2022–2023 mpox outbreak

2022 monkeypox outbreak
Spread of disease as of 12 July 2022   Endemic West African clade   Endemic Congo Basin (Central African) clade   Both clades recorded   West African clade outbreak in 2022   Suspected cases
Disease	Human monkeypox
Virus strain	Monkeypox virus (MPV), West African clade, 2017–2019 outbreak subclade
Source	Travel from Nigeria (presumed/hypothesis)
Standort	69 countries and territories (see § Cases per country and territory) (65 have confirmed cases while 4 have only suspected cases)
First outbreak	London, England (first outside West Africa)
Date	4 May 2022 – Present (2 years, 4 months, and 14 days)
Confirmed cases	12,956
Suspected cases‡	152
Deaths	12 (in African countries) [1 in Nigeria, 2 in the Central African Republic and 9 in the Democratic Republic of the Congo]
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

An ongoing outbreak of the viral disease monkeypox was confirmed in May 2022, beginning with a cluster of cases found in the United Kingdom. The first confirmed case was traced to an individual with travel links to Nigeria (where the disease is endemic) and was detected on 6 May 2022, although it has been suggested that cases were already spreading in the previous months. From 18 May onwards, cases were reported from an increasing number of countries and regions, predominantly in Europe, but also in North and South America, Asia, Africa, and Australia. As of 15 July, there have been a total of 12,590 confirmed cases. A total of 12 deaths have been confirmed as well. As of 27 June, the World Health Organization has declared this an "evolving health threat" rather than a Public Health Emergency of International Concern (PHEIC).

The outbreak marked the first time the disease has spread widely outside Central and West Africa. Cases have mainly but not exclusively been identified amongst men who have sex with men (MSM), but health authorities emphasized that anyone can catch the disease, particularly if they have close contact with a symptomatic person. Initial WHO assessments expressed the expectation of the outbreak to be contained, and of low impact to the general population in affected countries. A more recent statement acknowledged that undetected transmission had occurred for some time and called for urgent action to reduce transmission.

Monkeypox is a viral infection that manifests a week or two after exposure with fever and other non-specific symptoms, and then produces a rash with blisters that can last for a couple of weeks before usually clearing up. In infections before the current outbreak, 1–3% of people with known infections have died (without treatment). Cases in children are more likely to be severe.

Background

These paragraphs are an excerpt from Monkeypox.

Mpox (/ˈɛmpɒks/, EM-poks; formerly known as monkeypox) is an infectious viral disease that can occur in humans and other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild, and most infected individuals recover within a few weeks without treatment. The time from 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 suppressed immune systems.

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. Human-to-human transmission can occur through direct contact with infected skin or body fluids, including sexual contact. People remain infectious from the onset of symptoms until all the lesions have scabbed and healed. The virus may spread from infected animals through handling infected meat or via bites or scratches. Diagnosis can be confirmed by polymerase chain reaction (PCR) testing a lesion for the virus's DNA.

Emergency preparedness

In March 2021, the Nuclear Threat Initiative led a tabletop exercise at the Munich Security Conference simulating a hypothetical public health response to the release of a genetically-manipulated strain of monkeypox.

Cases and deaths in endemic areas

The Africa Centres for Disease Control and Prevention has alerted several members of the African Union in May 2022 about cases of monkeypox. The director of the Africa CDC, Ahmed Ogwell, said that four African countries have reported 1405 endemic cases with 62 deaths during early 2022 to May 2022. The case fatality rate in these four African countries combined is 4.4%.

In an article in The Conversation, Oyewale Tomori pointed out that the number of monkeypox infections in Nigeria through 2021 is likely to be under-reported because much of the Nigerian population has been avoiding healthcare facilities due to fear of contracting COVID-19. Nigeria's surveillance of various diseases, including monkeypox, had to focus on the global COVID-19 pandemic in 2020 and 2021, missing many cases and resulting in a drop in official statistics. As British health authorities reported the first case of monkeypox in the UK in May 2022, the Nigerian government has released to the public information and statistics on reported cases and deaths in the country. In the report of 9 May 2022, the NCDC stated that 230 cases were confirmed across 20 states and the Federal Capital Territory between 2017 and 2022. Rivers State was the most affected, followed by Bayelsa and Lagos. In the span from 2017 to 2022, the NCDC reported six deaths in six different states, making for a 3.3% case fatality ratio. On May 30, the first death from monkeypox was reported in Nigeria during 2022, the last time a death was reported in the country from this disease was in 2019.

The following table shows 2022 cases in countries which experienced endemic monkeypox before the current outbreak, as of 17 June according to the WHO:

Cases per country (endemic African countries)

Land	Confirmed	Probable	Suspected	Total	Data taken	Clade
Kamerun	Total: 3 Centre: 1 Southwest: 2	0	28	31	Jan 1, 2022 - Jun 2, 2022	West & Central
Zentralafrikanische Republik	Total: 8 Alindao: 1 Bimbo: 1 Mbaïki: 6	0	17	25	Mar 4, 2022 - May 23, 2022	Central
Republic of the Congo	Total: 2 Likouala 2	0	7	9	Jan 1, 2022 - May 30, 2022	Central
Democratic Republic of the Congo	10	0	Total: 1356 Maniema: 181 Sankuru: 481 Sud-Ubangi: 105 Tshopo: 169 Tshuapa: 111 Rest of Provinces: 309	1366	Jan 1, 2022 - May 22, 2022	Central
Liberia	0	0	4	4		West
Nigeria	Total: 41 Adamawa: 5 Bayelsa: 4 Cross River: 2 Delta: 3 FCT: 2 Imo: 2 Kano: 2 Lagos: 8 Nasarawa: 1 Plateau: 2 Niger: 1 Ogun: 1 Osun: 1 Oyo 1 Rivers: 3	0	162	203	Jan 1, 2022 - Jun 19, 2022	West
Sierra Leone	0	0	2	2		West
Total	64	0	1576	1640

Deaths in Africa

Land	Deaths
Democratic Republic of the Congo	9
Zentralafrikanische Republik	2
Nigeria	1

Outbreak characteristics

See also: Monkeypox § Epidemiology

Monkeypox is endemic to West and Central Africa. Prior to the 2022 outbreak, the United Kingdom had recorded only seven previous cases of monkeypox, all of which were imported cases from Africa or healthcare workers involved in their treatment. The first three such cases were in 2018, followed by a further case in 2019 and three more in 2021. The only major monkeypox outbreak to be recorded in a Western country prior to 2022 was the 2003 Midwest monkeypox outbreak in the United States. That one did not feature community transmission.

This outbreak is of the West African clade, which has a reported case fatality rate of 1% according to the World Health Organization. The genomic sequence of the virus associated with this outbreak was first published on 19 May by Portuguese researchers. They confirmed that the monkeypox virus was of the West African clade, related to other previous international outbreaks in 2018–19.

The 2022 outbreak has a different pattern of spread compared to prior monkeypox outbreaks outside Africa. Genetic evidence suggest the outbreak likely started in Nigeria. Given the unusually high frequency of human-to-human transmission observed in this event, and the probable community transmission without history of traveling to endemic areas, spread of the virus through close contact is more likely, with transmission during sexual activities being the most common route. Most cases have been in men. A significant proportion of cases, although not all, are in men who have sex with men (MSM), notably in Canada, Spain, and the UK, with many cases diagnosed in sexual health clinics. Cases are mostly in young and middle-aged men. This points to transmission due to close contact during sex as being one route of transmission. The European Centre for Disease Prevention and Control (ECDC) considers the monkeypox virus to be moderately transmissible among humans. According to the centre, among MSM who contracted the virus, the most common means of transmission is likely through sexual activity due to intimate contact with infectious skin lesions. The ECDC rates likelihood of transmission due to close contact, including sexual contact, as "high", but, without close contact, the likelihood of transmission between individuals is considered to be low. In Nature, Anne Rimoin and Raina MacIntyre speculate that the higher percentage of MSM affected is a result of coincidental introduction to the community and then sexual activity constituting "close contact" rather than the virus itself becoming sexually transmitted. Monkeypox is not primarily a sexually transmitted disease.

On 23 May, David Heymann, an advisor for the World Health Organization, said that the likely theory of how the outbreak started is transmission during sexual intercourse of gay and bisexual men at two raves in Belgium and Spain. On 25 May, The Guardian stated that many scientists suspect the disease was circulating in the UK and Europe before reaching the MSM community, possibly misdiagnosed or detected only in isolated cases; four cases were diagnosed in 2018 and 2019, all in individuals recently arrived from Nigeria.

The UK Human Animal Infections and Risk Surveillance (HAIRS) group warned that the virus could reach wildlife and become endemic as a result.

Initial reported cases in the United Kingdom

Main article: 2022 monkeypox outbreak in the United Kingdom

Guy's Hospital, where the April case was hospitalised

In the beginning of May 2022, a case of monkeypox in a British resident was reported who had travelled to Lagos and Delta State in Nigeria, in areas where monkeypox is considered to be an endemic disease. The person developed a rash on 29 April while in Nigeria and flew back to the United Kingdom, arriving on 4 May, and presented to hospital later the same day. Monkeypox infection was immediately suspected, and the patient was hospitalised at Guy's and St Thomas' NHS Foundation Trust and isolated, then tested positive for the virus on 6 May. Testing of patient swab samples by polymerase chain reaction revealed the outbreak to be of the West African clade of monkeypox, which is the less deadly of the two known monkeypox variants with a case fatality rate of around 1%.

Extensive contact tracing of people who had been in contact with the index case both on the international flight from Nigeria to the United Kingdom and within the country following their arrival was carried out, with potential contacts advised to remain aware of the symptoms of monkeypox and immediately isolate if any were to develop within 21 days of the contact event. Following this contact tracing effort, the World Health Organization (WHO) considered further transmission of the virus within the United Kingdom to be of "minimal" risk. Contact tracing was extended to Scotland on 14 May according to Public Health Scotland. A "small number" of people in Scotland were ordered to self-isolate following close contact with the person initially reported to have been infected, although overall risk to the general public remained "very low".

On 12 May two new cases of monkeypox were confirmed by the UK Health Security Agency (UKHSA), both in London, living together in the same household, with no known link between either of them and either the index case or travel to endemic regions. One of the new cases was hospitalised at St Mary's Hospital, while the other case with milder symptoms was said to be self-isolating at home. On 17 May, another four cases of monkeypox were confirmed by the UKHSA in three Londoners and a person in North East England who had previously travelled to London.

Unusually, none of these new cases had any known contact history with the previous three confirmed cases, which suggested a kind of transmission that had not been seen before, a wider community transmission of the virus in the London area. The UKHSA stated that the risk to the general public remained "very low". Patients with active monkeypox infection were confirmed to be hospitalised at the Royal Victoria Infirmary in Newcastle upon Tyne and at the Royal Free Hospital and Guy's Hospital in London.

Also on 20 May, Health Secretary of the UK Sajid Javid reported that another eleven cases had been confirmed, bringing the total in the country to twenty. UKHSA reported on 10 June that 311 of the 314 cases where sex was known were men, and that all of the 151 infected persons who filled out an additional questionnaire and answered questions about sexual practices were men who have sex with men. Dr Susan Hopkins from the UKHSA urged watchfulness among men who have sex with men. The UK Health Security Agency (UKHSA) advised people who have had close contact with a person infected with monkeypox to self-isolate for 21 days.

Multi-country outbreak

Main article: Timeline of the 2022 monkeypox outbreak

Cumulative confirmed cases

Daily confirmed cases, 7-day rolling average

File:Monkeypox cases.png

Monkeypox cases according to the WHO as of June 27, 2022

Further cases in multiple countries outside the endemic area were reported through the second half of May 2022. On 18 May, Portugal reported 14 cases of monkeypox. In Spain, there were seven confirmed cases as of 18 May. On the same day, the United States confirmed its first 2022 case of monkeypox and Canada reported 13 suspected cases.

On 19 May, Sweden, Belgium and Italy confirmed their first cases. On 20 May, Australia, Germany, France and the Netherlands confirmed their first cases. In the remainder of May, multiple European countries and Israel confirmed their first cases. The United Arab Emirates and Mexico also confirmed their first cases.

On 23 May, Dr. Sue Hopkins, the chief medical adviser for the UK Health Security Agency, announced that 37 new monkeypox cases had been confirmed, more than doubling the total confirmed in the UK to 57 cases.

Vaccination

Smallpox vaccines containing vaccinia such as Imvanex (Jynneos) can provide around 85% effectiveness against monkeypox. This protection level is calculated from studies using smallpox vaccines tested in late 1980 in Africa.. The UKHSA has begun using Imvanex as post-exposure prophylaxis for close contacts of known cases. According to the CDC the vaccination with Jynneos/Imvanex is "[a]dministered as two subcutaneous injections four weeks apart."

On 25 May, disease experts from the NICD in South Africa said they saw no need for mass vaccination, because they believe cases will not explode as they did in the COVID-19 pandemic.

In reaction to the current outbreak of monkeypox, a number of countries have stated they are buying vaccines and/or releasing vaccines from national stockpiles for use in the outbreak as there is a new concern of vaccine shortage as the demand of vaccine exceeds supply. In May 2022, the US, Spain, Germany and the UK all announced purchases of smallpox vaccine.

On 24 May, Centers for Disease Control (CDC) Deputy Director Jennifer McQuiston confirmed the United States is releasing some of their Jynneos vaccine supply from their Strategic National Stockpile for people who are "high-risk".

On 23 June, the New York City Department of Health announced a clinic at the Chelsea Sexual Health Clinic to offer the two dose JYNNEOS vaccine to "...all gay, bisexual, and other men who have sex with men (cisgender or transgender) ages 18 and older who have had multiple or anonymous sex partners in the last 14 days."

Social aspects

Public health authorities aim to target resources and education to affected groups, but avoid stigma which could discourage people with symptoms or who have been exposed from seeking help. LGBTQ+ rights groups have issued statements advising media to avoid stigmatising marginalised groups such as men who have sex with men. On 22 May, UNAIDS urged communicators to avoid stigma by taking an evidence-based approach, reiterated that the disease can affect anyone and that risk is by no means limited to men who have sex with men.

On 24 May, The Washington Post published an article that pointed out the lack of global attention to the disease when it only affected Africans, compared to the attention directed at it when a small number of cases started affecting Western countries. Some also objected to pictures used in media coverage of mild illnesses in Europe that featured severe cases in dark-skinned Africans.

Russian state television presenters Evgeny Popov and Olga Skabeeva mocked countries that had reported cases of monkeypox, saying "maybe it's not a coincidence" that countries where homosexuals had contracted monkeypox were sending weapons to Ukraine.

Misinformation

Misinformation and conspiracy theories spread online, including on Weibo. In an article published by the BBC countering misinformation about the monkeypox outbreak, journalist Rachel Schraer noted that social media accounts and news outlets from different countries including China, Russia, Ukraine and the United States have been promoting the idea that the outbreak was caused by a lab leak or that monkeypox is being used as a bioweapon. The Institute for Strategic Dialogue stated about this as "Reviving the spread of a set of cut-and-paste... conspiracies", referring to conspiracy theories used during the COVID-19 pandemic. The BBC also made it clear that the genetic sequences of the virus, as far as is known, date back to a West African strain.

Responses

United Nations

• World Health Organization (WHO): On 20 May, the WHO convened an emergency meeting of independent advisers to discuss the outbreak and assess the threat level. Its European chief, Hans Kluge, expressed concern that infections could accelerate in Europe as people gather for parties and festivals over the summer. On 14 June, the WHO announced plans to rename the monkeypox virus in order to combat stigma and racism surrounding the disease. Another meeting convened on 23 June determined that the outbreak does not constitute a Public Health Emergency of International Concern for the time being.

Nations

• Algerien: The Pasteur Institute of Algeria issued a communiqué in May, in which the Institute described the origins of Monkeypox in Sub-Saharan Africa, and recommended physical distancing, as well as the use of masks in crowded or enclosed places, in addition to avoiding contact with wild animals that may possess the virus.

• Bangladesch: On 22 May, the Directorate General of Health Services (DGHS) issued warnings at every port in the country to prevent the spread of monkeypox. The Directorate spokesperson said that they have asked all air, land and sea ports to be alert. Suspected cases are instructed to be sent to an infectious disease hospital and kept in isolation. Bangladesh became the first country bar shore passes, after the Chittagong Seaport barred shore passes for all crew unless in the case of an emergency, while signed-off crew will have to undergo health checks.

• Belgien: The Risk Assessment Group (RAG) and health authorities declared that those infected with monkeypox must self-isolate for 21 days.

• Brasilien: The Brazilian Ministry of Health started monitoring the Brazilian patient in Germany, requesting more information from the German Ministry of Health. It also created groups of biologists to monitor monkeys and medical groups to monitor possible cases. The Minister of Health of Brazil, Marcelo Queiroga, and his entourage are in Portugal to reach an agreement on medical exchanges in public health and bioethics. After the trip to Portugal, the minister will participate in the 75th World Health Assembly, thus having his return monitored by the proximity to Europe.

• Botswana: In June, the Ministry of Health advised the population of Botswana to go to the nearest hospital in case of any unusual symptoms. In addition, the ministry advised to avoid close contact with other people.

• Kambodscha: In May, Or Vandine, spokeswoman for the Ministry of Health, alerted the citizens of Cambodia that Monkeypox could be lethal due to the lesions caused by this disease, which can lead to complications in the body's organs. In June 2022, the Cambodian government ordered screening under the supervision of health workers of all air, sea and land entry points in the country, in addition to ordering mandatory quarantine of anyone infected or in contact with people with the disease.

• Kanada: On 21 April, Public Services and Procurement Canada published a tender request seeking to stockpile doses of smallpox vaccine to be prepared in the event of a future accidental or intentional release of the virus. The contract for 500,000 doses closed on May 5, and was awarded to Bavarian Nordic. On May 24, the Public Health Agency of Canada stated that they were in the process of extracting Imvamune vaccines from their National Emergency Strategic Stockpile for deployment across the country, starting with the province of Quebec. On May 26, Quebec announced that Imvamune vaccines would be made available to those who have been in close contact with confirmed or suspected monkeypox cases. On June 7, PHAC announced that travellers returning to Canada may be subject to a mandatory quarantine period if they become ill with monkeypox, and warned that quarantined travellers may have restricted access to health care and delays returning home.

• China: On June 2, the Chinese CDC issued a notice quoting WHO's document with a translation of the original "Stigmatising people because of a disease is never okay. Anyone can get or pass on monkeypox, regardless of their sexuality."

• Kolumbien: As of May, the Colombian Ministry of Health was taking follow-up and control measures. The Director of Epidemiology and Demography of the Ministry of Health, Claudia Cuellar, informed the Colombian population about how monkeypox is spread through people, and she spoke about the clinical presentation of the virus and international health regulations. Health authorities in the Department of Norte de Santander have been on alert, since the department is a border area where people pass between Colombia and Venezuela.

• Dominikanische Republik: In May, the Ministry of Public Health of the Dominican Republic issued a preventive epidemiological alert after monkeypox was reported in several countries.

• Ägypten: On 24 May, the Egyptian Ministry of Health and Population informed about measures to prevent new Monkeypox infections, among them, was to wash hands with soap or use an alcohol-based hand sanitiser, in addition to using personal protective equipment such as masks. In addition, the Ministry informed that veterinary quarantine procedures should be taken for animals that present the disease.

• Fidschi: The country's Centre for Disease Control and Border Health Protection Unit are monitoring the situation. The Ministry of Health has put in place infection prevention protocols at the border. Minister for Health Ifereimi Waqainabete said that the Ministry is on high alert after three suspected cases of Monkeypox returned negative results.

• Deutschland: Fabian Leendertz of the Robert Koch Institute described the outbreak as an epidemic that will not last long: "The cases can be well isolated via contact tracing and there are also drugs and effective vaccines that can be used if necessary."

• Guatemala: On 26 May, the Minister of Health of Guatemala, Francisco Coma, informed that the Ministry declared an epidemiological alert on the borders of the Central American country, with the objective of detecting possible cases of Monkeypox. The minister also mentioned that one of the main transmissions of Monkeypox is from injuries and body fluids as well as contact with contaminated clothing.

• Indien: Union Health Minister Mansukh Mandaviya directed the National Centre for Disease Control and the ICMR to keep a close watch and monitor the situation. The Union Health Ministry has also directed airport and port health officers to be vigilant, according to official sources. They have been instructed to isolate and send samples to the National Institute of Virology of any sick passenger with a travel history to infected countries.

• Indonesien: When cases of monkeypox were reported in Australia in May 2022, they triggered the alert of health authorities in Indonesia. Mohammad Syahril, ministry spokesperson, urged medical personnel and the country's population to be alert and aware of the symptoms of the disease.

• Irland: The Health Service Executive (HSE) has set up a multidisciplinary incident management team to prepare for the possible arrival of monkeypox, and infectious diseases experts are on alert for patients with symptoms of the virus.

• Kosovo: On 23 May, the Ministry of Health and the National Public Health Institute, have drafted a document of recommendations and measures to help prevent the spread of the disease. In a press statement, healthcare authorities have declared that the situation is being closely monitored.

• Luxemburg: On 21 May, the Ministry of Health said that they are monitoring the situation with its Europe. he National Infectious Diseases Department of the HLC and refrain from close contact activities until the infection has resolved.

• Malaysia: On 27 May, the Malaysian Ministry of Health reactivated the MySejahtera app to provide information and surveillance on monkeypox.

• Mexiko: In May, Mexican health authorities have posted notices in clinics and hospitals for the purpose of identifying suspected cases in the country. In addition, the Ministry of Health has issued an epidemiological alert on May 26, 2022.

• Marokko: In May, several regional directors of the Moroccan Ministry of Health are coordinating a surveillance system for Monkeypox with the Directorate of Epidemiology and Disease Control in order to prevent cases of Monkeypox from European countries from spreading to Morocco, according to the Al Akhbar newspaper. Due to the "Marhaba 2022" operation, an operation that aims to facilitate the travel of Moroccans living abroad by sea when they travel during the summer period, sanitary measures have already been put in place.

• Nigeria: The director general of the NCDC, Ifedayo Adetifa, advised the Nigerian population to avoid eating bush meat to prevent new Monkeypox infections, in addition to storing food properly to avoid being contaminated by rodents, as Monkeypox is a viral zoonosis.

• Philippinen: Health Secretary Francisco Duque III said that the Philippines was intensifying its border control measures amid the threat of the monkeypox virus. The health department stated it is exploring potential sources of monkeypox vaccines and antivirals.

• Saudi-Arabien: On 21 May, the Saudi Ministry of Health stated that they are ready to monitor and investigate cases of monkeypox, if any occurs. They added that it also has an integrated preventive plan to deal with such cases if they appear, including identifying suspected and confirmed cases.

• Senegal: Badara Ly of the Ministry of Health and Social Action, spoke about the creation of a contingency plan in Senegal during an online conference with the WHO in May, in addition the doctor alerted the health system and advised the creation of fact sheets on prevention methods and reinforcement of screening in border areas.

• Südafrika: On 26 May, the National Institute for Communicable Diseases (NICD) gave a communiqué on how the virus is transmitted, and the institute stated that the 2022 outbreak is the largest outbreak of Monkeypox outside of endemic regions. In addition, the NICD affirmed that the virus mainly spreads in tropical forest areas in West and Central Africa.

• Taiwan: On 30 May, the Taiwan Centers for Disease Control officially listed monkeypox as a notifiable infectious disease, and on June 23, monkeypox was officially upgraded to a second-class notifiable infectious disease, which means that confirmed cases must be notified within 24 hours, and if necessary, isolation treatment may be implemented in designated isolation treatment institutions.

• Thailand: On 24 May, the Department of Disease Control (DDC) started screening all overseas passengers from Central African countries and other outbreak countries at international airports. On 26 May 2022, the DDC set up an emergency operations center to monitor the outbreak situation and plan for a possible outbreak in the kingdom. Anutin Charnvirakul, Minister of Public Health, said that the government is seeking a smallpox vaccine from the WHO to bolster the public's immunity in case of a viral outbreak. On 30 May, The local news reported the first case of monkeypox in the country. The patient was a passenger who was transiting from Europe to Australia via Bangkok. However, the patient's symptoms developed and were diagnosed in Australia. There have been no local cases discovered as of yet.

• Vereinigtes Königreich: On 22 May, Education Secretary Nadhim Zahawi said "we're taking it very, very seriously" and that the UK government had already started purchasing smallpox vaccines. The Terrence Higgins Trust and British Association for Sexual Health and HIV (BASHH) expressed concern about the impact on sexual health services in the United Kingdom.

• Vereinigte Staaten: On 22 May, President Joe Biden commented "they haven't told me the level of exposure yet but it is something that everybody should be concerned about". National security advisor Jake Sullivan told reporters the US has a vaccine that is relevant to treating monkeypox. On 25 May, the CDC issued an alert for gay and bisexual men to be especially vigilant. In addition, the CDC placed its monkeypox travel alert at "Level 2", following reports of cases in Australia and several countries in Europe.

• Vietnam: On 24 May, Vietnam's Ministry of Health asked border localities to increase surveillance to detect possible cases of monkeypox.

Dependent territories

• Gibraltar: On 31 May, a Strategic Coordination Group met to discuss Gibraltar's state of preparedness in the eventuality that a case of Monkeypox was confirmed in the territory amid the rapid rise of cases in the United Kingdom and Spain.

Cases per country and territory

This is a table of confirmed and suspected monkeypox cases outside of African countries where the virus is endemic. It does not include countries where suspected cases were reported but later discarded such as Afghanistan, Costa Rica, and Fiji. Barbados confirmed a case on July 16th.

Cases per country and territory (outside of endemic African countries)

Land	Confirmed	Suspected	Total	Last update	First confirmed case	Last confirmed case
Andorra	1	—	1	2 July 2022	2 July 2022
Argentinien	12	—	12	13 July 2022	27 May 2022
Australien	33	—	33	14 July 2022	20 May 2022
Österreich	83	—	83	15 July 2022	22 May 2022
Bahamas	1	—	1	30 June 2022	30 June 2022
Belgien	225	1	226	12 July 2022	19 May 2022
Bosnien und Herzegowina	1	—	1	13 July 2022	13 July 2022
Brasilien	310	6	316	14 July 2022	9 June 2022
Bulgarien	3	—	3	12 July 2022	23 June 2022
Kanada	539	45	584	15 July 2022	19 May 2022
Chile	16	—	16	11 July 2022	17 June 2022
Kolumbien	7	—	7	13 July 2022	23 June 2022
Kroatien	3	—	3	12 July 2022	23 June 2022
Tschechische Republik	13	—	13	15 July 2022	24 May 2022
Dänemark	37	—	37	15 July 2022	23 May 2022
Dominikanische Republik	1	—	1	6 July 2022	6 July 2022
Ecuador	1	—	1	6 July 2022	6 July 2022
Estland	2	—	2	12 July 2022	28 June 2022
Finnland	13	—	13	11 July 2022	27 May 2022
Frankreich	912	—	912	12 July 2022	20 May 2022
Georgien	1	—	1	12 July 2022	15 June 2022
Deutschland	1,859	—	1,859	15 July 2022	20 May 2022
Ghana	19	—	19	4 July 2022	8 June 2022
Gibraltar	5	—	5	14 July 2022	1 June 2022
Griechenland	13	—	13	14 July 2022	8 June 2022
Ungarn	28	—	28	13 July 2022	31 May 2022
Indien	1	—	1	14 July 2022	14 July 2022
Island	7	—	7	14 July 2022	9 June 2022
Irland	54	—	54	13 July 2022	27 May 2022
Israel	88	—	88	14 July 2022	21 May 2022
Italien	339	—	339	15 July 2022	19 May 2022
Jamaika	1	—	1	6 July 2022	6 July 2022
Lettland	2	—	2	12 July 2022	3 June 2022
Libanon	1	—	1	20 June 2022	20 June 2022
Luxemburg	7	—	7	5 July 2022	15 June 2022
Malta	9	—	9	12 July 2022	28 May 2022
Mexiko	39	—	39	15 July 2022	28 May 2022
Marokko	1	1	2	14 June 2022	2 June 2022
Niederlande	549	—	549	14 July 2022	20 May 2022
Neukaledonien	1	—	1	12 July 2022	12 July 2022
Neuseeland	2	—	2	12 July 2022	9 July 2022
Norwegen	37	—	37	15 July 2022	31 May 2022
Panama	1	—	1	5 July 2022	5 July 2022
Peru	64	9	73	15 July 2022	26 June 2022
Polen	28	—	28	15 July 2022	10 June 2022
Portugal	515	—	515	13 July 2022	18 May 2022
Puerto Rico	6	2	8	14 July 2022	29 June 2022
Rumänien	16	—	16	14 July 2022	13 June 2022
Russland	1	—	1	12 July 2022	12 July 2022
Saudi-Arabien	1	—	1	14 July 2022	14 July 2022
Serbien	5	—	1	14 July 2022	17 June 2022
Singapur	6	—	6	14 July 2022	20 June 2022
Slowakei	1	—	1	12 July 2022	7 July 2022
Slowenien	20	—	20	14 July 2022	24 May 2022
Somalia	—	4	4	9 June 2022	—
Südafrika	3	—	3	11 July 2022	23 June 2022
Südkorea	1	—	1	22 June 2022	22 June 2022
Spanien	3,067	81	3,142	15 July 2022	18 May 2022
Schweden	58	—	58	13 July 2022	19 May 2022
Schweiz	198	—	198	15 July 2022	21 May 2022
Taiwan	2	—	2	13 July 2022	24 June 2022
Türkei	1	—	1	12 July 2022	30 June 2022
Vereinigte Arabische Emirate	13	—	13	7 June 2022	24 May 2022
Vereinigtes Königreich	1,856	—	1,856	14 July 2022	6 May 2022
Vereinigte Staaten	1,817	—	1,817	15 July 2022	18 May 2022
Uruguay	—	1	1	5 June 2022	—
Venezuela	1	—	1	12 June 2022	12 June 2022
Sambia	—	1	1	20 June 2022	—
Total	12,957	151	13,098	—

Timeline of first confirmed cases by country or territory

First confirmed monkeypox cases by country or territory

Date	Countries / Territories
6 May 2022	Vereinigtes Königreich
18 May 2022	Portugal • Spanien • Vereinigte Staaten
19 May 2022	Belgien • Kanada • Italien • Schweden
20 May 2022	Australien • Frankreich • Deutschland • Niederlande
21 May 2022	Israel • Schweiz
22 May 2022	Österreich
23 May 2022	Dänemark
24 May 2022	Tschechische Republik • Slowenien • Vereinigte Arabische Emirate
27 May 2022	Argentinien • Finnland • Irland
28 May 2022	Malta • Mexiko
31 May 2022	Ungarn • Norwegen
1 June 2022	Gibraltar
2 June 2022	Marokko
3 June 2022	Lettland
8 June 2022	Ghana • Griechenland
9 June 2022	Brasilien • Island
10 June 2022	Polen
12 June 2022	Venezuela
13 June 2022	Rumänien
15 June 2022	Georgien • Luxemburg
17 June 2022	Chile • Serbien
20 June 2022	Libanon • Singapur
22 June 2022	Südkorea
23 June 2022	Bulgarien • Kolumbien • Kroatien • Südafrika
24 June 2022	Taiwan
26 June 2022	Peru
28 June 2022	Estland
29 June 2022	Puerto Rico
30 June 2022	Bahamas • Türkei
2 July 2022	Andorra
5 July 2022	Panama
6 July 2022	Dominikanische Republik • Ecuador • Jamaika
7 July 2022	Slowakei
9 July 2022	Neuseeland
12 July 2022	Neukaledonien • Russland
13 July 2022	Bosnien und Herzegowina
14 July 2022	Indien • Saudi-Arabien

Timeline of suspected cases by country or territory

Countries listed below had only suspected cases at the time of reporting. Some countries reported confirmed cases after reporting suspected cases (i.e. Greece, Morocco, Turkey, Ecuador, Peru). Countries listed several times reported suspected cases again after they discarded suspected cases before.

Timeline of suspected monkeypox cases by country or territory

Date	Countries / Territories
20 May 2022	Griechenland (discounted on 22 May) • Israel (confirmed on 21 May)
23 May 2022	Französisch-Guayana (discounted on 1 June) • Marokko (discounted on 25 May)
25 May 2022	Bolivien (discounted between 3 and 10 June) • Sudan (discounted on 3 June)
27 May 2022	Ecuador (discounted on 30 May) • Iran (discounted on 4 June) • Malaysia (discounted on 31 May)
29 May 2022	Afghanistan (discounted between 31 May and 5 June)
30 May 2022	Peru (discounted on 2 June) • Brasilien (confirmed cases reported on 9 June)
1 June 2022	Costa Rica (discounted on 4 June) • Haiti (discounted on 5 July) • Paraguay (discounted on 7 June)
2 June 2022	Kambodscha (discounted on 2 June) • Cayman-Inseln • Mauritius (discounted on 10 June) • Uruguay
3 June 2022	Indien (discounted on 7 June)
4 June 2022	Kosovo (discounted on 15 June) • Türkei (discounted on 5 June)
5 June 2022	Georgien (confirmed on 15 June)
7 June 2022	Bahamas (confirmed cases reported on 30 June) • Bangladesch (discounted on 9 June)
8 June 2022	Uganda (discounted on 1 July)
9 June 2022	Somalia
14 June 2022	Ecuador (discounted on 15 June)
15 June 2022	Libyen (discounted on 13 July)
16 June 2022	Nepal (discounted on 17 June)
20 June 2022	Sambia
21 June 2022	Südkorea (confirmed on 22 June)
24 June 2022	Fidschi (discounted on 28 June)
8 July 2022	Indien (discounted on 9 July)
14 July 2022	Indien (confirmed on 14 July)

Articles for countries and regions

• Outbreak in 2022:
  • 2022 monkeypox outbreak in Asia
  • 2022 monkeypox outbreak in Europe
  • 2022 monkeypox outbreak in Canada
  • 2022 monkeypox outbreak in France
  • 2022 monkeypox outbreak in Germany
  • 2022 monkeypox outbreak in the Netherlands
  • 2022 monkeypox outbreak in Peru
  • 2022 monkeypox outbreak in Portugal
  • 2022 monkeypox outbreak in South Africa
  • 2022 monkeypox outbreak in Spain
  • 2022 monkeypox outbreak in the United Kingdom
  • 2022 monkeypox outbreak in the United States
• Monkeypox in Nigeria
• Monkeypox in the Democratic Republic of the Congo

External links

• Monkeypox outbreak – by World Health Organization
• 2022 Monkeypox and Orthopoxvirus Outbreak Global Map – CDC
• Monkeypox Meter – nice graphs and maps, but no source/reference links
• Monkeypox Tracker by BNO News ("This tracker is no longer being updated. The final update was on 11 June 2022.")
• Monkeypox_Public_www.global.health, a case-tracking spreadsheet maintained by the nonprofit Global.Health