WHO releases new External Situation Report on Monkeypox (Mpox) (16 February 2023)

Recently, the International Health Regulations Emergency Committee conducted its fourth meeting on Monkeypox (Mpox).

Background Information:

Monkeypox (Mpox) is historically found in tropical rainforest areas of Central and West Africa where the monkeypox virus (MPXV) is thought to be maintained in wild mammal populations, with occasional spill-over to humans. Following introduction into the human population, the virus may spread via human-to-human transmission as seen in the 2022 global mpox outbreak. While not definitely identified, several rodent species, most prominently tree squirrels and Gambian pouched rats, are suspected to serve as the natural reservoir(s) for MPXV.

In addition, several other mammals are known to be susceptible to MPXV infection, with apes and monkeys likely serving as intermediate hosts.

Not all infected animals will present with symptoms of MPXV infection, such as rash, making it difficult to identify them. Zoonotic transmission may occur through bites, scratches, or direct contact with the body fluids and/or the meat of infected animals. Such contacts commonly take place during hunting, butchering, wildlife handling or bushmeat consumption. Several studies have reported contact between a person with mpox and an animal which was the likely source of infection.

Mpox (monkeypox) presents with fever, an extensive characteristic rash and usually swollen lymph nodes. It is important to distinguish mpox from other illnesses such as chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.  

The incubation period of mpox can range from 5 to 21 days.

The febrile stage of illness usually lasts 1 to 3 days with symptoms including fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle ache), and an intense asthenia (lack of energy).

The febrile stage is followed by the skin eruption stage, lasting for 2 to 4 weeks. Lesions evolve from macules (lesions with a flat base) to papules (raised firm painful lesions) to vesicles (filled with clear fluid) to pustules (filled with pus), followed by scabs or crusts. The proportion of patients who die has varied between 0 and 11% in documented cases and has been higher among young children.

Treatment of mpox (monkeypox) patients is supportive dependent on the symptoms.

Key Messages:

Since the last situation report published on 2 February 2023, 411 new mpox cases (0.5% increase in total cases) and four new related deaths have been reported to WHO.

The public health risk at the global level is assessed as moderate, whereas the regional risk is assessed as moderate in the WHO Regions of Africa, Americas, Eastern Mediterranean and Europe and as low in the WHO regions of South-East Asia and Western Pacific, which is a change from Moderate to Low risk in the South-East Asia Region and from High to Moderate in the Region of the Americas.

Epidemiological surveillance of mpox should be maintained by all countries.

The number of weekly new cases reported globally has increased by 70% in week 6 (06 February through 12 February 2023) (n = 270 cases) compared to week 5 (30 January through 05 February 2023) (n = 159 cases), with the largest proportional increase observed in the Region of the Americas (76%). The Region of the Americas is the only region reporting an increase in cases, while the rest of the regions have reported a decline in cases or no proportional increase.

As of 13 February 2023, the 10 countries that have reported the highest cumulative number of cases globally are

  • the United States of America (n = 29 974),
  • Brazil (n = 10 808),
  • Spain (n = 7533),
  • France (n = 4128),
  • Colombia (n = 4074),
  • Mexico (n = 3828),
  • Peru (n = 3737),
  • The United Kingdom (n = 3735),
  • Germany (n = 3692), and
  • Canada (n = 1460).

Together, these countries account for 85% of the cases reported globally.

Among cases with sexual orientation reported, 84.2% (26 967/32 043) have identified as gay, bisexual and other men who have sex with men. Of all reported modes of transmission, transmission through skin and mucosal contact during sex was the most reported, in 15 073 of 21 939 (68.7%) of all reported transmission events.

Where this information is included, the most reported exposure setting is a party setting with sexual contact, comprising 3617 of 5354 (67.6%) reported exposure settings.

Among the cases (n=36 858) who reported at least one symptom, the most common symptom is any rash and is reported in 82.7% of cases followed by fever (59.7%) and systemic and genital rash (52.5% and 46.3% respectively).

Countries from the African region have reported both person-to-person transmission, including transmission through sexual contact, as well as in some contexts primarily in Central Africa, infection from presumed contact with infected animals.

The WHO Director-General concurs with the advice of the Committee that the event continues to constitute a Public Health Emergency of International Concern

Useful Links:

Link to the WHO page on Monkeypox:


Link to the latest IHR-EC External Situation Report:



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