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Possible scenarios for the spread of mpox outside the endemic focus in Africa
Over the past two years, mpox has twice been declared a “Public Health Emergency of International Concern”, PHEIC by the World Health Organization (WHO). In 2022, it was in response to a global outbreak of a new clade IIb primarily among men who have sex with men (MSM), ultimately with >100,000 cases reported worldwide centered in Europe and the US [1]. In August 2024, it was in response to a complex outbreak originating in the Democratic Republic of the Congo, DRC, and many fold increase in mpox cases caused by the original central African clade I variant (now designated Ia), but also the emergence of a human-to-human transmitted clade Ib that has since spread to neighboring countries [2].