Timeline of the 2023–2024 mpox epidemic

Major events in a virus outbreak

Map of confirmed cases. Yellow indicates that the country is awaiting test results.

This article documents the chronology and epidemiology of the 2023–2024 mpox epidemic, an outbreak of clade Ib of mpox.

## 2023

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### September

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Mpox cases from clade Ib infections were growing in the Democratic Republic of the Congo (DRC),[1][2] with several being identified in Kamituga, a mining town in the province of South Kivu.[1][3]

## 2024

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### January

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The Daily Telegraph reported that cases and deaths from mpox in the DRC were 2.5 to 3 times higher in 2023 than in 2022.[4] A nationwide outbreak was reported.[1]

### March

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The Republic of the Congo reported 43 new cases of mpox, while the DRC reported 600 deaths.[5]

### July

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#### 30 July

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Pierre Somsé, the Minister of Health of the Central African Republic, declared an outbreak of mpox in Bangui, following a period of time when the disease was mostly restricted to rural areas.[6] Somsé said that some families in the country were hiding infected relatives in fear of being stigmatized, thus increasing the risk of transmission of the disease.[6]

### August

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The Africa Centres for Disease Control and Prevention declared that the outbreak had become a public health emergency. They also reported that the fatality rate was 3-4%, significantly higher than the 1% rate reported for the 2022-2023 outbreak.[7][8]

#### 14 August

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The World Health Organization declared the outbreak a public health emergency of international concern.[9]

#### 15 August

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In Sweden, health officials confirmed a case of mpox caused by the clade Ib variant of the virus, in a patient who had recently travelled to a part of Africa where there had been a large outbreak of the disease.[10] The World Health Organization confirmed that this was the first diagnosed case of mpox caused by the clade Ib variant in a patient outside of Africa.[11][12]

The vaccine alliance, GAVI, announced the availability of up to $500 million (US dollars) from its “First Response” fund, intended to help establish vaccination programs and supply vaccine doses to the countries in Africa most affected by the mpox epidemic.[13][14] In June 2024, GAVI had earlier approved to establish a global stockpile of mpox vaccines over the course of its next five-year strategic period beginning 2026, but in the interim, GAVI would support the outbreak response in the DRC and surrounding countries, including vaccine dose donations and direct procurement efforts.[14] GAVI stressed that hurdles remain, including the need for the WHO to finalize its assessments and approve candidate vaccines for Emergency Use Listing.[13][14]

Pakistan reported a new case of mpox, potentially caused by the clade Ib variant, but was later confirmed as the clade II variant.[15][16]

#### 16 August

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In the European Union (EU), the European Centre for Disease Prevention and Control (ECDC) officially raised the risk level of clade I mpox to the general population living in the EU from "very low" to "low", due to the likelihood of more imported cases being identified across the continent, although the agency reiterated that the risk of sustained transmission of the virus strain in Europe was still considered to be minimum.[17][18] The ECDC also advised travellers to consider getting vaccinated against mpox should they visit African countries affected by the outbreak.[17][19]

The Danish pharmaceutical company Bavarian Nordic announced the submission of clinical data to the European Medicines Agency, including the early results of a NIH's National Institutes of Allergy and Infectious Diseases (NIAID)-sponsored trial in adolescents and adults to support the extension of the approval of Jynneos/Imvanex vaccines to include adolescents aged 12 to 17 years.[20][21][22] Bavarian Nordic also stated that a study of the vaccine in children aged 2 to 12 years would take place in the DRC and Uganda later in 2024.[21]

In China, the General Administration of Customs announced that national authorities would deploy screening measures for people and goods entering the country from areas affected by the outbreak for the following six months.[22][23]

In Pakistan, national authorities had started screening travellers at all airports and at border crossings with surrounding countries.[24]

#### 17 August

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In Pakistan, the health department of Khyber Pakhtunkhwa, confirmed that three patients had tested positive for mpox, with all three recently returning from the United Arab Emirates.[25][26] All three cases were later confirmed as being caused by the clade II variant and not the clade Ib variant of mpox.[27]

#### 18 August

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Taiwan reported three confirmed mpox cases, all of which were later confirmed as being from the clade II and not the clade Ib variant.[28][29]

#### 19 August

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In Pakistan, the fourth confirmed mpox case was reported, in a person returning from the Middle East.[30] A police hospital in Khyber Pakhtunkhwa was designated as a treatment center for mpox cases.[31] Later, the Pakistani Ministry of Health stated that none of the 4 reported cases in the country had been caused by the clade Ib mpox variant.[16]

The Philippines reported it's first suspected case, however this case was later confirmed as being caused by the clade II mpox variant.[32][33]

#### 20 August

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The Africa Centres for Disease Control and Prevention (Africa CDC) gave a briefing revealing the organization had been working with the African countries most affected by mpox to establish the logistics and communications needed for vaccine rollout using doses of mpox vaccine, pledged by the EU, Danish vaccine maker Bavarian Nordic, the USA and Japan that were due to arrive shortly. Jean Kaseya, the director-general of the Africa CDC said "we didn't start vaccinations yet. We'll start in a few days, if we are sure that everything is in place. End of next week vaccines will start to arrive in DRC and other countries".[34]

A Malawi hospital reported a suspected case of Mpox.[35]

#### 21 August

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The United Nation's International Organization for Migration (IOM) appealed for $18.5 million (US dollars) to assist health care provision to people impacted by the mpox outbreak in East and Southern Africa. IOM Director General Amy Pope said "the spread of mpox across East, Horn, and Southern Africa is a grave concern, especially for the vulnerable migrant, highly mobile populations and displaced communities often overlooked in such crises".[36]

Wayne County, Michigan, United States confirmed a case of mpox, but are awaiting test results to determine the variant.[37]

#### 22 August

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In Thailand, the Thai Department of Disease Control confirmed an mpox case caused by the clade Ib virus variant, making this the second confirmed case outside of Africa caused by the clade Ib variant.[38][39] The patient was reported to be a 66-year old European man who is a resident of Thailand who had recently visited a country in Africa affected by the outbreak, before returning to Thailand via an undisclosed Middle Eastern country.[39][40] Thongchai Keeratihattayakorn, director-general of the Thai Department of Disease Control said "this man is likely infected from an endemic country" and that no other local infections had been found by contact tracing.[39]

According to the Reuters news agency, on the 22 August 2024, the following countries had reported cases of mpox confirmed as being caused by the new clade Ib variant: Democratic Republic of Congo, Burundi, Kenya, Rwanda, Uganda, Sweden and Thailand.[41]

In Gabon, the Health Ministry reported the country's first case of mpox, without specifying the clade of the virus, in a man who recently returned from Uganda.[42][43] Similarly, the WHO reported the first cases of clade II mpox in the Ivory Coast since the widespread global outbreak of 2022.[44]

## References

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1. ^ a b c Cheng, Maria; Christina, Malkia (2 May 2024). "A new form of mpox that may spread more easily found in Congo's biggest outbreak". Associated Press. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
2. ^ Junaidi, Ikram (15 August 2024). "NCOC issues advisory as first suspected mpox case quarantined". Dawn. Reuters. Agence France-Presse. Archived from the original on 16 August 2024. Retrieved 15 August 2024.
3. ^ Newey, Sarah (16 April 2024). "Mutated strain of mpox with 'pandemic potential' found in DRC mining town". The Daily Telegraph. Archived from the original on 15 August 2024. Retrieved 14 August 2024.
4. ^ Newey, Sarah; Farmer, Ben (2024-01-30). "Children at centre of dangerous mpox outbreak 'accelerating' in DRC". The Telegraph. ISSN 0307-1235. Retrieved 2024-08-18.
5. ^ "More than 600 dead in spreading DR Congo mpox outbreak as Republic of Congo reports its first cases | CIDRAP". www.cidrap.umn.edu. 2024-03-15. Retrieved 2024-08-18.
6. ^ a b Chibelushi, Wedaeli (30 July 2024). "Central African Republic latest to declare mpox outbreak". BBC News. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
7. ^ Cheng, Maria (14 August 2024). "WHO declares mpox outbreaks in Africa a global health emergency as a new form of the virus spreads". Associated Press. Archived from the original on 16 August 2024. Retrieved 14 August 2024.
8. ^ "Explainer - Declaration of Public Health Emergency of Continental Security". Africa Centres for Disease Control and Prevention. 16 August 2024. Retrieved 16 August 2024.
9. ^ "WHO Director-General declares mpox outbreak a public health emergency of international concern". www.who.int. World Health Organization. 14 August 2024. Retrieved 16 August 2024.
10. ^ Kirby, Paul (15 August 2024). "First case of more contagious mpox found outside Africa". BBC. Archived from the original on 15 August 2024. Retrieved 15 August 2024.
11. ^ Ringstrom, Anna; Steenhuysen, Julie (15 August 2024). "WHO confirms first case of new mpox strain outside Africa as outbreak spreads". Reuters.
12. ^ "Mpox: Sweden confirms first case of 'more grave' variant outside Africa". The Guardian. 2024-08-16. ISSN 0261-3077. Retrieved 2024-08-21.
13. ^ a b Rigby, Jennifer (15 August 2024). "Mpox: Vaccine group Gavi says it has up to $500 million for shots". Reuters.
14. ^ a b c "Gavi statement on mpox emergency in Africa". www.gavi.org. Retrieved 2024-08-21.
15. ^ Junaidi, Ikram (15 August 2024). "NCOC issues advisory as first suspected mpox case quarantined". Dawn. Reuters. Agence France-Presse. Archived from the original on 16 August 2024. Retrieved 15 August 2024.
16. ^ a b Junaidi, Ikram (19 August 2024). "Another suspected mpox case sent to Pims; new strain not detected". Dawn. Reuters. Archived from the original on 21 August 2024. Retrieved 20 August 2024.
17. ^ a b "ECDC recommends enhancing preparedness as more imported cases of clade I mpox highly likely" (Press release). European Centre for Disease Prevention and Control. 16 August 2024. Archived from the original on 19 August 2024. Retrieved 18 August 2024.
18. ^ Satija, Bhanvi; Rigby, Jennifer (16 August 2024). "EU public health body raises mpox risk alert level". Reuters. Retrieved 20 August 2024.
19. ^ Roberts, Michelle (16 August 2024). "Mpox: Travellers advised to consider vaccine". BBC. Archived from the original on 21 August 2024. Retrieved 21 August 2024.
20. ^ Gilchrist, Karen (16 August 2024). "Mpox vaccine maker Bavarian Nordic seeks 'critical' EU approval for teens after WHO declares health emergency". CNBC. Retrieved 16 August 2024.
21. ^ a b Collins, Helen (16 August 2024). "Bavarian Nordic asks EU to extend mpox shot license to adolescents". Politico. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
22. ^ a b Sambado, Cristina (16 August 2024). "Mpox. Fabricante dinamarquês da vacina quer aprovação para adolescentes" (in European Portuguese). RTP. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
23. ^ Mai, Jun; Ziwen, Zhao (16 August 2024). "China to screen arrivals showing mpox symptoms as cases spread outside Africa". South China Morning Post. Retrieved 16 August 2024.
24. ^ Haider, Kamran (17 August 2024). "Pakistan Begins Screening All Travelers for Mpox Virus". Bloomberg News. Archived from the original on 19 August 2024. Retrieved 18 August 2024.
25. ^ Mehra, Pallavi (17 August 2024). "Pakistan Reports Three Mpox Cases". Times Now. Archived from the original on 18 August 2024. Retrieved 17 August 2024.
26. ^ Mehra, Pallavi (17 August 2024). "Pakistan Reports Three Mpox Cases". Times Now. Archived from the original on 18 August 2024. Retrieved 17 August 2024.
27. ^ "One case of clade 2 mpox detected in Pakistan, new strain not detected". Reuters. 19 August 2024.
28. ^ "Tainan confirms three mpox cases amid global outbreak". TVBS. 19 August 2024. Retrieved 19 August 2024.
29. ^ "Taiwan records 4 new local mpox cases: CDC - Focus Taiwan". Focus Taiwan - CNA English News. 2024-08-20. Retrieved 2024-08-21.
30. ^ "Mpox case found in Kashmir". www.hindustantimes.com. Retrieved August 20, 2024.
31. ^ Yousafzai, Wisal (2024-08-18). "Police hospital designated for mpox". The Express Tribune. Archived from the original on 2024-08-18. Retrieved 2024-08-18.
32. ^ Valmonte, Kaycee (19 August 2024). "Philippines detects new mpox case after WHO public health emergency declaration". Rappler. Retrieved 19 August 2024.
33. ^ "Philippines says recent mpox case is mild Clade 2 variant". Reuters. 21 August 2024.
34. ^ Miridzhanian, Anait (20 August 2024). "Africa could start mpox vaccinations within days, health agency says". Reuters.
35. ^ "Malawi on alert as referred hospital registers suspected mpox case". english.news.cn. Retrieved August 20, 2024.
36. ^ "UN migration agency appeals for $18.5 mln in assistance for mpox outbreak". Reuters. 21 August 2024.
37. ^ Booth-Singleton, DeJanay (2024-08-21). "Health officials confirm mpox case in Wayne County - CBS Detroit". www.cbsnews.com. Retrieved 2024-08-22.
38. ^ "Thailand says mpox case recorded in traveller from Africa". Reuters. 21 August 2024. Retrieved 21 August 2024.
39. ^ a b c Thepgumpanat, Panarat (22 August 2024). "Thailand confirms mpox case is clade 1b, second outside of Africa". Reuters.
40. ^ "New mpox case could be more transmissible strain". Bangkok Post. Bangkok Post Public Co. Ltd. 21 August 2024. Archived from the original on 21 August 2024. Retrieved 21 August 2024.
41. ^ "Countries with confirmed cases of new mpox variant". Reuters. 22 August 2024. Archived from the original on 22 August 2024. Retrieved 22 August 2024.
42. ^ https://www.lemonde.fr/en/health/article/2024/08/23/gabon-reports-its-first-mpox-case_6720631_14.html
43. ^ "Gabon records first mpox case". Reuters. 23 August 2024.
44. ^ "WHO says Africa's Ivory Coast reports cases of mpox Clade 2". Reuters. 22 August 2024.