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{{Short description|Viral disease of humans and animals}}
{{About|the disease|the virus that causes the disease|Monkeypox virus}}
{{Use dmy dates|date=October 2024}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition
| name          = Mpox
| image = Monkeypox.jpg
| caption = Mpox rash on arm and leg of a four-year-old girl in 1971
| alt           = A rash caused by mpox
| pronounce = {{IPAc-en|ˈ|ɛ|m|p|ɒ|k|s}}, {{respell|EM|poks}}
| field     = [[Infectious disease (medical specialty)|Infectious disease]]<ref name=WHOfact2023/>
| symptoms  = Rash, fever, exhaustion, swollen lymph nodes, muscle aches, sore throat<ref name=CDC_Sym/>
| complications = Secondary infections, pneumonia, sepsis, encephalitis, and loss of vision with severe eye infection<ref name=WHOfact2023/>
| onset         = 3–17 days post exposure<ref name=CDC_Sym/>
| duration      = 2 to 4 weeks{{Citation needed|date=August 2024}}
| types  = Clade{{nbsp}}I, Clade{{nbsp}}II; subclades Ia, Ib, IIa, IIb<ref name="UKHSA" />
| causes = [[Monkeypox virus]]
| risks  =
| diagnosis = Testing for viral DNA<ref name=WHOfact2023/>
| differential = [[Chickenpox]], [[smallpox]]<ref name=Mc2014/>
| prevention = [[Smallpox vaccine|Smallpox & mpox vaccine]], [[Hygiene#Medical hygiene|hand washing]], covering rash, [[personal protective equipment|PPE]], [[social distancing]]<ref name=WHOfact2023/>
| treatment = Supportive<ref name=WHOfact2023/>
| medication = [[Tecovirimat]], [[antivirals]]<ref name=WHOfact2023/>
| prognosis = Most recover<ref name=Gov.UK2022/>
}}

<!-- Definition and symptoms -->
'''Mpox''' ({{IPAc-en|ˈ|ɛ|m|p|ɒ|k|s}}, {{respell|EM|poks}}; formerly known as '''monkeypox''')<ref name="Who291122">{{cite press release |title=WHO recommends new name for monkeypox disease |date=28 November 2022 |publisher=[[World Health Organization]] (WHO) |url=https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease |access-date=29 November 2022 |url-status=live |archive-url=https://web.archive.org/web/20221201225437/https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease |archive-date=1 December 2022}}</ref> is an infectious [[viral disease]] that can occur in humans and other animals. Symptoms include a [[rash]] that forms [[blister]]s and then crusts over, fever, and [[lymphadenopathy|swollen lymph nodes]]. The illness is usually mild, and most infected individuals recover within a few weeks without treatment. The time from [[incubation period|exposure to the onset of symptoms]] ranges from three to seventeen days, and symptoms typically last from two to four weeks. However, cases may be severe, especially in children, pregnant women, or people with [[Immunodeficiency|suppressed immune systems]].<ref name="WHO_Q&A">{{cite web |date=17 August 2024 |title=Mpox |url=https://www.who.int/news-room/questions-and-answers/item/mpox |url-status=live |archive-url=https://web.archive.org/web/20240819162521/https://www.who.int/news-room/questions-and-answers/item/mpox |archive-date=19 August 2024 |access-date=22 August 2024 |publisher=[[World Health Organization]] (WHO) }}</ref><ref name="WHOfact20232">{{cite web |date=18 April 2023 |title=WHO Factsheet{{snd}}Mpox (Monkeypox) |url=https://www.who.int/news-room/fact-sheets/detail/monkeypox |url-status=live |archive-url=https://web.archive.org/web/20220421083742/https://www.who.int/news-room/fact-sheets/detail/monkeypox |archive-date=21 April 2022 |access-date=21 May 2023 |publisher=[[World Health Organization]] (WHO)}}</ref><ref name="CDC_Sym2">{{cite web |date=15 March 2024 |title=Mpox Symptoms |url=https://www.cdc.gov/poxvirus/mpox/symptoms/index.html |url-status=live |archive-url=https://web.archive.org/web/20240402174303/https://www.cdc.gov/poxvirus/mpox/symptoms/index.html |archive-date=2 April 2024 |access-date=22 August 2024 |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC)}}</ref>

<!-- Cause and diagnosis -->
The disease is caused by the [[monkeypox virus]], a [[zoonotic]] virus in the genus ''[[Orthopoxvirus]]''. The [[variola virus]], which causes [[smallpox]], is also in this genus.<ref name="WHOfact2023">{{cite web |date=18 April 2023 |title=WHO Factsheet{{snd}}Mpox (Monkeypox) |url=https://www.who.int/news-room/fact-sheets/detail/monkeypox |url-status=live |archive-url=https://web.archive.org/web/20220421083742/https://www.who.int/news-room/fact-sheets/detail/monkeypox |archive-date=21 April 2022 |access-date=21 May 2023 |publisher=[[World Health Organization]] (WHO)}}</ref> Human-to-human transmission can occur through direct contact with infected skin or body fluids, including sexual contact.<ref name="WHOfact2023" /> People remain infectious from the onset of symptoms until all the lesions have scabbed and healed.<ref name="WHO_Q&A" /> The virus may spread from infected animals through handling infected meat or via bites or scratches.<ref name="WHO_Q&A" /> Diagnosis can be confirmed by [[polymerase chain reaction]] (PCR) testing a lesion for the virus's [[DNA]].<ref name="WHOfact2023" />

<!-- Treatment -->
Vaccination is recommended for those at high risk of infection.<ref name="WHOfact2023" /> No vaccine has been developed specifically against mpox, but smallpox vaccines have been found to be effective.<ref>{{cite journal | vauthors = Christodoulidou MM, Mabbott NA | title = Efficacy of smallpox vaccines against Mpox infections in humans | journal = Immunotherapy Advances | volume = 3 | issue = 1 | pages = ltad020 | date = 1 January 2023 | pmid = 37886620 | pmc = 10598838 | doi = 10.1093/immadv/ltad020 }}</ref> There is no specific treatment for the disease, so the aim of treatment is to manage the symptoms and prevent complications.<ref name="WHOfact2023" /><ref name="NIH_Mpox">{{cite web |date=6 December 2022 |title=Mpox (formerly Monkeypox) |url=https://www.niaid.nih.gov/diseases-conditions/mpox |access-date=24 May 2023 |website=NIH: National Institute of Allergy and Infectious Diseases |archive-date=23 May 2023 |archive-url=https://web.archive.org/web/20230523142513/https://www.niaid.nih.gov/diseases-conditions/mpox |url-status=live }}</ref> Antiviral drugs such as [[tecovirimat]] can be used to treat mpox,<ref name="WHOfact2023" /> although their effectiveness has not been proved.<ref name="CSC_TPOXX">{{cite web |date=28 November 2022 |title=Patient's Guide to Mpox Treatment with Tecovirimat (TPOXX) |url=https://www.cdc.gov/poxvirus/mpox/if-sick/treatment.html |access-date=24 May 2023 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |archive-date=24 May 2023 |archive-url=https://web.archive.org/web/20230524202025/https://www.cdc.gov/poxvirus/mpox/if-sick/treatment.html |url-status=live }}</ref>

<!-- Epidemiology -->
Mpox is [[Endemic (epidemiology)|endemic]] in [[Central Africa|Central]] and [[West Africa|Western Africa]], where several species of mammals are suspected to act as a [[natural reservoir]] of the virus.<ref name="WHOfact2023" /> The first human cases were diagnosed in 1970 in [[Basankusu]], [[Democratic Republic of the Congo]].<ref name="Bunge2022">{{cite journal | vauthors = Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R | title = The changing epidemiology of human monkeypox-A potential threat? A systematic review | journal = PLOS Neglected Tropical Diseases | volume = 16 | issue = 2 | pages = e0010141 | date = February 2022 | pmid = 35148313 | pmc = 8870502 | doi = 10.1371/journal.pntd.0010141 | doi-access = free | title-link = doi }}</ref> Since then, the frequency and severity of outbreaks have significantly increased, possibly as a result of waning [[herd immunity|immunity]] since the cessation of routine smallpox vaccination.<ref name="Bunge2022" /> A global [[2022–2023 mpox outbreak|outbreak of clade II in 2022–2023]] marked the first incidence of widespread [[community transmission]] outside of Africa. In July 2022, the [[World Health Organization]] (WHO) declared the outbreak a [[public health emergency of international concern]] (PHEIC). The WHO reverted this status in May 2023,<ref name="WHO PR 20240814" /> as the outbreak came under control, citing a combination of vaccination and public health information as successful control measures.<ref name="WHO2023-05">{{cite web |title=Mpox (monkeypox) Outbreak |url=https://www.who.int/europe/emergencies/situations/monkeypox |access-date=13 May 2023 |website=[[World Health Organization]] (WHO) |archive-date=31 July 2022 |archive-url=https://web.archive.org/web/20220731232426/https://www.who.int/europe/emergencies/situations/monkeypox |url-status=live }}</ref>

An [[African mpox epidemic|outbreak of new variant of clade I mpox]] (known as clade Ib) was detected in the Democratic Republic of the Congo during 2023.<ref>{{cite web | title=Clade I Mpox Outbreak Originating in Central Africa | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=10 October 2024 | url=https://www.cdc.gov/mpox/outbreaks/2023/index.html | access-date=20 October 2024}}</ref> As of August 2024, it had spread to several African countries, raising concerns that it may have adapted to more sustained human transmission.<ref>{{cite web |date=30 July 2024 |title=How scientists are racing to understand the new Mpox strain in the Democratic Republic of the Congo |url=https://www.gavi.org/vaccineswork/how-scientists-are-racing-understand-new-mpox-strain-democratic-republic-congo |access-date=6 August 2024 |website= Gavi, the Vaccine Alliance }}</ref><ref name=":1" /> In August 2024, the WHO declared the outbreak a public health emergency of international concern.<ref name="MSN 20240814">{{cite web |date=14 August 2024 |title=WHO declares mpox a public health emergency as newer strain spreads in Africa |url=https://www.msn.com/en-us/news/health/who-declares-mpox-a-public-health-emergency-as-newer-strain-spreads-in-africa/ar-AA1oNOIk |access-date=14 August 2024 |website=MSN }}</ref><ref name="WHO PR 20240814">{{cite press release | title=WHO Director-General declares mpox outbreak a public health emergency of international concern | website=[[World Health Organization]] (WHO) | date=14 August 2024 | 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=19 October 2024}}</ref>

==Nomenclature==
The name ''monkeypox'' was originally coined because the disease was first identified in laboratory monkeys.<ref name="CDC_About">{{cite web |date=<!-- Unknown publication date. The source page says "Updated July 22, 2022", but the title of the page would have been different from the cited title if it was really from July 2022, so it has clearly been changed somewhat since then - probably after 28 November 2022 when the WHO recommended the name "MPox". --> |title=About Mpox |url=https://www.cdc.gov/poxvirus/mpox/about/index.html |access-date=13 March 2023 |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |archive-date=11 March 2023 |archive-url=https://web.archive.org/web/20230311032602/https://www.cdc.gov/poxvirus/mpox/about/index.html |url-status=live }}</ref> This name was later criticized by scientists as a [[misnomer]] since monkeys are not the main host or reservoir; it was also criticized by the [[Foreign Press Association of Africa]] because the name reinforced racism and stigma about African countries and their residents being a source of disease. In November 2022, the WHO announced that it "will adopt the term ''mpox'' in its communications, and encourages others to follow these recommendations".<ref name="pmid357101052">{{cite journal |vauthors=Taylor L |date=June 2022 |title=Monkeypox: WHO to rename disease to prevent stigma |journal=BMJ |volume=377 |issue= |pages=o1489 |doi=10.1136/bmj.o1489 |pmid=35710105}}</ref><ref name="Who2911222">{{cite press release |title=WHO recommends new name for monkeypox disease |date=28 November 2022 |publisher=[[World Health Organization]] (WHO) |url=https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease |access-date=29 November 2022 |url-status=live |archive-url=https://web.archive.org/web/20221201225437/https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease |archive-date=1 December 2022}}</ref>

The subtypes of monkeypox virus were renamed in August 2022 after requests by several public health organisations and scientists, who argued that the former geographical names were hindering efforts to contain the disease. The clade formerly known as "Congo Basin (Central African)" was renamed '''clade{{nbsp}}I''', and the clade formerly known as "West African" was renamed '''clade{{nbsp}}II.'''<ref>{{cite web |date=16 August 2022 |title=Urgent need for a non-discriminatory and non-stigmatizing nomenclature for monkeypox virus |url=https://virological.org/t/urgent-need-for-a-non-discriminatory-and-non-stigmatizing-nomenclature-for-monkeypox-virus/853 |url-status=live |archive-url=https://web.archive.org/web/20230525180513/https://virological.org/t/urgent-need-for-a-non-discriminatory-and-non-stigmatizing-nomenclature-for-monkeypox-virus/853 |archive-date=25 May 2023 |access-date=25 May 2023 |website=Virological }}</ref><ref>{{cite web |title=Monkeypox: experts give virus variants new names |url=https://www.who.int/news/item/12-08-2022-monkeypox--experts-give-virus-variants-new-names |access-date=16 August 2024 |website=[[World Health Organization]] (WHO) }}</ref>

==Signs and symptoms==
[[File:Stages of monkeypox lesion development.jpg|thumb|Stages of mpox lesion development]]
[[File:22-1374-F1.jpg|thumb|upright=1.3|Progression of necrotic mpox lesion after needlestick injury from a pustule<ref name=":4">{{cite journal | vauthors = Caldas JP, Valdoleiros SR, Rebelo S, Tavares M | title = Monkeypox after Occupational Needlestick Injury from Pustule | journal = Emerging Infectious Diseases | volume = 28 | issue = 12 | pages = 2516–2519 | date = December 2022 | pmid = 36252152 | pmc = 9707600 | doi = 10.3201/eid2812.221374 | s2cid = 252969061 }}</ref>]]
[[File:Monkeypox lesions.jpg|thumb|Mpox lesions on a penis]]
[[File:Oral monkeypox lesion.jpg|thumb|Right tonsillar enlargement with an overlying pustular lesion during the 2022 outbreak.]]
[[Prodrome|Initial symptoms]] of mpox infection are fever, [[muscle pains]], and sore throat, followed by an itchy or painful rash, headache, swollen lymph nodes, and [[fatigue]]. Not everyone will exhibit the complete range of symptoms.<ref name="WHOfact2023" /><ref name="CDC_Sym">{{cite web |date=15 March 2024 |title=Mpox Symptoms |url=https://www.cdc.gov/poxvirus/mpox/symptoms/index.html |url-status=live |archive-url=https://web.archive.org/web/20240402174303/https://www.cdc.gov/poxvirus/mpox/symptoms/index.html |archive-date=2 April 2024 |access-date=22 August 2024 |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC)}}</ref>

People with mpox usually become symptomatic about a week after infection. However the [[incubation period]] can vary in a range between one day and four weeks.<ref name="WHOfact2023" /><ref name="McFarland2023">{{cite journal | vauthors = McFarland SE, Marcus U, Hemmers L, Miura F, Iñigo Martínez J, Martínez FM, Montalbán EG, Chazelle E, Mailles A, Silue Y, Hammami N, Lecompte A, Ledent N, Vanden Berghe W, Liesenborghs L, Van den Bossche D, Cleary PR, Wallinga J, Robinson EP, Johansen TB, Bormane A, Melillo T, Seidl C, Coyer L, Boberg R, Jurke A, Werber D, Bartel A | 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 = Euro Surveillance | volume = 28 | issue = 27 | date = July 2023 | pmid = 37410383 | pmc = 10370040 | doi = 10.2807/1560-7917.ES.2023.28.27.2200806 }}</ref>

The rash comprises numerous small lesions, which may appear on the palms, soles, face, mouth, throat, genitals, or anus.<ref name="WHOfact2023" /> They begin as [[Macule|small flat spots]], before developing into [[Papule|small bumps]], which then fill [[vesicle (dermatology)|with fluid]], eventually bursting and scabbing over, typically lasting around ten days.<ref name="CDC_Sym" /> In rare cases, lesions may become necrotic, requiring [[debridement]] and taking longer to heal.<ref>{{cite journal |last1=Prasad |first1=Sonya |last2=Galvan Casas |first2=Cristina |last3=Strahan |first3=Alexis G. |last4=Fuller |first4=L. Claire |last5=Peebles |first5=Klint |last6=Carugno |first6=Andrea |last7=Leslie |first7=Kieron S. |last8=Harp |first8=Joanna L. |last9=Pumnea |first9=Teodora |last10=McMahon |first10=Devon E. |last11=Rosenbach |first11=Misha |last12=Lubov |first12=Janet E. |last13=Chen |first13=Geoffrey |last14=Fox |first14=Lindy P. |last15=McMillen |first15=Allen |date=March 2023 |title=A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring |journal=Journal of the American Academy of Dermatology |volume=88 |issue=5 |pages=1066–1073 |doi=10.1016/j.jaad.2022.12.035 |issn=0190-9622 |pmc=9833815 |pmid=36641010}}</ref><ref name=":4" />

Some people may manifest only a single sore from the disease, while others may have hundreds.<ref name="WHOfact2023" /> An individual can be infected with ''Orthopoxvirus monkeypox'' without showing [[Asymptomatic|any symptoms]].<ref name="WHOfact2023" /> Symptoms typically last for two to four weeks but may persist longer in people with weakened immune systems.<ref name=CDC_Sym/><ref name="WHOfact2023" />

===Complications===
Complications include [[Infection#Secondary infection|secondary infections]], [[pneumonia]], [[sepsis]], [[encephalitis]], and loss of vision following [[cornea]]l infection.<ref name=WHOfact2023/> Persons with weakened immune systems, whether due to medication, medical conditions, or HIV, are more likely to develop severe cases of the disease.<ref name="WHOfact2023" /> If infection occurs during pregnancy, this may lead to [[stillbirth]] or other complications.<ref name="WHO_Q&A" />

===Outcome===
Provided there are no complications, [[sequela]]e are rare; after healing, the scabs may leave [[hypopigmentation|pale marks]] before becoming [[hyperpigmentation|darker]] scars.<ref name="Goldman20202">{{cite book | vauthors = Petersen BW, Damon IK |title=[[Goldman-Cecil Medicine]] |date=2020 |publisher=Elsevier |isbn=978-0-323-53266-2 | veditors = Goldman L, Schafer AI |edition=26th |volume=2 |location=Philadelphia |pages=2180–2183 |chapter=348. Smallpox, monkeypox and other poxvirus infections |chapter-url=https://books.google.com/books?id=7pKqDwAAQBAJ&dq=monkeypox&pg=PA2180 |access-date=28 May 2022 |archive-date=19 January 2023 |archive-url=https://web.archive.org/web/20230119201623/https://books.google.com/books?id=7pKqDwAAQBAJ&dq=monkeypox&pg=PA2180 |url-status=live }}</ref>

===Deaths===
Historically, the [[case fatality rate]] (CFR) of past outbreaks was estimated at between 1% and 10%, with clade I considered to be more severe than clade II.<ref name="Death_Rates">{{cite journal |vauthors=Vogel L |date=August 2022 |title=Making sense of monkeypox death rates |journal=CMAJ |volume=194 |issue=31 |pages=E1097 |doi=10.1503/cmaj.1096012 |pmc=9377567 |pmid=35970550 | doi-access = free | title-link = doi }}</ref><ref name="Gessain 2022">{{cite journal |vauthors=Gessain A, Nakoune E, Yazdanpanah Y |date=November 2022 |title=Monkeypox |journal=The New England Journal of Medicine |volume=387 |issue=19 |pages=1783–1793 |doi=10.1056/NEJMra2208860 |pmid=36286263 | doi-access = free | title-link = doi }}</ref>

The case fatality rate of the [[2022–2023 mpox outbreak|2022–2023 global outbreak]] caused by clade IIb was very low, estimated at 0.16%, with the majority of deaths in individuals who were already [[Immunodeficiency|immunocompromized]].<ref>{{cite web |title=Mpox (monkeypox) – Prognosis |url=https://bestpractice.bmj.com/topics/en-gb/1611/prognosis |url-status=live |archive-url=https://web.archive.org/web/20230531173630/https://bestpractice.bmj.com/topics/en-gb/1611/prognosis |archive-date=31 May 2023 |access-date=31 May 2023 |website=BMJ Best Practice}}</ref> In contrast, {{As of|2024|April|lc=y}}, the outbreak of clade I in Democratic Republic of the Congo has a CFR of 4.9%.<ref name="pmid 38753567">{{cite journal |vauthors=McQuiston JH, Luce R, Kazadi DM, Bwangandu CN, Mbala-Kingebeni P, Anderson M, Prasher JM, Williams IT, Phan A, Shelus V, Bratcher A, Soke GN, Fonjungo PN, Kabamba J, McCollum AM, Perry R, Rao AK, Doty J, Christensen B, Fuller JA, Baird N, Chaitram J, Brown CK, Kirby AE, Fitter D, Folster JM, Dualeh M, Hartman R, Bart SM, Hughes CM, Nakazawa Y, Sims E, Christie A, Hutson CL |date=May 2024 |title=U.S. Preparedness and Response to Increasing Clade I Mpox Cases in the Democratic Republic of the Congo – United States, 2024 |journal=MMWR. Morbidity and Mortality Weekly Report | url=https://www.cdc.gov/mmwr/volumes/73/wr/pdfs/mm7319a3-H.pdf |volume=73 |issue=19 |pages=435–440 |doi=10.15585/mmwr.mm7319a3 |pmc=11115432 |pmid=38753567}}</ref>

The difference between these estimates is attributed to:
* differences in the [[virulence]] of clade I versus clade II.<ref name="pmid 38753567" />
* under-reporting of mild or [[asymptomatic]] cases in the endemic areas of Africa, which generally have poor healthcare infrastructure.<ref name="Death_Rates" />
* [[Optimal virulence|evolution]] of the virus to cause milder disease in humans.<ref>{{cite journal |vauthors=Dumonteil E, Herrera C, Sabino-Santos G |date=February 2023 |title=Monkeypox Virus Evolution before 2022 Outbreak |journal=Emerging Infectious Diseases |volume=29 |issue=2 |pages=451–453 |doi=10.3201/eid2902.220962 |pmc=9881786 |pmid=36692511}}</ref>
* better general health, and better health care, in the populations most affected by the 2022–2023 global outbreak.<ref name="Death_Rates" />

===In other animals===
It is thought that small mammals provide a reservoir for the virus in endemic areas.<ref name="CDC_Animals2">{{cite web |date=4 January 2023 |title=Mpox in Animals |url=https://www.cdc.gov/poxvirus/mpox/veterinarian/mpox-in-animals.html |access-date=25 May 2023 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |archive-date=15 August 2024 |archive-url=https://web.archive.org/web/20240815030808/https://www.cdc.gov/poxvirus/mpox/veterinarian/mpox-in-animals.html |url-status=live }}</ref> Spread among animals occurs via the [[fecal–oral route]] and through the nose, through wounds and eating infected meat.<ref name="Wingfield20092">{{cite book |vauthors=Nash SL, Palmer SB, Wingfield WE |title=Veterinary Disaster Response |date=2009 |publisher=John Wiley & Sons |isbn=978-0-8138-1014-0 |veditors=Wingfield WE, Palmer SB |location=Iowa |pages=167–168 |chapter=1.11. Zoonoses and zoonotic diseases |chapter-url=https://books.google.com/books?id=kffqobiSuqAC&dq=monkeypo&pg=PA167 |access-date=1 June 2022 |archive-date=15 August 2024 |archive-url=https://web.archive.org/web/20240815030801/https://books.google.com/books?id=kffqobiSuqAC&dq=monkeypo&pg=PA167#v=onepage&q&f=false |url-status=live }}</ref> The disease has also been reported in a wide range of other animals, including monkeys, anteaters, hedgehogs, prairie dogs, squirrels, and shrews. Signs and symptoms in animals are not well researched and further studies are in progress.<ref name="CDC_Animals2" />

There have been instances of animal infection outside of endemic Africa; during the 2003 US outbreak, [[prairie dog|prairie dogs (''Cynomys ludovicianus'')]] became infected and presented with fever, cough, [[conjunctivitis|sore eyes]], poor feeding and rash.<ref name="CDCanimals2">{{cite web |date=19 November 2019 |title=Examining Animals With Suspected Monkeypox |url=https://www.cdc.gov/poxvirus/monkeypox/veterinarian/examination.html |access-date=24 May 2022 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |archive-date=19 May 2022 |archive-url=https://web.archive.org/web/20220519194218/https://www.cdc.gov/poxvirus/monkeypox/veterinarian/examination.html |url-status=live }}</ref> There has also been an instance of a domestic [[Dog|dog (''Canis familiaris'')]] which became infected displaying lesions and ulceration.<ref>{{cite journal | vauthors = Seang S, Burrel S, Todesco E, Leducq V, Monsel G, Le Pluart D, Cordevant C, Pourcher V, Palich R | title = Evidence of human-to-dog transmission of monkeypox virus | journal = Lancet | volume = 400 | issue = 10353 | pages = 658–659 | date = August 2022 | pmid = 35963267 | pmc = 9536767 | doi = 10.1016/S0140-6736(22)01487-8 }}</ref>

==Cause==
Mpox in both humans and animals is caused by infection with ''Orthopoxvirus monkeypox'' – a [[DNA virus#Double-stranded DNA viruses|double-stranded DNA virus]] in the genus ''[[Orthopoxvirus]]'', family ''[[Poxviridae]],'' making it closely related to the smallpox, [[cowpox]], and [[vaccinia]] viruses.<ref name="WHOfact2023" />

The two major [[clade#viruses|subtypes of virus]] are clade{{nbsp}}I and clade{{nbsp}}II. In April 2024, after detection of a new variant, clade{{nbsp}}I was split into subclades designated Ia and Ib. Clade{{nbsp}}II is similarly divided into subclades: clade{{nbsp}}IIa and clade{{nbsp}}IIb.<ref name="WHOfact2023" /><ref name="UKHSA" >{{cite web |date=19 August 2024 |title=Mpox: background information |url=https://www.gov.uk/guidance/monkeypox |access-date=21 August 2024 |website=UK Health Security Agency }}</ref><ref>{{cite web |date=17 April 2024 |title=New mpox clade 1 lineage identified in DR Congo outbreak |url=https://www.cidrap.umn.edu/mpox/new-mpox-clade-1-lineage-identified-dr-congo-outbreak |access-date=21 August 2024 |website=[[Center for Infectious Disease Research and Policy]] (CIDRAP) }}</ref>

Clade{{nbsp}}I is estimated to cause more severe disease and higher mortality than clade{{nbsp}}II.<ref name="NIH_Mpox" />

[[File:Monkeypox viruses scale.png|thumb|Monkeypox viral structure and scale]]

The virus is considered to be [[endemic]] in [[tropical rainforest]] regions of Central and West Africa.<ref name="NIH_mpox">{{Citation | vauthors = Moore MJ, Rathish B, Zahra F |title=Mpox (Monkeypox) |date=30 November 2022 |url=https://www.ncbi.nlm.nih.gov/books/NBK574519/ |access-date=26 May 2023 |publisher=StatPearls Publishing |pmid=34662033 |archive-date=16 March 2023 |archive-url=https://web.archive.org/web/20230316164529/https://www.ncbi.nlm.nih.gov/books/NBK574519/ |url-status=live }}</ref> In addition to monkeys, the virus has been identified in [[Gambian pouched rat]]s (''Cricetomys gambianus''), [[dormice]] (''[[Graphiurus]]'' spp.) and African squirrels (''[[Heliosciurus]]'', and ''[[Funisciurus]]''). The use of these animals as food may be an important source of transmission to humans.<ref name="WHOfact2023" />

==Transmission==
The natural reservoir of ''Orthopoxvirus monkeypox'' is thought to be small mammals in tropical Africa.<ref name="NIH_mpox" /> The virus can be transmitted from animal to human from bites or scratches, or during activities such as hunting, skinning, or cooking infected animals. The virus enters the body through broken skin, or mucosal surfaces such as the mouth, respiratory tract, or genitals.<ref name="WHOfact2023" />

Mpox can be transmitted from one person to another through contact with infectious lesion material or fluid on the skin, in the mouth or on the genitals; this includes touching, close contact, and during sex. During the 2022–2023 global outbreak of clade II, transmission between people was almost exclusively via sexual contact.<ref name="WHOfact2023" /><ref name="CDC_Transmission">{{cite web |date=2 February 2023 |title=Mpox – How It Spreads |url=https://www.cdc.gov/poxvirus/mpox/if-sick/transmission.html |access-date=23 May 2023 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |archive-date=21 May 2023 |archive-url=https://web.archive.org/web/20230521160406/https://www.cdc.gov/poxvirus/mpox/if-sick/transmission.html |url-status=live }}</ref><ref>{{cite web |date=17 August 2024 |title=Mpox Q&A |url=https://www.who.int/news-room/questions-and-answers/item/mpox |access-date=8 September 2024 |website=[[World Health Organization]] (WHO) }}</ref>

There is also a risk of infection from [[fomite]]s (objects which can become infectious after being touched by an infected person) such as clothing or bedding which has been contaminated with lesion material.<ref name="CDC_Transmission" />

==Diagnosis==
Clinical differential diagnosis distinguishes between rash illnesses, such as chickenpox, measles, bacterial skin infections, [[scabies]], [[poison ivy]], [[syphilis]], and medication-associated allergies.{{medcn|date=October 2024}}

[[Polymerase chain reaction]] (PCR) testing of samples from skin lesions is the preferred diagnostic test, although it has the disadvantage of being relatively slow to deliver a result.<ref name="WHOfact2023" /> In October 2024, the WHO approved the first diagnostic test under the Emergency Use Listing (EUL) procedure. The [[Abbott Laboratories|Alinity]] m MPXV assay enables the detection of the virus by laboratory testing swabs of skin lesions, giving a result in less than two hours.<ref>{{cite web |title=WHO approves first mpox test for faster diagnoses |url=https://www.aljazeera.com/news/2024/10/4/who-approves-first-mpox-test-for-faster-diagnoses |access-date=4 October 2024 |website=Al Jazeera }}</ref><ref>{{cite web |title=Alinity m Monkeypox Assay |url=https://www.molecular.abbott/us/en/products/infectious-disease/alinity-m-monkeypox-assay |access-date=4 October 2024 |website=Abbott Laboratories }}</ref>

==Prevention==
===Vaccine===
{{Also|Smallpox vaccine}}
Historically, [[smallpox vaccine]] had been reported to reduce the risk of mpox among previously vaccinated persons in Africa. The decrease in immunity to poxviruses in exposed populations is a factor in the increasing prevalence of human mpox. It is attributed to waning cross-protective immunity among those vaccinated before 1980, when mass smallpox vaccinations were discontinued, and to the gradually increasing proportion of unvaccinated individuals.<ref name="Kantele, A. 2016">{{cite journal |vauthors=Kantele A, Chickering K, Vapalahti O, Rimoin AW |date=August 2016 |title=Emerging diseases-the monkeypox epidemic in the Democratic Republic of the Congo |journal=Clinical Microbiology and Infection |volume=22 |issue=8 |pages=658–659 |doi=10.1016/j.cmi.2016.07.004 |pmc=9533887 |pmid=27404372 | doi-access = free | title-link = doi }}</ref>

As of August 2024, there are four vaccines in use to prevent mpox. All were originally developed to combat smallpox.<ref>{{cite news | vauthors = Rigby J |date=14 August 2024 |title=Mpox vaccines likely months away even as WHO, Africa CDC discuss emergency |url=https://www.reuters.com/business/healthcare-pharmaceuticals/mpox-vaccines-likely-months-away-even-who-africa-cdc-discuss-emergency-2024-08-14/ |work=[[Reuters]]}}</ref>

* [[Smallpox vaccine#MVA-BN|MVA-BN]] (marketed as Jynneos, Imvamune or Imvanex) manufactured by Bavarian Nordic. Licensed for use against mpox in Europe, United States and Canada.<ref>{{cite web | vauthors = Cornall J |date=25 July 2022 |title=Bavarian Nordic gets European monkeypox approval for smallpox vaccine |url=https://www.labiotech.eu/trends-news/monkeypox-smallpox-vaccine/ |access-date=15 August 2024 |website=Labiotech UG }}</ref>
* [[Smallpox vaccine#LC16m8|LC16]] from KMB Biologics (Japan) – licensed for use in Japan.<ref>{{cite web |title=Mpox – Prevention |url=https://bestpractice.bmj.com/topics/en-us/1611/prevention |access-date=15 August 2024 |website=British Medical Journal }}</ref>
* OrthopoxVac, licensed for use in Russia and manufactured by the [[State Research Center of Virology and Biotechnology VECTOR|State Research Center of Virology and Biotechnology]] VECTOR in Russia<ref>{{cite web |date=26 September 2023 |title=The Vector center will soon commence the production of the smallpox vaccine |url=https://gxpnews.net/en/2023/09/the-vector-center-will-soon-commence-the-production-of-the-smallpox-vaccine/ |access-date=15 August 2024 |website=GxP News }}</ref>
* [[ACAM2000]], manufactured by Emergent BioSolutions. Approved for use against mpox in the United States as of August 2024.<ref name="FDA PR 20240830">{{cite press release | title=FDA Roundup: August 30, 2024 | website=U.S. [[Food and Drug Administration]] (FDA) | date=30 August 2024 | url=https://www.fda.gov/news-events/press-announcements/fda-roundup-august-30-2024 | access-date=1 September 2024}}</ref><ref>{{cite press release | title=Emergent BioSolutions' ACAM2000, (Smallpox and Mpox (Vaccinia) Vaccine, Live) Receives U.S. FDA Approval for Mpox Indication; Public Health Mpox Outbreak Continues Across Africa & Other Regions | publisher=Emergent Biosolutions | via=GlobeNewswire | date=29 August 2024 | url=https://www.globenewswire.com/en/news-release/2024/08/29/2938196/33240/en/Emergent-BioSolutions-ACAM2000-Smallpox-and-Mpox-Vaccinia-Vaccine-Live-Receives-U-S-FDA-Approval-for-Mpox-Indication-Public-Health-Mpox-Outbreak-Continues-Across-Africa-Other-Regio.html | access-date=1 September 2024}}</ref>

The MVA-BN vaccine, originally developed for smallpox, has been approved in the United States for use by persons who are either considered at high risk of exposure to mpox, or who may have recently been exposed to it.<ref>{{cite web |date=22 April 2024 |title=Interim Clinical Considerations for Use of Jynneos Vaccine for Mpox Prevention in the United States|url=https://www.cdc.gov/poxvirus/mpox/clinicians/vaccines/vaccine-considerations.html |access-date=15 August 2024 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) }}</ref><ref name="Jynneos">{{cite web |date=19 May 2023 |title=Jynneos Vaccine Effectiveness |url=https://www.cdc.gov/poxvirus/mpox/cases-data/JYNNEOS-vaccine-effectiveness.html |url-status=live |archive-url=https://web.archive.org/web/20230524073420/https://www.cdc.gov/poxvirus/mpox/cases-data/JYNNEOS-vaccine-effectiveness.html |archive-date=24 May 2023 |access-date=24 May 2023 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC)}}</ref><ref name="Imvanex">{{cite web |date=19 August 2022 |title=Considerations on posology for the use of the vaccine Jynneos/ Imvanex (MVA-BN) against monkeypox |url=https://www.ema.europa.eu/en/documents/other/considerations-posology-use-vaccine-jynneos/imvanex-mva-bn-against-monkeypox_en.pdf |url-status=live |archive-url=https://web.archive.org/web/20230528112802/https://www.ema.europa.eu/en/documents/other/considerations-posology-use-vaccine-jynneos/imvanex-mva-bn-against-monkeypox_en.pdf |archive-date=28 May 2023 |access-date=28 May 2023 |website=[[European Medicines Agency]] (EMA) }}</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=28 May 2023 |website=GOV.UK }}</ref> The United States [[Centers for Disease Control and Prevention]] (CDC) recommends that persons investigating mpox outbreaks, those caring for infected individuals or animals, and those exposed by close or intimate contact with infected individuals or animals should receive a vaccination.<ref name="CDC_About" />

===Other measures===
The CDC has made detailed recommendations in addition to the [[Transmission-based precautions#Standard precautions|standard precautions]] for infection control. These include that healthcare providers don a gown, mask, goggles, and a disposable filtering respirator (such as an [[N95 respirator|N95]]), and that an infected person should be isolated a private room to keep others from possible contact.<ref>{{cite web |date=31 October 2022 |title=Infection Prevention and Control of Mpox in Healthcare Settings |url=https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-hospital.html |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=21 May 2022 |archive-date=18 May 2022 |archive-url=https://web.archive.org/web/20220518152243/https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-hospital.html |url-status=live }}</ref>

Those living in countries where mpox is endemic should avoid contact with sick mammals such as rodents, marsupials, non-human primates (dead or alive) that could harbour ''Orthopoxvirus monkeypox'' and should refrain from eating or handling wild game ([[Bushmeat|bush meat]]).<ref>{{cite web |title=Multi-country monkeypox outbreak in non-endemic countries: Update |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388 |access-date=28 May 2023 |website=[[World Health Organization]] (WHO)|archive-date=30 May 2022 |archive-url=https://web.archive.org/web/20220530002122/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388 |url-status=live }}</ref><ref name="WHO_Q&A" />

During the 2022–2023 outbreak, several public health authorities launched public awareness campaigns in order to reduce spread of the disease.<ref>{{cite web |date=23 May 2023 |title=CDC's Mpox Toolkit for Event Organizers |url=https://www.cdc.gov/poxvirus/mpox/resources/toolkits/organizer.html |access-date=28 May 2023 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |archive-date=28 May 2023 |archive-url=https://web.archive.org/web/20230528072604/https://www.cdc.gov/poxvirus/mpox/resources/toolkits/organizer.html |url-status=live }}</ref><ref>{{cite web |title=Monkeypox – Campaign details |url=https://campaignresources.dhsc.gov.uk/campaigns/monkeypox/ |access-date=28 May 2023 |website=Department of Health and Social Care – Campaign Resource Centre |archive-date=28 May 2023 |archive-url=https://web.archive.org/web/20230528122209/https://campaignresources.dhsc.gov.uk/campaigns/monkeypox/ |url-status=live }}</ref><ref>{{cite web |date=10 June 2022 |title=Mpox (Monkeypox) awareness campaign: Communications toolkit for stakeholders |url=https://www.health.wa.gov.au/Articles/A_E/Campaign-monkeypox-awareness |access-date=28 May 2023 |website=Western Australia Department of Health |archive-date=28 May 2023 |archive-url=https://web.archive.org/web/20230528122208/https://www.health.wa.gov.au/Articles/A_E/Campaign-monkeypox-awareness |url-status=live }}</ref>

==Treatment==
Most cases of mpox present with mild symptoms and there is complete recovery within 2 to 4 weeks.<ref name="Gov.UK2022">{{cite web |date=19 August 2024 |title=Mpox: background information |url=https://www.gov.uk/guidance/monkeypox |url-status=live |archive-url=https://web.archive.org/web/20240820191452/https://www.gov.uk/guidance/monkeypox |archive-date=20 August 2024 |access-date=22 August 2024 |publisher=[[UK Health Security Agency]] }}</ref><ref name="WHO_Q&A" /> There is no specific treatment for the disease, although antivirals such as [[tecovirimat]] have been approved for the treatment of severe mpox.<ref name="CSC_TPOXX" /><ref>{{cite web |date=28 January 2022 |title=Tecovirimat SIGA |url=https://www.ema.europa.eu/en/medicines/human/EPAR/tecovirimat-siga |url-status=live |archive-url=https://web.archive.org/web/20220516151355/https://www.ema.europa.eu/en/medicines/human/EPAR/tecovirimat-siga |archive-date=16 May 2022 |access-date=19 May 2022 |publisher=[[European Medicines Agency]] (EMA) }}</ref><ref name="NIH_Mpox" /> A 2023 [[Cochrane (organisation)|Cochrane]] review found no completed [[Randomized controlled trial|randomized controlled trials]] studying therapeutics for the treatment of mpox.<ref name=":0">{{cite journal | vauthors = Fox T, Gould S, Princy N, Rowland T, Lutje V, Kuehn R | title = Therapeutics for treating mpox in humans | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 3 | pages = CD015769 | date = March 2023 | pmid = 36916727 | pmc = 10012405 | doi = 10.1002/14651858.CD015769 | collaboration = Cochrane Infectious Diseases Group }}</ref> The review identified non-randomized controlled trials which evaluated the safety of therapeutics for mpox, finding no significant risks from [[tecovirimat]] and low certainty evidence that suggests [[brincidofovir]] may cause mild liver injury.<ref name=":0" /> Pain is common and may be severe; [[Symptomatic treatment|supportive care]] such as [[Pain management|pain]] or [[Antipyretic|fever control]] may be administered.<ref name="WHO_Q&A" /><ref name="BMJ_Best">{{cite web |title=Mpox (monkeypox) – Treatment algorithm |url=https://bestpractice.bmj.com/topics/en-us/1611/treatment-algorithm |access-date=14 March 2023 |website=[[BMJ Best Practice]] |archive-date=4 December 2022 |archive-url=https://web.archive.org/web/20221204091145/https://bestpractice.bmj.com/topics/en-us/1611/treatment-algorithm |url-status=live }}</ref> People with mild disease should [[Isolation (health care)|isolate]] at home, stay hydrated, eat well, and take steps to maintain their mental health.<ref name="WHOfact2023" />

People who are at high risk from the disease include children, pregnant women, the elderly and those who are [[Immunodeficiency|immunocompromized]].<ref>{{cite web |date=25 October 2022 |title=Factsheet for health professionals on mpox (monkeypox) |url=https://www.ecdc.europa.eu/en/all-topics-z/monkeypox/factsheet-health-professionals |access-date=29 May 2023 |website=European Centre for Disease Prevention and Control |archive-date=20 June 2022 |archive-url=https://web.archive.org/web/20220620042406/https://www.ecdc.europa.eu/en/all-topics-z/monkeypox/factsheet-health-professionals |url-status=live }}</ref> For these people, or those who have severe disease, hospital admission and careful monitoring of symptoms is recommended.<ref name="BMJ_Best" /> Symptomatic treatment is recommended for complications such as [[proctitis]] and [[Itch|pruritis]].<ref name="BMJ_Best" />

A trial in the Democratic Republic of the Congo found that the antiviral drug [[tecovirimat]] did not shorten the duration of mpox lesions in people with clade I mpox.<ref>{{cite web |date=14 August 2024 |title=The antiviral tecovirimat is safe but did not improve clade I mpox resolution in Democratic Republic of the Congo |url=https://www.nih.gov/news-events/news-releases/antiviral-tecovirimat-safe-did-not-improve-clade-i-mpox-resolution-democratic-republic-congo |access-date=16 August 2024 |website=National Institutes of Health (NIH) }}</ref> Despite this, the trial's overall mortality rate of 1.7% was notably lower than the 3.6% or higher mortality rate seen in the Democratic Republic of the Congo's general mpox cases.<ref>{{cite web |last=Mast |first=Jason |date=15 August 2024 |title=Antiviral used for mpox no better than placebo, NIH says |url=https://www.statnews.com/2024/08/15/mpox-antiviral-tecovirimat-no-better-than-placebo-nih/ |access-date=16 August 2024 |website=STAT }}</ref> This suggests that hospitalization and high-quality supportive care significantly improve outcomes for mpox people.<ref>{{cite web |last=Priyan |first=Vishnu |date=16 August 2024 |title=NIAID reports preliminary data from trial of SIGA's Mpox treatment |url=https://www.clinicaltrialsarena.com/news/niaid-siga-mpox-trial/ |access-date=16 August 2024 |website=Clinical Trials Arena }}</ref> The trial was sponsored by the [[National Institutes of Health|NIH]] and co-led by the Democratic Republic of the Congo's Institut National de Recherche Biomédicale.

An additional 2024 study on [[SIGA Technologies|Siga Technologies]]’ antiviral drug, [[tecovirimat]], found it ineffective in reducing lesion healing time or pain in adults with the clade II strain of mpox.<ref>{{Cite news |date=10 Dec 2024 |title=Siga's mpox drug did not improve lesion resolution or pain, NIH study finds |url=https://www.reuters.com/business/healthcare-pharmaceuticals/sigas-mpox-drug-did-not-improve-lesion-resolution-or-pain-nih-study-finds-2024-12-10/?utm_campaign=pharmalittle&utm_medium=email&_hsenc=p2ANqtz--SRQmys8lnB7CdbOyZPTzPrigQpNzyQJUugeC-ccgx0zmL2rssAzNIr4JTsKoqBjtFR-uGFF_9-ecL8rbepfKTeqD_wA&_hsmi=338267625&utm_content=338267625 |work=Reuters}}</ref> Based on interim results, a safety board recommended halting further patient enrollment. The trial, launched in September 2022 by the U.S. [[National Institute of Allergy and Infectious Diseases]], involved patients from several countries, including the U.S., Argentina, and Japan, who had mpox symptoms for less than 14 days.<ref>{{Cite web |date=2024-12-11 |title=NIH Study Finds Tecovirimat Safe, But Ineffective for Treating Mpox |url=https://www.contagionlive.com/view/nih-study-finds-tecovirimat-safe-but-ineffective-for-treating-mpox |access-date=2024-12-15 |website=ContagionLive |language=en}}</ref> An interim analysis revealed no significant differences in lesion resolution or pain reduction between tecovirimat and a placebo.<ref>{{Cite web |date=2024-12-10 |title=NIH Study Finds Tecovirimat Was Safe but Did Not Improve Mpox Resolution or Pain |url=https://www.nih.gov/news-events/news-releases/nih-study-finds-tecovirimat-was-safe-did-not-improve-mpox-resolution-or-pain |access-date=2024-12-15 |website=National Institutes of Health (NIH) |language=EN}}</ref> 

=== Diagnostics in resource limited settings ===
With the August 2024 outbreak in the [[Democratic Republic of the Congo|DRC]], the [[World Health Organization]] (WHO) urged manufacturers to submit their products for emergency review.<ref>{{cite news |date=29 August 2024 |title=WHO invites makers of mpox tests for emergency review in push for rapid access |url=https://www.reuters.com/business/healthcare-pharmaceuticals/who-urges-rapid-access-mpox-diagnostic-tests-2024-08-29/ |publisher=Reuters}}</ref> This initiative is part of the WHO's effort to ensure effective diagnostics, particularly for low-income populations. The agency has called for manufacturers to submit their tests for Emergency Use Listing, which would allow the WHO to approve these medical products more quickly.<ref>{{cite web |title=WHO urges rapid access to mpox diagnostic tests, invites manufacturers to emergency review |url=https://www.who.int/news/item/29-08-2024-who-urges-rapid-access-to-mpox-diagnostic-tests--invites-manufacturers-to-emergency-review#:~:text=WHO%20has%20asked%20manufacturers%20of,particularly%20in%20low-income%20settings. |access-date=31 August 2024 |website=[[World Health Organization]] (WHO) }}</ref> This process is designed to help countries procure essential products through UN agencies and other partners. The urgency comes as a new, easily transmissible form of the 2024 outbreak has raised global concerns, leading the WHO to declare mpox a global public health emergency.<ref>{{cite web |title=Mpox global strategic preparedness and response plan |url=https://www.who.int/publications/m/item/mpox-global-strategic-preparedness-and-response-plan |access-date=31 August 2024 |website=[[World Health Organization]] (WHO) }}</ref>

==Epidemiology==
{{Update|part=section|date=May 2023|reason=More recent evidence is available}}
[[File:Monkeypox By Country.svg|thumb|upright=1.5|A global map showing the spread of ''[[Orthopoxvirus monkeypox]]''. {{legend|#8888ff|Endemic clade{{nbsp}}I}}{{legend|#ff8888|Endemic clade{{nbsp}}II}}{{legend|#aa44aa|Both clades recorded}}{{legend|#aa0000|Clade{{nbsp}}II outbreak in 2022}}{{legend|#FFC6C6|Suspected cases}}]]

===History===
Mpox was first identified as a distinct illness in 1958 among laboratory monkeys in [[Copenhagen]], Denmark.<ref>{{cite journal | vauthors = Parker S, Buller RM | title = A review of experimental and natural infections of animals with ''Orthopoxvirus monkeypox'' between 1958 and 2012 | journal = Future Virology | volume = 8 | issue = 2 | pages = 129–157 | date = February 2013 | pmid = 23626656 | pmc = 3635111 | doi = 10.2217/fvl.12.130 }}</ref> The first documented human cases occurred in 1970, involving six unvaccinated children during the smallpox eradication efforts, with the first being a 9-month-old boy in the Democratic Republic of the Congo.<ref name="Bunge2022" /><ref name="Cho1973">{{cite journal | vauthors = Cho CT, Wenner HA | title = Monkeypox virus | journal = Bacteriological Reviews | volume = 37 | issue = 1 | pages = 1–18 | date = March 1973 | pmid = 4349404 | pmc = 413801 | doi = 10.1128/br.37.1.1-18.1973 }}</ref> From 1981 to 1986, over 300 human cases of mpox were reported in the Democratic Republic of the Congo (then known as Zaire), primarily due to contact with animals.<ref name="Meyer2002">{{cite journal | vauthors = Meyer H, Perrichot M, Stemmler M, Emmerich P, Schmitz H, Varaine F, Shungu R, Tshioko F, Formenty P | title = Outbreaks of disease suspected of being due to human ''Orthopoxvirus monkeypox'' infection in the Democratic Republic of Congo in 2001 | journal = Journal of Clinical Microbiology | volume = 40 | issue = 8 | pages = 2919–2921 | date = August 2002 | pmid = 12149352 | pmc = 120683 | doi = 10.1128/JCM.40.8.2919-2921.2002 }}</ref> The virus has been detected in [[Gambian pouched rat]]s, [[dormice]], and African squirrels, which are often used as food.<ref name=":3">{{cite journal | vauthors = Falendysz EA, Lopera JG, Lorenzsonn F, Salzer JS, Hutson CL, Doty J, Gallardo-Romero N, Carroll DS, Osorio JE, Rocke TE | title = Further Assessment of Monkeypox Virus Infection in Gambian Pouched Rats (Cricetomys gambianus) Using In Vivo Bioluminescent Imaging | journal = PLOS Neglected Tropical Diseases | volume = 9 | issue = 10 | pages = e0004130 | date = 30 October 2015 | pmid = 26517839 | pmc = 4627722 | doi = 10.1371/journal.pntd.0004130 | doi-access = free | title-link = doi }}</ref><ref name="WHOfact2023" />

Many more mpox cases have been reported in Central and West Africa, particularly in the Democratic Republic of the Congo, where 2,000 cases per year were recorded between 2011 and 2014. However, the collected data is often incomplete and unconfirmed, hindering accurate estimations of the number of mpox cases over time.<ref name="Skle">{{cite journal | vauthors = Sklenovská N, Van Ranst M | title = Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans | journal = Frontiers in Public Health | volume = 6 | pages = 241 | date = September 2018 | pmid = 30234087 | pmc = 6131633 | doi = 10.3389/fpubh.2018.00241 | doi-access = free | title-link = doi }}</ref> Originally thought to be uncommon in humans, cases have increased since the 1980s,<ref name="Andrew2020">{{cite book | vauthors = James WD, Elston D, Treat JR, Rosenbach MA, Neuhaus I |title=Andrews' Diseases of the Skin: Clinical Dermatology |date=2020 |publisher=Elsevier |isbn=978-0-323-54753-6 |edition=13th |location=Edinburgh |page=389 |chapter=19. Viral diseases |chapter-url=https://books.google.com/books?id=UEaEDwAAQBAJ&dq=human&pg=PA389 |access-date=9 June 2022 |archive-date=19 January 2023 |archive-url=https://web.archive.org/web/20230119201622/https://books.google.com/books?id=UEaEDwAAQBAJ&dq=human&pg=PA389 |url-status=live }}</ref><ref name="Bunge2022" /> possibly as a result of waning immunity following the cessation of routine smallpox vaccination.<ref name="Mc2014">{{cite journal | vauthors = McCollum AM, Damon IK | title = Human monkeypox | journal = Clinical Infectious Diseases | volume = 58 | issue = 2 | pages = 260–267 | date = January 2014 | pmid = 24158414 | doi = 10.1093/cid/cit703 | doi-access = }}</ref>

===Future threat===
The natural reservoir of ''Orthopoxvirus monkeypox'' has not been conclusively determined. Small rodents are considered the most likely candidate. Without a major vaccination campaign, mpox outbreaks in humans will continue indefinitely in the endemic areas, with an ongoing risk that disease outbreaks will spread to non-endemic areas. Other evidence – that the virus is evolving to be more transmissible among humans, that it can infect a wide range of host species, and that human-to-animal transmission can occur – led to concerns that mpox may either become established in new natural reservoirs outside of Africa, or cause future global epidemics.<ref>{{cite journal | vauthors = Johnson PL, Bergstrom CT, Regoes RR, Longini IM, Halloran ME, Antia R | title = Evolutionary consequences of delaying intervention for monkeypox | journal = Lancet | volume = 400 | issue = 10359 | pages = 1191–1193 | date = October 2022 | pmid = 36152668 | pmc = 9534010 | doi = 10.1016/S0140-6736(22)01789-5 }}</ref><ref>{{cite web |title=Monkeypox cases waning, but global threat remains |url=https://www.gavi.org/vaccineswork/monkeypox-cases-waning-global-threat-remains |access-date=1 June 2023 |website=Gavi, the Vaccine Alliance |archive-date=1 June 2023 |archive-url=https://web.archive.org/web/20230601140741/https://www.gavi.org/vaccineswork/monkeypox-cases-waning-global-threat-remains |url-status=live }}</ref><ref>{{cite journal | vauthors = Adetifa I, Muyembe JJ, Bausch DG, Heymann DL | title = Mpox neglect and the smallpox niche: a problem for Africa, a problem for the world | journal = Lancet | volume = 401 | issue = 10390 | pages = 1822–1824 | date = May 2023 | pmid = 37146622 | pmc = 10154003 | doi = 10.1016/S0140-6736(23)00588-3 | s2cid = 258441920 }}</ref><ref>{{cite web |date=30 December 2022 |title=Mpox (monkeypox) and animals |url=https://www.canada.ca/en/public-health/services/diseases/mpox/risks/animals.html |access-date=1 June 2023 |website=Public Health Agency of Canada |archive-date=1 June 2023 |archive-url=https://web.archive.org/web/20230601140740/https://www.canada.ca/en/public-health/services/diseases/mpox/risks/animals.html |url-status=live }}</ref>

Following the 2022–2023 outbreak, mpox (clade IIb) remains present in the human population outside Africa at very low levels.<ref>{{cite journal | vauthors = Mathieu E, Spooner F, Dattani S, [[Hannah Ritchie|Ritchie H]], [[Max Roser|Roser M]] |date=24 May 2022 |title=Mpox (monkeypox) |url=https://ourworldindata.org/monkeypox |journal=Our World in Data |access-date=5 October 2023 |archive-date=3 July 2022 |archive-url=https://web.archive.org/web/20220703033822/https://ourworldindata.org/monkeypox |url-status=live }}</ref> In November 2023, the WHO reported increasing numbers of cases of mpox (clade I) in the Democratic Republic of the Congo, with 12,569 cases year-to-date and 651 fatalities; there was also the first evidence of sexual transmission of clade I.<ref>{{cite web |date=23 November 2023 |title=Mpox (monkeypox)- Democratic Republic of the Congo |url=https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON493 |access-date=25 November 2023 |website=[[World Health Organization]] (WHO) |archive-date=24 November 2023 |archive-url=https://web.archive.org/web/20231124220630/https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON493 |url-status=live }}</ref>

In 2024, the WHO added the monkeypox virus to its list of "priority pathogens" that could cause a pandemic.<ref>{{cite journal | vauthors = Mallapaty S |date=2 August 2024 |title=The pathogens that could spark the next pandemic |url=https://www.nature.com/articles/d41586-024-02513-3 |journal=Nature |volume=632 |issue=8025 |page=488 |doi=10.1038/d41586-024-02513-3 |pmid=39095457 |bibcode=2024Natur.632..488M |access-date=2 August 2024 |archive-date=2 August 2024 |archive-url=https://web.archive.org/web/20240802180033/https://www.nature.com/articles/d41586-024-02513-3 |url-status=live |url-access=subscription }}</ref>

==Outbreaks==
This section is an incomplete list of disease outbreaks which have been reported, including significant outbreaks in the endemic countries in tropical Africa (Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana, Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan).<ref>{{cite web |title=Multi-country monkeypox outbreak in non-endemic countries |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385 |access-date=31 May 2023 |website=[[World Health Organization]] (WHO) |archive-date=22 May 2022 |archive-url=https://web.archive.org/web/20220522002241/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385 |url-status=live }}</ref> Outbreaks of mpox are frequent in areas where the disease is endemic – these areas often [[Developing country|have poor healthcare infrastructure]] and outbreaks are rarely documented.<ref>{{cite journal | vauthors = Besombes C, Mbrenga F, Schaeffer L, Malaka C, Gonofio E, Landier J, Vickos U, Konamna X, Selekon B, Dankpea JN, Von Platen C, Houndjahoue FG, Ouaïmon DS, Hassanin A, Berthet N, Manuguerra JC, Gessain A, Fontanet A, Nakouné-Yandoko E | title = National Monkeypox Surveillance, Central African Republic, 2001–2021 | journal = Emerging Infectious Diseases | volume = 28 | issue = 12 | pages = 2435–2445 | date = December 2022 | pmid = 36328951 | pmc = 9707566 | doi = 10.3201/eid2812.220897 }}</ref><ref>{{cite journal | vauthors = Kozlov M | title = WHO may soon end mpox emergency - but outbreaks rage in Africa | journal = Nature | volume = 614 | issue = 7949 | pages = 600–601 | date = February 2023 | pmid = 36765257 | doi = 10.1038/d41586-023-00391-9 | url = https://www.nature.com/articles/d41586-023-00391-9 | access-date = 30 May 2023 | url-status = live | s2cid = 256764657 | bibcode = 2023Natur.614..600K | archive-url = https://web.archive.org/web/20230516144506/https://www.nature.com/articles/d41586-023-00391-9 | archive-date = 16 May 2023 | url-access = subscription }}</ref><ref>{{cite web |date=20 October 2022 |title=In Central Africa, a deadly monkeypox variant is surging |url=https://www.nationalgeographic.co.uk/science-and-technology/2022/10/in-central-africa-a-deadly-monkeypox-variant-is-surging |access-date=30 May 2023 |website=National Geographic |archive-date=30 May 2023 |archive-url=https://web.archive.org/web/20230530133148/https://www.nationalgeographic.co.uk/science-and-technology/2022/10/in-central-africa-a-deadly-monkeypox-variant-is-surging |url-status=live }}</ref>

{| class="wikitable sortable"
|+ ''Orthopoxvirus monkeypox'' disease outbreaks
|-
! Year
! Country
! Clade
! data-sort-type="number" | Human cases
! data-sort-type="number" | Human deaths
! data-sort-type="number" | [[Case fatality rate]]
! Notes
|-
| 1970
| {{DRC}}
| Clade I
| 5
| '' no data''
| N/A
|
|-
| 1971
| {{NGA}}
| Clade II
| 2
| '' no data''
| N/A
|
|-
| 1981–1986
| {{DRC}}
| Clade I
| 338
| '' no data''
| N/A
|
|-
| 1995–1996
| {{DRC}}
| Clade I
| >500
| '' no data''
| N/A
|
|-
| 2001–2004
| {{DRC}}
| Clade I
| 2,734
| '' no data''
| N/A
|
|-
| 2003
| {{USA}}
| Clade II
| 71
| 0
| 0%
|
|-
| 2015
| {{CAF}}<ref>{{cite journal | vauthors = Nakoune E, Lampaert E, Ndjapou SG, Janssens C, Zuniga I, Van Herp M, Fongbia JP, Koyazegbe TD, Selekon B, Komoyo GF, Garba-Ouangole SM, Manengu C, Manuguerra JC, Kazanji M, Gessain A, Berthet N | title = A Nosocomial Outbreak of Human Monkeypox in the Central African Republic | journal = Open Forum Infectious Diseases | volume = 4 | issue = 4 | pages = ofx168 | date = 2017 | pmid = 29732376 | pmc = 5920348 | doi = 10.1093/ofid/ofx168 }}</ref>
| Clade I
| 10
| 2
| 20%
|
|-
| 2017–2022
| {{NGA}}
| Clade II
| 558
| 8
| 1.4%
|
|-
| 2020
| {{DRC}}<ref>{{cite web |title=Monkeypox - Democratic Republic of the Congo October 2020 |url=https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox-democratic-republic-of-the-congo |publisher=[[World Health Organization]] (WHO) |access-date=20 March 2024 |archive-date=5 June 2022 |archive-url=https://web.archive.org/web/20220605103903/https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox-democratic-republic-of-the-congo |url-status=live }}</ref>
| Clade I
| 4,600
| 171
| 3.7%
|
|-
| 2022–2023
| [[2022–2023 mpox outbreak|Global outbreak]]
| Clade IIb
| 93,327
| 208
| 0.2%
|*ongoing<ref name=":6" />
|-
| 2023–2024*
|{{DRC}}<br />{{CAF}}<br />{{CGO}}<br />{{KEN}}<br />{{BDI}}
| Clade I<br />Clade Ib
| >18,245
| >919
| ~5%
| *ongoing<ref name="cohen" />
|-}
|}

===United States===
{{main|2003 Midwest monkeypox outbreak}}

In May 2003, a young child became ill with fever and rash after being bitten by a prairie dog purchased at a local swap meet near [[Milwaukee]], [[Wisconsin]].<ref>{{cite journal | vauthors = Anderson MG, Frenkel LD, Homann S, Guffey J | title = A case of severe monkeypox virus disease in an American child: emerging infections and changing professional values | journal = The Pediatric Infectious Disease Journal | volume = 22 | issue = 12 | pages = 1093–1096 | date = December 2003 | pmid = 14688573 | doi = 10.1097/01.inf.0000101821.61387.a5 }}</ref> In total, 71 cases of mpox were reported through 20 June 2003. All cases were traced to Gambian pouched rats imported from [[Accra]], [[Ghana]], in April 2003 by a Texas exotic animal distributor. No deaths resulted.<ref name="medscape">{{cite web | first=John | last=Bartlett |url=https://www.medscape.com/viewarticle/458671_11 |title=Medscape Monkeypox Review |publisher=Medscape |access-date=22 March 2013 |archive-date=2 December 2012 |archive-url=https://archive.today/20121202114953/http://bcbsma.medscape.com/viewarticle/458671_11 |url-status=live }}</ref> [[Electron microscope|Electron microscopy]] and serologic studies were used to confirm that the disease was human mpox.<ref>{{cite web |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |date=19 November 2021 |title=Monkeypox in the United States |url=https://www.cdc.gov/poxvirus/monkeypox/outbreak/us-outbreaks.html |access-date=27 April 2022 |archive-date=27 April 2022 |archive-url=https://web.archive.org/web/20220427074811/https://www.cdc.gov/poxvirus/monkeypox/outbreak/us-outbreaks.html |url-status=live }}</ref> Everyone affected reported direct or close contact with prairie dogs, later found to be infected with the ''Orthopoxvirus monkeypox''.<ref name="pmid12855947">{{cite journal | title = Update: multistate outbreak of monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 52 | issue = 27 | pages = 642–646 | date = July 2003 | pmid = 12855947 | url = https://www.cdc.gov/mmwr/PDF/wk/mm5227.pdf | access-date = 4 December 2022 | url-status = live | archive-url = https://web.archive.org/web/20221208161135/https://www.cdc.gov/mmwr/PDF/wk/mm5227.pdf | archive-date = 8 December 2022 | author1 = Centers for Disease Control and Prevention (CDC) }}</ref>

In July 2021, in the US, an American returning from a trip in Nigeria was diagnosed with mpox. Subsequent testing identified the virus as belonging to clade{{nbsp}}II. The patient was hospitalized and treated with tecovirimat and was discharged after 32 days.<ref>{{cite web |title=A Case of Monkeypox in a Returned Traveler |url=https://www.proquest.com/openview/78527319ec56ca1a4f45974d0a55d86d/1?pq-origsite=gscholar&cbl=136156 |access-date=23 May 2022 |website=[[ProQuest]] |archive-date=31 May 2022 |archive-url=https://web.archive.org/web/20220531133540/https://www.proquest.com/openview/78527319ec56ca1a4f45974d0a55d86d/1?pq-origsite=gscholar&cbl=136156 |url-status=live }}</ref>

The first case of clade I mpox in the United States was identified in November 2024; the California Department of Public Health reported that an unidentified individual outside San Francisco had tested positive following travel to and from [[East Africa]].<ref>{{Cite web |title=First U.S. Case of Severe Form of Mpox Reported in California |author=Apoorva Mandavilli |work=nytimes.com |date=2024-11-17 |access-date=2024-11-17 |url= https://www.nytimes.com/2024/11/16/health/mpox-california.html }}</ref> Clade II mpox continues to circulate at low levels.<ref>{{cite web | title=Mpox in the United States and Around the World: Current Situation | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=26 September 2024 | url=https://www.cdc.gov/mpox/situation-summary/index.html | access-date=20 October 2024}} {{PD-notice}}</ref><ref>{{cite web | title=U.S. Case Trends | website=U.S. [[Centers for Disease Control and Prevention]] (CDC) | date=15 October 2024 | url=https://www.cdc.gov/mpox/data-research/cases/index.html | access-date=20 October 2024}}</ref>

===Sudan===
During 2022, an outbreak of clade I mpox was reported in refugee camps in Sudan.<ref name="WHOfact2023" /> The first case in the country was recorded in August, and in September, six additional cases were discovered in [[Khartoum]].<ref name="Dafallah2023">{{cite journal |last1=Dafallah |first1=Mumen A. |title=The current status of monkeypox in Sudan |journal=Annals of Medicine & Surgery |date=June 2023 |volume=85 |issue=6 |pages=3202–3203 |doi=10.1097/MS9.0000000000000284|pmid=37363511 |pmc=10289688 }}</ref> In October, more than 100 cases were reported among Ethiopian refugee camps.<ref name="Dafallah2023"/>

===Nigeria===
{{main article|Mpox in Nigeria}}

Two cases of human mpox infections were identified in Nigeria in 1971.
In September 2017, ''Orthopoxvirus monkeypox'' was reported in Nigeria. The subsequent outbreak was, at that time, the largest ever outbreak of clade{{nbsp}}II of the virus, with 118 confirmed cases. Unlike previous outbreaks of this clade, infection was predominantly among young male adults and human-to-human transmission appears to have readily occurred. Seven deaths (5 male, 2 female, case fatality rate of 6%) were reported, including a baby and four [[HIV/AIDS]] people. Additionally, a pregnant woman in her second trimester had a spontaneous miscarriage attributed to ''Orthopoxvirus monkeypox'' infection.<ref>{{cite journal | vauthors = Yinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, McCollum A, Disu Y, Mamadu I, Akinpelu A, Ahmad A, Burga J, Ndoreraho A, Nkunzimana E, Manneh L, Mohammed A, Adeoye O, Tom-Aba D, Silenou B, Ipadeola O, Saleh M, Adeyemo A, Nwadiutor I, Aworabhi N, Uke P, John D, Wakama P, Reynolds M, Mauldin MR, Doty J, Wilkins K, Musa J, Khalakdina A, Adedeji A, Mba N, Ojo O, Krause G, Ihekweazu C | title = Outbreak of human monkeypox in Nigeria in 2017–18: a clinical and epidemiological report | journal = The Lancet. Infectious Diseases | volume = 19 | issue = 8 | pages = 872–879 | date = August 2019 | pmid = 31285143 | pmc = 9628943 | doi = 10.1016/S1473-3099(19)30294-4 | s2cid = 195842553 }}</ref>

In May 2022, the Nigerian government released a report stating that between 2017 and 2022, 558 cases were confirmed across 32 states and the Federal Capital Territory. There were 8 deaths reported, making for a 1.4% [[Case fatality rate|Case Fatality Ratio]]. In 2022, NCDC implemented a National Technical Working Group for reporting and monitoring infections, strengthening response capacity.<ref>{{cite web | vauthors = Ileyemi M |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 |website=Premium Times |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>

===United Kingdom===
In September 2018, the United Kingdom's first case of mpox was recorded. The person, a Nigerian national, is believed to have contracted mpox in [[Nigeria]] before travelling to the United Kingdom.<ref>{{cite news |title=First ever case of monkeypox recorded in the UK |url=https://www.theguardian.com/uk-news/2018/sep/08/first-ever-case-of-monkeypox-recorded-in-the-uk |access-date=8 September 2018 |work=[[The Guardian]] |date=8 September 2018 |archive-date=8 September 2018 |archive-url=https://web.archive.org/web/20180908204740/https://www.theguardian.com/uk-news/2018/sep/08/first-ever-case-of-monkeypox-recorded-in-the-uk |url-status=live }}</ref> A second case was confirmed in the town of [[Blackpool]], with a further case that of a medical worker who cared for the infected person from Blackpool.<ref>{{cite web |url=https://www.theguardian.com/society/2018/sep/26/medic-becomes-third-person-infected-with-monkeypox-in-england |title=Medic becomes third person infected with monkeypox in England |newspaper=[[The Guardian]] |date=26 September 2018 | vauthors = Damien G |access-date=26 September 2018 |archive-date=26 September 2018 |archive-url=https://web.archive.org/web/20180926170017/https://www.theguardian.com/society/2018/sep/26/medic-becomes-third-person-infected-with-monkeypox-in-england |url-status=live }}</ref>

In December 2019, mpox was diagnosed in a person in South West England who had traveled to the UK from Nigeria.<ref name="PHE4Dec2019">{{cite web|url=https://www.gov.uk/government/news/monkeypox-case-confirmed-in-england|title=Monkeypox case confirmed in England|date=4 December 2019|publisher=[[Public Health England]] |access-date=12 December 2019|archive-date=12 December 2019|archive-url=https://web.archive.org/web/20191212092044/https://www.gov.uk/government/news/monkeypox-case-confirmed-in-england|url-status=live}}</ref>

In May 2021, two cases of mpox from a single household were identified by [[Public Health Wales]] in the UK. The [[index case]] had traveled from Nigeria. Covid guidance to isolate after travel helped detection of the outbreak and to prevent further transmission.<ref>{{cite journal | vauthors = Hobson G, Adamson J, Adler H, Firth R, Gould S, Houlihan C, Johnson C, Porter D, Rampling T, Ratcliffe L, Russell K, Shankar AG, Wingfield T | title = Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021 | journal = Euro Surveillance | volume = 26 | issue = 32 | date = August 2021 | pmid = 34387184 | doi = 10.2807/1560-7917.ES.2021.26.32.2100745 | doi-access = free | title-link = doi | pmc = 8365177 }}</ref>

===Singapore===
In May 2019, a 38-year-old man who traveled from Nigeria was hospitalized in an isolation ward at the [[National Centre for Infectious Diseases]] in Singapore, after being confirmed as the country's first case of mpox. As a result, 22 people were quarantined.<ref name="CIDRAPMay2019">{{cite web|url=https://www.cidrap.umn.edu/ebola/news-scan-may-09-2019|title= News Scan for May 09, 2019 |website=[[Center for Infectious Disease Research and Policy]] (CIDRAP) |date=9 May 2019 |access-date=10 May 2019|archive-date=10 May 2019|archive-url=https://web.archive.org/web/20190510020038/http://www.cidrap.umn.edu/news-perspective/2019/05/news-scan-may-09-2019|url-status=live}}</ref> The case may have been linked to a simultaneous outbreak in Nigeria.<ref name="WHO_May_2019">{{cite web |url=https://www.who.int/csr/don/16-may-2019-monkeypox-singapore/en/ |archive-url=https://web.archive.org/web/20190701132211/https://www.who.int/csr/don/16-may-2019-monkeypox-singapore/en/ |url-status=dead |archive-date=1 July 2019 |title=Monkeypox – Singapore |publisher=[[World Health Organization]] (WHO) |date=16 May 2019 |access-date=17 May 2019}}</ref>

===2022–2023 global outbreak===
{{Main|2022–2023 mpox outbreak}}

An outbreak of mpox caused by clade IIb of the virus was first identified in May 2022.<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]] (WHO)}}</ref> The first case was detected in London, United Kingdom, on 6&nbsp;May,&nbsp;in a patient with a recent travel history from [[Nigeria]], where the disease is [[endemic (epidemiology)|endemic]].<ref name="gov.uk">{{cite web |date=6 September 2022 |title=Monkeypox cases confirmed in England – latest updates |url=https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates |url-status=live |archive-url=https://web.archive.org/web/20220516173645/https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates |archive-date=16 May 2022 |access-date=25 September 2022 |website=GOV.UK }}</ref><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]] (WHO)}}</ref> Subsequent cases were reported in an increasing number of countries and regions.{{refn|<ref name="arg">{{cite web|date=26 May 2022|title=Viruela del mono: confirmaron el primer caso del virus en el país|url=https://www.lanacion.com.ar/sociedad/viruela-del-mono-confirmaron-el-primer-caso-del-virus-en-el-pais-nid26052022/|access-date=26 May 2022|language=es|archive-date=24 June 2022|archive-url=https://web.archive.org/web/20220624004100/https://www.lanacion.com.ar/sociedad/viruela-del-mono-confirmaron-el-primer-caso-del-virus-en-el-pais-nid26052022/|url-status=live}}</ref><ref name="alarabiya">{{cite web |title=UAE reports first case of monkeypox in the country |url=https://english.alarabiya.net/News/gulf/2022/05/24/UAE-reports-first-case-of-monkeypox-in-the-country |website=[[Al Arabiya]] |date=24 May 2022 |access-date=24 May 2022 |archive-date=24 May 2022 |archive-url=https://web.archive.org/web/20220524192332/https://english.alarabiya.net/News/gulf/2022/05/24/UAE-reports-first-case-of-monkeypox-in-the-country |url-status=live }}</ref><ref name="1stisrael">{{cite news| vauthors = Efrati I |title=Israel Confirms First Case of Monkeypox Virus|work=[[Haaretz]] |url=https://www.haaretz.com/israel-news/israel-discovers-first-case-of-monkeypox-virus-1.10812439|access-date=21 May 2022|archive-date=20 May 2022|archive-url=https://web.archive.org/web/20220520192033/https://www.haaretz.com/israel-news/israel-discovers-first-case-of-monkeypox-virus-1.10812439|url-status=live}}</ref><ref name="aus">{{cite web |date=20 May 2022 |title=Monkeypox confirmed in Melbourne and Sydney |url=https://www.abc.net.au/news/2022-05-20/monkeypox-case-in-sydney-and-melbourne/101084864 |url-status=live |archive-url=https://web.archive.org/web/20220520071749/https://www.abc.net.au/news/2022-05-20/monkeypox-case-in-sydney-and-melbourne/101084864 |archive-date=20 May 2022 |access-date=20 May 2022 |publisher=[[Australian Broadcasting Corporation]]}}</ref><ref name="moroc1st">{{cite web |title=Morocco Reports First Monkeypox Case |url=https://www.moroccoworldnews.com/2022/06/349441/morocco-reports-first-monkeypox-case |website=[[Morocco World News]] |access-date=2 June 2022 |archive-date=21 June 2022 |archive-url=https://web.archive.org/web/20220621015327/https://www.moroccoworldnews.com/2022/06/349441/morocco-reports-first-monkeypox-case |url-status=live }}</ref><ref name="ghanafirstcase">{{cite web | vauthors = Christian Y |title=5 cases of monkeypox confirmed in Ghana |url=https://www.myjoyonline.com/5-cases-of-monkeypox-confirmed-in-ghana/ |website=MyJoyOnline.com |date=8 June 2022 |access-date=8 June 2022 |archive-date=21 June 2022 |archive-url=https://web.archive.org/web/20220621191942/https://www.myjoyonline.com/5-cases-of-monkeypox-confirmed-in-ghana/ |url-status=live }}<!-- Reliable source? --></ref>}} In July 2022, the WHO declared the outbreak a public health emergency of international concern. This status was terminated in May 2023 due to steady progress in controlling the spread of the disease, attributed to a combination of vaccination and public health information.<ref name="kimball511">{{cite web | vauthors = Kimball S |date=11 May 2023 |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=11 May 2023 |website=CNBC |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> {{As of|2024|August}}, clade IIb mpox cases outside of endemic regions in Africa continued to be reported at a low level.<ref name=":6">{{cite web |title=Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin: 15 August 2024 |url=https://www.who.int/europe/publications/m/item/joint-ecdc-who-regional-office-for-europe-monkeypox-surveillance-bulletin--15-august-2024 |access-date=24 August 2024 |website=[[World Health Organization]] (WHO) }}</ref>

===2023–2024 Central Africa outbreak===
{{Main|2023–2024 mpox epidemic}}
During 2023, a clade I outbreak of mpox disease in the Democratic Republic of the Congo resulted in 14,626 suspected cases being reported, with 654 associated deaths, making for a case-fatality rate of 4.5%. The outbreak continued into 2024, with 3,576 suspected mpox cases and 265 deaths reported in the Democratic Republic of the Congo through the first nine weeks of the year, making for an estimated CFR of 7.4%.<ref name="drcmpox">{{cite news | vauthors = Van Beusekom M |title=More than 600 dead in spreading DR Congo mpox outbreak as Republic of Congo reports its first cases |url=https://www.cidrap.umn.edu/mpox/more-600-dead-spreading-dr-congo-mpox-outbreak-republic-congo-reports-its-first-cases |access-date=19 March 2024 |publisher=[[Center for Infectious Disease Research and Policy]] (CIDRAP) |date=16 March 2024 |archive-date=19 March 2024 |archive-url=https://web.archive.org/web/20240319082039/https://www.cidrap.umn.edu/mpox/more-600-dead-spreading-dr-congo-mpox-outbreak-republic-congo-reports-its-first-cases |url-status=live }}</ref>

Transmission of the virus in the outbreak appears to be primarily through sexual and close familial contact, with cases occurring in areas without a history of mpox, such as [[South Kivu]] and [[Kinshasa]]. An estimated 64% of the cases and 85% of fatalities have occurred in children. The outbreak consists of two separate sub-variants of clade I, with one of the sub-variants having a novel mutation, making detection with standard assays unreliable.<ref name="drcmpox" /><ref>{{cite news | vauthors = Stawiska Z |title=Deadly Mpox Transmission in DR Congo Happening Under Radar; Most Victims are Children |url=https://healthpolicy-watch.news/deadlly-mpox-transmission-in-dr-congo-happening-under-radar-children-main-victims/ |access-date=6 August 2024 |agency=Health Policy Watch |date=13 March 2024 |archive-date=15 August 2024 |archive-url=https://web.archive.org/web/20240815030810/https://healthpolicy-watch.news/deadlly-mpox-transmission-in-dr-congo-happening-under-radar-children-main-victims/ |url-status=live }}</ref>

The outbreak spread to the neighbouring country of the [[Republic of Congo|Republic of the Congo]], with 43 cases reported in March 2024.<ref name="drcmpox" /> By August 2024, the outbreak spread further into central and southern Africa with cases of clade I and clade II strains reported in [[Burundi]], [[Rwanda]], [[Uganda]], [[Kenya]], [[Côte d'Ivoire]], and [[South Africa]].<ref name="cohen">{{cite news | vauthors = Cohen J |title=Deadlier strain of mpox spreads to multiple African countries |url=https://www.science.org/content/article/deadlier-strain-mpox-spreads-more-african-countries |access-date=5 August 2024 |agency=Science |date=3 August 2024 |archive-date=15 August 2024 |archive-url=https://web.archive.org/web/20240815030815/https://www.science.org/content/article/deadlier-strain-mpox-spreads-more-african-countries |url-status=live }}</ref><ref name=":1">{{cite web |date=5 August 2024 |title=WHO considers public health emergency as mpox cases mount in Africa |url=https://www.cidrap.umn.edu/mpox/who-considers-public-health-emergency-mpox-cases-mount-africa |access-date=6 August 2024 |website= [[Center for Infectious Disease Research and Policy]] (CIDRAP) |archive-date=6 August 2024 |archive-url=https://web.archive.org/web/20240806202217/https://www.cidrap.umn.edu/mpox/who-considers-public-health-emergency-mpox-cases-mount-africa |url-status=live }}</ref>

The WHO declared a global health emergency in August 2024.<ref name="MSN 20240814" /><ref name="WHO PR 20240814" /><ref>{{cite news |url=https://www.nytimes.com/2024/08/14/health/mpox-who-emergency-africa.html |title=W.H.O. Declares Global Emergency over New Mpox Outbreak |work=[[The New York Times]] |access-date=14 August 2024 |archive-date=14 August 2024 |archive-url=https://web.archive.org/web/20240814174239/https://www.nytimes.com/2024/08/14/health/mpox-who-emergency-africa.html |url-status=live | vauthors = Mandavilli A |date=14 August 2024 }}</ref> [[Sweden]] became the first non-African country to report a case of clade I mpox.<ref name=":5">{{cite news |title=Sweden confirms first case of mpox strain outside Africa |url=https://www.aljazeera.com/news/2024/8/15/sweden-confirms-first-case-of-mpox-strain-outside-africa |access-date=16 August 2024 |agency=Al Jazeera |date=15 August 2024}}</ref> A case of mpox was confirmed in Pakistan.<ref>{{cite web |title=Pakistan registers 1st case of mpox | date=16 August 2024 |url=https://www.dw.com/en/pakistan-registers-1st-case-of-mpox/a-69957813 |access-date=7 September 2024 |website=DW }}</ref>

==See also==
* [[1964 outbreak of mpox at Rotterdam Zoo]], in the Netherlands (with no cases in humans)
* [[2022–2023 mpox outbreak]]
* [[2022–2023 mpox outbreak in Canada]]
* [[2022–2023 mpox outbreak in the United States]]
* [[2022–2023 mpox outbreak in the United Kingdom]]

==Notes==
{{notelist}}

==References==
{{reflist}}

==External links==
{{Commons category|Monkeypox}}
* [https://www.cdc.gov/poxvirus/mpox/index.html Mpox] US [[Centers for Disease Control and Prevention]] (CDC)
* [https://www.who.int/news-room/fact-sheets/detail/monkeypox Monkeypox Fact Sheet] [[World Health Organization]] (WHO)
* [https://www.scientificamerican.com/article/could-monkeypox-take-over-where-smallpox-left-off/ "Could Monkeypox Take Over Where Smallpox Left Off?"]. ''[[Scientific American]]'', 4 March 2013.
* [https://www.monkeypoxtracker.net/ MonkeypoxTracker] – Monkeypox statistics visualization site
* [https://poxapp.stanford.edu/ PoxApp – the mpox app] – Assesses skin lesions and symptoms with [[artificial intelligence]] developed by [[Stanford University]]

{{Medical resources
| ICD11           = {{ICD11|1E71}}
| ICD10           = {{ICD10|B04}}
| ICD9            = {{ICD9|059.01}}
| SNOMED CT       = 359811007
}}
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