Mpox worldwide overview

Overview

Globally, monkeypox virus (MPXV) clade I and clade II are circulating in multiple countries. Since 2022, MPXV clade II has mainly been circulating outside of the African continent among men who have sex with men. In 2024, an increase in MPXV clade Ia and Ib was reported in the Democratic Republic of the Congo (DRC), while clade Ia cases continued to be reported by the Central African Republic and the Republic of the Congo (Congo), where it is endemic. 

In 2025, cases continue to be reported in DRC and other countries in Africa where clade I was first detected the previous year. Additionally, sporadic cases have been reported outside Africa, mostly linked to travel and with limited onward transmission. 

The countries in Africa that have reported clade I detection (Ia and/or Ib) in 2025, are: DRC, Uganda, Burundi, Kenya, Zambia, Tanzania, Congo, South Sudan, Central African Republic, South Africa and Angola. Zimbabwe reported cases of clade Ib in 2024 and Gabon reported mpox cases for which clade information is not available (Global Mpox Trends). 

Overall, in Africa, until the beginning of April 2025, most confirmed and suspected clade I cases have been reported from the DRC, Uganda and Burundi (Mpox: multi-country external situation report no. 50, 11 April 2025, WHO Global Report with data until 6 April 2025). However different trends have been observed recently in each country. 

In DRC, clade Ia and Ib co-circulate to different degrees. The number of confirmed cases has plateaued over the last four weeks. Testing coverage remained low during the same period (Africa CDC Special Briefing on Mpox and other Health Emergencies, 10 April 2025, Mpox: multi-country external situation report no. 50, 11 April 2025). In Kinshasa, both clades Ia and Ib co-circulate. Epidemiological data and sequencing suggest there is human-to-human transmission of clade Ia with high rates of APOBEC3-driven mutations. Similar signals have not been reported in provinces outside Kinshasa where clade Ia is circulating in DRC. However, the number of samples sequenced and analysed varies across provinces in DRC (Mpox: multi-country external situation report no. 48, 10 March 2025). APOBEC3 mutations have also been noted in clade Ib. Based on the available information on clade Ia circulation in Kinshasa there is currently no evidence that the strain is inherently more transmissible than other clade Ia strains or clade Ib according to WHO (Mpox: multi-country external situation report no. 48, 10 March 2025). 

Uganda is currently the African country reporting most mpox clade Ib cases after DRC. Over 1 400 cases have been reported in the past six weeks, including 15 deaths (WHO data as of 6 April 2025). The number of cases has been showing an increasing trend with a total of 5 538 cases and 37 deaths reported overall as of end of March 2025 (Africa CDC Special Briefing on Mpox and other Health Emergencies, 10 April 2025). According to WHO, Uganda is the country reporting the highest number of cases in recent weeks. The age group mainly affected in Uganda is 20-39 year-olds. Transmission is reported in sexual networks and the highest incidence is reported in and around Kampala (Africa CDC Special Briefing on Mpox and other Health Emergencies, 10 April 2025; Mpox: multi-country external situation report no. 48, 10 March 2025). 

In Burundi, the decreasing trend observed in the last weeks in the number of reported mpox cases continues and only clade Ib has been detected (Mpox: multi-country external situation report no. 50, 11 April 2025). In the past six weeks, 199 cases have been reported and no deaths, according to WHO (WHO data as of 6 April 2025). 

Detailed information on the mpox clade I case numbers can be found in the WHO Global Report (as of 14 April the report included data until 6 April 2025). In general, and as of 14 April 2025, no major changes were noted in the epidemiological trends of mpox clade I in Africa. 

Outside Africa, travel-associated cases or sporadic cases reporting epidemiological links with travel-associated cases of MPXV clade I have been reported in the EU/EEA by: Sweden (in 2024), Germany (in 2024 and 2025), Belgium (in 2024 and 2025), France and Ireland (in 2025). 

In addition to Africa and the EU/EEA, since August 2024, clade I cases have been reported by Thailand, India, the UK, the United States (US), Canada, Pakistan, Oman, China, the United Arab Emirates, Qatar and Brazil. On 4 April, China reported the first case mpox clade Ia in the country, with travel history to DRC. On 8 April 2025, Switzerland also reported the first case of mpox clade lb. The person had recently travelled to Uganda at the beginning of April. 

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

Confirmed secondary transmission of mpox due to MPXV clade Ib outside of Africa was reported for the first time in 2024 in the EU/EEA by Germany and Belgium, and outside of the EU/EEA by the UK and China. The number of secondary cases reported in these events outside of Africa has been low. Based on the available information, all transmission events were due to close contact, secondary cases presented with mild symptoms and no deaths have been reported.

On 13 August 2024, Africa CDC declared mpox a Public Health Emergency of Continental Security. On 14 August 2024, WHO convened a meeting of the IHR Emergency Committee to discuss the mpox upsurge and declared the current outbreak of mpox due to MPXV clade I as a public health emergency of international concern. 

Transmission patterns of mpox due to monkeypox virus clade I – update 13 March 2025 

Since September 2024, following an analysis of the patterns of MPXV transmission observed at the national level and given the limitations and uncertainties, ECDC has used official epidemiological information to classify countries according to whether MPXV clade I is endemic or was reported for the first time since 2024. The categories are as follows: 

• Countries reporting only travel-associated cases or cases with a clear link to travel-associated cases: Angola, Belgium, Brazil, Canada, China, Germany, France, India, Ireland, Oman, Pakistan, Qatar, South Africa, South Sudan, Sweden, Switzerland, Thailand, United Kingdom, the US, and Zimbabwe;
• Clusters of cases or limited transmission: Tanzania, the United Arab Emirates, and Zambia;
• Community transmission: Burundi, Central African Republic, Congo, the DRC, Kenya, Rwanda, and Uganda. 

The categorisation was last updated on 14 April 2025 to include Switzerland (category of countries with travel associated cases or cases with links to travel-associated cases). 

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

• On 25 March 2025, the UK reported the eleventh mpox clade Ib case. This case reported no travel history and no contact with any known mpox case or with anyone who had travelled to any affected country (Mpox: multi-country external situation report no. 50, 11 April 2024, Latest update on Clade Ib mpox - GOV.UK). No secondary cases had been identified inked to this case, as of 14 April 2025. Given that this is a sporadic case, the UK is still included in the first category of the classification. In case more information becomes available, the classification may be modified.
• The United Arab Emirates have reported a single case with travel history to Uganda, however a number of other countries have reported cases with travel history to the United Arab Emirates. Although there is no evidence of wider community transmission in the United Arab Emirates, it is presumed that undetected transmission is ongoing (Mpox: multi-country external situation report no. 50, 11 April 2024). The United Arab Emirates are therefore classified as having 'clusters of cases or limited transmission'.
• Congo has reported clade Ib detection (Congo is endemic for clade Ia) (Africa CDC Press Briefing of 20 February 2025). A total of 26 confirmed cases have been reported in 2025 (until week ending 30 March 2025) according to the National Situation Report published of 10 April 2025 (Epidémie de Mpox : Rapport de Situation (SITREP) N°48 du 10 avril 2025 | OMS | Bureau régional pour l'Afrique). The total number of confirmed cases reported in 2024 was 24. Most cases have been reported close to the border with DRC. Based on the national report, there is a large number of suspected cases in different areas of the country.
• South Sudan and South Africa are currently in the first category given the small number of confirmed cases (five and three cases respectively reported the past six weeks according to WHO, and as of 6 April). No additional information on suspected cases are available and there are no indications of wider community transmission.

The epidemiological situation is continuously monitored and the classification is reviewed and adjusted depending on a qualitative assessment of reported trends.