Mpox

Primary reference(s)

WHO, 2024. Mpox. World Health Organization. Accessed 26 May 2025.

Annotations

Key relevant UN convention / multilateral treaty

International Health Regulations (2005), 3rd ed. (WHO, 2016).

Drivers

Exposure to body fluids or skin lesions or eating inadequately cooked meat of infected animals is a possible risk factor (WHO, 2017).

Secondary, or human-to-human, transmission can result from close contact with infected respiratory tract secretions, skin lesions of an infected person or objects recently contaminated by patient fluids or lesion materials. Transmission occurs primarily via respiratory droplets or mucous membranes, usually requiring prolonged face-to-face contact, which puts household members of active cases at greater risk of infection. Transmission can also occur by inoculation or via the placenta as in congenital pox (WHO, 2017).

Children, pregnant people and people with weak immune systems, including people living with HIV that is not well controlled, are at higher risk for serious illness and death due to complications from mpox (WHO, 2024a).

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.

Groups that may be at high risk of mpox include:

• health and care workers at risk of exposure,
• people in the same household or close community as someone who has mpox, including children,
• people who have multiple sex partners, including men who have sex with men; and
• sex workers of any gender and their clients.

Impacts

Some people with mpox become very sick. For example, the skin can become infected with bacteria, leading to abscesses or serious skin damage. Other complications include pneumonia; corneal infection with loss of vision; pain or difficulty swallowing; vomiting and diarrhoea causing dehydration or malnutrition; and infections of the blood (sepsis), brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis). Mpox can be fatal in some cases (WHO, 2024a). 

Stigma and discrimination against any disease are never acceptable. Stigma linked to mpox can undermine public health efforts or prolong a disease outbreak, as people may be more reluctant to come forward and seek care and treatment. For mpox, stigma, discrimination and racism have been particularly directed against communities initially most affected by the disease, namely men who have sex with men, trans people and gender-diverse communities (WHO, 2024a). 

Multi-hazard context

The natural reservoir of the Mpox virus is unknown, but various small mammals such as squirrels and monkeys are susceptible. Mpox can be transmitted through close contact with someone who has mpox, with contaminated materials, or with infected animals. During pregnancy, the virus may be passed to the foetus, or to the newborn during or after birth (WHO, 2024a). 

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. More information on the global outbreak is available here, including information on community responses to control the outbreak. (WHO, 2024a). 

In 2022, outbreaks of mpox due to clade I occurred in refugee camps in the Republic of the Sudan. 

Since 2022, there has also been an upsurge in mpox cases and deaths in the Democratic Republic of 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. (WHO, 2024a). 

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 (WHO, 2024a).

Risk Management

Getting an mpox vaccine can help prevent infection (pre-exposure prophylaxis). It is recommended for people at high risk of getting mpox, especially during an outbreak. The vaccine can also be administered after a person has been in contact with someone who has mpox (post-exposure prophylaxis). In these cases, the vaccine should be given less than 4 days after contact with someone who has mpox. The vaccine can be given for up to 14 days if the person has not developed symptoms (WHO, 2022a). 

To prevent the spread of mpox to others, people with mpox should isolate at home following guidance from their health care provider, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a well-fitting mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk of getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact. If having sex, use condoms as a precaution for 12 weeks (about 3 months) after you have recovered. Taking a break from sexual activity with new partners during periods of increased transmission can reduce the risk of getting mpox. Those who have had contact with someone with mpox should monitor for signs and symptoms for 21 days (3 weeks) and take precautions such as avoiding sexual activity during this period (WHO, 2024a). 

Some antivirals have received emergency use authorization in some countries and are being evaluated in clinical trials. To date, there is no proven effective antiviral treatment for mpox. It is a priority to continue the evaluation of therapeutics in robust clinical trials and to focus on optimizing supportive care for patients. Conservative treatment of rash lesions is recommended depending on their stage, with aims to relieve discomfort, speed healing and prevent complications, such as secondary infections or exfoliation (WHO 2022b; 2024a). 

Surveillance and rapid identification of new cases is critical for outbreak containment (WHO, 2017). The key objectives of surveillance and case investigation for mpox are to rapidly identify cases and clusters of infections as well as the sources of infection as soon as possible in order to: provide optimal clinical care; isolate cases to prevent further transmission; identify, manage and follow-up contacts to recognize early signs of infection; identify risk groups for infection and for severe disease; protect frontline health workers; and tailor effective control and prevention measures (WHO, 2024c). 

Infection in people can be reduced by raising awareness of the risk factors and educating people about measures they can take to reduce exposure to the virus. Control measures include isolation of affected persons, good respiratory and hand hygiene, and other personal protective measures. Those at highest risk, such as health workers or laboratory personnel, can be protected through vaccination. A vaccine against mpox was licensed in 2019 (WHO, 2019; 2020). 

Health workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard and droplet infection control precautions (WHO, 2024a). 

WHO, Member States and partners work together to prevent and respond to outbreaks of mpox. This includes coordinating research on vaccines and treatments, strengthening country health systems, and working to facilitate equitable access to vaccines, therapeutics, diagnostics and other tools (WHO, 2024a).

Monitoring

The section and the table below offer an overview of monitoring for mpox. This information can be used for forecasting within a national early warning system (EWS). Since EWS capacities and processes differ across countries, the most current and specific information regarding EWS should be obtained from the appropriate national or regional agency/authority responsible for disaster management.