An epidemic of a new variant of clade I mpox (formerly known as monkeypox), called clade 1b, began in Central Africa at least as early as September 2023. As of September 2024, more than 29,000 cases have been reported, with over 800 fatalities (~3% fatality rate), nearly all in the Democratic Republic of the Congo. According to the European CDC: "The size of these outbreaks could be larger than reported due to under-ascertainment and under-reporting."
On 14 August 2024, the World Health Organization declared the epidemic a public health emergency of international concern.
Background
Mpox is an infectious viral disease that is endemic among small mammals in central areas of Africa; it can also infect humans. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild, and most infected individuals recover within a few weeks without treatment. However, cases may be severe, especially in children, pregnant women, or people with suppressed immune systems.
In May 2022, the World Health Organization (WHO) declared a prior mpox outbreak, involving a clade IIb of the virus, a global health emergency. The disease had infected 87,000 individuals and caused 140 deaths when the WHO ended its global emergency in May 2023, citing a combination of vaccination and public health information as successful control measures. Cases of clade IIb which can be traced to this outbreak are continuing to be detected worldwide, although at a relatively low level.
In September 2023, cases of mpox started increasing in the Democratic Republic of the Congo and continued into 2024. The Africa Centres for Disease Control and Prevention (ACDC) reported a 160% increase in cases from the previous year. Most of these cases were determined to be caused by clade I of the virus.
Outbreak
Timeline
Mpox cases from clade Ib infections were growing in the Democratic Republic of the Congo (DRC) by September 2023, with several of them being identified in Kamituga, a mining town in the province of South Kivu. A nationwide outbreak was reported in January 2024.
On 12 August 2024, the Africa Centres for Disease Control and Prevention declared that the growing mpox outbreaks in Africa had become a public health emergency, with over 517 deaths being reported. As a result, the organization requested the help and intervention of the international community to control the spread of the virus and treat infected patients. The ACDC stated that the fatality rate of the strain of virus causing the outbreak was 3–4%, significantly higher than the less than 1% fatality rate recorded during the 2022–2023 mpox outbreak. On 14 August, the World Health Organization declared the epidemic a public health emergency of international concern or global health emergency.
As of 16 August 2024, fifteen countries were reported to have identified cases of mpox; and over 96% of all reported cases and fatalities from the disease were confirmed in the DRC, with 16,839 reported cases and 501 reported deaths. The ACDC reported that 70% of reported cases in the DRC were in children under 15, as that demographic represented 85% of reported deaths. Epidemiologist Jacques Alonda expressed concern over the disease's spread in refugee camps in the DRC and its neighbor countries, mainly due to the amount of pressure already applied to the national healthcare system by concurrent outbreaks of cholera and measles, as well as widespread malnutrition.
Also on 16 August, the European Centre for Disease Prevention and Control (ECDC) officially raised the risk level of clade I to the general European population from "very low" to "low" due to the likelihood of more imported cases being identified across the continent, although the agency reiterated that the risk of sustained transmission of the virus strain in Europe was still considered to be minimum. The ECDC also advised travellers to consider getting vaccinated against mpox should they visit African countries affected by the outbreak.
As of 19 September 2024, 15 of the 55 member states of the African Union have reported cases according the Africa CDC. Rwanda started its vaccination campaign, while the Democratic Republic of Congo, the epicentre of the outbreak, is set to start vaccinations in early October 2024.
In October 2024, the WHO approved the first diagnostic test under the Emergency Use Listing (EUL) procedure. The Alinity m MPXV assay enables the detection of the virus by testing swabs of skin lesions.
Countries with widespread transmission
Democratic Republic of the Congo
As of August 2024, a cumulative total of 16,839 suspected cases of mpox (at least 1,888 of which were laboratory confirmed) and 570 deaths (at least 8 of which were laboratory confirmed) have been reported in the Democratic Republic of the Congo (DRC).
On 19 August, the DRC's Ministry of Public Health, Samuel Roger Kamba Mulamba, said in a press conference that all of the country's provinces, including the capital city of Kinshasa, had been affected by the outbreak, while announcing that the national government would launch a €45 million response plan including awareness campaigns, medical team deployment and patient care, but not vaccines.
Various media reported that the impact of the mpox outbreak across the DRC, and especially in eastern provinces, had been significantly worsened by factors such as widespread conflicts in the region, including an offensive by the Rwanda-backed March 23 Movement in North Kivu— which had displaced thousands of civilians, most of whom had been forced to gather in refugee camps around Goma or in the city itself— , widespread extreme poverty, poor access to healthcare services, and the circulation of the infection within sex workers in illicit mining industries. Medair's health advisor in the DRC, Pierre Olivier Ngadjole, said that around 70% of the new mpox cases registered in the Goma area between June and August 2024 had involved people living in displacement camps, while the director of the Bulengo refugee camp, Mahoro Faustin, expressed concerns over the lack of testing kits available in the area.
Countries with limited local transmission
As of August 2024, fifteen countries have reported cases of mpox; the WHO reported that new cases of the mpox strain, all of which linked to the outbreak in the DRC, had been identified for the first time in four East African nations: Burundi, Kenya, Rwanda, and Uganda. Ivory Coast also reported new cases for the first time.
Central African Republic
On 30 July 2024, the Minister of Health of the Central African Republic, Pierre Somsé, declared an outbreak of mpox in Bangui following a period when the disease was mostly restricted to rural areas. Somsé reported that some families in the country were hiding infected relatives in fear of being stigmatized, thus increasing the risk of transmission of the disease.
Germany
In October 2024 the first travel-associated case of mpox clade 1b was reported in Germany. In 2024-2025 more travel-associated cases were reported by Germany's Public Health Agency. In early 2026, local transmission in Germany was confirmed in Germany during in outbreak in Berlin.
Sweden
On 15 August 2024, Sweden's Public Health Agency reported the first case outside Africa, which involved a person who had contracted clade I mpox during a stay in an area of Africa affected by the outbreak. In a public statement, the agency said that, while the case in itself did not represent a higher risk to the general population, occasional imported cases "may continue to occur".
Thailand
On 21 August 2024, Thailand's Department of Disease Control confirmed a mpox case involving a 66-year-old European man who was a resident of Thailand, and had returned from an African country affected by the outbreak, with his flight transiting through an undisclosed Middle Eastern country. The strain was later confirmed to be clade 1b. The patient who tested positive for clade Ib was a European male who arrived in Bangkok last week from Africa, according to the Department of Disease Control of Thailand's health ministry.
South Africa
On 23 September 2026, the South African Health Department reported that 22 cases of mpox had been confirmed (18 in the Western Cape, 3 in Gauteng, 1 in Kwazulu Natal).
Spain
In December 2025, Spanish authorities reported what is believed to be the first case of human-to-human transmission of mpox clade 1b outside of Africa without any known travel link.
Clade II cases
Some countries have reported contemporary mpox cases that then turned out to be infections with clade II variants, presumably unrelated to the clade Ib outbreak. There is a global outbreak of clade II infections that began in 2022.
Pakistan
On 15 August 2024, Pakistan's National Command and Operation Center (NCOC) reported a suspected case of mpox in the province of Khyber Pakhtunkhwa, involving a resident of Mardan who had recently returned from an Arab Gulf state; the person was later confirmed to have been diagnosed with mpox by the Pakistani Ministry of Health, although sequencing of viral samples was still ongoing in order to determine the nature of the variant.
On 17 August, the health department of Khyber Pakhtunkhwa confirmed that two patients had tested positive for mpox, while another one was waiting for confirmation; all of the patients had recently returned to Pakistan from the United Arab Emirates.
On 19 August, another suspected mpox case was reported, involving a resident of Azad Kashmir who had just returned from a Middle Eastern country; however, the Ministry of Health stated that none of the reported cases in the country had been caused by clade 1b of the virus.
Taiwan
On 18 August 2024, the Public Health Bureau of the city council of Tainan, Taiwan, announced that as of 16 August, three cases of mpox—all of which involved men who have had close contact with unspecified people—had been confirmed in the city since the start of the year; further details about the patients' traveling history and the variant were not disclosed.
Portugal
On 16 August, Portugal's Directorate-General of Health (DGS) confirmed that three new cases of mpox had been confirmed in the country between May and July 2024; the agency reported that all of the cases had been detected in the North Region, with two of them having travelled abroad during the incubation period of the disease. However, the DGS said that all of the three patients had contracted clade IIb mpox, whereas no clade I cases had been reported.
Indonesia
On 17 August 2024, Indonesia's Independence day, the national Ministry of Health (Kemenkes) reported a total of 14 confirmed mpox cases from January to April 2024. This brought the cumulative total to 88 cases in Indonesia when combined with the previous outbreak's 73 cases reported in 2023, as well as one case from 2022. The Indonesian government later reported a 100% recovery rate of all 88 confirmed cases since 2022. The latest outbreak, which initially began in Jakarta, then spread to the Riau Islands. Among the total cases, 87 patients had been declared cured, with 54 cases involving the clade IIb variant. The distribution of cases by region included 59 in Jakarta, 13 in West Java, nine in Banten, three in East Java, three in the Special Region of Yogyakarta (DIY), and one in the Riau Islands.
As of 4 September 2024, there were no known cases of Clade Ib mpox in Indonesia; 11 cases that were previously suspected to belong to Clade Ib had all returned negative from further PCR tests. Following the detection of multiple suspected cases across different points in Indonesia, including Bali and Jakarta, between August and September, the Indonesian government decided to partially restore its past COVID-19 mitigation efforts, including the use of the SATUSEHAT health pass for all travelers entering Indonesia.
Philippines
On 19 August 2024, the Philippines' Department of Health (DOH) announced that a 33-year-old male from Metro Manila, with no prior history of traveling overseas, had tested positive for mpox the day prior. The patient was later determined to have contracted clade II mpox.
New Zealand
On 9 September 2024, an mpox case was confirmed in New Zealand after attending the Winter Pride festival in Queenstown in August 2024. On 11 September, a second mpox case was linked to the Queenstown Winter Pride festival. By 20 September, a total of 11 cases of mpox were linked to the Winter Pride festival. The Queenstown outbreak included several cases of mpox clade II.