Materiały źródłowe

• #1

  https://www.who.int/news-room/fact-sheets/detail/mpox

  Mpox, previously known as monkeypox, is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. There are two distinct clades of the virus: clade I (with subclades Ia and Ib) and clade II (with subclades IIa and IIb). In 20222023 a global outbreak of mpox was caused by the clade IIb strain. […] Mpox continues to be a threat today, and an upsurge of cases in the Democratic Republic of the Congo and other countries caused by clades Ia and Ib has raised concern. […] A global outbreak of clade IIb began in 2022 and continues to this day, including in some African countries. There are also growing outbreaks of clades Ia and Ib affecting the Democratic Republic of the Congo and other countries in Africa. As of August 2024, clade Ib has also been detected beyond Africa.

• #2 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-formerly-monkeypox

  Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) […] EPIDEMIOLOGY […] Monkeypox virus (MPXV) was first isolated in Denmark in the late 1950s from a colony of laboratory monkeys from Singapore that were going to be used for polio virus research. During the following decade, additional outbreaks of mpox were seen in laboratory animals in the United States as well as zoo animals in Rotterdam. MPXV was first identified as a cause of disease in humans in the 1970s in what is now the Democratic Republic of the Congo (DRC). […] Geographic distribution — Since the discontinuation of smallpox immunization, which also protects against mpox, cases of mpox have generally occurred in Central and West Africa. The first outbreak of mpox in the Western hemisphere occurred in the United States in 2003. After that, sporadic cases were reported in several previously nonendemic countries, mostly related to travel from Africa. However, in May 2022 a global multi-country outbreak was recognized; this outbreak was associated with person-to-person transmission and involved thousands of individuals in dozens of countries. The geographic distribution of mpox outbreaks will be discussed here. Transmission of MPXV is discussed below.

• #3

  https://www.who.int/news-room/fact-sheets/detail/mpox

  More research is needed on how mpox spreads during outbreaks in different settings and under different conditions. […] The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research. The first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (1970). Following the eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa. Since then, mpox has been reported sporadically in central and east Africa (clade I) and west Africa (clade II). In 2003, an outbreak in the United States of America was linked to imported wild animals (clade II). Since 2005, thousands of cases are reported in the Democratic Republic of the Congo every year. In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travellers to other destinations.

• #4

  https://www.who.int/news-room/fact-sheets/detail/mpox

  In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions. The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men and has spread person-to-person through sexual networks. […] Since 2022, there has also been an upsurge in mpox cases and deaths in the Democratic Republic of the Congo. In some areas of the country, a new offshoot of clade I, called clade Ib, has been spreading person-to-person. As of mid-2024, the clade has also been reported in other countries. […] Over 120 countries have reported mpox between Jan 2022 Aug 2024, with over 100 000 laboratory-confirmed cases reported and over 220 deaths among confirmed cases.

• #5 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  Since 2017, there has been an increase in mpox cases in Nigeria; this occurred after almost 40 years with no reported cases. Some cases from this outbreak in Nigeria have occurred in travelers returning to nonendemic countries. In 2022, the WHO reported that mpox was endemic in several African countries including Benin, Cameroon, the Central African Republic, the DRC, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. From January to May 2022, most suspected cases of mpox occurred in the DRC, with 1284 cases and 58 deaths reported. […] Global multi-country outbreak — A global multi-country outbreak of mpox was first recognized in Europe in May 2022. Cases related to this outbreak were reported in previously nonendemic countries worldwide, providing evidence of community spread. On July 23, 2022, the WHO declared this outbreak of mpox a public health emergency of international concern. The public health emergency was declared over on May 11, 2023, but mpox cases have continued to occur since the emergency ended.

• #6 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  Thousands of confirmed mpox/orthopoxvirus cases in dozens of countries were subsequently reported. At the outbreak peak in the second week of August 2022, there were 1000 cases per day worldwide. By contrast, in 2024, 646 new laboratory-confirmed cases of mpox were reported during the entire month of May. An updated list of case counts and countries can be found on the Centers for Disease Control and Prevention (CDC) website, the European Centers for Disease Control website, and the WHO website. […] Additional details of this outbreak include: Burden of disease – During the multi-country outbreak that started in 2022, most cases have been identified in men who have sex with men (MSM), leading to the hypothesis that there may be spread as a result of close contact during sexual activity. In a report of 528 cases of confirmed human mpox infection from 16 countries between April and June of 2022, 98 percent of the persons were MSM. Although the number of mpox cases have decreased since 2023, most cases continue to be reported in MSM.

• #7 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-formerly-monkeypox

  Africa […] Outbreak in Central and East Africa starting in 2023 — On August 14, 2024, the World Health Organization (WHO) declared for a second time that mpox was a global public health emergency. From January 1, 2024 to August 18, 2024, a total of 21,786 laboratory-confirmed mpox cases leading to 607 deaths were reported from 12 African countries, with approximately 90 percent of the cases occurring in the DRC. Travel-associated cases outside of Africa have also been linked to this outbreak. […] This outbreak started in the DRC in early 2023 and then spread to neighboring countries including the Republic of the Congo and the Central African Republic. Although clade 1 mpox is endemic in these countries, the epidemiologic pattern suggested a link to the DRC. In July 2024, cases linked to the DRC were also reported in the previously nonendemic countries of Burundi, Rwanda, and Uganda.

• #8 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  The ongoing outbreak in Central and East Africa is complex because there appear to be two types of outbreaks happening: One is an outbreak from clade 1a virus that mostly involves children and is likely from multiple zoonotic introductions. This outbreak has occurred primarily in previously endemic rural areas of the northwestern provinces of the DRC through zoonotic spillover, and person-to-person transmission has occurred through household contact and within the health care setting. A second outbreak in previously unaffected and more populated regions of eastern DRC has also been noted. This outbreak mostly involves adults. In a report of 108 polymerase chain reaction (PCR)-confirmed mpox cases in a densely populated mining area, the median age of patients was 22 years, 52 percent were female, and 29 percent were sex workers, suggesting a role for sexual transmission.

• #9 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-formerly-monkeypox

  The ongoing outbreak in Central and East Africa is complex because there appear to be two types of outbreaks happening: One is an outbreak from clade 1a virus that mostly involves children and is likely from multiple zoonotic introductions. This outbreak has occurred primarily in previously endemic rural areas of the northwestern provinces of the DRC through zoonotic spillover, and person-to-person transmission has occurred through household contact and within the health care setting. A second outbreak in previously unaffected and more populated regions of eastern DRC has also been noted. This outbreak mostly involves adults. In a report of 108 polymerase chain reaction (PCR)-confirmed mpox cases in a densely populated mining area, the median age of patients was 22 years, 52 percent were female, and 29 percent were sex workers, suggesting a role for sexual transmission. This outbreak is due to a novel clade 1 lineage, clade 1b, which is linked to sustained human-to-human transmission.

• #10 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  Transmission — Animal-to-human and human-to-human transmission can occur. […] Animal-to-human transmission — MPXV can be acquired through contact with an infected animal’s bodily fluids or through a bite. It can also be acquired through preparation of bushmeat (raw or minimally processed meat that comes from wild animals in certain regions of the world, including Africa). […] In Africa, evidence of MPXV infection has been found in many types of animals, including rope squirrels, tree squirrels, Gambian pouched rats, dormice, and different species of monkeys. Monkeys and humans are incidental hosts; the reservoir remains unknown but is likely to be rodents. […] Findings from the 2003 United States prairie dog outbreak highlighted the importance of type of exposure and risk of infection (eg, bite wound versus touching an infected animal) as well as severity of clinical manifestations of mpox, presumably related to level of exposure. As an example, one study categorized exposures to a prairie dog as noninvasive (eg, the person touched an infected animal, cleaned an infected animal’s cage) or „complex” (eg, invasive bite or scratch from an ill prairie dog). Patients with complex exposures were more likely than patients with noninvasive exposures to develop signs of systemic illness.

• #11 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  Human-to-human transmission […] Routes of person-to-person transmission — Human-to-human transmission of MPXV can occur in several ways: […] Direct contact – Spread of MPXV is thought to occur primarily through direct contact with infectious sores, scabs, or body fluids. As such, mpox can spread during activities that include close, personal contact with an infected individual. Transmission may be facilitated by touching infectious material and then the facial mucous membranes or any breach in the skin of the recipient. […] During the multi-country outbreak of mpox that started in 2022, close contact with infectious material from skin or lesions on mucous membranes (eg, occurring during sexual and/or close intimate contact) is considered the main risk factor for acquisition. […] In most cases, transmission occurs from persons who are already symptomatic; however, some people can spread MPXV to others from one to four days before symptoms onset. Data from the Netherlands reported five cases where transmission occurred before the person who transmitted the infection developed symptoms.

• #12 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  The risk of transmission after specific types of nonsexual exposures is discussed separately. […] Indirect contact through fomites – Transmission can occur through contact with materials or fomites that have become contaminated with infected material in the household or patient care environment, such as clothing or linens contaminated with infectious material from body fluids or sores. In one report that investigated respiratory isolation rooms, viral DNA was found in rooms, bathrooms, anterooms, and on nontouch surfaces (eg, >1.5 meters from the bed) as well as on health care workers’ PPE. […] It is unclear whether contact through fomites is a common source of transmission however, the widespread surface contamination of the patient care environment calls for a systematic approach to the use of infection prevention precautions in the home and healthcare settings.

• #13 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  Respiratory secretions – It is unclear to what degree mpox is spread through respiratory secretions. Most of the mpox transmission studies in humans before 2022 were conducted in African households, and while droplet transmission was thought to have played a role, household settings involve various modes of acquisition such as caregiving and bed-sharing. In addition, in a health care setting investigation in 2022 in the United States, none of the 313 health care personnel exposed to patients with mpox became infected. This included seven individuals reportedly exposed during aerosol-generating procedures, four of whom did not wear an N95 respirator. […] However, activities resulting in resuspension of dried material from lesions (eg, shaking contaminated linens) may present a risk and should be avoided. During the multi-country outbreak, a study evaluating 181 mpox cases found that samples from skin lesions contain much more viral DNA than do those from the throat.

• #14 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  Vertical transmission – The virus can cross the placenta from the mother to her fetus, which can lead to congenital mpox, although the rate of transmission or risk by trimester is not known. In a report of four pregnant women with mpox from the DRC, one gave birth to a healthy infant, two had miscarriages in the first trimester, and one had fetal death with the stillborn showing diffuse cutaneous maculopapular skin lesions consistent with vertical transmission. During the multi-country outbreak, one case of perinatal transmission was reported, but pregnancy has not always resulted in transmission to the baby. […] Percutaneous inoculation – There have been case reports of transmission via needlestick injuries from supplies used to collect cutaneous lesion samples. The mpox lesions appeared at the site of the needlestick. Transmission has also been associated with piercing or tattooing; in some of these cases patients presented with a systemic cutaneous rash.

• #15 Epidemiology, clinical manifestations, and diagnosis of mpox (formerly monkeypox) – UpToDate

  https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-mpox-monkeypox

  Risk of spread through other body fluids – At this time, it is not known if mpox can spread through semen, vaginal fluids, or other body fluids, although viral DNA has been detected in semen. In a report of 12 cases from Spain during the multi-country outbreak, there were high rates of PCR positivity in specimens collected from saliva, semen, urine, and feces. In a multi-country study, 29 of 32 semen samples had detectable MPXV DNA. In at least one case, MPXV isolated from a semen sample was replication competent in cell culture, but it is still unknown if semen can transmit an infection. Thus, testing of semen should not be used to guide precautions after recovery or assessing the risk of onward transmission given lack of data. […] Risk of transmission in different settings — The risk of transmission may vary depending upon the setting.

• #16 Mpox in the United States and Around the World: Current Situation | Mpox | CDC

  https://www.cdc.gov/mpox/situation-summary/index.html

  There have been cases or outbreaks of clade I mpox in several countries in Central and Eastern Africa. […] CDC is working with public health partners in the United States and throughout Africa to monitor for mpox cases and increase surveillance capacity, in addition to other activities. […] CDC regularly assesses the risk to the overall population and specific populations within the United States posed by the clade I mpox outbreak; it remains low. […] CDC continues critical work to protect the United States from emerging and infectious diseases. […] CDC has collaborated closely with key USG partners in affected countries to help support efforts to stop mpox at the source. […] CDC and in-country partners across Africa have worked together on disease surveillance, laboratory capacity-building, strengthening local workforce capacity, case investigation, strengthening case management, infection prevention and control, and vaccine strategy and planning.

• #17 Mpox in the United States and Around the World: Current Situation | Mpox | CDC

  https://www.cdc.gov/mpox/situation-summary/index.html

  CDC trained 80 field epidemiologists in DRC and continues to provide key support for many who are still working in priority health zones. […] CDC works closely with state, tribal, local, and territorial public health departments to provide recommendations for clinical management, diagnosis, and prevention of mpox cases in the U.S. […] CDC continually increases capacity in communities across the United States for early detection of mpox through existing surveillance systems, including wastewater testing. […] CDC conducts assessments to determine the risks of mpox to the people in the United States.

• #18 Joint ECDC-WHO Regional Office for Europe Mpox Surveillance Bulletin

  https://monkeypoxreport.ecdc.europa.eu/

  In the last three months, 713 cases have been reported from 24 countries and areas. Over the past 4 weeks, 289 cases of mpox have been identified from 18 countries and areas. […] Since 7 March 2022, a total of 29 607 cases of mpox (formerly named monkeypox) have been identified through IHR mechanisms, official public sources and The European Surveillance System (TESSy) up to 14 April 2025, 14:00, from 47 countries and areas throughout the WHO European Region. Case-based data were reported for 29 455 cases from 43 countries and areas to ECDC and the WHO Regional Office for Europe through TESSy, up to 14 April 2025, 10:00. Of the 29 455 cases reported in TESSy, 0.65% were probable cases. […] Since August 2024, 23 cases of clade 1b have been detected in 6 countries. All these cases either travelled themselves or are contacts of travelers from countries with known local transmission of clade Ib. Also one case of clade 1a has been detect in Ireland.

• #19 U.S. Mpox Wastewater Data | National Wastewater Surveillance System | CDC

  https://www.cdc.gov/nwss/wastewater-surveillance/mpox-data.html

  Wastewater (sewage) can be tested to detect the virus that causes mpox circulating in the community. This data can provide an early warning of mpox activity and spread in communities and inform public health action. […] Wastewater sites across the United States are testing for traces of the virus that causes mpox. Wastewater data are updated every Friday with the previous weeks data, which allows for data to be reviewed for accuracy. Data may change as more reports are received. […] Laboratory tests are used for monitoring wastewater for the virus that causes mpox. These tests can tell us if genetic material from the virus (viral DNA) is present in untreated community wastewater. […] Currently, testing methodology for the virus that causes mpox varies between wastewater sites. […] Wastewater detections of the virus that causes mpox in the past 4 weeks, United States

• #20 U.S. Mpox Wastewater Data | National Wastewater Surveillance System | CDC

  https://www.cdc.gov/nwss/wastewater-surveillance/mpox-data.html

  There are two distinct genetic clades of the virus that causes mpox: clade I and clade II. […] Clade II mpox cases continue to spread at low levels in many countries around the world, including the United States. […] Wastewater surveillance complements other existing surveillance systems to monitor mpox. Mpox wastewater data include data collected and reported to CDCs National Wastewater Surveillance System (NWSS) by: […] Sources reporting wastewater mpox data to CDC use different methodologies. Some test wastewater solids, others test liquids, and some test both. The data displayed does not differentiate between methodologies.

• #21 Evaluation of the mpox surveillance system in Cameroon from 2018 to 2022: a laboratory cross-sectional study | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09802-2

  Formal assessment of a surveillance systems features and its ability to achieve objectives is crucial for disease control and prevention. Since the implementation of the mpox surveillance system in Cameroon, no evaluation has been conducted. […] In Cameroon, mpox is a priority disease under surveillance in both the human health and zoonosis sectors. The surveillance strategy involves case-based surveillance under the Integrated Disease Surveillance and Response (IDSR) strategy implemented in 2002, with immediate notification of suspected cases. […] Despite efforts to enhance surveillance following global outbreaks, MPXV cases in Cameroon remain underreported and outbreaks are often detected late. The exact burden of mpox in Cameroon is unknown, highlighting the need for formal evaluation of the surveillance system to ensure its effectiveness and identify areas for improvement. The mpox surveillance system has not been assessed since its establishment in Cameroon.

• #22 Global Mpox Trends

  https://worldhealthorg.shinyapps.io/mpx_global/

  This report provides a comprehensive summary of data from the global mpox surveillance started by WHO in 2022, and strengthened during the ongoing public health emergency of international concern (PHEIC). […] For further information on the epidemiological situation in Africa, see Section 3. […] The current spread of mpox in the Democratic Republic of the Congo is attributed to two increasingly interspersed outbreaks: […] The spread of clade Ia MPXV, largely in endemic provinces of the country, and […] The spread of clade Ib MPXV, which emerged in 2023 in the South Kivu province. […] Clade Ib MPXV recently emerged in the eastern part of the Democratic Republic of the Congo and is undergoing sustained human-to-human transmission. […] In the Democratic Republic of the Congo, a significant number of suspected mpox cases, that are clinically compatible with mpox remain untested due to limited diagnostic capacity and thus never get confirmed.

• #23 Global Mpox Trends

  https://worldhealthorg.shinyapps.io/mpx_global/

  Moreover, not all countries have robust surveillance systems for mpox, meaning reported case counts are likely underestimating the extent of community transmission. […] The distribution of clades reported in Africa, and the outbreak status of countries on the continent is shown in the maps below. […] The latest global mpox rapid risk assessment in February 2025. Based on the available information, the risk is assessed as follows: […] Please note that regardless of geographic area, epidemiological context, biological sex, gender identity or sexual behaviour, individual-level risk is largely dependent on individual factors such as exposure risk and immune status. […] The report presents trends based on three key data sources: […] All surveillance data are subject to reporting delays, and data cleaning is ongoing.

• #24 Monkeypox: a review of epidemiological modelling studies and how modelling has led to mechanistic insight

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10468816/

  The epidemiological model framework for mpox has been established over the past few decades, and many models capturing human-human, and animal-human interactions have been explored. […] The SIR model often oversimplifies complex disease transmission dynamics. […] The increase in cases from the 2022 mpox global outbreak has been shown to be strongly associated with close intimate sexual contact. […] Population-level human-to-human models of mpox throughout the 2022 epidemic have been largely based on SIR and SEIR frameworks. […] The population modelling studies of the 2022 global outbreak all agree, based on current data on mpox trends, that the outbreaks occurring in non-endemic countries are generally under control and on a declining trend. […] Predictive modelling for future mpox peaks will be important in aiding policy decision-makers.

• #25 Monkeypox: a review of epidemiological modelling studies and how modelling has led to mechanistic insight

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10468816/

  The recent 2022 emergence and outbreaks of mpox are still under investigation. One hypothesis for the increase in cases relates to the decline in population cross-immunity provided by the smallpox vaccine. […] The declining immunity from vaccination to smallpox represents an epidemiological threat by increasing the mpox reproduction number. […] The basic reproduction number, R0, of any infectious disease is dynamic and depends on many variables, including characteristics of the pathogen characteristics and the host. […] A definitive mpox virus reservoir host is still unknown and under study. Currently, giant-pouched rats, rope squirrels, and African dormice are posited as the most likely candidates. […] The One Health approach aims to recognize the strong linkage between the health of humans, animals, plants, and the environment, to develop integrated and sustainable solutions. […] Climate change has altered human-environment systems. The emergence and re-emergence of many infectious diseases are projected to increase due to the negative impact of climate change. […] Understanding mpox spatial ecology is essential to predict future outbreaks under climate change conditions.

• #26 Updating Reproduction Number Estimates for Mpox in the Democratic Republic of Congo Using Surveillance Data in: The American Journal of Tropical Medicine and Hygiene Volume 110 Issue 3 (2024)

  https://www.ajtmh.org/view/journals/tpmd/110/3/article-p561.xml

  Incidence of human monkeypox (mpox) has been increasing in West and Central Africa, including in the Democratic Republic of Congo (DRC), where monkeypox virus (MPXV) is endemic. […] Most published estimates of Rt for MPXV in the DRC are based on data from the 1980s and range from approximately 0.3 to 0.5. […] Given the changing epidemiology of mpox, updated estimates of the virus transmissibility are needed in historically affected countries. The aims of this study were to identify clusters of mpox cases from surveillance data in Tshuapa Province, DRC, and to use the cluster sizes to estimate Rt and the rate at which MPXV spills over into the human population. […] We estimated an Rt of 0.82 (95% CI: 0.79-0.85) and an annual spillover rate of MPXV into the human population of 132 (95% CI: 122-143). […] Our results suggest that the transmissibility of MPXV in the DRC has more than doubled since the 1980s. […] The estimated Rt from our study is consistent with a study published in 2020. […] Further research is needed to understand why the Rt for MPXV has increased in the DRC.

• #27 Global genomic surveillance of monkeypox virus | Nature Medicine

  https://www.nature.com/articles/s41591-024-03370-3

  The global mpox surveillance that was quickly established in 2022 provided a platform for the generation of genome sequencing data. […] Mpox surveillance programs and their associated genomic strategies globally remain critical to the understanding of the disease and the characterization of the virus evolutionary trajectory and genetic diversity, and provide potential insights into the associated phenotype. […] Our results therefore underpin the importance of further studies to understand how humans become infected with clade I viruses and studies carrying out functional characterization of diverse clade I viruses.

• #28 Global genomic surveillance of monkeypox virus | Nature Medicine

  https://www.nature.com/articles/s41591-024-03370-3

  Monkeypox virus (MPXV) is endemic in western and Central Africa, and in May 2022, a clade IIb lineage (B.1) caused a global outbreak outside Africa, resulting in its detection in 116 countries and territories. […] Our study underscores the importance of genomic surveillance in tracking spatiotemporal dynamics of MXPV clades and the need to strengthen such surveillance, including in some parts of eastern Africa. […] In response to the global outbreak, a number of countries have started to establish mpox surveillance programs. […] In addition to the global outbreak, the detection of mpox is spreading to new African countries such as Burundi, Rwanda, Uganda and Kenya, which led to the declaration of a second Public Health Emergency of International Concern in August 2024 by the World Health Organization (WHO).

• #29 Welcome to the Mpox (Monkeypox) outbreak toolbox

  https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/mpox-outbreak-toolbox

  Mpox epidemiology, preparedness and response for African outbreak contexts: Open WHO course. (Geneva: World Health Organisation; 2020). […] Variole du singe : pidmiologie, prparation et rponse aux contextes d’pidmies en Afrique (Geneva: Organisation Mondiale de la Sant ; 2022). […] Surveillance, case investigation and contact tracing for Mpox, Interim guidance (Geneva; World Health Organization, 20 March 2024). […] Considerations for wastewater and environmental surveillance for monkeypox virus: Interim guidance 2024.

• #30 Strengthening Africa’s Fight Against Mpox: A Unified Surveillance Protocol – Africa CDC

  https://africacdc.org/news-item/strengthening-africas-fight-against-mpox-a-unified-surveillance-protocol/

  In response, Africa CDC declared mpox a Public Health Emergency of Continental Security in August 2024, highlighting the need for immediate and coordinated action. […] To address these challenges, Africa CDC introduced a comprehensive protocol aimed at standardising surveillance and improving case detection. […] By harmonising data collection and leveraging genomic sequencing, it seeks to track viral evolution, identify at-risk populations, and enhance outbreak response. […] Central to the protocols success is the timely collection and reporting of data, which requires member states to share comprehensive information on cases, including demographic details, symptoms, and genomic sequencing outcomes. […] This systematic approach ensures a consistent flow of information to Africa CDC and WHO, facilitating effective resource mobilisation and real-time monitoring.

• #31 Strengthening Africa’s Fight Against Mpox: A Unified Surveillance Protocol – Africa CDC

  https://africacdc.org/news-item/strengthening-africas-fight-against-mpox-a-unified-surveillance-protocol/

  Moreover, harmonising data collection across member states fosters collaboration and strengthens regional public health initiatives. […] By ensuring that all member states adhere to standardised reporting protocols, the initiative enhances the overall capacity to respond to outbreaks swiftly and effectively. […] The protocol recommends collecting lesion samples for testing, with nucleic acid amplification testing (NAAT) identified as the primary diagnostic tool. […] Additionally, genomic sequencing enhances diagnostic capabilities by tracking viral mutations and identifying new strains, which is vital for monitoring the evolution of the virus and informing public health responses. […] Monitoring and evaluation mechanisms ensure the protocols effectiveness. […] The protocol emphasises genomic sequencing to uncover mpoxs evolution and transmission dynamics.

• #32 Mpox in Central Africa: complex epidemiology requires a constellation approach | npj Viruses

  https://www.nature.com/articles/s44298-024-00081-x

  In September 2023 an outbreak of Clade I mpox associated with human-to-human circulation among sexual networks was reported in South Kivu province, DRC, and genomic analysis of these early cases identified a novel subclade, Clade Ib, associated with more sustained human-to-human transmission. […] In 2023, there were 14,626 suspected mpox cases in DRC and thus far in 2024 case counts have more than doubled with 30,766 suspected mpox cases reported from January 29-September 2024. […] This rapid expansion of case counts and geographic distribution has led to the implementation of the first vaccination campaigns on the African continent and regional discussions on disease control and case management in DRC and Nigeria. […] Thus, this is an opportune time to reflect on the factors complicating the epidemiology of mpox in Central Africa and discuss the current pressing need for comprehensive and long-lasting mpox control across endemic regions.

• #33 Mpox in Central Africa: complex epidemiology requires a constellation approach | npj Viruses

  https://www.nature.com/articles/s44298-024-00081-x

  Assessing the case fatality rate for Clade I mpox has been similarly confounded. […] Recent epidemiological analysis has highlighted the differences found across age groups and estimated an overall CFR of 2.9%. […] However, epidemiological data largely suggest that Clade I mpox CFRs typically range from 1-4.5%. […] Taken together, it is important to improve disease reporting structures and consider the impacts of confounding variables such as age, region, and underlying health status when considering mpox CFRs. […] A high-impact and lasting response strategy is urgently needed to contain this growing regional mpox outbreak and prevent future outbreaks.

• #34 WHO analysis of 67 years of mpox surveillance data reveals patterns in spread, mutations over time | CIDRAP

  https://www.cidrap.umn.edu/mpox/who-analysis-67-years-mpox-surveillance-data-reveals-patterns-spread-mutations-over-time

  A World Health Organization (WHO) analysis of global mpox surveillance from 1958 to 2024 reveals highly mobile clade 1 viruses in Central Africa, sustained human-to-human spread of clade 2b lineage A in the Eastern Mediterranean, distinct mutations that can distinguish between sustained transmission among humans with that among animals, and unique clade 1 sequences from Sudan that suggest local circulation in Eastern Africa. […] As of August 12, 2024, the outbreak, which is mainly driven by sexual transmission among men who have sex with men, had led to 99,176 infections and 208 deaths, for a case-fatality rate of 0.21%. […] It is now time to strengthen mpox surveillance, including in Africa, focusing on populations at highest risk and ensuring integration with existing systems to ensure comprehensive and seamless delivery of care. […] „If we want to prevent the next mpox global outbreak, it is now time to strengthen mpox surveillance, including in Africa, focusing on populations at highest risk and ensuring integration with existing systems to ensure comprehensive and seamless delivery of care.”

• #35 JMIR Public Health and Surveillance – Spatiotemporal Epidemiological Trends of Mpox in Mainland China: Spatiotemporal Ecological Comparison Study

  https://publichealth.jmir.org/2024/1/e57807/

  These findings provide geographically precise and visualized evidence to assist in identifying key areas for targeted prevention and control. […] The WHO declared mpox an international public health emergency on July 23, 2022, which was reaffirmed on February 15, 2023. […] According to the WHO, the confirmation of a single case of mpox in a country is considered an outbreak. […] Therefore, it is crucial to prioritize the mpox pandemic owing to its potentially disastrous consequences for public health, socioeconomic factors, and overall health care systems. […] Spatial epidemiological studies have accurately visualized the spatial distribution and clustering of diseases via mapping. […] The attack rate is a crucial indicator for measuring the frequency and intensity of disease occurrence and for evaluating the effectiveness of disease prevention and control within a short period. […] Our analysis aimed to identify spatial distribution characteristics and spatial clustering patterns and to determine the presence of cold and hot spots of spatial clustering.

• #36 Development of Machine Learning-Based Mpox Surveillance Models in a Learning Health System | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.09.25.24314318v2

  We developed machine learning and deep learning models to identify mpox cases from clinical notes as part of a learning health system initiative. […] Lasso regression outperformed deep learning models, excelled in minimizing false positives, and may prove helpful for flagging missed or delayed diagnoses as part of continuous quality improvement.

• #37

  https://link.springer.com/article/10.1007/s40726-024-00299-6

  The purposes of WBS of MPXV are rapidly identified hotspots, clusters, and areas of the source of spreading this virus. […] The findings suggest wastewater can be used to effectively detect and monitor MPXV. […] The results highlight that wastewater surveillance could be used as a complementary early warning tool for monitoring future Mpox.

• #38 Mpox test support | Mpox surveillance | QIAGEN

  https://www.qiagen.com/us/applications/infectious-disease/monkeypox

  Mpox is an ongoing global health challenge, with continued cases in endemic countries and the offshoot of the clade I variant, clade Ib. An effective public health response to mpox requires coordinated action surveillance, diagnostics, risk communication and community engagement. […] We support wastewater-based epidemiology efforts with research tools spanning nucleic acid extraction, amplification and detection.

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