news/20220718/Researchers-assess-the-evolution-and-diversity-of-monkeypox-virus-genomes-using-phylogenomic-analysis.aspx |url-status=live }}</ref><ref>{{Cite journal |last1=Gigante |first1=Crystal M. |last2=Korber |first2=Bette |last3=Seabolt |first3=Matthew H. |last4=Wilkins |first4=Kimberly |last5=Davidson |first5=Whitni |last6=Rao |first6=Agam K. |last7=Zhao |first7=Hui |last8=Smith |first8=Todd G. |last9=Hughes |first9=Christine M. |last10=Minhaj |first10=Faisal |last11=Waltenburg |first11=Michelle A. |last12=Theiler |first12=James |last13=Smole |first13=Sandra |last14=Gallagher |first14=Glen R. |last15=Blythe |first15=David |last16=Myers |first16=Robert |last17=Schulte |first17=Joann |last18=Stringer |first18=Joey |last19=Lee |first19=Philip |last20=Mendoza |first20=Rafael M. |last21=Griffin-Thomas |first21=Latoya A. |last22=Crain |first22=Jenny |last23=Murray |first23=Jade |last24=Atkinson |first24=Annette |last25=Gonzalez |first25=Anthony H. |last26=Nash |first26=June |last27=Batra |first27=Dhwani |last28=Damon |first28=Inger |last29=McQuiston |first29=Jennifer |last30=Hutson |first30=Christina L. |display-authors=1 |title=Multiple lineages of monkeypox virus detected in the United States, 2021–2022 |journal=Science |date=2022 |volume=378 |issue=6619 |pages=560–565 |biorxiv=10.1101/2022.06.10.495526 |doi=10.1126/science.add4153 |pmid=36264825 |bibcode=2022Sci...378..560G |doi-access=free |pmc=10258808 }}</ref><ref>{{cite web |title=Nextstrain – Monkeypox |url=https://nextstrain.org/monkeypox/hmpxv1 |website=nextstrain.org |access-date=22 July 2022 |archive-date=19 July 2022 |archive-url=https://web.archive.org/web/20220719111119/https://nextstrain.org/monkeypox/hmpxv1 |url-status=live }}</ref>
===Long incubation periods=== Most mpox patients become symptomatic 4–11 days after infection. Very short incubation periods are also possible, with 5% of patients developing symptoms within 3 days. This outbreak revealed that incubation periods of up to 4 weeks are possible, with 5% of cases having incubation periods longer than the previously assumed 21 days.<ref name="McFarland2023">{{Cite journal |last1=McFarland |first1=Sarah E |last2=Marcus |first2=Ulrich |last3=Hemmers |first3=Lukas |last4=Miura |first4=Fuminari |last5=Iñigo Martínez |first5=Jesús |last6=Martínez |first6=Fernando Martín |last7=Montalbán |first7=Elisa Gil |last8=Chazelle |first8=Emilie |last9=Mailles |first9=Alexandra |last10=Silue |first10=Yassoungo |last11=Hammami |first11=Naïma |last12=Lecompte |first12=Amaryl |last13=Ledent |first13=Nicolas |last14=Vanden Berghe |first14=Wim |last15=Liesenborghs |first15=Laurens |last16=Van den Bossche |first16=Dorien | last17=Cleary |first17=Paul R. |last18=Wallinga |first18=Jacco |last19=Robinson |first19=Eve P.| last20=Johansen |first20=Tone B. |last21=Bormane |first21=Tanya |last22=Seidl |first22=Cornelia |last23=Coyer |first23=Lisa |last24=Boberg |first24=Ronja |last25=Jurke |first25=Anette |last26=Werber |first26=Dirk |last27=Bartel |first27=Alexander |date=2023-07-06 |title=Estimated incubation period distributions of mpox using cases from two international European festivals and outbreaks in a club in Berlin, May to June 2022 |journal=Eurosurveillance |language=en |volume=28 |issue=27 |doi=10.2807/1560-7917.ES.2023.28.27.2200806 |pmid=37410383 |issn=1560-7917|pmc=10370040 }}</ref><ref>{{Cite journal |last1=Miura |first1=Fuminari |last2=Backer |first2=Jantien A |last3=van Rijckevorsel |first3=Gini |last4=Bavalia |first4=Roisin |last5=Raven |first5=Stijn |last6=Petrignani |first6=Mariska |last7=Ainslie |first7=Kylie E C |last8=Wallinga |first8=Jacco |last9=for the Dutch Mpox Response Team |date=2023-04-04 |title=Time Scales of Human Mpox Transmission in The Netherlands |url=https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiad091/7103467 |journal=The Journal of Infectious Diseases |volume=229 |issue=3 |pages=800–804 |language=en |doi=10.1093/infdis/jiad091 |pmid=37014716 |issn=0022-1899 |doi-access=free |pmc=10938196 |access-date=8 July 2023 |archive-date=8 July 2023 |archive-url=https://web.archive.org/web/20230708155600/https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiad091/7103467 |url-status=live }}</ref>
===Mild clinical manifestations=== An analysis of studies by a journalist in August 2022 indicated that "about 10-to-15% of cases had been hospitalized, mostly for pain and bacterial infections that can occur as a result of mpox lesions".<ref>{{cite news |title=Understanding Monkeypox and How Outbreaks Spread |url=https://www.washingtonpost.com/business/understanding-monkeypox-and-how-outbreaks-spread/2022/07/27/9673e7f2-0d83-11ed-88e8-c58dc3dbaee2_story.html |access-date=23 August 2022 |newspaper=Washington Post}}</ref> Studies published a month later, in August indicated hospitalizations of small cohorts of early patients were 8%<ref>{{cite journal |last1=Philpott |first1=David |title=Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022 |journal=MMWR. Morbidity and Mortality Weekly Report |date=2022 |volume=71 |issue=32 |pages=1018–1022 |doi=10.15585/mmwr.mm7132e3 |pmid=35951487 |pmc=9400536 |s2cid=251430107 |language=en-us |issn=0149-2195}}</ref> and 13%.<ref>{{cite journal |last1=Thornhill |first1=John P. |last2=Barkati |first2=Sapha |last3=Walmsley |first3=Sharon |last4=Rockstroh |first4=Juergen |last5=Antinori |first5=Andrea |last6=Harrison |first6=Luke B. |last7=Palich |first7=Romain |last8=Nori |first8=Achyuta |last9=Reeves |first9=Iain |last10=Habibi |first10=Maximillian S. |title=Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022 |journal=New England Journal of Medicine |date=21 July 2022 |volume=387 |issue=8 |pages=679–691 |doi=10.1056/NEJMoa2207323 |pmid=35866746 |s2cid=250953579 |language=en|doi-access=free |hdl=11380/1289204 |hdl-access=free }}</ref> A short review suggested supportive care may typically be sufficient and that several antivirals and vaccinia immune globulin intravenous (VIGIV) are available as treatments.<ref>{{cite journal |last1=Rizk |first1=John G. |last2=Lippi |first2=Giuseppe |last3=Henry |first3=Brandon M. |last4=Forthal |first4=Donald N. |last5=Rizk |first5=Youssef |title=Prevention and Treatment of Monkeypox |journal=Drugs |date=1 June 2022 |volume=82 |issue=9 |pages=957–963 |doi=10.1007/s40265-022-01742-y |pmid=35763248 |pmc=9244487 |language=en |issn=1179-1950}} * News article: {{cite news |title=Researchers investigate prevention and therapy against monkeypox infection |url=https://www.news-medical.net/news/20220704/Researchers-investigate-prevention-and-therapy-against-monkeypox-infection.aspx |access-date=22 July 2022 |work=News-Medical.net |date=4 July 2022 |language=en |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701040814/https://www.news-medical.net/news/20220704/Researchers-investigate-prevention-and-therapy-against-monkeypox-infection.aspx |url-status=live }}</ref> The outbreak showed there can be (rare) asymptomatic infections.<ref>{{cite journal|doi=10.1038/s41591-022-02004-w |title=Retrospective detection of asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium |year=2022 |last1=De Baetselier |first1=Irith |last2=Van Dijck |first2=Christophe |last3=Kenyon |first3=Chris |last4=Coppens |first4=Jasmine |last5=Michiels |first5=Johan |last6=De Block |first6=Tessa |last7=Smet |first7=Hilde |last8=Coppens |first8=Sandra |last9=Vanroye |first9=Fien |last10=Bugert |first10=Joachim Jakob |last11=Girl |first11=Philipp |last12=Zange |first12=Sabine |last13=Liesenborghs |first13=Laurens |last14=Brosius |first14=Isabel |last15=Van Griensven |first15=Johan |last16=Selhorst |first16=Philippe |last17=Florence |first17=Eric |last18=Van Den Bossche |first18=Dorien |last19=Ariën |first19=Kevin K. |last20=Rezende |first20=Antonio Mauro |last21=Vercauteren |first21=Koen |last22=Van Esbroeck |first22=Marjan |last23=Ramadan |first23=Kadrie |last24=Platteau |first24=Tom |last25=Van Looveren |first25=Karin |last26=Baeyens |first26=Jolien |last27=Van Hoyweghen |first27=Cindy |last28=Mangelschots |first28=Marianne |last29=Heyndrickx |first29=Leo |last30=Hauner |first30=Anne |journal=Nature Medicine |volume=28 |issue=11 |pages=2288–2292 |pmid=35961373 |pmc=9671802 |display-authors=1 |doi-access=free}}</ref>
===Fear of zoonotic spread=== In May 2022, the UK Human Animal Infections and Risk Surveillance (HAIRS) group<ref>{{cite web |url=https://www.gov.uk/government/collections/human-animal-infections-and-risk-surveillance-group-hairs |title=Human Animal Infections and Risk Surveillance group (HAIRS) |access-date=3 June 2022 |website=gov.uk |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530201838/https://www.gov.uk/government/collections/human-animal-infections-and-risk-surveillance-group-hairs |url-status=live }}</ref> warned that the virus could reach wildlife and become endemic as a result.<ref>{{cite web |url=https://publicnewstime.com/health-news/over-100-britons-have-now-caught-monkeypox-health-chiefs-spot-another-16-cases/ |title=Over 100 Britons have now caught monkeypox: Health chiefs spot another 16 cases |access-date=3 June 2022 |website=publicnewstime.com |date=27 May 2022 |quote=The panel warned that hedgehogs, rats, mice, squirrels, rabbits and hares could all harbour the virus if monkeypox was to spill into Britain's wildlife populations. |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628125406/https://publicnewstime.com/health-news/over-100-britons-have-now-caught-monkeypox-health-chiefs-spot-another-16-cases/ |url-status=live }}</ref><ref>{{cite web |url=https://www.gov.uk/government/publications/hairs-risk-assessment-monkeypox/qualitative-assessment-of-the-risk-to-the-uk-human-population-of-monkeypox-infection-in-a-canine-feline-mustelid-lagomorph-or-rodent-uk-pet |title=Qualitative assessment of the risk to the UK human population of monkeypox infection in a canine, feline, mustelid, lagomorph or rodent UK pet |date=27 May 2022 |access-date=3 June 2022 |website=gov.uk |quote=Do environmental conditions in the UK support the natural reservoirs or vectors of disease? Outcome: yes. Quality of evidence: satisfactory. Various animal species have been identified as susceptible to MPXV. Rodents are considered natural reservoirs of infection, including rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates (21) and other species (22).[...] |archive-date=3 June 2022 |archive-url=https://web.archive.org/web/20220603132651/https://www.gov.uk/government/publications/hairs-risk-assessment-monkeypox/qualitative-assessment-of-the-risk-to-the-uk-human-population-of-monkeypox-infection-in-a-canine-feline-mustelid-lagomorph-or-rodent-uk-pet |url-status=live }}</ref> There was a concern that if the ongoing outbreak is prolonged, it "could establish new ecological niches in wild animals" in regions outside of Africa.<ref name="10.1093/ofid/ofac310"/>
In August, the first known case of probable human-to-dog transmission was reported with the canine exhibiting very similar signs and symptoms of mpox infection to that of humans.<ref>{{cite journal |last1=Seang |first1=Sopie |last2=Burrell |first2=Sonia |last3=Todesco |first3=Eve |last4=Leducq |first4=Valentin |last5=Monsel |first5=Gentiane |last6=Le Pluart |first6=Diane |last7=Cordevant |first7=Christophe |last8=Pourcher |first8=Valerie |last9=Palich |first9=Romaine |title=Evidence of human-to-dog transmission of monkeypox virus |journal=The Lancet |date=10 August 2022 |volume=400 |issue=10353 |pages=658–659 |doi=10.1016/S0140-6736(22)01487-8 |pmid=35963267 |pmc=9536767 |s2cid=251475955 }}</ref>
== Chronology == {{See also|Timeline of the 2022–2023 mpox outbreak}} thumb|right|Epidemic curve shown by month for mpox cases reported to WHO up to 31 March 2024 In the beginning of May 2022, a case of mpox in a British resident who had travelled to Lagos and Delta State in Nigeria,<ref name="WHO1">{{cite web |date=16 May 2022 |title=Monkeypox – United Kingdom of Great Britain and Northern Ireland |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 |url-status=live |archive-url=https://web.archive.org/web/20220517223855/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 |archive-date=17 May 2022 |access-date=17 May 2022 |website=World Health Organization}}</ref> in areas where mpox is considered to be an endemic disease, was reported. The person developed a rash on 29 April while in Nigeria and flew back to the United Kingdom, arriving on 4 May,<ref name="bbc-scotland" /> and presented to hospital later the same day. Mpox infection was immediately suspected, and the patient was hospitalised at a specialist clinical unit of the Guy's and St Thomas' NHS Foundation Trust<ref name="bbc-scotland" /> and isolated, then tested positive for the virus on 6 May.<ref name="WHO1" /> Testing of patient swab samples by polymerase chain reaction revealed clade II of monkeypox virus,<ref name=WHOvariants/> which is the less deadly of the two known monkeypox virus variants with a case fatality rate of around 1%.<ref name="WHO1" /> The genomic sequence of the virus associated with this outbreak was first published on 19 May by Portuguese researchers.<ref name=":8">{{cite web |date=19 May 2022 |title=First draft genome sequence of Monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal) |url=https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799 |access-date=23 May 2022 |website=Virological |language=en |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520005425/https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799 |url-status=live }}</ref>
Extensive contact tracing of people who had been in contact with the index case both on the international flight from Nigeria to the United Kingdom and within the country following their arrival was carried out, with potential contacts advised to remain aware of the symptoms of mpox and immediately isolate if any were to develop within 21 days of the contact event.<ref name="WHO1" /> Following this contact tracing effort, the World Health Organization (WHO) considered further transmission of the virus within the United Kingdom to be of "minimal" risk.<ref name="WHO1" /> Contact tracing was extended to Scotland on 14 May according to Public Health Scotland. A "small number" of people in Scotland were ordered to self-isolate following close contact with the person initially reported to have been infected, although overall risk to the general public remained "very low".<ref name="bbc-scotland" />
On 12 May two new cases of mpox were confirmed by the UK Health Security Agency (UKHSA), both in London,<ref name="BBC-15May">{{cite web |date=15 May 2022 |title=Monkeypox: Two more confirmed cases of viral infection |url=https://www.bbc.co.uk/news/uk-england-london-61449214 |url-status=live |archive-url=https://web.archive.org/web/20220515190510/https://www.bbc.co.uk/news/uk-england-london-61449214 |archive-date=15 May 2022 |access-date=17 May 2022 |website=BBC News}}</ref> living together in the same household, with no known link between either of them and either the index case or travel to endemic regions. One of the new cases was hospitalised at St Mary's Hospital, while the other case with milder symptoms was said to be self-isolating at home.<ref name="BBC-15May" /> On 17 May, another four cases of mpox were confirmed by the UKHSA in three Londoners and a person in North East England who had previously travelled to London.<ref name="BBC-17May">{{cite web |date=17 May 2022 |title=Monkeypox: Four more cases detected in England |url=https://www.bbc.co.uk/news/health-61470940 |url-status=live |archive-url=https://web.archive.org/web/20220517012207/https://www.bbc.co.uk/news/health-61470940 |archive-date=17 May 2022 |access-date=17 May 2022 |website=BBC News}}</ref>
thumb|Right tonsillar enlargement with an overlying pustular lesion during the outbreak Unusually, none of these new cases had any known contact history with the previous three confirmed cases, which suggested a kind of transmission that had not been seen before,<ref name="jama">{{Cite journal |last=Harris |first=Emily |date=27 May 2022 |title=What to Know About Monkeypox |journal=JAMA |volume=327 |issue=23 |pages=2278–2279 |doi=10.1001/jama.2022.9499 |pmid=35622356 |s2cid=249096570 |issn=0098-7484 |doi-access=free }}</ref> a wider community transmission of the virus in the London area. The UKHSA stated that the risk to the general public remained "very low".<ref name="BBC-17May" /><ref name="telegraphMay17">{{cite web |last1=Pinkstone |first1=Joe |date=17 May 2022 |title=Monkeypox 'spreading in sexual networks' |url=https://www.telegraph.co.uk/news/2022/05/17/monkeypox-likely-sexually-transmissible-infection-health-officials/ |url-status=live |archive-url=https://web.archive.org/web/20220517223851/https://www.telegraph.co.uk/news/2022/05/17/monkeypox-likely-sexually-transmissible-infection-health-officials/ |archive-date=17 May 2022 |access-date=17 May 2022 |website=The Telegraph}}</ref> Patients with active mpox infection were confirmed to be hospitalised at the Royal Victoria Infirmary in Newcastle upon Tyne and at the Royal Free Hospital and Guy's Hospital in London.<ref name="BBC-17May" />
Also on 20 May, UK Health Secretary Sajid Javid reported that another eleven cases had been confirmed, bringing the total in the country to twenty. UKHSA reported on 10 June that 311 of the 314 cases where sex was known were men, and that all of the 151 infected persons who filled out an additional questionnaire and answered questions about sexual practices were men who have sex with men, abbreviated MSM.<ref name="UKHSA20220610">{{cite web |date=10 June 2022 |title=Investigation into monkeypox outbreak in England: technical briefing 1 |url=https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1 |url-status=live |archive-url=https://web.archive.org/web/20220611141448/https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1 |archive-date=11 June 2022 |access-date=11 June 2022 |website=UK Health Security Agency}}</ref> Dr. Susan Hopkins from the UKHSA urged watchfulness among men who have sex with men.<ref>{{cite web |date=20 May 2022 |title=UK monkeypox cases double to 20 – Sajid Javid |url=https://www.bbc.com/news/health-61520228 |access-date=20 May 2022 |website=BBC News |language=en-GB |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520142412/https://www.bbc.com/news/health-61520228 |url-status=live }}</ref> The UK Health Security Agency (UKHSA) advised people who have had close contact with a person infected with mpox to self-isolate for 21 days.<ref>{{cite web |last=Taylor |first=Chloe |date=23 May 2022 |title=People coming into contact with monkeypox are now being advised to quarantine for three weeks |url=https://fortune.com/2022/05/23/people-contact-monkeypox-advised-quarantine-3-weeks-belgium-uk/ |access-date=24 May 2022 |website=Fortune |language=en |archive-date=23 May 2022 |archive-url=https://web.archive.org/web/20220523112129/https://fortune.com/2022/05/23/people-contact-monkeypox-advised-quarantine-3-weeks-belgium-uk/ |url-status=live }}</ref>
Further cases in multiple countries outside the endemic area were reported through the second half of May 2022. On 18 May, Portugal reported 14 cases of mpox.<ref name="dnpt18may2022">{{cite web |title=Monkeypox. Já há 14 casos de varíola dos macacos em Portugal |trans-title=Monkeypox. There are already 14 cases of monkeypox in Portugal |url=https://www.dn.pt/sociedade/ja-ha-14-casos-de-variola-dos-macacos-em-portugal-14869281.html |url-status=live |archive-url=https://web.archive.org/web/20220518213313/https://www.dn.pt/sociedade/ja-ha-14-casos-de-variola-dos-macacos-em-portugal-14869281.html |archive-date=18 May 2022 |access-date=18 May 2022 |website=dn.pt |date=18 May 2022 |language=pt-PT}}</ref> In Spain, there were seven confirmed cases as of 18 May.<ref>{{cite web |last=Güell |first=Oriol |date=18 May 2022 |title=Sanidad confirma que los análisis de los siete primeros casos sospechosos de viruela del mono han dado positivo |trans-title=Health confirms that the analyzes of the first seven suspected cases of monkeypox have tested positive |url=https://elpais.com/sociedad/2022-05-18/madrid-eleva-a-23-el-numero-de-casos-sospechosos-de-sufrir-viruela-de-los-monos-atendidos-la-region.html |url-status=live |archive-url=https://web.archive.org/web/20220518213051/https://elpais.com/sociedad/2022-05-18/madrid-eleva-a-23-el-numero-de-casos-sospechosos-de-sufrir-viruela-de-los-monos-atendidos-la-region.html |archive-date=18 May 2022 |access-date=18 May 2022 |website=El País |language=es}}</ref> On the same day, the United States confirmed its first 2022 case of mpox and Canada reported 13 suspected cases.<ref>{{cite web |date=18 May 2022 |title=Massachusetts confirms rare monkeypox case, the first in the US this year |url=https://www.bostonherald.com/2022/05/18/massachusetts-confirms-rare-monkeypox-case-the-first-in-the-us-this-year/ |url-status=live |archive-url=https://web.archive.org/web/20220520095157/https://www.bostonherald.com/2022/05/18/massachusetts-confirms-rare-monkeypox-case-the-first-in-the-us-this-year/ |archive-date=20 May 2022 |access-date=18 May 2022 |website=Boston Herald |language=en-US}}</ref><ref>{{cite web |last=ICI.Radio-Canada.ca |first=Zone Santé- |title=Variole du singe : au moins 13 cas en cours d'examen à Montréal |trans-title=Monkey pox: at least 13 cases being examined in Montreal |url=https://ici.radio-canada.ca/nouvelle/1884547/orthopoxvirose-simienne-monkeypox-maladie-sante-publique-quebec-canada |url-status=live |archive-url=https://web.archive.org/web/20220518213614/https://ici.radio-canada.ca/nouvelle/1884547/orthopoxvirose-simienne-monkeypox-maladie-sante-publique-quebec-canada |archive-date=18 May 2022 |access-date=18 May 2022 |website=Radio-Canada.ca |date=18 May 2022 |language=fr-ca}}</ref>
On 19 May, Sweden, Belgium<ref>{{cite news |title=Ett fall av apkoppor rapporterat i Sverige – Folkhälsomyndigheten |trans-title=A case of smallpox reported in Sweden – Public Health Agency |url=https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2022/maj/ett-fall-av-apkoppor-rapporterat-i-sverige/ |url-status=live |archive-url=https://web.archive.org/web/20220519110819/https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2022/maj/ett-fall-av-apkoppor-rapporterat-i-sverige/ |archive-date=19 May 2022 |access-date=19 May 2022}}</ref><ref name="vrtnws">{{cite news |date=19 May 2022 |title=Eerste besmetting met apenpokkenvirus vastgesteld in ons land |trans-title=First infection with monkey pox virus detected in our country |language=nl|website=VRT NWS |url=https://www.vrt.be/vrtnws/nl/2022/05/19/apenpokken-eerste-geval-in-ons-land/ |url-status=live |access-date=19 May 2022 |archive-url=https://web.archive.org/web/20220519203910/https://www.vrt.be/vrtnws/nl/2022/05/19/apenpokken-eerste-geval-in-ons-land/ |archive-date=19 May 2022}}</ref> and Italy confirmed their first cases.<ref>{{cite news |date=19 May 2022 |title=Italy reports first case of monkeypox infection, two more suspected |website=Reuters |url=https://www.reuters.com/business/healthcare-pharmaceuticals/italy-reports-first-case-monkeypox-infection-two-more-suspected-2022-05-19/ |url-status=live |access-date=19 May 2022 |archive-url=https://web.archive.org/web/20220519131733/https://www.reuters.com/business/healthcare-pharmaceuticals/italy-reports-first-case-monkeypox-infection-two-more-suspected-2022-05-19/ |archive-date=19 May 2022}}</ref> On 20 May, Australia,<ref>{{Cite news |date=20 May 2022 |title=Monkeypox cases investigated in Europe, US, Canada and Australia |language=en-GB |publisher=BBC News |url=https://www.bbc.com/news/health-61506562 |url-status=live |access-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520020207/https://www.bbc.com/news/health-61506562 |archive-date=20 May 2022}}</ref><ref>{{cite news |last1=Parkes-Hupton |first1=Heath |last2=Johnson |first2=Sian |title=Monkeypox confirmed in Melbourne and Sydney |url=https://www.abc.net.au/news/2022-05-20/monkeypox-case-in-sydney-and-melbourne/101084864 |access-date=20 May 2022 |website=ABC News |date=20 May 2022 |publisher=Australian Broadcasting Commission |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520071749/https://www.abc.net.au/news/2022-05-20/monkeypox-case-in-sydney-and-melbourne/101084864 |url-status=live }}</ref> Germany, France and the Netherlands confirmed their first cases.<ref>{{cite news |title=Erster Fall von Affenpocken in Deutschland bestätigt |trans-title=First case of monkeypox confirmed in Germany |url=https://www.zeit.de/gesundheit/2022-05/erster-fall-von-affenpocken-in-deutschland-bestaetigt |access-date=20 May 2022 |website=Die Zeit |date=20 May 2022 |language=de |archive-date=21 May 2022 |archive-url=https://web.archive.org/web/20220521030324/https://www.zeit.de/gesundheit/2022-05/erster-fall-von-affenpocken-in-deutschland-bestaetigt |url-status=live |last1=Schlitt |first1=Anna-Lena }}</ref><ref name="f24">{{cite web |date=20 May 2022 |title=France, Germany, Belgium report first monkeypox cases amid unusual spread in Europe |url=https://www.france24.com/en/europe/20220520-france-germany-belgium-report-first-monkeypox-cases-amid-unusual-spread-in-europe |access-date=20 May 2022 |website=France 24 |language=en |archive-date=21 May 2022 |archive-url=https://web.archive.org/web/20220521020725/https://www.france24.com/en/europe/20220520-france-germany-belgium-report-first-monkeypox-cases-amid-unusual-spread-in-europe |url-status=live }}</ref><ref name=":2">{{Cite news |date=20 May 2022 |title=Dutch health agency confirms first monkeypox case in the Netherlands |language=en |publisher=Reuters |url=https://www.reuters.com/world/europe/several-suspected-monkeypox-cases-netherlands-anp-citing-health-agency-2022-05-20/ |access-date=20 May 2022 |archive-date=21 May 2022 |archive-url=https://web.archive.org/web/20220521020604/https://www.reuters.com/world/europe/several-suspected-monkeypox-cases-netherlands-anp-citing-health-agency-2022-05-20/ |url-status=live }}</ref> For the remainder of May, multiple European countries<ref name="yahoo">{{cite web |title=Austria's first case of monkeypox confirmed, Vienna health authority says |url=https://news.yahoo.com/austrias-first-case-monkeypox-confirmed-153959022.html |website=Yahoo! News |date=22 May 2022 |access-date=22 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192341/https://news.yahoo.com/austrias-first-case-monkeypox-confirmed-153959022.html |url-status=live }}</ref><ref>{{Cite Q | Q112115989 }}</ref><ref name="DK first">{{cite news|title=Det første tilfælde af abekopper er nu påvist i Danmark |trans-title=The first case of monkey pox has now been detected in Denmark |url=https://www.ssi.dk/aktuelt/nyheder/2022/det-foerste-tilfaelde-af-abekopper-er-nu-paavist-i-dk|date=23 May 2022|publisher=Statens Serum Institut|access-date=23 May 2022|language=da|archive-date=24 May 2022|archive-url=https://web.archive.org/web/20220524192412/https://www.ssi.dk/aktuelt/nyheder/2022/det-foerste-tilfaelde-af-abekopper-er-nu-paavist-i-dk|url-status=live}}</ref><ref name="czech-first">{{cite web|date=24 May 2022|title=Czech Republic detects its first case of monkeypox|website=Reuters |url=https://www.reuters.com/world/europe/czech-republic-detects-its-first-case-monkeypox-2022-05-24/|access-date=24 May 2022|archive-date=24 May 2022|archive-url=https://web.archive.org/web/20220524193041/https://www.reuters.com/world/europe/czech-republic-detects-its-first-case-monkeypox-2022-05-24/|url-status=live}}</ref> and Israel confirmed their first cases.<ref name=":3">{{Cite news |date=21 May 2022 |title=Switzerland confirms its first case of monkeypox |language=en |publisher=Reuters |url=https://www.reuters.com/world/europe/switzerland-confirms-its-first-case-monkeypox-2022-05-21/ |access-date=21 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192333/https://www.reuters.com/world/europe/switzerland-confirms-its-first-case-monkeypox-2022-05-21/ |url-status=live }}</ref><ref name="1stisrael"/> The United Arab Emirates<ref>{{cite web |author=<!--Staff writer(s); no by-line.--> |title=UAE detects first case of monkeypox |url=https://www.khaleejtimes.com/uae/uae-detects-first-case-of-monkeypox |access-date=24 May 2022 |website=Khaleej Times |language=en |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192342/https://www.khaleejtimes.com/uae/uae-detects-first-case-of-monkeypox |url-status=live }}</ref> and Mexico also confirmed their first cases.<ref>{{cite web |title=Viruela del mono: confirman primer caso en México |url=https://www.eluniversal.com.mx/nacion/viruela-del-mono-confirman-primer-caso-en-mexico |website=El Universal México |date=28 May 2022 |access-date=28 May 2022 |language=es |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528172431/https://www.eluniversal.com.mx/nacion/viruela-del-mono-confirman-primer-caso-en-mexico |url-status=live }}</ref>
thumb|440px|Stages of lesion development during the outbreak On 23 May, David Heymann, an advisor for the World Health Organization, said that the likely theory of how the outbreak started is transmission during sexual intercourse of gay and bisexual men at two raves in Belgium and Spain.<ref name="McFarland2023" /><ref>{{cite news |date=23 May 2022 |title=Monkeypox likely spread by sex at two raves in Europe, expert says |url=https://www.nbcnews.com/health/health-news/monkeypox-likely-spread-sex-two-raves-europe-expert-says-rcna30055 |access-date=24 May 2022 |website=NBC News |agency=Associated Press |language=en |archive-date=23 May 2022 |archive-url=https://web.archive.org/web/20220523124128/https://www.nbcnews.com/health/health-news/monkeypox-likely-spread-sex-two-raves-europe-expert-says-rcna30055 |url-status=live }}</ref> On 25 May, ''The Guardian'' stated that many scientists suspect the disease was circulating across Europe before reaching the MSM community, possibly misdiagnosed or detected only in isolated cases; four cases were diagnosed in 2018 and 2019, all in individuals who recently arrived from Nigeria.<ref>{{cite news |date=25 May 2022 |title=Monkeypox may have been circulating in UK for years, scientists say |work=The Guardian |url=https://www.theguardian.com/world/2022/may/25/monkeypox-may-have-been-circulating-in-uk-for-years-scientists-say |access-date=25 May 2022 |archive-date=25 May 2022 |archive-url=https://web.archive.org/web/20220525163843/https://www.theguardian.com/world/2022/may/25/monkeypox-may-have-been-circulating-in-uk-for-years-scientists-say |url-status=live }}</ref>
In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.<ref>{{cite web |url=https://www.cnbc.com/2022/06/10/some-monkeypox-patients-also-have-sexually-transmitted-diseases-cdc-says.html |title=Some monkeypox patients also have sexually transmitted diseases, CDC says |date=2022-06-10 |access-date=2022-07-30 |website=cnbc.com |archive-date=30 July 2022 |archive-url=https://web.archive.org/web/20220730134119/https://www.cnbc.com/2022/06/10/some-monkeypox-patients-also-have-sexually-transmitted-diseases-cdc-says.html |url-status=live }}</ref>
===Deaths outside of Africa=== The first death outside of endemic Africa was reported in Brazil on 29 July 2022, in a 41-year-old man with underlying comorbidities.<ref name="brazildeath"/> On the same day Spain reported its first death, a 44-year-old man in Alicante, with the cause of death being encephalitis associated with mpox infection.<ref name="frankfurterallgemeine">{{cite news |title=Erste Affenpocken-Todesfälle in Europa – Notstand in New York |url=https://www.faz.net/aktuell/gesellschaft/gesundheit/zweiter-affenpocken-todesfall-in-europa-notstand-in-new-york-18211034.html |website=Frankfurter Allgemeine Zeitung |access-date=31 July 2022 |language=de |archive-date=30 July 2022 |archive-url=https://web.archive.org/web/20220730193524/https://www.faz.net/aktuell/gesellschaft/gesundheit/zweiter-affenpocken-todesfall-in-europa-notstand-in-new-york-18211034.html |url-status=live }}</ref><ref>{{cite web |title=Sanidad confirma la primera muerte por viruela del mono en España |url=https://elpais.com/sociedad/2022-07-29/sanidad-confirma-la-primera-muerte-por-viruela-del-mono-en-espana.html |website=El País |date=29 July 2022 |access-date=30 July 2022 |language=es |archive-date=29 July 2022 |archive-url=https://web.archive.org/web/20220729233828/https://elpais.com/sociedad/2022-07-29/sanidad-confirma-la-primera-muerte-por-viruela-del-mono-en-espana.html |url-status=live }}</ref><ref name="spain2deaths"/><ref>{{Cite web|title=Unexpected info on Spain's 2 fatal #MPX cases|url=https://twitter.com/HelenBranswell/status/1554464200768077827|website=Twitter - Helen Branswell|date=2 August 2022|access-date=2 August 2022|archive-date=2 August 2022|archive-url=https://web.archive.org/web/20220802135048/https://twitter.com/HelenBranswell/status/1554464200768077827|url-status=live}}</ref> Spain reported its second mpox-related death on 30 July 2022, in a 31-year-old man in Córdoba, who had also suffered from encephalitis according to reports.<ref name="spain2deaths"/><ref>{{cite web |title=El Ministerio de Sanidad informa de la segunda muerte por la viruela del mono en España |url=https://www.europapress.es/cantabria/noticia-ministerio-sanidad-informa-segunda-muerte-viruela-mono-espana-20220730154040.html |website=Europa Press (news agency) |date=30 July 2022 |access-date=30 July 2022 |language=es |archive-date=30 July 2022 |archive-url=https://web.archive.org/web/20220730192138/https://www.europapress.es/cantabria/noticia-ministerio-sanidad-informa-segunda-muerte-viruela-mono-espana-20220730154040.html |url-status=live }}</ref><ref name="frankfurterallgemeine"/> On 1 August 2022, India confirmed its first mpox death, a 22-year-old male who died in Thrissur, Kerala on 30 July.<ref name="indiafirstdeath"/> On the same day, Peru reported the death of a mpox-affected 45-year-old male, who also had HIV and septic shock.<ref name="First death in Peru"/>
On 30 August 2022, a Texan from Harris County became the first American to die of the mpox epidemic.<ref>Texas Health and Human Service.(30 August 2022) Texas Confirms First Death of a Person with Monkeypox.[press release].retrieved from https://dshs.texas.gov/news-alerts/texas-confirms-first-death-of-a-person-with-monkeypox/#:~:text=Aug.,County%20who%20was%20severely%20immunocompromised {{Webarchive|url=https://web.archive.org/web/20220906041458/https://dshs.texas.gov/news-alerts/texas-confirms-first-death-of-a-person-with-monkeypox/#:~:text=Aug.,County%20who%20was%20severely%20immunocompromised |date=6 September 2022 }}.</ref>
== Transmission == A large portion of those infected had not recently travelled to areas of Africa where mpox is endemic, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is transmitted by close contact with infected people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The disease can spread via respiratory secretions or by direct contact with rashes, body fluids or by touching objects and fabrics that have been used by someone with mpox. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.<ref>{{Cite web |last=Vargas |first=Ramon Antonio |date=2022-06-07 |title=US raises monkeypox alert level but says risk to public remains low |url=https://www.theguardian.com/world/2022/jun/07/monkeypox-cases-cdc-alert-level-us |access-date=2022-06-09 |website=The Guardian |language=en |archive-date=28 September 2022 |archive-url=https://web.archive.org/web/20220928155129/https://www.theguardian.com/world/2022/jun/07/monkeypox-cases-cdc-alert-level-us |url-status=live }}</ref>
===Transmission patterns=== The 2022–2023 outbreak initially had a different pattern of spread compared to prior mpox outbreaks outside Africa.<ref name="Adalja22">{{cite journal |last1=Adalja |first1=Amesh |last2=Inglesby |first2=Tom |title=A Novel International Monkeypox Outbreak |journal=Annals of Internal Medicine |date=24 May 2022 |volume=175 |issue=8 |pages=1175–1176 |doi=10.7326/M22-1581|pmid=35605243 |s2cid=249014928 }}</ref> Genetic evidence suggest the outbreak likely started in Nigeria.<ref name=":4" /><ref name="NPR">{{cite web|last1=Nsofor|first1=Ifeanyi|date=2 June 2022|title=OPINION: Media coverage of monkeypox paints it as an African virus.|url=https://www.npr.org/sections/goatsandsoda/2022/06/02/1102199023/opinion-media-coverage-of-monkeypox-paints-it-as-an-african-virus-that-makes-me-|access-date=2 June 2022|publisher=NPR|archive-date=2 February 2023|archive-url=https://web.archive.org/web/20230202220150/https://www.npr.org/sections/goatsandsoda/2022/06/02/1102199023/opinion-media-coverage-of-monkeypox-paints-it-as-an-african-virus-that-makes-me-|url-status=live}}</ref> Given the unusually high frequency of human-to-human transmission observed in this event, and the probable community transmission without history of traveling to endemic areas, spread of the virus through close contact is more likely, with transmission during sexual activities being the most common route.<ref name=":6" /> Most cases have been in men.<ref name="Dye22" /> A significant proportion of cases, although not all, are in men who have sex with men (MSM), notably in Canada, Spain, and the UK,<ref name="Dye22" /> with many cases diagnosed in sexual health clinics.<ref name="Adalja22" /> Cases are mostly in young and middle-aged men.<ref name="aidsmapmay22">{{cite web | url=https://www.aidsmap.com/news/may-2022/monkeypox-spreading-among-gay-men-worldwide | title=Monkeypox is spreading among gay men worldwide | date=25 May 2022 | access-date=30 May 2022 | archive-date=28 May 2022 | archive-url=https://web.archive.org/web/20220528011743/https://www.aidsmap.com/news/may-2022/monkeypox-spreading-among-gay-men-worldwide | url-status=live }}</ref> This points to transmission due to close contact during sex as being the main route of transmission.<ref name="Dye22">{{cite journal |last1=Dye |first1=Christopher |last2=Kraemer |first2=Moritz |title=Investigating the monkeypox outbreak |journal=The BMJ |date=26 May 2022 |volume=377 |article-number=o1314 |doi=10.1136/bmj.o1314 |pmid=35618293 |s2cid=249047134 |url=https://www.bmj.com/content/377/bmj.o1314 |access-date=31 May 2022 |archive-date=31 May 2022 |archive-url=https://web.archive.org/web/20220531223043/https://www.bmj.com/content/377/bmj.o1314 |url-status=live |doi-access=free }}</ref> In May 2022, the European Centre for Disease Prevention and Control (ECDC) considered the monkeypox virus to be moderately transmissible among humans. According to the centre, among MSM who contracted the virus, the most common means of transmission is likely through sexual activity due to intimate contact with infectious skin lesions. The ECDC rated likelihood of transmission due to close contact, including sexual contact, as "high", but, without close contact, as low.<ref name=":6">{{cite web |date=20 May 2022 |title=Epidemiological update: Monkeypox outbreak |url=https://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-outbreak |access-date=23 May 2022 |website=European Centre for Disease Prevention and Control |language=en |archive-date=23 May 2022 |archive-url=https://web.archive.org/web/20220523064948/https://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-outbreak |url-status=live }}</ref> In ''Nature'', Anne Rimoin and Raina MacIntyre speculate that the higher percentage of MSM affected is a result of coincidental introduction to the community and then sexual activity constituting "close contact" rather than the virus itself becoming sexually transmitted.<ref name=":7">{{Cite journal |last=Kozlov |first=Max |date=20 May 2022 |title=Monkeypox goes global: why scientists are on alert |journal=Nature |volume=606 |issue=7912 |pages=15–16 |language=en |doi=10.1038/d41586-022-01421-8 |pmid=35595996 |bibcode=2022Natur.606...15K |s2cid=248947652 |doi-access=free }}</ref> However, in a study published in August 2022, infectious monkeypox virus was able to be isolated from semen samples,<ref name="Lapa">{{cite journal |last1=Lapa |first1=Daniele |last2=Carletti |first2=Fabrizio |last3=Mazzotta |first3=Valentina |last4=Matusali |first4=Giulia |last5=Pinnetti |first5=Carmela |last6=Meschi |first6=Silvia |last7=Gagliardini |first7=Roberta |last8=Colavita |first8=Francesca |last9=Mondi |first9=Analisa |last10=Minosse |first10=Claudia |last11=Scorzolini |first11=Laura |last12=Cicalini |first12=Stefania |last13=Maggi |first13=Fabrizio |title=Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding |journal=Lancet Infectious Diseases |date=2 August 2022 |volume=22 |issue=9 |pages=1267–1269 |doi=10.1016/S1473-3099(22)00513-8 |pmid=35931095 |pmc=9629691 |s2cid=251289584 |url=https://doi.org/10.1016/S1473-3099(22)00513-8 |access-date=3 August 2022 |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701040827/https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00513-8/fulltext |url-status=live }}</ref> and the prolonged shedding of virus in seminal fluids raised the possibility of a genital reservoir for human mpox.<ref name="Lapa" />
On 21 July, a study on a sample of 528 infections diagnosed between 27 April and 24 June outside endemic regions in Africa indicated that: 99% cases were in men; 98% of cases occurred in the community of men who have sex with men (MSM), mainly those who have multiple sex partners (median of 5 partners in the previous 3 months); 75% were white; 41% had HIV/AIDS, of which 96% were on antiretroviral therapy, while 57% of the persons who were not known to have HIV infection were on pre-exposure prophylaxis; 29% had another concomitant sexually transmitted infection; and in the previous month, 32% attended a sex on premises venue and 20% engaged in chemsex.<ref name="nejm-demographic">{{Cite journal |vauthors=Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, Palich R, Nori A, Reeves I, Habibi MS, Apea V |display-authors=6 |date=21 July 2022 |title=Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022 |journal=New England Journal of Medicine |volume=387 |issue=8 |pages=679–691 |doi=10.1056/NEJMoa2207323 |pmid=35866746 |s2cid=250953579 |issn=0028-4793|doi-access=free |hdl=11380/1289204 |hdl-access=free }}</ref> On 2 August, data collected by the Joint ECDC-WHO Regional Office for Europe Mpox Surveillance indicated that 99% (15,439/15,572) of the cases reported throughout the European region were among males, with 44% among MSM, 1% among heterosexuals and another 55% in males whose sexual orientation is unknown. Among cases with known HIV status, 36% (2,690/7,487) were HIV-positive.<ref name="ecdcbulletin">{{cite web |title=Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin |url=https://monkeypoxreport.ecdc.europa.eu/ |access-date=4 August 2022 |website=European Centre for Disease Prevention and Control |archive-date=2 September 2022 |archive-url=https://web.archive.org/web/20220902130552/https://monkeypoxreport.ecdc.europa.eu/ |url-status=live }} Updated frequently.</ref>
A preprint suggests that cases "where a small fraction of individuals have disproportionately large numbers of partners, can explain the sustained growth of mpox cases among the MSM population".<ref>{{cite news |last1=Bajaj |first1=Simar |title=What You Need to Know About the History of Monkeypox |url=https://www.smithsonianmag.com/history/what-you-need-to-know-about-the-history-of-monkeypox-180980301/ |access-date=22 July 2022 |work=Smithsonian Magazine |language=en |archive-date=21 July 2022 |archive-url=https://web.archive.org/web/20220721123757/https://www.smithsonianmag.com/history/what-you-need-to-know-about-the-history-of-monkeypox-180980301/ |url-status=live }}</ref><ref>{{Cite medRxiv |last1=Endo |first1=Akira |last2=Murayama |first2=Hiroaki |last3=Abbott |first3=Sam |last4=Ratnayake |first4=Ruwan |last5=Pearson |first5=Carl A. B. |last6=Edmunds |first6=W. John |last7=Fearon |first7=Elizabeth |last8=Funk |first8=Sebastian |title=Heavy-tailed sexual contact networks and the epidemiology of monkeypox outbreak in non-endemic regions, May 2022 |language=en |date=13 June 2022 |medrxiv=10.1101/2022.06.13.22276353v1}}</ref>{{Unreliable source?|reason=This is a pre-print, and therefore not peer-reviewed.|date=August 2022|sure=y}}
The basic reproduction number during the initial phase of the 2022 global outbreak of mpox was estimated to be 1.29,<ref>{{Cite journal |last1=Du |first1=Zhanwei |last2=Shao |first2=Zhenyang |last3=Bai |first3=Yuan |last4=Wang |first4=Lin |last5=Cowling |first5=Benjamin |title=Reproduction number of monkeypox in the early stage of the 2022 multi-country outbreak |journal=Journal of Travel Medicine |date=2022 |volume=29 |issue=8 |article-number=taac099 |doi=10.1093/jtm/taac099 |pmid=36006837 |medrxiv=10.1101/2022.07.26.22278042v1}}</ref> and the herd immunity of mpox was estimated to be 24.94%.<ref>{{cite journal |last1=Al-Raeei |first1=Marwan |title=The study of human monkeypox disease in 2022 using the epidemic models: herd immunity and the basic reproduction number case |journal=Annals of Medicine & Surgery |year=2023 |volume=85 |issue=2 (February) |pages=316–321 |doi=10.1097/MS9.0000000000000229 |pmid=36845803 |pmc=9949786 }}</ref>
As the mpox outbreak developed, nosocomial and other forms of human-to-human spread became apparent, with a notable example being a doctor in an Israeli hospital becoming infected probably while removing protective clothing after examining mpox patients.<ref>{{cite news |last1=Horovitz |first1=Michael |title=Medical staff call to be vaccinated against monkeypox after doctor infected |url=https://www.timesofisrael.com/medical-staff-call-to-be-vaccinated-against-monkeypox-after-doctor-infected/ |access-date=7 August 2022 |agency=The Times of Israel |date=5 August 2022 |archive-date=6 August 2022 |archive-url=https://web.archive.org/web/20220806211541/https://www.timesofisrael.com/medical-staff-call-to-be-vaccinated-against-monkeypox-after-doctor-infected/ |url-status=live }}</ref> Contaminated surfaces within hospitals and households may be infectious,<ref>{{cite journal |last1=Nörz |first1=Dominik |last2=Pfefferle |first2=Susanne |last3=Brehm |first3=Thomas T. |last4=Franke |first4=Gefion |last5=Grewe |first5=Ilka |last6=Knobling |first6=Birte |last7=Aepfelbacher |first7=Martin |last8=Huber |first8=Samuel |last9=Klupp |first9=Eva M. |last10=Jordan |first10=Sabine |last11=Addo |first11=Marylyn M. |last12=Wiesch |first12=Julian Schulze zur |last13=Schmiedel |first13=Stefan |last14=Lütgehetmann |first14=Marc |last15=Knobloch |first15=Johannes K. |title=Evidence of surface contamination in hospital rooms occupied by patients infected with monkeypox, Germany, June 2022 |journal=Eurosurveillance |date=30 June 2022 |volume=27 |issue=26 |article-number=2200477 |doi=10.2807/1560-7917.ES.2022.27.26.2200477 |pmid=35775427 |pmc=9248266 |s2cid=250356219 |language=en |issn=1560-7917}} * News article: {{cite news |title=The contamination of surfaces in hospital rooms housing monkeypox patients |url=https://www.news-medical.net/news/20220706/The-contamination-of-surfaces-in-hospital-rooms-housing-monkeypox-patients.aspx |work=News-Medical.net |date=6 July 2022 |language=en |access-date=5 August 2022 |archive-date=10 August 2022 |archive-url=https://web.archive.org/web/20220810202529/https://www.news-medical.net/news/20220706/The-contamination-of-surfaces-in-hospital-rooms-housing-monkeypox-patients.aspx |url-status=live }}</ref> with widespread contamination of surface and air samples taken from mpox isolation rooms in UK hospitals being documented.<ref>{{Cite journal |last1=Gould |first1=Susan |last2=Atkinson |first2=Barry |last3=Okechukwu |first3=Onianwa |last4=Spencer |first4=Anthony |last5=Furneaux |first5=Jenna |last6=Dunning |first6=Jake |title=Air and surface sampling for monkeypox virus in a UK hospital: An observational study |journal=The Lancet Microbe |date=2022 |volume=3 |issue=12 |pages=e904–e911 |doi=10.1016/s2666-5247(22)00257-9 |pmid=36215984 |pmc=9546519 |medrxiv=10.1101/2022.07.21.22277864v1}}</ref>
=== Wastewater surveillance === A study from the Faculty of Medicine at Chulalongkorn University reported multiple traces of monkeypox virus were detected in non-sewered wastewater with sparse sampling collected from both the Bangkok, Thailand with increasing concentrations from June to August 2022.<ref name="Wannigama" /> Monkeypox viral DNA was first detected in wastewater in the second week of June 2022.<ref name="Wannigama" /> From the first week of July, the number of viral DNA copies increased. Sanger sequencing confirmed the identification of the monkeypox virus and its relation to the 2022–2023 mpox outbreak.<ref name="Wannigama" />
==Interventions== [[File:20230121 095346 Mpox Consultation Clinic.jpg|thumb|Mpox vaccination event in Auckland, New Zealand held in January 2023]]
===Testing and containment=== In early July 2022, scientists reported that the window to be able to contain the outbreak is closing or has closed.<ref>{{cite news |title=The world is 'losing the window' to contain monkeypox, experts warn |url=https://www.sciencenews.org/article/who-losing-effort-contain-monkeypox-virus |access-date=23 August 2022 |work=Science News |date=22 July 2022 |archive-date=23 August 2022 |archive-url=https://web.archive.org/web/20220823121139/https://www.sciencenews.org/article/who-losing-effort-contain-monkeypox-virus |url-status=live }}</ref><ref>{{cite news |title=Monkeypox: US experts issue warning amid limited vaccines and testing |url=https://www.theguardian.com/world/2022/jul/18/monkeypox-vaccines-testing-us-latest-warning-threat |access-date=23 August 2022 |work=The Guardian |date=18 July 2022 |language=en |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701041320/https://www.theguardian.com/world/2022/jul/18/monkeypox-vaccines-testing-us-latest-warning-threat |url-status=live }}</ref> Previous attempts to control the disease had included encouraging individuals to quarantine or inoculation efforts directed at high-risk individuals.<ref>{{Cite web |title=Mpox |url=https://www.who.int/news-room/fact-sheets/detail/mpox |access-date=2024-10-10 |website=who.int |language=en}}</ref><ref>{{Cite web |title=WHO Director-General declares mpox outbreak a public health emergency of international concern |url=https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern |access-date=2024-10-10 |website=who.int |language=en}}</ref> By late July 23, the WHO declared the mpox a public health emergency due to its prevalence and spread in multiple countries.<ref>{{Cite web |date=2024-08-14 |title=Mpox outbreak - PAHO/WHO {{!}} Pan American Health Organization |url=https://www.paho.org/en/mpox |access-date=2024-10-10 |website=paho.org |language=en}}</ref> Mpox testing is done in various ways, usually using a swab or test sample from an infected persons lesions, throat, blood, or semen.<ref>{{Cite web |date=2024-09-26 |title=Mpox: diagnostic testing |url=https://www.gov.uk/guidance/monkeypox-diagnostic-testing |access-date=2024-10-10 |website=GOV.UK |language=en}}</ref> Upon the recommendation of the WHO, PCR testing became the most common test for diagnosing mpox during the outbreak. PCR testing used genome sequencing to identify genomes which are unique to MPVX to use in diagnosis.<ref>{{Cite journal |last1=Zhou |first1=Yunfan |last2=Chen |first2=Zixin |date=2023 |title=Mpox: a review of laboratory detection techniques |journal=Archives of Virology |volume=168 |issue=8 |page=221 |doi=10.1007/s00705-023-05848-w |issn=0304-8608 |pmid=37543543|pmc=10404179 }}</ref>
===Vaccination=== As of June 2022, ring-vaccinations and pre-exposure vaccination of MSM were strategies in some countries to contain the outbreak. Local transmission leading to sizeable clusters may have gone unnoticed for some time.<ref name="10.1093/ofid/ofac310">{{cite journal |last1=Titanji |first1=Boghuma K |last2=Tegomoh |first2=Bryan |last3=Nematollahi |first3=Saman |last4=Konomos |first4=Michael |last5=Kulkarni |first5=Prathit A |title=Monkeypox: A Contemporary Review for Healthcare Professionals |journal=Open Forum Infectious Diseases |date=1 July 2022 |volume=9 |issue=7 |article-number=ofac310 |doi=10.1093/ofid/ofac310 |pmid=35891689 |pmc=9307103 |issn=2328-8957}}</ref> Two vaccines are available. Smallpox vaccines containing vaccinia such as Imvanex (Jynneos) and ACAM2000 can provide around 85% effectiveness against mpox.<ref name=":15" /> This protection level is calculated from studies using smallpox vaccines tested in late 1980 in Africa.<ref>{{cite web |date=24 May 2022 |title=JYNNEOS Smallpox (Monkeypox) Vaccine |url=https://www.precisionvaccinations.com/vaccines/jynneos-smallpox-monkeypox-vaccine |website=Precision Vaccinations |language=en |access-date=26 May 2022 |archive-date=23 January 2022 |archive-url=https://web.archive.org/web/20220123001731/https://www.precisionvaccinations.com/vaccines/jynneos-smallpox-monkeypox-vaccine |url-status=live }}</ref><ref>{{cite journal|date=24 May 2022 |title=Human Monkeypox |pmc=5895105 |language=en |last1=McCollum |first1=A. M. |last2=Damon |first2=I. K. |last3=Braden |first3=Z. |last4=Carroll |first4=D. S. |last5=Bostik |first5=V. |last6=Karem |first6=K. |last7=Smith |first7=S. K. |last8=Davidson |first8=W. |last9=Li |first9=Y. |last10=Moundeli |first10=A. |last11=Mombouli |first11=J. V. |last12=Jumaan |first12=A. O. |last13=Schmid |first13=D. S. |last14=Regnery |first14=R. L. |last15=Damon |first15=I. K. |journal=Clinical Infectious Diseases |volume=48 |issue=1 |pages=e6–e8 |doi=10.1086/595552 |pmid=19025497 }}</ref><ref>{{cite web |last=Liu |first=Angus |date=19 May 2022 |title=As monkeypox cases emerge in US and Europe, Bavarian Nordic inks vaccine order |url=https://www.fiercepharma.com/manufacturing/bavarian-nordic-inks-vaccine-order-monkeypox-cases-crop-us-eu |access-date=23 May 2022 |website=Fierce Pharma |language=en |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520012959/https://www.fiercepharma.com/manufacturing/bavarian-nordic-inks-vaccine-order-monkeypox-cases-crop-us-eu |url-status=live }}</ref> According to the CDC the vaccination with Jynneos/Imvanex is "[a]dministered as two subcutaneous injections four weeks apart" while the vaccination with ACAM2000 is "administered as one percutaneous dose via multiple puncture technique with a bifurcated needle".<ref name=":15">{{cite web |url=https://www.cdc.gov/poxvirus/monkeypox/considerations-for-monkeypox-vaccination.html |title=Considerations for Monkeypox Vaccination |access-date=9 July 2022 |website=cdc.gov |archive-date=29 July 2022 |archive-url=https://web.archive.org/web/20220729145323/https://www.cdc.gov/poxvirus/monkeypox/considerations-for-monkeypox-vaccination.html |url-status=live }}</ref> However, ACAM2000 is not recommended for potentially immunocompromised persons due to high replication competency of vaccinia while Imvanex (Jynneos) is recommended for potentially immunocompromised persons due it containing an attenuated, non-replicating orthopoxvirus, Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN).<ref>{{Cite journal |last=Research |first=Center for Biologics Evaluation and |date=17 February 2021 |title=ACAM2000 (Smallpox Vaccine) Questions and Answers |url=https://www.fda.gov/vaccines-blood-biologics/vaccines/acam2000-smallpox-vaccine-questions-and-answers |journal=FDA |language=en |access-date=28 July 2022 |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520084917/https://www.fda.gov/vaccines-blood-biologics/vaccines/acam2000-smallpox-vaccine-questions-and-answers |url-status=dead }}</ref><ref name=":15" /> The UKHSA has begun using Imvanex as post-exposure prophylaxis for close contacts of known cases.<ref>{{Cite news |last=Rigby |first=Jennifer |date=19 May 2022 |title=Britain offers smallpox shot as monkeypox cases spread in Europe |language=en |publisher=Reuters |url=https://www.reuters.com/business/healthcare-pharmaceuticals/britain-offers-smallpox-shot-monkeypox-cases-spread-europe-2022-05-19/ |access-date=23 May 2022 |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520144052/https://www.reuters.com/business/healthcare-pharmaceuticals/britain-offers-smallpox-shot-monkeypox-cases-spread-europe-2022-05-19/ |url-status=live }}</ref>
On 25 May, disease experts from the NICD in South Africa said they saw no need for mass vaccination, because they believe cases will not explode as they did in the COVID-19 pandemic.<ref>{{cite news |title=South Africa: No need for mass monkeypox immunisation – experts |url=https://www.aljazeera.com/news/2022/5/25/south-africa-no-need-for-mass-monkeypox-immunisation-experts |access-date=25 May 2022 |publisher=Al Jazeera |date=25 May 2022 |archive-date=25 May 2022 |archive-url=https://web.archive.org/web/20220525142735/https://www.aljazeera.com/news/2022/5/25/south-africa-no-need-for-mass-monkeypox-immunisation-experts |url-status=live }}</ref>
In reaction to this outbreak of mpox, a number of countries have stated they are buying vaccines and/or releasing vaccines from national stockpiles for use in the outbreak. In May 2022, the US,<ref>{{cite web |last1=Morris |first1=Chris |title=U.S. government places $119 million order for 13 million freeze-dried Monkeypox vaccines |url=https://fortune.com/2022/05/19/monkeypox-vaccine-purchase-2022-us-government/ |website=Fortune |access-date=21 May 2022 |language=en|date=19 May 2022 |quote=Bavarian Nordic, the biotech company that makes the vaccine, has announced a $119 million order placed by the U.S., with an option to buy $180 million more, for delivery in 2023 and 2024. Should the second option be exercised, it would work out to approximately 13 million doses. |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520194153/https://fortune.com/2022/05/19/monkeypox-vaccine-purchase-2022-us-government/ |url-status=live }}</ref><ref name=":5">{{cite web |last=Scribner |first=Herb |date=20 May 2022 |title=HHS says recent U.S. smallpox vaccine order not related to monkeypox outbreak |url=https://www.axios.com/2022/05/20/smallpox-vaccine-order-monkeypox |access-date=22 May 2022 |website=Axios |language=en |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520201527/https://www.axios.com/2022/05/20/smallpox-vaccine-order-monkeypox |url-status=live }}</ref> Spain,<ref>{{cite web |last=Güell |first=Oriol |date=19 May 2022 |title=España prepara la compra de miles de vacunas contra la viruela tradicional para hacer frente al brote del virus del mono |url=https://elpais.com/sociedad/2022-05-19/espana-prepara-la-compra-de-miles-de-vacunas-frente-a-la-viruela-tradicional-para-hacer-frente-al-brote-del-virus-del-mono.html |access-date=26 May 2022 |website=El País |language=es |archive-date=26 May 2022 |archive-url=https://web.archive.org/web/20220526220440/https://elpais.com/sociedad/2022-05-19/espana-prepara-la-compra-de-miles-de-vacunas-frente-a-la-viruela-tradicional-para-hacer-frente-al-brote-del-virus-del-mono.html |url-status=live }}</ref> Germany<ref>{{cite web |date=24 May 2022 |title=Germany orders 40,000 vaccine doses as precaution against monkeypox spread |url=https://www.reuters.com/world/europe/germany-orders-40000-vaccine-doses-precaution-monkeypox-spread-2022-05-24/ |access-date=26 May 2022 |website=Reuters |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524125501/https://www.reuters.com/world/europe/germany-orders-40000-vaccine-doses-precaution-monkeypox-spread-2022-05-24/ |url-status=live }}</ref> and the UK<ref>{{Cite news |date=26 May 2022 |title=Britain's UKHSA says it has procured 20,000 doses of vaccine against monkeypox |language=en |publisher=Reuters |url=https://www.reuters.com/world/uk/britains-ukhsa-says-it-has-procured-20000-doses-vaccine-against-monkeypox-2022-05-26/ |access-date=26 May 2022 |archive-date=26 May 2022 |archive-url=https://web.archive.org/web/20220526173342/https://www.reuters.com/world/uk/britains-ukhsa-says-it-has-procured-20000-doses-vaccine-against-monkeypox-2022-05-26/ |url-status=live }}</ref> all announced purchases of smallpox vaccine.
On 24 May, Centers for Disease Control (CDC) Deputy Director Jennifer McQuiston confirmed the United States is releasing some of their Jynneos vaccine supply from their Strategic National Stockpile for people who are "high-risk".<ref>{{cite news |last1=Howard |first1=Jacqueline |last2=Langmaid |first2=Virginia |date=23 May 2022 |title=US in process of releasing monkeypox vaccine from national stockpile for 'high-risk' people, CDC says |url=https://www.cnn.com/2022/05/23/health/monkeypox-cdc/index.html |access-date=24 May 2022 |website=CNN |archive-date=23 May 2022 |archive-url=https://web.archive.org/web/20220523195447/https://www.cnn.com/2022/05/23/health/monkeypox-cdc/index.html |url-status=live }}</ref><ref name="mmwr">{{Cite journal |last=Rao |first=Agam K. |date=2022 |title=Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022 |url=https://www.cdc.gov/mmwr/volumes/71/wr/mm7122e1.htm |journal=MMWR. Morbidity and Mortality Weekly Report |language=en-us |volume=71 |issue=22 |pages=734–742 |doi=10.15585/mmwr.mm7122e1 |pmid=35653347 |pmc=9169520 |s2cid=249142212 |issn=0149-2195 |access-date=28 May 2022 |archive-date=31 May 2022 |archive-url=https://web.archive.org/web/20220531053538/https://www.cdc.gov/mmwr/volumes/71/wr/mm7122e1.htm |url-status=live }}</ref>
On 23 June, the New York City Department of Health announced a clinic at the Chelsea Sexual Health Clinic would offer the two-dose Jynneos vaccine to "...all gay, bisexual, and other men who have sex with men (cisgender or transgender) ages 18 and older who have had multiple or anonymous sex partners in the last 14 days".<ref>{{cite web |title=Monkeypox Vaccine Clinic for People Who May Have Been Exposed to Monkeypox – NYC Health |url=https://www1.nyc.gov/site/doh/about/press/pr2022/monkeypox-vaccine-clinic.page |access-date=23 June 2022 |website=www1.nyc.gov |archive-date=27 June 2022 |archive-url=https://web.archive.org/web/20220627215124/https://www1.nyc.gov/site/doh/about/press/pr2022/monkeypox-vaccine-clinic.page |url-status=live }}</ref> By July 27, the federal government had distributed 300,000 doses to state and local health authorities, with distribution at clinics nation-wide, and was planning to release 786,000 more that week.<ref>{{Cite web |url=https://www.cnbc.com/2022/07/27/us-to-release-786000-additional-monkeypox-vaccine-doses-as-outbreak-spreads.html |title=U.S. to release 786,000 additional monkeypox vaccine doses as outbreak spreads |website=CNBC |date=27 July 2022 |access-date=2 August 2022 |archive-date=29 April 2023 |archive-url=https://web.archive.org/web/20230429205100/https://www.cnbc.com/2022/07/27/us-to-release-786000-additional-monkeypox-vaccine-doses-as-outbreak-spreads.html |url-status=live }}</ref>
Bavarian Nordic is the only manufacturer of Jynneos in the world, and its manufacturing facility closed in spring 2022 to be refitted to make vaccines for other diseases using the MVA-BN technology. The company projects Jynneos manufacturing will restart in 2023, except for 15 million doses that just need final "fill and finish" repackaging.<ref name="hpw" /> The United States helped fund the development of Jynneos, leading to concerns that existing contracts will lead to vaccine nationalism and hoarding, and prompting calls for allocating doses to lower-income countries via GAVI.<ref name="hpw">{{Cite web |url=https://healthpolicy-watch.news/exclusive-china-monkeypox-bavarian-nordics/ |title=Exclusive: Closure of World's Only Manufacturing Plant for Monkeypox Vaccine Raises Questions About World's Ability to Meet Rising Demand |date=31 July 2022 |access-date=2 August 2022 |archive-date=7 August 2022 |archive-url=https://web.archive.org/web/20220807014106/https://healthpolicy-watch.news/exclusive-china-monkeypox-bavarian-nordics/ |url-status=live }}</ref>
On 9 August, the FDA gave emergency use authorization for intradermal (rather than subcutaneous) mpox vaccination using a lower dose of Jynneos, which would increase the number of available doses up to five-fold. The vaccination would still be given in two doses, 28 days apart. A 2015 study had tested a regimen of one-fifth dose given intradermally.<ref name="eua">{{Cite web |date=2022-08-09 |title=Monkeypox Update: FDA Authorizes Emergency Use of JYNNEOS Vaccine to Increase Vaccine Supply |url=https://www.fda.gov/news-events/press-announcements/monkeypox-update-fda-authorizes-emergency-use-jynneos-vaccine-increase-vaccine-supply |access-date=2022-08-14 |publisher=FDA |language=en |archive-date=11 August 2022 |archive-url=https://web.archive.org/web/20220811092247/https://www.fda.gov/news-events/press-announcements/monkeypox-update-fda-authorizes-emergency-use-jynneos-vaccine-increase-vaccine-supply |url-status=dead }}</ref>
Another mpox vaccine, the modern LC16m8 vaccine, the only mpox vaccine approved for children, was developed in Japan as a national asset, and the manufacturer initially said it could not assist other countries.<ref name="hpw" /> In August 2024, though, the Japanese government decided to send donations of the vaccine to the Democratic Republic of the Congo to help in their mitigation efforts.<ref>{{Cite web |date=2024-08-27 |title=Japan Poised To Donate The Only Mpox Vaccine Licensed For Children To DRC - Health Policy Watch |url=https://healthpolicy-watch.news/japan-poised-to-donate-the-only-mpox-vaccine-licensed-for-children-to-drc/ |access-date=2024-09-25 |language=en-US}}</ref>
== Social aspects == As of May 2022, public health authorities had aimed to target resources and health education to affected groups, but avoid stigma which could discourage people with symptoms or who have been exposed from seeking help.<ref name="aidsmapmay22" /> LGBT rights groups issued statements advising media to avoid stigmatizing marginalized groups such as men who have sex with men or transgender individuals.<ref name=":12">{{cite web |title=UNAIDS warns that stigmatizing language on Monkeypox jeopardises public health |url=https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2022/may/20220522_PR_Monkeypox |access-date=28 May 2022 |website=unaids.org |language=en |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528155211/https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2022/may/20220522_PR_Monkeypox |url-status=live }}</ref><ref>{{cite web |last=Brownworth |first=Victoria A. |date=25 May 2022 |title=Analysis: Media must separate monkeypox risk from stigma |url=https://epgn.com/2022/05/25/analysis-media-must-separate-monkeypox-risk-from-stigma/ |access-date=28 May 2022 |website=Philadelphia Gay News |language=en-US |archive-date=27 May 2022 |archive-url=https://web.archive.org/web/20220527195201/https://epgn.com/2022/05/25/analysis-media-must-separate-monkeypox-risk-from-stigma/ |url-status=live }}</ref> On 22 May, UNAIDS urged communicators to avoid stigma by taking an evidence-based approach, and reiterated that the disease can affect anyone and that risk is by no means limited to men who have sex with men.<ref>{{cite news |date=22 May 2022 |title=Monkeypox: UNAIDS 'concerned' about stigmatizing language against LGTBI people |work=UN News |publisher=United Nations |url=https://news.un.org/en/story/2022/05/1118762 |url-status=live |access-date=23 May 2022 |archive-url=https://web.archive.org/web/20220524193913/https://news.un.org/en/story/2022/05/1118762 |archive-date=24 May 2022}}</ref>
On 24 May, ''The Washington Post'' published an article that pointed out the lack of global attention to the disease at a time when it only affected Africans, compared to the attention directed at it when a small number of cases started affecting Western countries.<ref name="double">{{cite news |url=https://www.washingtonpost.com/world/2022/05/24/africa-europe-monkeypox-virus-outbreak/ |title=As monkeypox panic spreads, doctors in Africa see a double standard |newspaper=The Washington Post |access-date= |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528115257/https://www.washingtonpost.com/world/2022/05/24/africa-europe-monkeypox-virus-outbreak/ |url-status=live }}</ref> Some also objected to pictures used in media coverage of mild illnesses in Europe that featured severe cases in sub-Saharan Africans.<ref name="double" />
On 25 May, the World Health Organization released several statements and pamphlets aimed at gay and bisexual men describing the symptoms of mpox, as well as possible transmission routes. The statements emphasized that mpox was not a disease that was exclusive to the LGBT community, or to men, but that because these groups were disproportionately affected, the WHO felt they should tailor some health material to these groups.<ref>{{Cite web |title=Monkeypox: public health advice for gay, bisexual and other men who have sex with men |url=https://www.who.int/news/item/25-05-2022-monkeypox--public-health-advice-for-gay--bisexual-and-other-men-who-have-sex-with-men |access-date=2024-09-25 |website=who.int |language=en}}</ref>
On 26 July, Owen Jones of ''The Guardian'' argued that the focus needs to be on testing, awareness and vaccination, that targeted health messages help protect as many people as possible from the virus, and that those most at risk should be protected without stigma, noting that some members of the LGBT community already started to adjust behaviors to reduce risk.<ref>{{cite news |last1=Jones |first1=Owen |title=Saying monkeypox is tearing through communities of queer men isn't stigmatising – being afraid to say it is |url=https://www.theguardian.com/commentisfree/2022/jul/26/monkeypox-gay-communities-vaccines-health-messages |access-date=3 August 2022 |work=The Guardian |date=26 July 2022 |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701041320/https://www.theguardian.com/commentisfree/2022/jul/26/monkeypox-gay-communities-vaccines-health-messages |url-status=live }}</ref>
On 30 July, Rod Dreher of ''The American Conservative'' criticized public health officials for not shutting down gay sex clubs in response to the outbreak.<ref>{{Cite web |last=Dreher |first=Rod |date=2022-07-30 |title=The Price Of Pride |url=https://www.theamericanconservative.com/the-price-of-pride/ |access-date=2022-08-06 |website=The American Conservative |language=en-US |archive-date=6 August 2022 |archive-url=https://web.archive.org/web/20220806141305/https://www.theamericanconservative.com/the-price-of-pride/ |url-status=live }}</ref> Similarly, many conservative commentators have accused public health officials of hypocrisy for implementing harsh restrictions on everyday life in response to the COVID-19 pandemic while not encouraging similar restrictions in response to mpox, such as shutting down sex parties and practicing abstinence.<ref name=":9">{{Cite web |last=Hays |first=Gabriel |date=2022-08-05 |title=After COVID lockdowns, Twitter outraged at report that officials won't stop sex parties to prevent monkeypox |url=https://www.foxnews.com/media/after-covid-lockdowns-twitter-outraged-report-officials-wont-stop-sex-parties-prevent-monkeypox.amp |access-date=2022-08-06 |website=Fox News |archive-date=6 August 2022 |archive-url=https://web.archive.org/web/20220806141503/https://www.foxnews.com/media/after-covid-lockdowns-twitter-outraged-report-officials-wont-stop-sex-parties-prevent-monkeypox.amp |url-status=live }}</ref> In response, public health officials have "reject[ed] comparisons to the early days of the coronavirus pandemic, when they mandated masks and shut down public spaces. They noted that the novel coronavirus was unfamiliar, far deadlier and airborne, with hospitals overrun with patients at various points over the past two years." and that "Monkeypox has known treatments and vaccines, although they have been challenging to access; it also has not killed anyone in the United States, and hospitalizations are uncommon."<ref name=":9" /><ref>{{Cite news |last1=Nirappil |first1=Fenit |last2=Jayakumar |first2=Amrita |date=2022-08-04 |title=As monkeypox strikes gay men, officials debate warnings to limit partners |newspaper=The Washington Post |url=https://www.washingtonpost.com/health/2022/08/04/monkeypox-gay-safe-sex/ |access-date=2022-08-06}}</ref>
An August survey by the CDC found that gay and bisexual men have significantly reduced sexual encounters in response to the mpox outbreak.<ref>{{Cite web |last=Hansford |first=Amelia |date=2022-08-29 |title=Monkeypox: Gay and bi men are cutting back on sex to avoid virus, survey shows |url=https://www.pinknews.co.uk/2022/08/29/monkeypox-gay-sex-survey/ |access-date=2022-08-30 |website=PinkNews |language=en-GB |archive-date=30 August 2022 |archive-url=https://web.archive.org/web/20220830015747/https://www.pinknews.co.uk/2022/08/29/monkeypox-gay-sex-survey/ |url-status=live }}</ref> An additional WHO survey, also conducted in August, showed similar patterns in queer men in Europe. Many of the men surveyed noted that they had reduced how often they went out with others, limited their number of sexual partners, or began temporarily practicing abstinence.<ref>{{Cite web |title=Perceptions of monkeypox from those most at risk: men who have sex with men having multiple sexual partners |url=https://www.who.int/europe/news/item/26-08-2022-perceptions-of-monkeypox-from-those-most-at-risk--men-who-have-sex-with-men-having-multiple-sexual-partners |access-date=2024-09-25 |website=who.int |language=en}}</ref>
=== Misinformation === Misinformation and conspiracy theories immediately spread online in various social media networks.<ref>{{cite web |date=23 May 2022 |title=Five conspiracy theories about monkeypox debunked as false claims start to spread online |url=https://inews.co.uk/news/monkeypox-conspiracy-theories-false-claims-virus-debunked-misinformation-online-1645306 |url-status=live |archive-url=https://web.archive.org/web/20220524193954/https://inews.co.uk/news/monkeypox-conspiracy-theories-false-claims-virus-debunked-misinformation-online-1645306 |archive-date=24 May 2022 |access-date=23 May 2022 |website=inews.co.uk |language=en}}</ref><ref>{{cite news |date=23 May 2022 |title='US let monkeypox loose' conspiracy theories swirl on China's Weibo platform |work=South China Morning Post |url=https://www.scmp.com/news/asia/article/3178814/us-let-monkeypox-loose-conspiracy-theories-swirl-chinas-weibo-platform |url-status=live |access-date=23 May 2022 |archive-url=https://web.archive.org/web/20220524193038/https://www.scmp.com/news/asia/article/3178814/us-let-monkeypox-loose-conspiracy-theories-swirl-chinas-weibo-platform |archive-date=24 May 2022}}</ref> In an article published by the BBC in May 2022 countering misinformation about the mpox outbreak, journalist Rachel Schraer noted that social media accounts and news outlets from different countries including China, Russia, Ukraine and the United States have been promoting the idea that the outbreak was caused by a lab leak or that mpox is being used as a bioweapon.<ref name="CNNPort">{{cite web |title=A Rússia tem uma tese nova: diz que a Monkeypox é uma arma biológica desenvolvida pelos EUA |url=https://cnnportugal.iol.pt/russia/estados-unidos/a-russia-tem-uma-tese-nova-diz-que-a-monkeypox-e-uma-arma-biologica-desenvolvida-pelos-eua/20220527/6290e03f0cf2f9a86ea63e97 |access-date=1 June 2022 |website=CNN Portugal |language=pt |archive-date=27 May 2022 |archive-url=https://web.archive.org/web/20220527191236/https://cnnportugal.iol.pt/russia/estados-unidos/a-russia-tem-uma-tese-nova-diz-que-a-monkeypox-e-uma-arma-biologica-desenvolvida-pelos-eua/20220527/6290e03f0cf2f9a86ea63e97 |url-status=live }}</ref> The Institute for Strategic Dialogue described this as "Reviving the spread of a set of cut-and-paste... conspiracies", referring to conspiracy theories used during the COVID-19 pandemic.<ref name=":4" /><ref>{{cite web |date=10 June 2022 |title=Following the 'Covid playbook': How conspiracy theorists are using old tricks around Monkeypox |url=https://www.codastory.com/newsletters/monkeypox-conspiracy-theories/ |access-date=17 June 2022 |website=Coda Story |language=en-US |archive-date=17 June 2022 |archive-url=https://web.archive.org/web/20220617022738/https://www.codastory.com/newsletters/monkeypox-conspiracy-theories/ |url-status=live }}</ref> The BBC also made it clear that the genetic sequences of the virus, as far as is known, date back to a West African strain.<ref name=":4">{{Cite news |last=Schraer |first=Rachel |date=28 May 2022 |title=Monkeypox wasn't created in a lab – and other claims debunked |language=en-GB |publisher=BBC News |url=https://www.bbc.com/news/health-61580089 |access-date=30 May 2022 |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530154659/https://www.bbc.com/news/health-61580089 |url-status=live }}</ref> Some online misinformation also included claims that the COVID-19 vaccine included mpox or that mpox was going to be used to justify new widespread lockdowns akin to those that occurred during COVID-19.<ref>{{Cite web |last=Yandell |first=Kate |date=2024-09-18 |title=Posts Sharing Mpox Misinformation Recycle Claims from Prior Viral Outbreaks |url=https://www.factcheck.org/2024/09/posts-sharing-mpox-misinformation-recycle-claims-from-prior-viral-outbreaks/ |access-date=2024-09-26 |website=FactCheck.org |language=en-US}}</ref>
== Responses == === World Health Organization === On 20 May, the World Health Organization (WHO) convened an emergency meeting of independent advisers to discuss the outbreak and assess the threat level.<ref>{{Cite news |last=Rigby |first=Jennifer |date=20 May 2022 |title=WHO to hold emergency meeting on monkeypox on Friday -sources |language=en |publisher=Reuters |url=https://www.reuters.com/business/healthcare-pharmaceuticals/who-hold-emergency-meeting-monkeypox-friday-sources-2022-05-20/ |url-status=live |access-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520215707/https://www.reuters.com/business/healthcare-pharmaceuticals/who-hold-emergency-meeting-monkeypox-friday-sources-2022-05-20/ |archive-date=20 May 2022}}</ref> Initial assessments expressed the expectation of the outbreak to be contained, and of low impact to the general population in affected countries.<ref name="WHO13" /><ref>{{cite web |last=Constantino |first=Annika Kim |date=26 May 2022 |title=Monkeypox has spread to more than 20 countries, but the outbreaks are containable, WHO says |url=https://www.cnbc.com/2022/05/26/monkeypox-has-spread-to-more-than-20-countries-but-the-outbreaks-are-containable-who-says.html |access-date=3 June 2022 |publisher=CNBC |language=en |archive-date=2 June 2022 |archive-url=https://web.archive.org/web/20220602234505/https://www.cnbc.com/2022/05/26/monkeypox-has-spread-to-more-than-20-countries-but-the-outbreaks-are-containable-who-says.html |url-status=live }}</ref> Its European chief, Hans Kluge, expressed concern that infections could accelerate in Europe as people gather for parties and festivals over the summer.<ref name="Reuters">{{Cite news |last1=Rigby |first1=Jennifer |last2=Grover |first2=Natalie |date=20 May 2022 |title=WHO calls emergency meeting as monkeypox cases top 100 in Europe |publisher=Reuters |url=https://www.reuters.com/world/europe/monkeypox-outbreak-europe-largest-ever-region-cases-cross-100-2022-05-20/ |url-status=live |access-date=21 May 2022 |archive-url=https://web.archive.org/web/20220520212102/https://www.reuters.com/world/europe/monkeypox-outbreak-europe-largest-ever-region-cases-cross-100-2022-05-20/ |archive-date=20 May 2022}}</ref> On 1 June, a WHO statement acknowledged that undetected transmission had occurred for some time,<ref>{{cite web |title=WHO Director-General's opening remarks at the COVID-19 media briefing– 1 June 2022 |url=https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-covid-19-media-briefing--1-june-2022 |access-date=3 June 2022 |publisher=World Health Organization |language=en |archive-date=2 June 2022 |archive-url=https://web.archive.org/web/20220602234503/https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-covid-19-media-briefing--1-june-2022 |url-status=live }}</ref> and called for urgent action to reduce transmission.<ref>{{cite web |date=1 June 2022 |title=Monkeypox has likely spread undetected 'for some time': WHO |url=https://www.aljazeera.com/news/2022/6/1/monkeypox-has-likely-spread-undetected-for-some-time-who-says |access-date=3 June 2022 |publisher=Al Jazeera |language=en |archive-date=2 June 2022 |archive-url=https://web.archive.org/web/20220602234503/https://www.aljazeera.com/news/2022/6/1/monkeypox-has-likely-spread-undetected-for-some-time-who-says |url-status=live }}</ref><ref name="CNBC-undetected-spread">{{cite web |last=Kimball |first=Spencer |date=1 June 2022 |title=WHO says monkeypox has been spreading undetected as global cases rise to more than 550 |url=https://www.cnbc.com/2022/06/01/who-says-monkeypox-has-been-spreading-undetected-as-global-cases-rise-to-more-than-550.html |access-date=3 June 2022 |publisher=CNBC |language=en |archive-date=2 June 2022 |archive-url=https://web.archive.org/web/20220602234503/https://www.cnbc.com/2022/06/01/who-says-monkeypox-has-been-spreading-undetected-as-global-cases-rise-to-more-than-550.html |url-status=live }}</ref> On 14 June, the WHO announced plans to rename disease from ''monkeypox'' to ''mpox'' to combat stigma and racism surrounding the disease.<ref>{{Cite news |date=13 June 2022 |title=WHO Will Rename Monkeypox Virus to Minimize Stigma, Racism |language=en |work=Bloomberg.com |url=https://www.bloomberg.com/news/articles/2022-06-13/who-weighs-renaming-monkeypox-virus-to-minimize-stigma-racism |access-date=15 June 2022 }}</ref> A meeting convened on 23 June determined that the outbreak did not constitute a public health emergency of international concern for the time being,<ref>{{cite web |title=Meeting of the International Health Regulations (2005) Emergency Committee regarding the multi-country monkeypox outbreak |url=https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak |access-date=26 June 2022 |website=who.int |publisher=WHO |language=en |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628012204/https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak |url-status=live }}</ref> but that decision was overturned by a later meeting on 23 July.<ref name="bbc-highest-alert">{{cite news |title=WHO declares highest alert over monkeypox |url=https://www.bbc.com/news/health-62279436 |access-date=23 July 2022 |agency=BBC News |date=23 July 2022 |archive-date=24 July 2022 |archive-url=https://web.archive.org/web/20220724055115/https://www.bbc.com/news/health-62279436 |url-status=live }}</ref> After consistently dropping cases and several countries seemingly having a grasp on the outbreak, the WHO would declare the mpox epidemic over in May 2023. However, they continued to urge governments and their citizens to be wary of a potential resurgence of mpox.<ref>{{Cite web |title=Mpox (monkeypox) |url=https://www.who.int/europe/emergencies/situations/monkeypox |access-date=2024-09-26 |website=who.int |language=en}}</ref>
=== Countries === *{{flag|Algeria}}: The Pasteur Institute of Algeria issued a communiqué in May, in which the Institute described the origins of mpox in Sub-Saharan Africa, and recommended physical distancing, as well as the use of masks in crowded or enclosed places, in addition to avoiding contact with wild animals that may possess the virus.<ref>{{cite web |date=22 May 2022 |title=La variole du singe .. Pasteur Algérie publie une déclaration importante |trans-title=The monkey pox . Pasteur Algeria issues an important statement |url=https://www.algerie-focus.com/la-variole-du-singie-pasteur-algerie-publie-une-declaration-importante/ |access-date=27 May 2022 |website=Algérie Focus |language=fr-FR |archive-date=22 May 2022 |archive-url=https://web.archive.org/web/20220522221732/https://www.algerie-focus.com/la-variole-du-singe-pasteur-algerie-publie-une-declaration-importante/ |url-status=live }}</ref> *{{flag|Armenia}}: On 28 July, Health Minister Anahit Avanesian told reporters that the country had not yet recorded any cases of mpox, but confirmed that the country had received test kits from Russia.<ref>{{Cite web |title=No monkeypox cases registered in Armenia – Health Minister |url=https://en.armradio.am/2022/07/28/no-monkeypox-cases-registered-in-armenia-health-minister/ |access-date=30 July 2022 |website=Public Radio of Armenia |language=en-US |archive-date=30 July 2022 |archive-url=https://web.archive.org/web/20220730022131/https://en.armradio.am/2022/07/28/no-monkeypox-cases-registered-in-armenia-health-minister/ |url-status=live }}</ref> *{{Flag|Australia}}: On 28 July, the Chief Medical Officer of Australia declared the increasing presence of mpox "a communicable disease incident of national significance".<ref>{{Cite news |date=28 July 2022 |title=Chief Medical Officer declares monkeypox a disease of national significance |language=en-AU |work=ABC News |url=https://www.abc.net.au/news/2022-07-28/monkey-pox-declared-a-disease-of-significance-australia/101277158 |access-date=28 July 2022 |archive-date=10 August 2023 |archive-url=https://web.archive.org/web/20230810023957/https://www.abc.net.au/news/2022-07-28/monkey-pox-declared-a-disease-of-significance-australia/101277158 |url-status=live }}</ref> On 4 August, the Health Minister announced the securing of 450,000 third-generation mpox vaccines.<ref>{{Cite news |date=2022-08-04 |title=New monkeypox vaccines secured in 'highly contested' global market as case numbers increase |language=en-AU |work=ABC News |url=https://www.abc.net.au/news/2022-08-04/monkeypox-vaccines-secured-as-global-numbers-increase/101300598 |access-date=2022-08-04 |archive-date=4 August 2022 |archive-url=https://web.archive.org/web/20220804112231/https://www.abc.net.au/news/2022-08-04/monkeypox-vaccines-secured-as-global-numbers-increase/101300598 |url-status=live }}</ref> *{{flag|Bangladesh}}: On 22 May, the Directorate General of Health Services (DGHS) issued warnings at every port in the country to prevent the spread of mpox. The Directorate spokesperson said that they have asked all air, land and sea ports to be alert. Suspected cases are instructed to be sent to an infectious disease hospital and kept in isolation.<ref>{{Cite news |date= 21 May 2022 |title= Monkeypox: Government put ports on alert |language=en |work= The Business Standard |url= https://www.tbsnews.net/bangladesh/monkeypox-govt-puts-ports-alert-424318?amp |access-date= 22 May 2022 |archive-date= 24 May 2022 |archive-url= https://web.archive.org/web/20220524193915/https://www.tbsnews.net/bangladesh/monkeypox-govt-puts-ports-alert-424318?amp |url-status= live }}</ref><ref>{{Cite news |date=22 May 2022 |title=মাঙ্কিপক্স ঠেকাতে বন্দরে বাড়তি সতর্কতা |trans-title=Extra precautions at ports to prevent monkeypox |language=bn |work=Bangladesh Pratidin |url=https://www.bd-pratidin.com/first-page/2022/05/22/771011 |access-date=22 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524193913/https://www.bd-pratidin.com/first-page/2022/05/22/771011 |url-status=live }}</ref> Bangladesh became the first country to bar shore passes, after the Chittagong Seaport barred shore passes for all crew unless in the case of an emergency, while signed-off crew will have to undergo health checks.<ref>{{cite web |date=31 May 2022 |title=Bangladesh becomes first nation to bar shore passes over monkeypox fears |url=https://splash247.com/bangladesh-becomes-first-nation-to-bar-shore-passes-over-monkeypox-fears/ |access-date=7 June 2022 |website=Splash247 |language=en-GB |archive-date=7 June 2022 |archive-url=https://web.archive.org/web/20220607113951/https://splash247.com/bangladesh-becomes-first-nation-to-bar-shore-passes-over-monkeypox-fears/ |url-status=live }}</ref> *{{flag|Belgium}}: The Risk Assessment Group (RAG) and health authorities declared that those infected with mpox must self-isolate for 21 days.<ref>{{cite web |title=Monkeypox patients must spend 21 days in isolation |url=https://www.brusselstimes.com/226540/monkeypox-patients-must-spend-21-days-in-isolation |website=The Brussels Times |access-date=22 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192714/https://www.brusselstimes.com/226540/monkeypox-patients-must-spend-21-days-in-isolation |url-status=live }}</ref> *{{flag|Brazil}}: The Brazilian Ministry of Health created groups of biologists to monitor monkeys and medical groups to monitor possible cases.<ref>{{cite web |title=Governo cria grupo para monitorar varíola dos macacos e acompanha caso de brasileiro |trans-title=Government creates group to monitor monkeypox and follows up on Brazilian case |url=https://www.cnnbrasil.com.br/saude/ministerio-cria-grupo-de-cientistas-para-monitorar-a-variola-dos-macacos/ |website=CNN |access-date=22 May 2022 |language=pt-BR |date=21 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192717/https://www.cnnbrasil.com.br/saude/ministerio-cria-grupo-de-cientistas-para-monitorar-a-variola-dos-macacos/ |url-status=live }}</ref> On August 8, 2022, during a podcast, the president of Brazil Jair Bolsonaro made homophobic jokes about the disease. When questioning the host about whether he would get a mpox vaccine, and the host says yes; Jair Bolsonaro replied: "I'm sure you want to get the vaccine. You don't fool me" followed by laughter. The host remains in his serious speech on the subject, Bolsonaro commented: "Don't you understand?" clarifying the homophobic tone of the comment.<ref>{{Cite web |title=Bolsonaro insinua que quem se vacinar contra monkeypox é gay |trans-title=Bolsonaro insinuates that anyone who gets vaccinated against monkeypox is gay |url=https://www.terra.com.br/nos/bolsonaro-insinua-que-quem-se-vacinar-contra-monkeypox-e-gay,92b8014c3d0ac1448d299df0b356b9a24x46yzp3.html |access-date=2022-08-09 |website=Terra |language=pt-BR |archive-date=9 August 2022 |archive-url=https://web.archive.org/web/20220809181254/https://www.terra.com.br/nos/bolsonaro-insinua-que-quem-se-vacinar-contra-monkeypox-e-gay,92b8014c3d0ac1448d299df0b356b9a24x46yzp3.html |url-status=live }}</ref><ref>{{Cite web |last=Gouveia |first=Lais |date=2022-08-09 |title=Participação de Bolsonaro no Flow tem alerta de fake news e piada homofóbica com varíola dos macacos (vídeo) |trans-title=Bolsonaro's participation in Flow has fake news alert and homophobic joke with monkeypox (video) |url=https://www.brasil247.com/midia/participacao-de-bolsonaro-no-flow-tem-alerta-de-fake-news-e-piada-homofobica-com-variola-dos-macacos-video |access-date=2022-08-09 |website=Brasil 247 |language=pt-br |archive-date=1 July 2024 |archive-url=https://web.archive.org/web/20240701041320/https://www.brasil247.com/midia/participacao-de-bolsonaro-no-flow-tem-alerta-de-fake-news-e-piada-homofobica-com-variola-dos-macacos-video |url-status=live }}</ref> *{{Flag|Botswana}}: In June, the Ministry of Health advised the population of Botswana to go to the nearest hospital in case of any unusual symptoms.<ref>{{cite web |last=Basimanebotlhe |first=Tsaone |date=23 June 2022 |title=Botswana on monkey pox alert |url=https://www.mmegi.bw/news/botswana-on-monkey-pox-alert/news |access-date=25 June 2022 |website=Mmegi Online |language=en |archive-date=26 June 2022 |archive-url=https://web.archive.org/web/20220626080533/https://www.mmegi.bw/news/botswana-on-monkey-pox-alert/news |url-status=live }}</ref> In addition, the ministry advised to avoid close contact with other people.<ref>{{cite web |date=6 June 2022 |title=Africa and the West join forces against Monkeypox |url=https://www.weekendpost.co.bw/34601/news/africa-and-the-west-join-forces-against-monkeypox/ |access-date=25 June 2022 |website=Weekend Post |language=en-GB |archive-date=9 June 2022 |archive-url=https://web.archive.org/web/20220609124115/https://www.weekendpost.co.bw/34601/news/africa-and-the-west-join-forces-against-monkeypox/ |url-status=live }}</ref> *{{Flag|Cambodia}}: In May, Or Vandine, spokeswoman for the Ministry of Health, alerted the citizens of Cambodia that mpox could be lethal due to the lesions caused by this disease, which can lead to complications in the body's organs.<ref>{{cite web |last=Kunthear |first=Mom |title=Monkeypox deadly with lack of care, says Vandine |url=https://www.phnompenhpost.com/national/monkeypox-deadly-lack-care-says-vandine |access-date=25 June 2022 |website=Phnom Penh Post |language=en |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628020049/https://www.phnompenhpost.com/national/monkeypox-deadly-lack-care-says-vandine |url-status=live }}</ref> In June 2022, the Cambodian government ordered screening under the supervision of health workers of all air, sea and land entry points in the country, in addition to ordering mandatory quarantine of anyone infected or in contact with people with the disease.<ref>{{cite web |date=9 June 2022 |title=Monkeypox screening at all entry points – Khmer Times |url=https://www.khmertimeskh.com/1091358/monkeypox-screening-at-all-entry-points/ |access-date=25 June 2022 |archive-url=https://web.archive.org/web/20220628125415/https://www.khmertimeskh.com/1091358/monkeypox-screening-at-all-entry-points/ |archive-date=28 June 2022 |url-status=live}}</ref> *{{flag|Canada}}: On 21 April, Public Services and Procurement Canada published a tender request seeking to stockpile doses of smallpox vaccine to be prepared in the event of a future accidental or intentional release of the virus.<ref>{{cite web |last=Public Services and Procurement Canada |date=21 April 2022 |title=Third Generation Smallpox Vaccine (6D024-215700/A) |url=https://buyandsell.gc.ca/procurement-data/tender-notice/PW-PH-893-81160 |url-status=live |archive-url=https://web.archive.org/web/20220620184646/https://buyandsell.gc.ca/procurement-data/tender-notice/PW-PH-893-81160 |archive-date=20 June 2022 |access-date=20 June 2022 |website=Government of Canada}}</ref> The contract for 500,000 doses closed on 5 May, and was awarded to Bavarian Nordic.<ref>{{cite web |last=Laura |first=Osman |date=20 May 2022 |title=Canada considering smallpox vaccine for monkeypox cases, says Dr. Theresa Tam |url=https://www.ctvnews.ca/health/article/canada-considering-smallpox-vaccine-for-monkeypox-cases-says-dr-theresa-tam/ |url-status=live |archive-url=https://web.archive.org/web/20220620201557/https://www.ctvnews.ca/health/canada-considering-smallpox-vaccine-for-monkeypox-cases-says-dr-theresa-tam-1.5913357 |archive-date=20 June 2022 |access-date=20 June 2022 |website=CTV News |language=en}}</ref> On 24 May, the Public Health Agency of Canada stated that they were in the process of extracting Imvamune vaccines from their National Emergency Strategic Stockpile for deployment across the country, starting with the province of Quebec.<ref>{{cite web |last=Canada |first=Public Health Agency of |date=24 May 2022 |title=Statement from the Minister of Health on Canada's Response to Monkeypox |url=https://www.canada.ca/en/public-health/news/2022/05/statement-from-the-minister-of-health-on-canadas-response-to-monkeypox.html |access-date=26 May 2022 |website=canada.ca |archive-date=11 June 2022 |archive-url=https://web.archive.org/web/20220611020614/https://www.canada.ca/en/public-health/news/2022/05/statement-from-the-minister-of-health-on-canadas-response-to-monkeypox.html |url-status=live }}</ref> On 26 May, Quebec announced that Imvamune vaccines would be made available to those who have been in close contact with confirmed or suspected mpox cases.<ref>{{cite web |title=We're seeing a 'ripple effect' in monkeypox cases, McGill's Vinh says |url=https://montrealgazette.com/news/local-news/quebec-confirms-25-cases-of-monkeypox-will-begin-offering-smallpox-vaccine |access-date=26 May 2022 |website=montrealgazette |date=26 May 2022 |language=en-CA |archive-date=26 May 2022 |archive-url=https://web.archive.org/web/20220526144547/http://montrealgazette.com/news/local-news/quebec-confirms-25-cases-of-monkeypox-will-begin-offering-smallpox-vaccine |url-status=live }}</ref> On 7 June, PHAC announced that travellers returning to Canada may be subject to a mandatory quarantine period if they become ill with mpox, and warned that quarantined travellers may have restricted access to health care and delays returning home.<ref>{{cite web |last=Global Affairs Canada |date=17 June 2022 |title=Monkeypox: Advice for travellers |url=https://travel.gc.ca/travelling/health-safety/travel-health-notices/229 |url-status=live |archive-url=https://web.archive.org/web/20220617215345/https://travel.gc.ca/travelling/health-safety/travel-health-notices/229 |archive-date=17 June 2022 |access-date=20 June 2022 |website=Government of Canada}}</ref> *{{flag|China}}: On 2 June, the Chinese CDC issued a notice quoting a WHO's document with a translation of the original "Stigmatising people because of a disease is never okay. Anyone can get or pass on monkeypox, regardless of their sexuality."<ref>{{cite web|date=2 June 2022|title=世界卫生组织通报猴痘疫情进展并发布针对特定群体的公共卫生建议|language=zh |url=https://mp.weixin.qq.com/s/y8XXFqDTu5qNHgsrb17n2w |access-date=3 June 2022|url-status=live|archive-url=https://web.archive.org/web/20220621020458/https://mp.weixin.qq.com/s/y8XXFqDTu5qNHgsrb17n2w|archive-date=21 June 2022}}</ref> On June 10, the General office of the National Health Commission of the People's Republic of China and the Office of the State Administration of Traditional Chinese Medicine issued the ''Guidelines for the Diagnosis and Treatment of Monkeypox (2022 Version)''.<ref>{{cite web |website=nhc.gov.cn |author=国家卫生健康委办公厅 国家中医药管理局办公室 |title=关于印发猴痘诊疗指南（2022年版）的通知 |url=http://www.nhc.gov.cn/yzygj/s7653p/202206/d687b12fe8b84bbfaede2c7a5ca596ec.shtml |access-date=2022-07-26 |url-status=live |archive-date=2022-06-21 |archive-url=https://web.archive.org/web/20220621051104/http://www.nhc.gov.cn/yzygj/s7653p/202206/d687b12fe8b84bbfaede2c7a5ca596ec.shtml}}</ref> On July 25, after the declaration of mpox as a public health emergency of international concern by World Health Organization, the General Administration of Customs of the People's Republic of China issued the ''Announcement on Preventing Monkeypox from Spreading into China''.<ref>{{Cite web |date=2022-07-24 |title=海关总署公告2022年第65号（关于防止猴痘疫情传入我国的公告） |trans-title=General Administration of Customs Announcement No. 65 of 2022 (Announcement on Preventing the Introduction of Monkeypox Epidemic into our country) |website=中华人民共和国海关总署 |url=http://kunming.customs.gov.cn/customs/302249/302266/302267/4482275/index.html }} [https://web.archive.org/web/20260123122047/http://kunming.customs.gov.cn/customs/302249/302266/302267/4482275/2022072514200183520.pdf PDF Version] (New Links added on 23 January 2026)</ref> In September 2022, the Chinese CDC's chief epidemiologist advised Chinese citizens to avoid "direct skin-to-skin contact with foreigners".<ref>{{Cite news |date=2022-09-18 |title=Don't touch foreigners to reduce monkeypox risk, says senior Chinese health official |language=en |work=Reuters |url=https://www.reuters.com/business/healthcare-pharmaceuticals/dont-touch-foreigners-reduce-monkeypox-risk-says-senior-chinese-health-official-2022-09-18/ |access-date=2022-09-19 |archive-date=19 September 2022 |archive-url=https://web.archive.org/web/20220919034939/https://www.reuters.com/business/healthcare-pharmaceuticals/dont-touch-foreigners-reduce-monkeypox-risk-says-senior-chinese-health-official-2022-09-18/ |url-status=live }}</ref> Months after the end of the WHO public health emergency, in the late summer and early fall of 2023, China accounted for half of the world's new confirmed cases amid a spike in positive test results. At the time of the 2023 outbreak, it had not yet approved any of the three existing mpox vaccines for domestic use, with some analysts citing vaccine nationalism and homophobia as contributing factors.<ref>{{cite news |last1=Kekatos |first1=Mary |title=First was COVID. Now China is facing an mpox crisis as cases spike |url=https://abcnews.go.com/Health/mpox-cases-rising-china-infections-spiking-50-3/story?id=101895763 |access-date=7 October 2023 |publisher=ABC News |date=2 August 2023 |archive-url=https://web.archive.org/web/20230913084103/https://abcnews.go.com/Health/mpox-cases-rising-china-infections-spiking-50-3/story?id=101895763 |archive-date=13 September 2023 |language=en}}</ref><ref>{{cite news |title=Many of the world's new mpox cases are in China |url=https://www.economist.com/china/2023/10/05/many-of-the-worlds-new-mpox-cases-are-in-china |access-date=7 October 2023 |publisher=The Economist |date=5 October 2023 |archive-url=https://web.archive.org/web/20231006123938/https://www.economist.com/china/2023/10/05/many-of-the-worlds-new-mpox-cases-are-in-china |archive-date=6 October 2023}}</ref> *{{flag|Colombia}}: As of May, the Colombian Ministry of Health was taking follow-up and control measures. The Director of Epidemiology and Demography of the Ministry of Health, Claudia Cuellar, informed the Colombian population about how mpox is spread through people, and she spoke about the clinical presentation of the virus and international health regulations.<ref>{{cite web |last=Ibarguen |first=Yorely |date=23 May 2022 |title=Viruela del mono: Colombia se declara en riesgo moderado por la propagación |url=https://caracol.com.co/radio/2022/05/23/salud/1653313955_020164.html |access-date=28 May 2022 |website=Caracol Radio |language=es |archive-date=5 June 2022 |archive-url=https://web.archive.org/web/20220605082248/https://caracol.com.co/radio/2022/05/23/salud/1653313955_020164.html |url-status=live }}</ref> Health authorities in the Department of Norte de Santander have been on alert, since the department is a border area where people pass between Colombia and Venezuela.<ref>{{cite web |title=Alerta en Norte de Santander por la viruela del mono |url=https://www.laopinion.com.co/region/alerta-en-norte-de-santander-por-la-viruela-del-mono |access-date=28 May 2022 |website=La Opinión |language=es-co |archive-date=6 June 2022 |archive-url=https://web.archive.org/web/20220606152708/https://www.laopinion.com.co/region/alerta-en-norte-de-santander-por-la-viruela-del-mono |url-status=live }}</ref> *{{flag|Dominican Republic}}: In May, the Ministry of Public Health of the Dominican Republic issued a preventive epidemiological alert after mpox was reported in several countries.<ref>{{cite web |date=23 May 2022 |title=Viruela del mono (monkeypox): ¿en qué países se han detectado casos? |url=https://cnnespanol.cnn.com/2022/05/23/viruela-del-mono-monkeypox-paises-casos-trax/ |access-date=28 May 2022 |website=CNN |language=es |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528012144/https://cnnespanol.cnn.com/2022/05/23/viruela-del-mono-monkeypox-paises-casos-trax/ |url-status=live }}</ref><ref>{{cite web |date=22 May 2022 |title=República Dominicana en alerta preventiva por viruela del mono |url=https://www.dw.com/es/rep%C3%BAblica-dominicana-en-alerta-preventiva-por-viruela-del-mono/a-61890810 |access-date=28 May 2022 |website=Deutsche Welle |language=es |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528012718/https://www.dw.com/es/rep%C3%BAblica-dominicana-en-alerta-preventiva-por-viruela-del-mono/a-61890810 |url-status=live }}</ref> *{{flag|Egypt}}: On 24 May, the Egyptian Ministry of Health and Population informed about measures to prevent new mpox infections, among them, was to wash hands with soap or use an alcohol-based hand sanitiser, in addition to using personal protective equipment such as masks. In addition, the Ministry informed that veterinary quarantine procedures should be taken for animals that present the disease.<ref>{{cite web |date=24 May 2022 |title=جدري القردة..الصحة المصرية تكشف إجراءات الوقاية منه |url=https://arabic.cnn.com/health/article/2022/05/24/monkeypox-egypt-preventative-measures |access-date=29 May 2022 |website=CNN Arabic |language=ar |archive-date=27 May 2022 |archive-url=https://web.archive.org/web/20220527091659/https://arabic.cnn.com/health/article/2022/05/24/monkeypox-egypt-preventative-measures |url-status=live }}</ref> *{{flag|Fiji}}: The country's Centre for Disease Control and Border Health Protection Unit are monitoring the situation. The Ministry of Health has put in place infection prevention protocols at the border.<ref>{{cite web |author=Koroi Tadulala |title=Fiji monitoring outbreaks of concern including monkeypox |url=https://www.fbcnews.com.fj/news/health/fiji-monitoring-outbreaks-of-concern-including-monkeypox/ |access-date=24 May 2022 |website=Fiji Broadcasting Corporation |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192715/https://www.fbcnews.com.fj/news/health/fiji-monitoring-outbreaks-of-concern-including-monkeypox/ |url-status=live }}</ref><ref>{{cite web |author=Koroi Tadulala |title=MOH prepares to deal with monkeypox |url=https://www.fbcnews.com.fj/news/health/moh-prepares-to-deal-with-monkeypox/ |access-date=24 May 2022 |website=Fiji Broadcasting Corporation |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192755/https://www.fbcnews.com.fj/news/health/moh-prepares-to-deal-with-monkeypox/ |url-status=live }}</ref> Minister for Health Ifereimi Waqainabete said that the Ministry is on high alert after three suspected cases of mpox returned negative results.<ref>{{cite web |author=Kirisitiana Uluwai |title=Ministry on high alert: Dr Waqainabete |url=https://www.fbcnews.com.fj/news/health/ministry-on-high-alert-dr-waqainabete/ |access-date=28 June 2022 |website=Fiji Broadcasting Corporation |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628125409/https://www.fbcnews.com.fj/news/health/ministry-on-high-alert-dr-waqainabete/ |url-status=live }}</ref> *{{flag|France}}: On 11 July 2022, Frances National Authority for Health released vaccines to the public with the hope of vaccinating vulnerable groups including sex workers and MSM communities. In total, the Directorate General of Health sent out 30,000 vaccines, though it was unclear how many were administered to citizens.<ref>{{Cite news |date=2022-07-26 |title=Monkeypox: Why are gay and bisexual men more affected? |url=https://www.lemonde.fr/en/health/article/2022/07/26/monkeypox-why-are-gay-and-bisexual-men-more-affected_5991445_14.html |access-date=2024-09-25 |language=en}}</ref> *{{flag|Germany}}: Fabian Leendertz of the Robert Koch Institute described the outbreak as an epidemic that would not last long: "The cases can be well isolated via contact tracing and there are also drugs and effective vaccines that can be used if necessary."<ref name="Reuters"/> *{{flag|Guatemala}}: On 26 May, the Minister of Health of Guatemala, Francisco Coma, informed that the Ministry declared an epidemiological alert on the borders of the Central American country, with the objective of detecting possible cases of mpox.<ref>{{cite web |title=Ministerio de Salud envía alerta epidemiológica a las fronteras de Guatemala por la viruela de mono |url=https://www.prensalibre.com/guatemala/comunitario/ministerio-de-salud-envia-alerta-epidemiologica-a-las-fronteras-de-guatemala-por-la-viruela-de-mono-breaking/ |access-date=28 May 2022 |website=Prensa Libre |date=26 May 2022 |language=es-GT |archive-date=27 May 2022 |archive-url=https://web.archive.org/web/20220527181750/https://www.prensalibre.com/guatemala/comunitario/ministerio-de-salud-envia-alerta-epidemiologica-a-las-fronteras-de-guatemala-por-la-viruela-de-mono-breaking/ |url-status=live }}</ref> The minister also mentioned that one of the main transmissions of mpox is from injuries and body fluids as well as contact with contaminated clothing.<ref>{{cite web |last=Mutz |first=Viviana |title=Sistema de Salud de Guatemala en alerta por viruela del mono |url=https://republica.gt/guatemala/centros-de-salud-de-guatemala-en-alerta-epidemiologica-por-viruela-del-mono-202252011390 |access-date=28 May 2022 |website=República.gt |language=es |archive-date=31 May 2022 |archive-url=https://web.archive.org/web/20220531232512/https://republica.gt/guatemala/centros-de-salud-de-guatemala-en-alerta-epidemiologica-por-viruela-del-mono-202252011390 |url-status=live }}</ref> *{{flag|India}}: Union Health Minister Mansukh Mandaviya directed the National Centre for Disease Control and the ICMR to keep a close watch and monitor the situation. The Union Health Ministry has also directed airport and port health officers to be vigilant, according to official sources. They have been instructed to isolate and send samples to the National Institute of Virology of any sick passenger with a travel history to infected countries.<ref>{{Cite news |date= 21 May 2022 |title= Monkeypox outbreak: India to screen arrival for virus signs, isolate sick patients; details here |language= en |work= Zee News |url= https://zeenews.india.com/india/monkeypox-outbreak-india-to-screen-arrival-for-virus-signs-isolate-sick-patients-details-here-2465745.html |access-date= 22 May 2022 |archive-date= 24 May 2022 |archive-url= https://web.archive.org/web/20220524192722/https://zeenews.india.com/india/monkeypox-outbreak-india-to-screen-arrival-for-virus-signs-isolate-sick-patients-details-here-2465745.html |url-status= live }}</ref> *{{flag|Indonesia}}: When cases of mpox were reported in Australia in May 2022, they triggered the alert of health authorities in Indonesia. Mohammad Syahril, ministry spokesperson, urged medical personnel and the country's population to be alert and aware of the symptoms of the disease.<ref>{{cite web |last=Loasana |first=Nina |title=Indonesia on alert as monkeypox emerges in Australia |url=https://www.thejakartapost.com/indonesia/2022/05/27/indonesia-on-alert-as-monkeypox-emerges-in-australia.html |access-date=29 May 2022 |website=The Jakarta Post |language=en |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530000043/https://www.thejakartapost.com/indonesia/2022/05/27/indonesia-on-alert-as-monkeypox-emerges-in-australia.html |url-status=live }}</ref> *{{flag|Ireland}}: The Health Service Executive (HSE) has set up a multidisciplinary incident management team to prepare for the possible arrival of mpox, and infectious diseases experts are on alert for patients with symptoms of the virus.<ref>{{cite news |date= 20 May 2022 |title= Ireland on alert for monkeypox as virus spreads across Europe |language= en |newspaper=The Irish Times |url=https://www.irishtimes.com/news/world/europe/ireland-on-alert-for-monkeypox-as-virus-spreads-across-europe-1.4883747 |access-date=23 May 2022 |archive-date= 20 May 2022 |archive-url= https://web.archive.org/web/20220520143721/https://www.irishtimes.com/news/world/europe/ireland-on-alert-for-monkeypox-as-virus-spreads-across-europe-1.4883747 |url-status=live}}</ref> On 26 July, the Government of Ireland confirmed the issuing of a vaccination for specific groups and to increase awareness.<ref>{{cite web | url=https://www.rte.ie/news/ireland/2022/0726/1312357-monkeypox-ireland/ | title=Jab offered to those at high risk of monkeypox exposure | website=RTÉ.ie | date=26 July 2022 | access-date=26 July 2022 | archive-date=26 July 2022 | archive-url=https://web.archive.org/web/20220726202112/https://www.rte.ie/news/ireland/2022/0726/1312357-monkeypox-ireland/ | url-status=live }}</ref> *{{flag|Japan}}: The Japanese health ministry confirmed its first case of mpox on 25 July 2022. It was detected from a man in his 30s residing in the Tokyo area.<ref>{{Cite web |title=The first monkeypox case confirmed in Japan {{!}} NHK WORLD-JAPAN News |url=https://www3.nhk.or.jp/nhkworld/en/news/20220725_39/ |archive-url=https://web.archive.org/web/20220725115309/https://www3.nhk.or.jp/nhkworld/en/news/20220725_39/ |url-status=dead |archive-date=25 July 2022 |access-date=25 July 2022 |website=NHK WORLD |language=en}}</ref> *{{Flag|Kosovo}}: On 23 May, the Ministry of Health and the National Public Health Institute drafted a document of recommendations and measures to help prevent the spread of the disease. In a press statement, healthcare authorities have declared that the situation is being closely monitored.<ref>{{cite web |date=24 May 2022 |title=Kosovo takes preventive measures against the spread of monkeypox |url=https://euronews.al/en/kosovo/2022/05/24/kosovo-takes-preventive-measures-against-the-spread-of-monkeypox/ |access-date=1 June 2022 |website=Euronews |language=en-US |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524113950/https://euronews.al/en/kosovo/2022/05/24/kosovo-takes-preventive-measures-against-the-spread-of-monkeypox/ |url-status=live}}</ref> *{{flag|Luxembourg}}: On 21 May, the Ministry of Health said that they were monitoring the situation with Europe.<ref>{{cite web |date=24 May 2022 |title=Kosovo takes preventive measures against the spread of monkeypox – Euronews Albania |work=Euronews Albania - Top stories in Albania, Kosovo and the Balkans |url=https://euronews.al/en/kosovo/2022/05/24/kosovo-takes-preventive-measures-against-the-spread-of-monkeypox/ |access-date=1 June 2022 |language=en-US |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524113950/https://euronews.al/en/kosovo/2022/05/24/kosovo-takes-preventive-measures-against-the-spread-of-monkeypox/ |url-status=live}}</ref> The National Infectious Diseases Department of the HLC and refrained from close contact activities until the infection has resolved.<ref>{{cite news |date= 21 May 2022 |title= Ministry of Health: Luxembourg spared from monkeypox so far |language= en |work= RTL Today |url= https://today.rtl.lu/news/luxembourg/a/1916605.html |access-date=23 May 2022 |archive-date= 24 May 2022 |archive-url= https://web.archive.org/web/20220524192722/https://today.rtl.lu/news/luxembourg/a/1916605.html |url-status= live }}</ref> *{{flag|Malaysia}}: On 27 May, the Malaysian Ministry of Health reactivated the MySejahtera app to provide information and surveillance on mpox.<ref>{{cite web |last=Zainuddin |first=Alifah |date=26 May 2022 |title=MySejahtera Reactivated For Monkeypox Surveillance |url=https://codeblue.galencentre.org/2022/05/26/mysejahtera-reactivated-for-monkeypox-surveillance/ |access-date=30 May 2022 |website=CodeBlue |language=en-US |archive-date=26 May 2022 |archive-url=https://web.archive.org/web/20220526112958/https://codeblue.galencentre.org/2022/05/26/mysejahtera-reactivated-for-monkeypox-surveillance/ |url-status=live}}</ref> *{{flag|Mexico}}: In May, Mexican health authorities have posted notices in clinics and hospitals for the purpose of identifying suspected cases in the country. In addition, the Ministry of Health issued an epidemiological alert on 26 May 2022.<ref>{{cite web |last=Camhaji |first=Elías |date=26 May 2022 |title=México emite una alerta epidemiológica para identificar casos de la viruela del mono |url=https://elpais.com/mexico/2022-05-26/mexico-emite-una-alerta-epidemiologica-para-identificar-casos-de-la-viruela-del-mono.html |access-date=28 May 2022 |website=El País México |language=es |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528234746/https://elpais.com/mexico/2022-05-26/mexico-emite-una-alerta-epidemiologica-para-identificar-casos-de-la-viruela-del-mono.html |url-status=live}}</ref> *{{flag|Morocco}}: In May, several regional directors of the Moroccan Ministry of Health coordinated a surveillance system for mpox with the Directorate of Epidemiology and Disease Control to prevent cases of mpox from European countries from spreading to Morocco, according to the {{Interlanguage link|Al Akhbar (Morocco)|lt=Al Akhbar|ar|جريدة الأخبار المغربية}} newspaper.<ref name=":1f">{{cite web |title=Variole du singe: le ministère de la Santé prend les devants |url=https://fr.le360.ma/societe/variole-du-singe-le-ministere-de-la-sante-prend-les-devants-260469 |access-date=28 May 2022 |website=Le360.ma |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520204000/https://fr.le360.ma/societe/variole-du-singe-le-ministere-de-la-sante-prend-les-devants-260469 |url-status=live}}</ref> Due to the "Marhaba 2022" operation, an operation that aims to facilitate the travel of Moroccans living abroad by sea when they travel during the summer period,<ref>{{cite web |last1=López-Fonseca |first1=Óscar |last2=Peregil |first2=Francisco |date=11 April 2022 |title=Interior inicia los preparativos de la Operación Paso del Estrecho tras el fin de la crisis con Marruecos |url=https://elpais.com/espana/2022-04-11/interior-inicia-los-preparativos-de-la-operacion-paso-del-estrecho-tras-el-fin-de-la-crisis-con-marruecos.html |access-date=28 May 2022 |website=El País |language=es |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528011136/https://elpais.com/espana/2022-04-11/interior-inicia-los-preparativos-de-la-operacion-paso-del-estrecho-tras-el-fin-de-la-crisis-con-marruecos.html |url-status=live}}</ref> sanitary measures have already been put in place.<ref name=":1f" /> *{{flag|Netherlands}}: The Netherlands started vaccinating people considered 'at risk' for mpox infection at the end of July 2022. This includes people on pre-exposure prophylaxis for HIV prevention.<ref>{{Cite web| title = Vaccinaties apenpokken begonnen, 32.000 mensen uitgenodigd| access-date = 25 July 2022| date = 25 July 2022| language = nl-NL| publisher = Nederlandse Omroep Stichting| url = https://nos.nl/artikel/2438265-vaccinaties-apenpokken-begonnen-32-000-mensen-uitgenodigd| archive-date = 25 July 2022| archive-url = https://web.archive.org/web/20220725122615/https://nos.nl/artikel/2438265-vaccinaties-apenpokken-begonnen-32-000-mensen-uitgenodigd| url-status = live}}</ref> *{{flag|Nigeria}}: The director general of the NCDC, Ifedayo Adetifa, advised the Nigerian population to avoid eating bush meat to prevent new mpox infections, in addition to storing food properly to avoid being contaminated by rodents, as mpox is a viral zoonosis.<ref>{{cite web |date=26 May 2022 |title=Nigeria Disease Control Agency Issues Warning Over Monkeypox |url=https://humanglemedia.com/nigeria-disease-control-agency-issues-warning-over-monkeypox/ |access-date=27 May 2022 |website=HumAngle Media |language=en-US |archive-date=26 May 2022 |archive-url=https://web.archive.org/web/20220526144448/https://humanglemedia.com/nigeria-disease-control-agency-issues-warning-over-monkeypox/ |url-status=live}}</ref> *{{flag|Philippines}}: Former health secretary Francisco Duque III said that the Philippines was intensifying its border control measures amid the threat of the monkeypox virus.<ref>{{cite web |title=Philippines tightens border control amid monkeypox threat |url=https://www.gmanetwork.com/news/topstories/nation/832413/philippines-tightens-border-control-amid-monkeypox-threat/story/ |website=GMA News Online |date=21 May 2022 |access-date=22 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192723/https://www.gmanetwork.com/news/topstories/nation/832413/philippines-tightens-border-control-amid-monkeypox-threat/story/ |url-status=live }}</ref> The health department stated it is exploring potential sources of mpox vaccines and antivirals.<ref>{{cite news |title=DOH now exploring sources of monkeypox vaccines, antivirals for possible outbreak |url=https://www.cnnphilippines.com/news/2022/5/27/DOH-monkeypox-vaccines-antivirals.html |access-date=28 May 2022 |publisher=CNN Philippines |date=27 May 2022 |archive-date=27 May 2022 |archive-url=https://web.archive.org/web/20220527125308/https://www.cnnphilippines.com/news/2022/5/27/DOH-monkeypox-vaccines-antivirals.html |url-status=dead }}</ref><ref>{{cite news |last1=Yang |first1=Angelica Y. |title=No FDA approval yet for monkeypox antivirals — DOH |url=https://www.philstar.com/headlines/2022/05/28/2184357/no-fda-approval-yet-monkeypox-antivirals-doh |access-date=28 May 2022 |work=The Philippine Star |date=28 May 2022 |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528032808/https://www.philstar.com/headlines/2022/05/28/2184357/no-fda-approval-yet-monkeypox-antivirals-doh |url-status=live }}</ref> *{{flag|Saudi Arabia}}: On 21 May, the Saudi Ministry of Health stated that they are ready to monitor and investigate cases of mpox, if any occurs. They added that it also has an integrated preventive plan to deal with such cases if they appear, including identifying suspected and confirmed cases.<ref>{{cite web |date=21 May 2022 |title=No monkeypox cases detected in Saudi Arabia, health ministry says |url=https://arab.news/mm5m5 |access-date=31 May 2022 |website=Arab News |language=en |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628125413/https://www.arabnews.com/node/2087001/saudi-arabia |url-status=live }}</ref> *{{Flag|Senegal}}: Badara Ly of the Ministry of Health and Social Action, spoke about the creation of a contingency plan in Senegal during an online conference with the WHO in May, in addition the doctor alerted the health system and advised the creation of fact sheets on prevention methods and reinforcement of screening in border areas.<ref>{{cite web |title=Variole du singe / Le Sénégal anticipe : " Nous sommes en train de travailler sur l'élaboration d'un plan de contingence spécifique … " (Dr Badara Ly) |url=https://www.dakaractu.com/Variole-du-singe-Le-Senegal-anticipe-Nous-sommes-en-train-de-travailler-sur-l-elaboration-d-un-plan-de-contingence_a219618.html |access-date=26 June 2022 |website=Dakaractu |language=fr |archive-date=26 June 2022 |archive-url=https://web.archive.org/web/20220626231739/https://www.dakaractu.com/Variole-du-singe-Le-Senegal-anticipe-Nous-sommes-en-train-de-travailler-sur-l-elaboration-d-un-plan-de-contingence_a219618.html |url-status=live }}</ref> *{{flag|South Africa}}: On 26 May, the National Institute for Communicable Diseases (NICD) gave a communiqué on how the virus is transmitted, and the institute stated that the 2022 outbreak is the largest outbreak of mpox outside of endemic regions. In addition, the NICD affirmed that the virus mainly spreads in tropical forest areas in West and Central Africa.<ref>{{cite web |last=Brandt |first=Kevin |title=NICD says current monkeypox outbreak is largest outside of endemic locations |url=https://ewn.co.za/2022/05/26/nicd-says-current-monkeypox-outbreak-is-largest-outside-of-endemic-locations |access-date=28 May 2022 |website=Eyewitness News |language=en |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528235903/https://ewn.co.za/2022/05/26/nicd-says-current-monkeypox-outbreak-is-largest-outside-of-endemic-locations |url-status=live }}</ref> *{{flag|Taiwan}}: On 30 May, the Taiwan Centers for Disease Control officially listed mpox as a notifiable infectious disease, and on 23 June, mpox was officially upgraded to a second-class notifiable infectious disease, which means that confirmed cases must be notified within 24 hours, and if necessary, isolation treatment may be implemented in designated isolation treatment institutions.<ref>{{cite web |title=CDC publishes guidelines for monkeypox |url=https://www.taipeitimes.com/News/front/archives/2022/06/26/2003780573 |access-date=28 June 2022 |website=taipeitimes.com |date=26 June 2022 |language=en |archive-date=27 June 2022 |archive-url=https://web.archive.org/web/20220627041412/https://www.taipeitimes.com/News/front/archives/2022/06/26/2003780573 |url-status=live }}</ref> *{{flag|Thailand}}: On 24 May, the Department of Disease Control (DDC) started screening all overseas passengers from Central African countries and other outbreak countries at international airports.<ref>{{cite web |title=Anti-Monkeypox measures introduced at Thai airports |url=https://www.thaipbsworld.com/anti-monkeypox-measures-introduced-at-thai-airports |access-date=31 May 2022 |website=Thai PBS |language=en |archive-date=31 May 2022 |archive-url=https://web.archive.org/web/20220531071040/https://www.thaipbsworld.com/anti-monkeypox-measures-introduced-at-thai-airports/ |url-status=live }}</ref> On 26 May 2022, the DDC set up an emergency operations center to monitor the outbreak situation and plan for a possible outbreak in the kingdom.<ref>{{cite web |title=What risk to Thailand as monkeypox spreads across the world? |url=https://www.thaipbsworld.com/what-risk-to-thailand-as-monkeypox-spreads-across-the-world |access-date=31 May 2022 |website=Thai PBS |language=en |archive-date=31 May 2022 |archive-url=https://web.archive.org/web/20220531071040/https://www.thaipbsworld.com/what-risk-to-thailand-as-monkeypox-spreads-across-the-world/ |url-status=live }}</ref> Anutin Charnvirakul, Minister of Public Health, said that the government is seeking a smallpox vaccine from the WHO to bolster the public's immunity in case of a viral outbreak.<ref>{{Cite news |title=Govt seeks monkeypox vaccine |url=https://www.bangkokpost.com/thailand/general/2316542/govt-seeks-monkeypox-vaccine |access-date=31 May 2022 |website=Bangkok Post |date=27 May 2022 |language=en |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628125413/https://www.bangkokpost.com/thailand/general/2316542/govt-seeks-monkeypox-vaccine |url-status=live }}</ref> On 30 May, the local news reported the first case of mpox in the country.<ref>{{cite web |title=Thailand reports first case of monkeypox in transit passenger to Australia |url=https://www.thaipbsworld.com/thailand-reports-first-case-of-monkeypox-in-transit-passenger-to-australia/ |website=ThaiPBS |access-date=30 May 2022 |language=en |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530132058/https://www.thaipbsworld.com/thailand-reports-first-case-of-monkeypox-in-transit-passenger-to-australia/ |url-status=live }}</ref> The patient was a passenger who was transiting from Europe to Australia via Bangkok. However, the patient's symptoms developed and were diagnosed in Australia. Multiple traces of mpox DNA were detected in non-sewered wastewater in Bangkok between late June and August, and the first clinical case was reported on July 21.<ref name="Wannigama">{{Cite journal |last1=Wannigama |first1=Dhammika Leshan |last2=Amarasiri |first2=Mohan |last3=Hongsing |first3=Parichart |last4=Hurst |first4=Cameron |last5=Modchang |first5=Charin |last6=Chadsuthi |first6=Sudarat |last7=Anupong |first7=Suparinthon |last8=Phattharapornjaroen |first8=Phatthranit |last9=S.M. |first9=Ali Hosseini Rad |last10=Fernandez |first10=Stefan |last11=Huang |first11=Angkana T. |last12=Kueakulpattana |first12=Naris |last13=Tanasatitchai |first13=Chanikan |last14=Vatanaprasan |first14=Porames |last15=Saethang |first15=Thammakorn|display-authors=6|date=2022-10-29 |title=Multiple traces of monkeypox detected in non-sewered wastewater with sparse sampling from a densely populated metropolitan area in Asia |journal=Science of the Total Environment |volume=858 |issue=Pt 1 |article-number=159816 |language=en |id=159816 |doi=10.1016/j.scitotenv.2022.159816 |pmid=36461562 |issn=0048-9697 |pmc=9620434}}</ref> *{{flag|United Kingdom}}: On 22 May, Education Secretary Nadhim Zahawi said "we're taking it very, very seriously" and that the UK government had already started purchasing smallpox vaccines.<ref>{{cite web |title=UK Confirms Local Transmission of Monkeypox |url=https://ewn.co.za/2022/05/22/uk-confirms-local-transmission-of-monkeypox |website=Eyewitness News (South Africa) |access-date=22 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192725/https://ewn.co.za/2022/05/22/uk-confirms-local-transmission-of-monkeypox |url-status=live }}</ref> The Terrence Higgins Trust and British Association for Sexual Health and HIV (BASHH) expressed concern about the impact on sexual health services in the United Kingdom.<ref>{{cite web |date=21 May 2022 |title=Monkeypox could have 'big detrimental effect' on access to sexual health services, experts warn |url=https://inews.co.uk/news/health/monkeypox-could-detrimental-effect-access-sexual-health-services-experts-warn-1643210 |access-date=23 May 2022 |website=inews.co.uk |language=en |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524193914/https://inews.co.uk/news/health/monkeypox-could-detrimental-effect-access-sexual-health-services-experts-warn-1643210 |url-status=live }}</ref><ref name=":10">{{Cite news |date=21 May 2022 |title=Monkeypox: Doctors concerned over impact on sexual health |language=en-GB |publisher=BBC News |url=https://www.bbc.com/news/health-61527835 |access-date=23 May 2022 |archive-date=20 May 2022 |archive-url=https://web.archive.org/web/20220520230245/https://www.bbc.com/news/health-61527835 |url-status=live }}</ref> *{{flag|United States}}: On 22 May, President Joe Biden commented "they haven't told me the level of exposure yet but it is something that everybody should be concerned about". National security advisor Jake Sullivan told reporters the US has a vaccine that is relevant to treating mpox.<ref>{{cite web |title=Biden says 'everybody' should be concerned about spread of monkeypox |url=https://www.theguardian.com/us-news/2022/may/22/biden-monkeypox-infections-spread |website=The Guardian |date=22 May 2022 |access-date=22 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524193913/https://www.theguardian.com/us-news/2022/may/22/biden-monkeypox-infections-spread |url-status=live }}</ref> On 25 May, the CDC issued an alert for gay and bisexual men to be especially vigilant.<ref name="CNBCKimball">{{Cite news |last=Kimball |first=Spencer |date=23 May 2022 |title=CDC officials sound alarm for gay and bisexual men as monkeypox spreads in community |url=https://www.cnbc.com/2022/05/23/cdc-officials-sound-alarm-for-gay-and-bisexual-men-as-monkeypox-spreads-in-community-.html |access-date=24 May 2022 |publisher=CNBC |language=en |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524171609/https://www.cnbc.com/2022/05/23/cdc-officials-sound-alarm-for-gay-and-bisexual-men-as-monkeypox-spreads-in-community-.html |url-status=live }}</ref><ref name="CNBCKopecki">{{Cite news |last=Kopecki |first=Dawn |date=23 May 2022 |title=Monkeypox outbreak is primarily spreading through sex, WHO officials say |url=https://www.cnbc.com/2022/05/23/monkeypox-outbreak-is-primarily-spreading-through-sex-who-officials-say.html |access-date=24 May 2022 |publisher=CNBC |language=en |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524174733/https://www.cnbc.com/2022/05/23/monkeypox-outbreak-is-primarily-spreading-through-sex-who-officials-say.html |url-status=live }}</ref> In addition, the CDC placed its mpox travel alert at "Level 2", following reports of cases in Australia and several countries in Europe.<ref>{{cite web |last=Fox |first=Alison |title=CDC Issues Travel Warning Amid Spread of Monkeypox Virus — What to Know |url=https://www.travelandleisure.com/travel-news/cdc-issues-travel-warning-for-monkeypox |access-date=30 May 2022 |website=Travel + Leisure |language=en |archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530184602/https://www.travelandleisure.com/travel-news/cdc-issues-travel-warning-for-monkeypox |url-status=live }}</ref> Beginning 18 July, Sonic Healthcare USA started testing for mpox using CDC's orthopoxvirus test, which includes monkeypox virus at Sonic Reference Laboratory in Austin, Texas.<ref>{{cite web |date=18 July 2022 |title=Sonic Healthcare USA Begins Monkeypox Testing, Increasing Nationwide Testing Capacity |url=https://emergency.cdc.gov/newsletters/coca/071822.htm |access-date=21 July 2022 |website=emergency.cdc.gov |archive-date=21 July 2022 |archive-url=https://web.archive.org/web/20220721171203/https://emergency.cdc.gov/newsletters/coca/071822.htm |url-status=live }}</ref> *{{flag|Vietnam}}: On 24 May, Vietnam's Ministry of Health asked border localities to increase surveillance to detect possible cases of mpox.<ref>{{cite web |title=Vietnam tightens entry surveillance over fears of Monkeypox |url=https://hanoitimes.vn/vietnam-tightens-entry-surveillance-over-fears-of-monkeypox-320864.html |access-date=30 May 2022 |website=Hanoi Times |language=en |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628125424/https://hanoitimes.vn/vietnam-tightens-entry-surveillance-over-fears-of-monkeypox-320864.html |url-status=live }}</ref>
=== Dependent territories === *{{flag|Gibraltar}}: On 31 May, a Strategic Coordination Group met to discuss Gibraltar's state of preparedness in the eventuality that a case of mpox was confirmed in the territory amid the rapid rise of cases in the United Kingdom and Spain.<ref>{{cite web |title=Gibraltar Government prepares for Monkeypox, as UK cases rise |url=https://www.chronicle.gi/gibraltar-government-prepares-for-monkeypox-as-uk-cases-rise/ |access-date=1 June 2022 |website=Gibraltar Chronicle |language=en |archive-date=1 June 2022 |archive-url=https://web.archive.org/web/20220601160257/https://www.chronicle.gi/gibraltar-government-prepares-for-monkeypox-as-uk-cases-rise/ |url-status=live }}</ref>
== Cases per country and territory == <!-- If a new country has a suspected case or confirmed case, please create a new redirect to this page titled "2022–2023 mpox outbreak in (country)". --> <!-- Please update the number of countries in the Infobox outbreak above after updating the table; if you're planning to do many updates, it's okay to update the infobox only after the last change to the table --> <!-- It would be appreciated if citations of English sources have language tags too for easier auto-translations of the table into other wikis (some non-English sources will have missing tags, so it is not correct to assume all untagged sources are in English) --> <!-- Guadeloupe, Saint Martin and Martinique are already counted in with France and shouldn't be double-counted in the total! --> This is a table of confirmed mpox cases in countries and territories during 2022. Countries whose 2022 timeline precede the 6 May index case are shaded orange. The table does not include countries where suspected cases were reported but later discarded. {{2022–2023 mpox outbreak cases}}
=== Timeline of first confirmed cases by country or territory=== {{mw-datatable}} {| class="wikitable mw-datatable" |+First confirmed mpox cases by country or territory in 2022 |- !scope="col"| Date !scope="col"| Countries / ''Territories'' |- | style="background:BlanchedAlmond;"|From 1 January | style="background:BlanchedAlmond;"|{{CMR}} • {{COG}} • {{DRC}} • {{NGA}} |- | style="background:BlanchedAlmond;"|From February | style="background:BlanchedAlmond;"|{{CAF}} |- | {{dts|6 May 2022}} | {{flagdeco|GBR}} United Kingdom |- | {{dts|18 May 2022}} | {{flagdeco|PRT}} Portugal • {{flagdeco|ESP}} Spain • {{flagdeco|USA}} United States |- | {{dts|19 May 2022}} | {{BEL}} • {{flagdeco|CAN}} Canada • {{ITA}} • {{SWE}} |- | {{dts|20 May 2022}} | {{AUS}} • {{FRA}} • {{GER}} • {{flagdeco|NLD}} Netherlands |- | {{dts|21 May 2022}} | {{flagdeco|ISR}} Israel • {{SWI}} |- | {{dts|22 May 2022}} | {{AUT}} |- | {{dts|23 May 2022}} | {{DEN}} |- | {{dts|24 May 2022}} | {{CZE}} • {{SVN}} • {{UAE}} |- | {{dts|27 May 2022}} | {{ARG}} • {{FIN}} • {{IRL}} |- | {{dts|28 May 2022}} | {{MLT}} • {{MEX}} |- | {{dts|31 May 2022}} | {{HUN}} • {{NOR}} |- | {{dts|1 June 2022}} | ''{{GIB}}''{{efn-la|name=fn1}} |- | {{dts|2 June 2022}} | {{MOR}} |- | {{dts|3 June 2022}} | {{LAT}} |- | {{dts|8 June 2022}} | {{GHA}} • {{GRE}} |- | {{dts|9 June 2022}} | {{BRA}} • {{ISL}} |- | {{dts|10 June 2022}} | {{POL}} |- | {{dts|12 June 2022}} | {{VEN}} |- | {{dts|13 June 2022}} | {{ROM}} |- | {{dts|14 June 2022}} | {{BEN}} |- | {{dts|15 June 2022}} | {{GEO}} • {{LUX}} |- | {{dts|17 June 2022}} | {{CHI}} • {{SRB}} |- | {{dts|20 June 2022}} | {{LBN}} • {{SIN}} |- | {{dts|22 June 2022}} | {{KOR}} |- | {{dts|23 June 2022}} | {{BUL}} • {{COL}} • {{CRO}} • {{flagdeco|RSA}} South Africa |- | {{dts|24 June 2022}} | {{TWN}}{{efn-la|name=fn2}} |- | {{dts|26 June 2022}} | {{PER}} |- | {{dts|28 June 2022}} | {{EST}} |- | {{dts|29 June 2022}} | ''{{PRI}}''{{efn-la|name=fn3}} |- | {{dts|30 June 2022}} | {{BAH}} • {{TUR}} |- | {{dts|2 July 2022}} | {{AND}} |- | {{dts|5 July 2022}} | {{PAN}} |- | {{dts|6 July 2022}} | {{DOM}} • {{ECU}} • {{JAM}} |- | {{dts|7 July 2022}} | {{SVK}} |- | {{dts|9 July 2022}} | {{NZL}} |- | {{dts|12 July 2022}} | {{flagicon image|Flag of FLNKS.svg}} ''New Caledonia''{{efn-la|name=fn4}}{{efn-la|name=fn5}} • {{RUS}} |- | {{dts|13 July 2022}} | {{BIH}} |- | {{dts|14 July 2022}} | {{IND}} • {{KSA}} |- | {{dts|16 July 2022}} | {{BAR}} |- | {{dts|17 July 2022}} | {{flagicon image|Snake Flag of Martinique.svg}} ''Martinique''{{efn-la|name=fn6}}{{efn-la|name=fn5}} |- | {{dts|20 July 2022}} | {{CRI}} • {{QAT}} |- | {{dts|21 July 2022}} | {{THA}} |- | {{dts|22 July 2022}} | {{MON}} • {{flagicon image|Flag of Bermuda.svg}} ''Bermuda''{{efn-la|name=fn1}} |- | {{dts|23 July 2022}} | {{flagicon image|Flag of Jersey.svg}} ''Jersey''{{efn-la|name=fn7}} • {{LBR}} |- | {{dts|25 July 2022}} | ''{{flag|Guadeloupe|local}}''{{efn-la|name=fn6}}{{efn-la|name=fn5}} • {{JAP}} |- | {{dts|29 July 2022}} | {{PHI}} • {{URY}} |- | {{dts|31 July 2022}} | {{MNE}} • {{SUD}} |- | {{dts|1 August 2022}} | {{BOL}} • ''{{flag|Collectivity of Saint Martin}}''{{efn-la|name=fn5}} |- | {{dts|2 August 2022}} | {{CYP}} |- | {{dts|3 August 2022}} | {{GUA}} • {{LIT}} |- | {{dts|8 August 2022}} | {{MLD}} |- | {{dts|9 August 2022}} | ''{{GRL}}''{{efn-la|name=fn8}} |- | {{dts|12 August 2022}} | {{HON}} |- | {{dts|16 August 2022}} | {{IRN}} |- | {{dts|19 August 2022}} | {{IDN}} |- | {{dts|22 August 2022}} | ''{{ARU}}''{{efn-la|name=fn9}} • {{GUY}} |- | {{dts|24 August 2022}} | ''{{CUR}}''{{efn-la|name=fn9}} |- | {{dts|25 August 2022}} | {{PAR}} |- | {{dts|27 August 2022}} | ''{{MYT}}''{{efn-la|name=fn6}}{{efn-la|name=fn5}} |- | {{dts|30 August 2022}} | {{ELS}} |- | {{dts|6 September 2022}} | ''{{HKG}}''{{efn-la|name=fn10}} |- | {{dts|7 September 2022}} | {{EGY}} |- | {{dts|12 September 2022}} | ''{{GUM}}''{{efn-la|name=fn3}} |- | {{dts|14 September 2022}} | ''{{REU}}''{{efn-la|name=fn6}}{{efn-la|name=fn5}} |- | {{dts|16 September 2022}} | {{CHN}} • {{JOR}} • {{UKR}} • {{BHR}} |- | {{dts|3 October 2022}} | {{VIE}} |- | {{dts|5 October 2022}} | {{MOZ}} |- | {{dts|20 October 2022}} | {{SMR}} |- | {{dts|4 November 2022}} | {{SRI}} |- |} {{notelist-la|refs= {{efn-la|name=fn1|British Overseas Territory.}} {{efn-la|name=fn2|Non-member of the United Nations with limited recognition by some UN member states.}} {{efn-la|name=fn3|Unincorporated territory of the United States.}} {{efn-la|name=fn4|''Sui generis'' collectivity of France.}} {{efn-la|name=fn5|Part of Overseas France.}} {{efn-la|name=fn6|Single territorial collectivity and Overseas Department of France.}} {{efn-la|name=fn7|British Crown Dependency.}} {{efn-la|name=fn8|Constituent country of the Kingdom of Denmark.}} {{efn-la|name=fn9|Constituent country of the Kingdom of the Netherlands.}} {{efn-la|name=fn10|Special administrative region of China.}} }}
=== Timeline of suspected cases by country or territory === ''Countries listed below had only suspected cases at the time of reporting. Some countries reported confirmed cases after reporting suspected cases (i.e. Greece, Morocco, Turkey, Ecuador, Peru). Countries listed several times reported suspected cases again after they discarded suspected cases before.'' {| class="wikitable mw-datatable" |+Timeline of suspected mpox cases by country or territory |- ! scope="col" | Date ! scope="col" | Countries / ''Territories'' |- | {{dts|20 May 2022}} | {{GRE}} ''(discounted on 22 May)'' • {{ISR}} ''(confirmed on 21 May)'' |- | {{dts|23 May 2022}} | {{flagicon image|Flag of French Guiana.svg}} ''French Guiana''{{efn-la|name=fn1}}{{efn-la|name=fn2}} ''(discounted on 1 June)'' • {{MOR}} ''(discounted on 25 May)'' |- | {{dts|25 May 2022}} | {{BOL}} ''(discounted between 3 and 10 June)''<ref>{{cite news |title=Los casos sospechosos de viruela del mono en Bolivia fueron 'totalmente descartados' |trans-title=The suspected cases of monkeypox in Bolivia were "totally discarded" |url=https://www.la-razon.com/sociedad/2022/06/10/los-casos-sospechosos-de-viruela-del-mono-en-bolivia-fueron-totalmente-descartados/ |access-date=10 June 2022 |work=La Razón |date=10 June 2022 |location=La Paz, Bolivia |language=es |archive-date=10 June 2022 |archive-url=https://web.archive.org/web/20220610141311/https://www.la-razon.com/sociedad/2022/06/10/los-casos-sospechosos-de-viruela-del-mono-en-bolivia-fueron-totalmente-descartados/ |url-status=live }}</ref> • {{SUD}} ''(discounted on 3 June)'' |- | {{dts|27 May 2022}} | {{ECU}} ''(discounted on 30 May)'' • {{IRN}} ''(discounted on 4 June)'' • {{MYS}} ''(discounted on 31 May)'' |- | {{dts|29 May 2022}} | {{AFG}} ''(discounted between 31 May and 5 June)''<ref name="arianaaf">{{cite web |date=31 May 2022 |title=IEA denies reports of monkeypox in Afghanistan |url=https://www.ariananews.af/iea-denies-reports-of-monkeypox-in-afghanistan/ |access-date=1 June 2022 |website=Ariana News |archive-date=1 June 2022 |archive-url=https://web.archive.org/web/20220601031452/https://www.ariananews.af/iea-denies-reports-of-monkeypox-in-afghanistan/ |url-status=live }}</ref><ref name="pajhwok">{{Cite news |date=6 June 2022 |title=WHO to provide MoPH kits for monkeypox tests |language=en-GB |work=Pajhwok Afghan News |url=https://pajhwok.com/2022/06/06/who-to-provide-moph-kits-for-monkeypox-tests/ |access-date=8 June 2022 |archive-date=8 June 2022 |archive-url=https://web.archive.org/web/20220608110017/https://pajhwok.com/2022/06/06/who-to-provide-moph-kits-for-monkeypox-tests/ |url-status=live }}</ref> |- | {{dts|30 May 2022}} | {{PER}} ''(discounted on 2 June)'' • {{BRA}} ''(confirmed cases reported on 9 June)'' |- | {{dts|1 June 2022}} | {{CRI}} ''(discounted on 4 June)'' • {{HAI}} ''(discounted on 5 July)''<ref>{{cite news|url=https://lenouvelliste.com/article/236853/haiti-les-cas-suspects-de-variole-du-singe-sont-negatifs|title=Haïti : les cas suspects de variole du singe sont négatifs|work=Le Nouvelliste|date=5 July 2022|language=fr|access-date=9 July 2022|archive-date=7 July 2022|archive-url=https://web.archive.org/web/20220707173013/https://lenouvelliste.com/article/236853/haiti-les-cas-suspects-de-variole-du-singe-sont-negatifs|url-status=live}}</ref> • {{PAR}} ''(discounted on 7 June)''<ref>{{cite news|url=https://www.prensa-latina.cu/2022/06/07/descartan-en-paraguay-primer-caso-de-viruela-del-mono|title=Descartan en Paraguay primer caso de viruela del mono|work=Prensa Latina|date=7 June 2022|language=es|access-date=8 June 2022|archive-date=9 June 2022|archive-url=https://web.archive.org/web/20220609002943/https://www.prensa-latina.cu/2022/06/07/descartan-en-paraguay-primer-caso-de-viruela-del-mono|url-status=live}}</ref> |- | {{dts|2 June 2022}} | {{CAM}} ''(discounted on 2 June)'' • ''{{CYM}}''{{efn-la|name=fn3}} ''(discounted on 30 June)''<ref>{{cite web|date=30 June 2022|title=Tests confirm no local cases of monkeypox|url=https://www.caymancompass.com/2022/06/30/tests-confirm-no-local-cases-of-monkeypox/|access-date=30 June 2022|website=Cayman Compass|archive-date=30 June 2022|archive-url=https://web.archive.org/web/20220630213733/https://www.caymancompass.com/2022/06/30/tests-confirm-no-local-cases-of-monkeypox/|url-status=live |last1=Ragoonath |first1=Reshma }}</ref> • {{MUS}} ''(discounted on 10 June)''<ref>{{cite news|url=https://defimedia.info/la-variole-du-singe-inclue-dans-la-liste-des-maladies-declaration-obligatoire|title=La variole du singe inclue dans la liste des maladies à déclaration obligatoire|work=Defimedia|date=10 June 2022|language=fr|access-date=10 June 2022|archive-date=10 June 2022|archive-url=https://web.archive.org/web/20220610214309/https://defimedia.info/la-variole-du-singe-inclue-dans-la-liste-des-maladies-declaration-obligatoire|url-status=live}}</ref> • {{URU}} ''(confirmed cases reported on 29 July)'' |- | {{dts|3 June 2022}} | {{IND}} ''(discounted on 7 June)'' |- | {{dts|4 June 2022}} | {{KOS}} ''(discounted on 15 June)'' • {{TUR}} ''(discounted on 5 June)'' |- | {{dts|5 June 2022}} | {{GEO}} ''(confirmed on 15 June)''<ref>{{cite web |title=В соседней Грузии выявлены случаи с подозрением на оспу обезьян |url=https://1news.az/news/20220606104013980-V-sosednei-Gruzii-vyyavleny-sluchai-s-podozreniem-na-ospu-obezyan |access-date=30 June 2022 |website=1news.az |language=ru |archive-date=30 June 2022 |archive-url=https://web.archive.org/web/20220630131604/https://1news.az/news/20220606104013980-V-sosednei-Gruzii-vyyavleny-sluchai-s-podozreniem-na-ospu-obezyan |url-status=live }}</ref> |- | {{dts|7 June 2022}} | {{BAH}} ''(confirmed cases reported on 30 June)'' • {{BGD}} ''(discounted on 9 June)'' |- | {{dts|8 June 2022}} | {{UGA}} ''(discounted on 1 July)''<ref>{{cite web|url=https://english.news.cn/africa/20220701/0b4565b9c3d443b6b2fbb4151064db18/c.html|title=Uganda says no monkeypox outbreak after samples test negative|work=Xinhua News Agency|date=1 July 2022|language=en|access-date=1 July 2022|archive-date=1 July 2024|archive-url=https://web.archive.org/web/20240701041323/https://english.news.cn/africa/20220701/0b4565b9c3d443b6b2fbb4151064db18/c.html|url-status=live}}</ref> |- | {{dts|9 June 2022}} | {{SOM}} |- | {{dts|14 June 2022}} | {{ECU}} ''(discounted on 15 June)''<ref>{{cite web|url=https://www.elcomercio.com/actualidad/segundo-caso-sospechoso-viruela-mono-descartado.html|title=Segundo caso sospechoso de viruela del mono en Ecuador es descartado|work=El Comercio|date=15 June 2022|language=es|access-date=17 June 2022|archive-date=17 June 2022|archive-url=https://web.archive.org/web/20220617205457/https://www.elcomercio.com/actualidad/segundo-caso-sospechoso-viruela-mono-descartado.html|url-status=live}}</ref> |- | {{dts|15 June 2022}} | {{LBY}} ''(discounted on 13 July)''<ref>{{cite web|url=https://www.libyaobserver.ly/health/libya-free-monkeypox-ncdc-says|title=Libya is free of monkeypox, NCDC says|work=The Libya Observer|date=13 July 2022|language=en|access-date=13 July 2022|archive-date=16 July 2022|archive-url=https://web.archive.org/web/20220716093758/https://www.libyaobserver.ly/health/libya-free-monkeypox-ncdc-says|url-status=live}}</ref> |- | {{dts|16 June 2022}} | {{NEP}} ''(discounted on 17 June)''<ref>{{cite web|url=https://thehimalayantimes.com/nepal/suspected-monkeypox-case-in-nepal-confirmed-as-leprosy|title=Suspected monkeypox case in Nepal confirmed as Leprosy|work=The Himalayan Times|date=17 June 2022|language=en|access-date=18 June 2022|archive-date=17 June 2022|archive-url=https://web.archive.org/web/20220617151330/https://thehimalayantimes.com/nepal/suspected-monkeypox-case-in-nepal-confirmed-as-leprosy|url-status=live}}</ref> |- | {{dts|20 June 2022}} | {{ZAM}} |- | {{dts|21 June 2022}} | {{KOR}} ''(confirmed on 22 June)'' |- | {{dts|24 June 2022}} | {{FIJ}} ''(discounted on 28 June)''<ref>{{cite web |author=Apenisa Waqairadovu |title=Negative test for third suspected monkeypox case |url=https://www.fbcnews.com.fj/news/health/test-negative-for-third-suspected-monkeypox-case/ |access-date=28 June 2022 |website=Fiji Broadcasting Corporation |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628125509/https://www.fbcnews.com.fj/news/health/test-negative-for-third-suspected-monkeypox-case/ |url-status=live }}</ref> |- | {{dts|8 July 2022}} | {{IND}} ''(discounted on 9 July)''<ref>{{cite web |date=10 July 2022 |title=Kolkata youth tests negative for monkeypox, is being treated for chickenpox |url=https://www.news9live.com/health/health-conditions/kolkata-youth-tests-negative-for-monkeypox-is-being-treated-for-chicken-pox-181685 |access-date=16 July 2022 |website=News 9 |archive-date=16 July 2022 |archive-url=https://web.archive.org/web/20220716142919/https://www.news9live.com/health/health-conditions/kolkata-youth-tests-negative-for-monkeypox-is-being-treated-for-chicken-pox-181685 |url-status=live }}</ref> |- | {{dts|14 July 2022}} | {{IND}} ''(confirmed on 14 July)''<ref name="keralafirst"/> |}
{{Notelist-la|refs= {{Efn-la|name=fn1|Single territorial collectivity and Overseas Department of France.}} {{efn-la|name=fn2|Part of Overseas France}} {{efn-la|name=fn3|British Overseas Territory}} }}
=== Timeline of first deaths by country or territory (in countries with initial 2022 detection from 6 May onwards) === {| class="wikitable mw-datatable" |+Timeline of mpox deaths by country or territory |- ! scope="col" | Date ! scope="col" | Countries / ''territories'' |- | 29 July 2022 | {{flagdeco|Brazil}} Brazil • {{flagdeco|Spain}} Spain |- | 31 July 2022 | {{flagdeco|Ghana}} Ghana |- | 1 August 2022 | {{flagdeco|India}} India • {{flagdeco|Peru}} Peru |- | 8 August 2022 | {{ECU}} |- | 23 August 2022 | {{CUB}} • {{flagdeco|Mexico}} Mexico |- | 30 August 2022 | {{flagdeco|United States}} United States • {{flagdeco|Belgium}} Belgium |- | 22 September 2022 | {{CZE}} |- | 24 September 2022 | {{flagdeco|Sudan}} Sudan |- | 7 October 2022 | {{BOL}} |- |16 November 2022 | {{CHI}} |- |29 November 2022 | {{ARG}} |}
== See also == * Mpox in the Democratic Republic of the Congo * Mpox in Nigeria * 2023 Crimean–Congo hemorrhagic fever outbreak * 2024 mpox epidemic
== References == {{reflist|colwidth=30em}}
==External links== {{Commons}} * [https://www.who.int/emergencies/emergency-events/item/2022-e000121 Monkeypox outbreak] – by the World Health Organization * [https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html 2022 Mpox Outbreak Global Map] – CDC * [https://www.monkeypoxmeter.com/ Monkeypox Meter] – nice graphs and maps, but no source/reference links * [https://bnonews.com/monkeypox/ Monkeypox Tracker] by BNO News ("This tracker is no longer being updated. The final update was on 11 June 2022.") * [https://docs.google.com/spreadsheets/d/1CEBhao3rMe-qtCbAgJTn5ZKQMRFWeAeaiXFpBY3gbHE/htmlview Monkeypox_Public_www.global.health], a case-tracking spreadsheet maintained by the nonprofit Global.Health
{{2022–2023 mpox outbreak}} {{Epidemics}} {{Authority control}}
{{DEFAULTSORT:Mpox outbreak, 2022}} Category:2022–2023 mpox outbreak Category:2022 disease outbreaks Category:2023 disease outbreaks Category:2022 in LGBTQ history Category:2023 in LGBTQ history Category:May 2022 Category:July 2022 Category:June 2022 Category:August 2022 2022-2023 Category:Public health emergencies of international concern