Geneva: From January 1, 2022, through October 31, 2023, a cumulative total of 91,788 laboratory-confirmed cases of mpox, including 167 deaths, have been reported from 116 countries, the World Health Organization (WHO) said today. It, however, noted that 668 new cases were reported in October, a 23% decline from the number of new cases reported during the previous month.
In the last month (October 1-31, 2023), 29 countries reported cases, with 13 reporting an increase compared to the previous month (September 1-30, 2023). Germany reported the highest relative increase in cases in the European Region. Vietnam reported the highest relative increase in cases in the Western Pacific Region. China reported a 61% decline in new cases last month but continues to influence the high case counts in the Western Pacific Region. A decline in reported cases was observed in the African Region, at least partly due to irregular reporting (- for example, has not published mpox surveillance data since July 2023).
As of October 31, 2023, the ten countries that have reported the highest cumulative number of cases globally are the United States of America, Brazil, Spain, France, Colombia, Mexico, the United Kingdom, Peru, Germany, and China. Together, these countries account for 81.7% of the cases reported globally.
Situation at a Glance
Mpox remains endemic in densely forested regions of West, Central and East Africa, particularly in the northern and central regions of the Democratic Republic of the Congo. Eleven of the 26 provinces of the Democratic Republic of the Congo are identified as endemic for mpox, but in recent years the number of provinces reporting mpox has been growing, to 22 provinces as of November 2023.
There are two known clades of MPXV: clade I, previously known as the Congo Basin clade; and clade II, previously called the West African clade; clade II further has two subclades: clade IIa and clade IIb. The Democratic Republic of the Congo has not reported cases of mpox linked to clade IIb MPXV during the global outbreak to date; only clade I MPXV has been detected in the country.
Before April 2023, no formally documented cases of sexual transmission of clade I MPXV were registered globally. The first known case of sexual transmission in this report is of a resident of Belgium who tested positive for clade I in Kwango province during a visit to the Democratic Republic of the Congo. Thereafter, sexual contacts of this case in the Democratic Republic of the Congo also tested positive for clade I MPXV, with closely related viral sequences.
From January 1, 2023, through November 12, 2023, a total of 12, 569 suspected mpox cases, including 581 deaths (case fatality ratio: 4.6%), have been reported in 156 health zones from 22 out of 26 (85%) provinces in the Democratic Republic of the Congo. This is the highest number of annual cases ever reported, with new cases in geographic areas that had previously not reported mpox, including Kinshasa, Lualaba, and South Kivu. Among suspected cases, 1106 were tested by reverse transcriptase-polymerase chain reaction (RT-PCR), and 714 were positive for MPXV (positivity rate of 65%).
This is the first time that reported clade I MPXV infection is linked to sexual transmission. Another outbreak in the country is also being reported with multiple cases of mpox among sex workers. In the Democratic Republic of the Congo, human-to-human transmission of mpox through close contact has been reported since the 1970s, mostly in a small household or community outbreaks following presumed zoonotic transmission. Nonetheless, the dynamics of MPXV clade I transmission in the Democratic Republic of the Congo are not well understood. in 2023.
It is important to note that just 9% of the cases reported in the Democratic Republic of the Congo in 2023 are laboratory-confirmed due to limited access to diagnostic testing for remote areas. The suspected case numbers reported reflect specific case definitions used in the country, as well the experience of health workers with a well-known disease, leading to high average test positivity rates, particularly in known endemic areas. These new features of sexual transmission now raise additional concerns over the continuing rapid expansion of the outbreak in the country in a nationally and internationally mobile key population.
– global bihari bureau
