Epidemiological update: Monkeypox multi-country outbreak

Monkeypox (MPX) is a zoonotic disease and is currently the most prevalent orthopoxvirus infection in humans after the eradication of smallpox and the cessation of universal smallpox vaccination. In endemic areas, monkeypox virus (MPXV) is probably maintained in nature through circulation among a number of mammals, with occasional spill-over events to humans. In endemic areas, MPXV is transmitted to humans through a bite or direct contact with an infected animal’s blood, meat, bodily fluids or cutaneous/mucosal lesions.

The latest report from the European Centres for Disease Control (ECDC) presents an update of MPX confirmed cases identified in the European Union/European Economic Area (EU/EEA) and worldwide. Cases detected in the EU/EEA have been reported according to the ECDC case definition and are obtained through screening of official websites. Cases reported from outside the EU/EEA are collected through screening of official websites and media sources.

Epidemiological update

On 14 May 2022, a familial cluster of two cases of monkeypox was reported in the United Kingdom (UK) by the UK Health Security Agency (UKHSA). These cases had no relation to a case imported from Nigeria that was previously reported on 7 May 2022 in the UK. In the following days, several other EU/EEA Member States and other countries have reported cases of monkeypox not linked to travel to endemic countries.

As of 25 May, a total of 118 confirmed MPX cases have been reported from 12 EU/EEA Member States (Table 1, Figure 1). Most cases are in young men, self-identifying as MSM. There have been no deaths. The clinical presentation is generally described to be mild, with most cases presenting with lesions on the genitalia or peri-genital area, indicating that transmission likely occurred during close physical contact during sexual activities. This is the first time that chains of transmission are reported in Europe without known epidemiological links to West or Central Africa, where this disease is endemic. These are also the first cases worldwide reported among MSM.

Worldwide update

As of 25 May 2022, a total of 219 confirmed cases have been reported from countries where the disease is not considered to be endemic. Countries reporting cases outside the EU/EEA, include Argentina (1 suspected case), Australia (2), Canada (15), Israel (1), the United Kingdom (71), the United States (9), Switzerland (2) United Arab Emirates (1 with a travel history to West Africa) and Morocco (3 suspected cases). In total, 101 confirmed cases of monkeypox have been reported in seven non-EU/EEA countries.

ECDC actions

ECDC continues to monitor this event through epidemic intelligence activities and report relevant news on an ad-hoc basis. A news item was published on 19 May and an epidemiological update was posted on 20 May. Multi-lateral meetings between affected countries, WHO EURO and ECDC have taken place to share information and coordinate response. An item has been created in EpiPulse to allow countries to share information with one another, WHO EURO and ECDC and to report data on detected cases. Reporting in TESSy is currently being implemented.