Mpox worldwide overview

Mpox clade II summary

Mpox clade II has been circulating globally since 2022. In African countries with recent mpox clade II outbreaks (e.g. Ghana, Guinea, Liberia), cases have been reported among young adults, affecting both males and females. Sexual contact has been described as a main driver of transmission (Multi country outbreak of mpox, External situation report #60 – 8 December 2025, Multi-country outbreak of mpox, External situation report #62-23 January 2026, Multi-country external situation report #63– 24 February 2026, Multi-country oubtreak of mpox, External Situation Report #65-30 April 2026). According to the WHO data published on 8 May, including cases as of 3 May 2026, fewer than 100 cases have been reported the past six weeks and as of 3 May in Guinea (34 cases) and Liberia (25 cases). Outside Africa, cases were mostly reported in adults (99%) and males (97%), the majority of whom reported having had sex with men (89%) (Global Mpox Trends published 8 May 2026).

Mpox clade I summary and transmission patterns classification

In Africa, since 2025, the five countries that reported most confirmed mpox clade I cases are DRC, Uganda and Burundi, followed by Madagascar and Kenya. According to WHO, in the past six weeks, and as of 3 May 2026, most confirmed cases of clade I were reported by Madagascar and DRC (656 and 154 cases, respectively). All other countries in Africa with clade I detections have reported fewer than 100 cases during the last six weeks. Overall, a decreasing trend in mpox clade I cases that has been reported in Africa since May 2025 continues in March 2026 (Global Mpox Trends published 8 May 2026). 

Since August 2024, in EU/EEA travel-associated mpox clade I cases, or locally-acquired mpox clade I cases have been reported by several EU/EEA countries (Surveillance of Mpox in the EU/EEA, monthly report, April 2026). In addition to Africa and the EU/EEA, since August 2024, mpox clade I cases have been reported by Thailand, India, Türkiye, the United Kingdom, the United States, Canada, Pakistan, Oman, China, the United Arab Emirates, Qatar, Brazil, Switzerland, Australia, Japan, Israel, Mexico, Nepal, Singapore, Colombia, Malaysia, Argentina, and Ecuador (Global Mpox Trends published 8 May 2026). Most travel-associated cases reported outside African countries had links to affected countries in Africa. Imported cases with a travel history to China, Germany, Lebanon, Malaysia, Nepal, Netherlands, Oman, Pakistan, Russia, Thailand, United Arab Emirates, and VietNam have also been reported (Global Mpox Trends published 8 May 2026).

Since October 2025, several EU/EEA countries have reported mpox clade I in men who have sex with men, most of whom have no travel history. In addition to the cases reported among men who have sex with men, confirmed limited secondary transmission of clade I within households has been reported in the EU/EEA, mainly among household contacts since 2024, by Germany, Belgium, and Ireland. Outside the EU/EEA and Africa, secondary transmission has also been reported in the UK, China, Qatar, and Australia. The number of secondary cases reported in these events has been low (range: 1–6 cases per event; Global Mpox Trends published 6 March 2026). Based on the information available, all transmission events were due to close contact and no deaths were reported. 

In March-April 2026, Pakistan reported an mpox oubreak among neonates where clade Ib was identified. Overall, 249 suspected cases were reported 14 March-20 April, including 29 laboratory confirmed and 8 deaths. The cases were reported across nine districts in Sindh province (Multi country oubtreak of mpox, External Situation Report #65-30 April 2026).

Transmission patterns of mpox due to MPXV clade I – update 12 March 2026

Since September 2024, following an analysis of the patterns of MPXV transmission observed at the national level and given the limitations and uncertainties, ECDC has used official epidemiological information to classify countries that have reported MPXV clade I cases since 2024. 

The definitions of the categories have been revised to account for context and availability of epidemiological data (see note below). The classification is as follows: 

• Community transmission: Burundi, Central African Republic, Congo, DRC, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Pakistan, Rwanda, the United Arab Emirates, Tanzania, Uganda, and Zambia. 
• Countries with travel-associated cases or limited transmission: Angola, Argentina, Austria, Australia, Belgium, Brazil, Canada, China, Colombia, Comoros, Czechia, Denmark, Ecuador, France, Germany, Greece, India, Ireland, Israel, Italy, Japan, Luxembourg, Malaysia, Mauritius, Mexico, Namibia, Nepal, the Netherlands, Oman, Poland, Portugal, Romania, Qatar, Senegal, Singapore, Slovakia, Spain, South Africa, South Sudan, Sweden, Switzerland, Thailand, Türkiye, the United Kingdom, the United States, and Zimbabwe. 

Note: Community transmission is defined as follows: 
When there are adequate epidemiological data and the following apply: 

• cases without links to travel-associated cases are reported, 
• multiple age groups are affected, 
• cases are reported outside specific risk groups/settings, 
• there is wide geographical spread. 

If epidemiological data and/or testing are known to be limited and at least one of the following apply: 

• there is a large number of suspected cases, 
• there are multiple (suspected or confirmed) cases with limited data on transmission chains, 
• multiple cases likely infected in the country are reported from other areas/countries. 

Countries are classified as with travel-associated cases or limited transmission when the following apply: 

• only travel-associated cases have been reported; 
• sporadic cases have been reported having epidemiological links with travel-associated cases; 
• there is only a small number of cases for which epidemiological links to travel-associated cases have not been reported or are unclear; 
• transmission chains are mostly contained within specific groups or settings (e.g. groups with high numbers of sexual partners, camps with internally displaced populations, prisons); 
• there is limited spillover to other groups (e.g. children); 
• zoonotic spillover and small clusters of cases reported in endemic countries; 
• there is no evidence of wider community transmission (e.g. clade I following patterns similar to clade II in countries where clade II has been reported since 2022 and has been circulating continuously at low levels and in groups with high numbers of sexual contacts).

In the most recent update of 13 May 2026, Pakistan has been added to the category of countries with community transmission (Multi-country oubtreak of mpox, External Situation Report #65-30 April 2026). The category of countries with travel-associated cases or limited transmission has been updated to include countries that reported clade I for the first time since the previous update. There are several limitations and caveats in the classification of community transmission of mpox clade I as the extend of ongoing undetected transmission cannot be quantified with certainty. Moreover, a number of countries have reported cases with travel history to regions/countries with limited number of clade I cases or no clade I cases and further information on transmission chains is not available (Global Mpox Trends published 8 May 2026), For example, VietNam, Mali, Russia, and Lebanon have not reported any mpox clade I detection and they have been reported as places of travel of known cases elsewhere. Imported cases with a travel history to countries that have reported a small number of mostly travel associated cases have also been reported e.g. Malaysia, Nepal, Thailand, Oman, and China (Global Mpox Trends published 8 May 2026). Countries that have been categorised as having community transmission for fulfilling the definitions may be reporting currently smaller number of cases (e.g. Kenya) or decreasing case trends. All the above should be taken into account when interpreting the classification.