Globally, monkeypox virus (MPXV) clade I and clade II are circulating in multiple countries. Since 2022, MPXV clade II has mainly been circulating outside of the African continent among men who have sex with men. In 2024, an increase in MPXV clade Ia and Ib was reported in the DRC, while clade Ia cases continued to be reported by the Central African Republic and the Republic of the Congo (Congo), where it is endemic. 

Following the epidemic of MPXV clade I in the DRC, and since the beginning of 2024, MPXV clade I was first detected in Angola, Burundi, Rwanda, South Sudan, Uganda, and Zambia (all countries neighbouring the DRC), as well as in Kenya, Zimbabwe and South Africa. Overall, on the African continent in 2024 and in 2025 until the beginning of March 2025, most confirmed and suspected clade I cases have been reported from the DRC. DRC along with Uganda and Burundi have reported most cases in 2025 (as of the beginning of March). However different trends have been observed recently in each country.

In DRC, clade Ia and Ib co-circulate to different degrees. There has been a decline in the number of cases in the past five weeks and testing coverage also has declined during the same period (Africa CDC Special Briefing on Mpox and other Health Emergencies, 13 March 2025). According to the WHO External Situation report published on 10 March 2025, clade Ib has been detected in 10 provinces, mostly in the east of the country, and in five provinces, clade Ib co-circulates with clade Ia (Mpox: multi-country external situation report no. 48, 10 March 2024). In Kinshasa, epidemiological data and sequencing suggest there is human-to-human transmission of clade Ia with high rates of APOBEC3-driven mutations. Similar signals have not been reported in provinces outside Kinshasa where clade Ia is circulating in DRC. However, the number of samples sequenced and analysed varies across provinces in DRC (Mpox: multi-country external situation report no. 48, 10 March 2024). APOBEC3 mutations have also been noted in clade Ib. Based on the available information from clade Ia circulation in Kinshasa there is currently no evidence that the strain is inherently more transmissible than other clade Ia strains or clade Ib according to WHO (Mpox: multi-country external situation report no. 48, 10 March 2024). 

In Burundi, the decreasing trend observed in the last weeks in the number of reported mpox cases continues and only clade Ib has been detected (Mpox: multi-country external situation report no. 48, 10 March 2024). In the past six weeks, 640 cases have been reported and no deaths, according to WHO (9 March 2025). 

In Uganda, where clade Ib has been detected, over 1 600 cases have been reported in the past six weeks, including 12 deaths (according to WHO as of 9 March 2025). The number of cases has been showing an increasing trend with a total of 3 685 cases and 31 deaths reported overall as of beginning of March 2025 (Africa CDC Special Briefing on Mpox and other Health Emergencies, 13 March 2025). The age group mainly affected in Uganda is 18- 39 year-olds, transmission amongst sexual networks is reported and high incidence is reported in and around Kampala (Africa CDC Special Briefing on Mpox and other Health Emergencies, 13 March 2025, Mpox: multi-country external situation report no. 48, 10 March 2024). 

Other countries in Africa which have reported mpox clade I cases since 2024 (for the first time) include, Rwanda (104 cases), Kenya (53), Zambia (24) and Zimbabwe (2)(WHOGlobal report on mpox (data as of 9 March 2025)). Additionally, South Africa reported three clade I cases all in 2025. Previously, in 2024, South Africa had reported clade II cases (WHO Global Report with data until 9 March 2025). South Sudan also has reported seven cases of mpox in 2025 (WHO Global Report with data until 9 March 2025, clade Ib). 

Outside Africa, travel-associated cases or sporadic cases reporting epidemiological links with travel-associated cases of MPXV clade I have been reported in the EU/EEA by: Sweden (in 2024) and Germany, Belgium (in 2024 and 2025) and France and Ireland (in 2025). 

In addition to Africa and the EU/EEA, since August 2024, clade I cases have been reported by Thailand, India, the UK, the United States (US), Canada, Pakistan, Oman, China, the United Arab Emirates and Qatar. In March, Brazil also reported one case which had no travel history but was a contact of a person with travel history to DRC. 

Most travel-associated cases who reported travel to non-African countries had links to affected countries in Africa. However, China, India, Oman, Pakistan and Thailand have reported at least one case each with travel links to the United Arab Emirates (Mpox: Multi-country external situation report 44, 23 December 2024, Mpox: multi-country external situation report no. 46, 28 January 2025, Mpox: multi-country external situation report no. 47, 13 February 2025, Mpox: multi-country external situation report no. 48, 10 March 2024).

Confirmed secondary transmission of mpox due to MPXV clade Ib outside of Africa was reported for the first time in 2024 in the EU/EEA by Germany and Belgium, and outside of the EU/EEA by the UK and China. The number of secondary cases reported in these events outside of Africa has been low. Based on the available information, all transmission events were due to close contact, secondary cases presented with mild symptoms and no deaths have been reported. 

On 13 August 2024, Africa CDC declared mpox a Public Health Emergency of Continental Security. On 14 August 2024, WHO convened a meeting of the IHR Emergency Committee to discuss the mpox upsurge and declared the current outbreak of mpox due to MPXV clade I as a public health emergency of international concern. 

Transmission patterns of mpox due to monkeypox virus clade I – update 13 March 2025 

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 according to whether MPXV clade I is endemic or was reported for the first time since 2024. The categories are as follows: 

• Countries reporting only travel-associated cases or cases with a clear link to travel-associated cases: Angola, Belgium, Brazil, Canada, China, Germany, France, India, Ireland, Oman, Pakistan, Qatar, South Africa, South Sudan, Sweden, Thailand, the UK, the US, and Zimbabwe;
• Clusters of cases or limited transmission: Tanzania, the United Arab Emirates, and Zambia;
• Community transmission: Burundi, Central African Republic, Congo, the DRC, Kenya, Rwanda, and Uganda. 

The categorisation was last updated on 13 March 2025 to include Brazil (category of countries with travel associated cases or cases with links to travel associated cases). 

Below you can find some notes on the interpretation of the different trends reported in countries included: 

• The United Arab Emirates have reported a single case with travel history to Uganda, however a number of other countries have reported cases with travel history to the United Arab Emirates. Although there is no evidence of wider community transmission in the United Arab Emirates, it is presumed that undetected transmission is ongoing (Mpox: multi-country external situation report no. 48, 10 March 2024). The United Arab Emirates have therefore been added in the second category of the transmission classification.
• Undetected transmission may be ongoing in Tanzania, given that mpox clade Ib cases with travel links to Tanzania have been reported elsewhere and recently the country reported two confirmed mpox cases (Mpox: multi-country external situation report no. 47, 13 February 2025 and Press Release MoH Tanzania, 10 March 2025).
• Congo has reported clade Ib detection (Congo is endemic for clade Ia) (Africa CDC Press Briefing of 20 February 2025). A total of 20 confirmed cases have been reported in 2025 (weeks 1 to 9 of 2025 (ending 28 February 2025) according to the National Situation Report published on 10 March 2025 (Epidémie de Mpox : Rapport de Situation (SITREP) N°45 du 10 mars 2025 | OMS | Bureau régional pour l’Afrique). The total number of confirmed cases reported in 2024 was 24. Most cases have been reported close to the border with DRC. Based on the national report, there is a large number of suspected cases in different areas of the country.
• South Sudan has been included in the classification since the clade detected in the recently reported cases is clade Ib. The first case reported in 2025 was travel-associated case. The case is a person with travel history to Uganda. According to the press release from the Ministry of Health the strain is consistent with the one circulating in East Africa. As of 9 March 2025, seven cases had been reported by South Sudan from at least two counties 2025 (WHO Mpox Global Mpox Trends, 9 March 2025, WHO AFRO Weekly Bulletin, 2 March 2025).