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WHO: 2022 Monkeypox Outbreak: Global Trends (14 September 2022)

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  • WHO: 2022 Monkeypox Outbreak: Global Trends (14 September 2022)

    Source: https://worldhealthorg.shinyapps.io/mpx_global/


    2022 Monkeypox Outbreak:
    Global Trends


    World Health Organization

    Produced on 14 September 2022




    1 Overview

    This report provides a global overview of the monkeypox epidemiological situation as reported to WHO as of September 13 2022. The report focuses on laboratory confirmed cases1 as defined by the WHO’s working case definition published in the Surveillance, case investigation and contact tracing for monkeypox interim guidance. Note that countries may use their own case definitions separate from those outlined in the above document. This report should be considered in the context of other WHO information products associated with the 2022 monkeypox outbreak, and monkeypox in general:
    • The biweekly Situation Report provides a comprehensive update of the monkeypox situation and response activities across a variety of domains such as epidemiology, clinical management and communications, replacing the previous Disease Outbreak News format;
    • The Emergency Dashboard provides the latest daily data on total cases and deaths of monkeypox, as well as other events and emergencies to which WHO is responding;
    • This global epidemiological report provides in-depth epidemiological information about the monkeypox situation, based primarily on case report forms provided by Member States to WHO under Article 6 of the International Health Regulations (IHR 2005).
    Links to these products can be see in more detail at the end of the report.
    Since 1 January 2022, cases of monkeypox have been reported to WHO from 102 Member States across all 6 WHO regions. As of September 13 2022 at 17h CEST, a total of 58,285 laboratory confirmed cases and 480 probable cases, including 22 deaths, have been reported to WHO. Since 13 May 2022, a high proportion of these cases have been reported from countries without previously documented monkeypox transmission. This is the first time that cases and sustained chains of transmission have been reported in countries without direct or immediate epidemiological links to areas of West or Central Africa.
    With the exception of countries2 in West and Central Africa, the ongoing outbreak of monkeypox continues to primarily affect men who have sex with men who have reported recent sex with one or multiple partners. At present there is no signal suggesting sustained transmission beyond these networks.
    Confirmation of one case of monkeypox, in a country, is considered an outbreak. The unexpected appearance of monkeypox in several regions in the initial absence of epidemiological links to areas in West and Central Africa, suggests that there may have been undetected transmission for some time.
    WHO assesses the global risk as Moderate. Regionally, WHO assesses the risk in the European Region as High and as Moderate in the African Region, Region of the Americas, Eastern Mediterranean Region and the South-East Asia Region. The risk in the Western Pacific Region is assessed as Low-Moderate. The IHR Emergency Committee on the multi-country outbreak of monkeypox held its second meeting on 21 July 2022. Having considered the views of committee members and advisors as well as other factors in line with the International Health Regulations (2005), the WHO Director-General declared this outbreak a public health emergency of international concern and issued temporary recommendations in relation to the outbreak.

    1. For the WHO European region, both confirmed and probable cases are included within confirmed case counts and detailed case data.
    2. Throughout this document, any use of the word country should be considered shorthand for a country, area, or territory
    3. All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).





    2 Global situation update

    The number of weekly1 reported new cases globally has decreased by 3.2% in week 36 (05 Sep - 11 Sep) (n = 4,863 cases) compared to week 35 (29 Aug - 04 Sep) (n = 5,026 cases). The majority of cases reported in the past 4 weeks were notified from the Region of the Americas (74.9%) and the European Region (24.1%).
    The 10 most affected countries globally are: United States of America (n = 21,504), Spain (n = 6,947), Brazil (n = 6,033), France (n = 3,785), The United Kingdom (n = 3,552), Germany (n = 3,547), Peru (n = 1,937), Canada (n = 1,321), Netherlands (n = 1,195), and Colombia (n = 938). Together, these countries account for 87.1% of the cases reported globally.
    In the past 7 days, 24 countries reported an increase in the weekly number of cases, with the highest increase reported in Mexico. 33 countries have reported no new cases in the past 21 days.
    In the past 7 days, 1 country reported their first case. countries which reported their first case in the past 7 days are: Jordan (08 September).
    Global data are data collected by public sources. These data are largely aggregated cases that have been reported from open and official country sources. The below epidemic curve shows the aggregated number of cases by week according to the date of case reporting.Epidemic curve shown for cases reported up to 11 Sep 2022 to avoid showing incomplete weeks of data.















    1. Weekly reported cases, and weekly cases shown in the epidemic curve are aggregated according to international standard weeks, running from Monday to Sunday.





    3 Detailed case data

    Detailed case data are acquired via direct reporting of case based data via WHO Member States. Data from cases are reported1 according to the WHO minimum dataset under the International Health Regulations (IHR 2005) Article 6, and subsequently aggreagated and presented below. Note that completeness of records is variable, meaning denominators for each output may be different from one another. All of the following is derived from the detailed case data, and as a result, overall numbers may not be reflective of figures shown with aggregate case numbers. All detailed cases shown are confirmed cases, where the reporting date occured after 01 January 2022.
    1. Note that a small number of detailed case reports are constructed from official public reports about individual cases.



    3.1 Reporting coverage

    The detailed case dataset was last updated on September 11 2022. As of this date, the total number of detailed confirmed cases reported is 49,644, representing 86.3% of all aggregated cases reported.
    The table below indicate the reporting coverage between reported aggregated confirmed cases and detailed confirmed cases by countries and per region.
    Note that for all tables below, in order to best align modes of reporting, total confirmed cases are shown as of:
    1. The most recent Friday (09 September) for data in the Region of the Americas.
    2. The most recent Tuesday (13 September) for data in the European Region.
    Total cases shown fully as of 13 September are shown in the global trends section.
    Monkeypox reporting completeness
    As of 13 Sep 20221
    32,877 26,403 80.3%
    23,837 23,003 96.5%
    585 173 29.6%
    165 20 12.1%
    47 39 83.0%
    18 6 33.3%
    1 Total confirmed cases shown as of date of last detailed case report for the WHO Region of the Americas and WHO European Region.
    2 Note that in rare cases total detailed cases may exceed total confirmed cases due to ongoing data cleaning issues
















    3.2 Trends in cases

    Trends in cases are shown for all submitted detailed cases. These are shown by:
    1. Date of symptom onset
    2. Date of lab or clinical diagnosis (if date of symptom onset is not available)
    3. Date of reporting (if date of symptom onset and date of diagnosis are not available)
    Note that reporting of detailed cases is subject to some delay. The epidemic curves shown are not right censored, and therefore trends in the most recent 1-3 weeks should be interpreted with caution. It should be additionally noted that date of report does not reflect the date of reporting to WHO, but rather reporting to national or regional authorities.
    Delay between date of onset and date of report were calculated for all countries where reporting quality passed minimum quality checks. Delays were only shown when the time between onset and reporting was between -5 and 40 days.
    • Median delay between onset and reporting was 6 days
    • The interquartile range between onset and reporting was 3-10 days.















    3.3 Case profile (overall)

    As shown below, and stated previously, the ongoing outbreak is largely developing in men who have sex with men (defined as homosexual or bisexual males in detailed case forms) networks. In the following analyses, we have re-coded men reported as bisexual as men who have sex with men. Note that reported sexual orientation does not necessarily reflect who the case has had recent sexual history with nor does it imply sexual activity. Generally, severity has been low, with few reported hospitalisations and deaths:
    Key features of these cases are as follows:
    • 98.1% (28394/28931) of cases with available data are male, the median age is 36 years (IQR: 30 - 43).
    • Males between 18-44 years old continue to be disproportionately affected by this outbreak as they account for 78.0% of cases.
    • Of all cases with available data, 1.9% (537/28931) are female:
      • The majority of of these cases are reported from the European Region (314/537; 58%) and the Region of the Americas (156/537; 29%)
      • Of the cases where sexual orientation is reported, the majority are Heterosexual (159/169; 94%).
      • The most commonly reported exposure setting is in a household (26/80; 32%), and the most common form of transmission is via sexual encounters (94/142; 66%)
    • Of the 29,565 cases where age was available, there were 175 (0.6%) cases reported aged 0-17, out of which 47 (0.2%) were aged 0-4:
      • The majority of cases aged 0-17 are reported from the African Region (65 /175; 37%).
      • Of the cases aged 0-17, 0 have reported exposure in a school setting.
    • Among cases with known data on sexual orientation, 95.0% (12661/13324) identified as men who have sex with men. Of those identified as men who have sex with men, 231 / 12661 (1.8%) were identified as bisexual men.
    • Among those with known HIV status 45.6% (5,971/13,080) were HIV-positive. Note that information on HIV status is not available for the majority of cases, and for those for which it is available, it is likely to be skewed towards those reporting positive HIV results.
    • 322 cases were reported to be health workers. However, most were infected in the community and further investigation is ongoing to determine whether the remaining infection was due to occupational exposure.
    • Of all reported types of transmission, a sexual encounter was reported most commonly, with 8,432 of 9,310 (90.6%) of all reported transmission events.
    • Of all settings in which cases were likely exposed, the most common was in party setting with sexual contacts, with 3,029 of 5,068 (59.8%) of all likely exposure categories.
    Note that the proportions shown below should be interpreted with caution. When considering some variables, it is more likely that a yes response will be obtained when compared to a no response after consideration of true proportions of these factors. This is most likely to be true for variables where reported answers can only be yes or no, such as HIV status, health worker status, travel history, hospitalisation, ICU, and death.
    Case profiles
    As of September 11 2022
    12661 (95.0%) 663 (5.0%) 36305
    5971 (45.7%) 7108 (54.3%) 36550
    322 (4.1%) 7481 (95.9%) 41826
    1327 (26.5%) 3690 (73.5%) 44612
    8430 (90.6%) 878 (9.4%) 40321
    1792 (9.1%) 17968 (90.9%) 29869
    11 (0.1%) 8536 (99.9%) 41082
    4 (0.0%) 20898 (100.0%) 28727
    1 Note given true proportions of variables, yes reporting may be common than no reporting
    2 May be hospitalised for isolation or medical treatment















    3.4 Case profile (excluding men who have sex with men)

    The following outputs apply to cases that are not men who have sex with men, and sexual orientation is known. Other categories of sexual orientation that are reportable are:
    • Heterosexual
    • Lesbian (women who have sex with women)
    • Other
    As stated above, men who have sex with men in this case refers to those who have a reported sexual orientation of men whi have sex with men, and men reported as bisexual. As above, note that reported sexual orientation does not necessarily reflect persons who the case has had recent sexual history with nor does it imply sexual activity. Up until this point in time, the 2022 multi-country Monkeypox outbreak has been overwhelmingly concentrated in networks of men who have sex with men For this reason, understanding events in which individuals of other sexual orientation have acquired monkeypox is important to monitor potential of sustained spillover into the general population.
    • 75.1% (497/662) of cases with available data are male; the median age is 34 years (IQR: 28-42).
    • Males between 18-44 years old account for 59.9% of cases.
    • Among those with known HIV status 16.9% (91/538) were HIV-positive. Note that information on HIV status is not available for the majority of cases, and for those for which it is available, it is likely to be skewed towards those reporting positive HIV results.
    • 17 cases were reported to be health workers. However, most were infected in the community and further investigation is ongoing to determine whether the remaining infection was due to occupational exposure.
    • Of all reported types of transmission, sexual encounter was reported most commonly, with 192 of 244 (78.7%) of all reported transmission events.
    • Of all settings in which cases were likely exposed, the most common was in party setting with sexual contacts, with 49 of 158 (31.0%) of all likely exposure categories.
    Note that the proportions shown below should be interpreted with caution. When considering some variables, it is more likely that a yes response will be obtained when compared to a no response after consideration of true proportions of these factors. This is most likely to be true for variables where reported answers can only be yes or no, such as HIV status, health worker status, travel history, hospitalisation, ICU, and death.
    Case profiles (excluding men who have sex with men)
    As of September 11 2022
    0 663 (100.0%) 0
    91 (16.9%) 447 (83.1%) 125
    17 (3.7%) 441 (96.3%) 205
    72 (29.5%) 172 (70.5%) 419
    192 (78.7%) 52 (21.3%) 419
    70 (13.4%) 451 (86.6%) 142
    0 356 (100.0%) 307
    0 600 (100.0%) 63
    1 Note given true proportions of variables, yes reporting may be common than no reporting
    2 May be hospitalised for isolation or medical treatment













    3.5 Symptomatology

    Although most cases in current outbreaks have presented with mild disease symptoms, monkeypox virus (MPXV) may cause severe disease in certain population groups (young children, pregnant women, immunosuppressed persons)
    Among the cases who reported at least one symptom, the most common symptom is any rash and is reported in 84% of cases with at least one reported symptom. Note that identifying true denominators for symptomatology is difficult due to a general lack of negative reporting and symptom definitions that may vary between countries’ reporting systems.
    A bar chart and table showing symptoms is shown below. Here any rash refers to one or more rash symptoms (systemic, oral, genital, or unknown location), and any lymphadenopathy refers to either general or local lymphadenopathy.












    4 In focus: West and Central Africa

    Since 1970, human cases of monkeypox have been reported in 9 countries in the WHO African region: Cameroon, Central African Republic, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Gabon, Liberia, Nigeria, and Sierra Leone. The true burden of monkeypox in these countries is not known. This section specifically focuses on those countries in the African region with a history of monkeypox, in order to highlight any differences in epidemiology between those countries and those within the ongoing 2022 monkeypox outbreak without a history of monkeypox. Notably, while the ongoing 2022 monkeypox outbreak has been associated with Clade II of monkeypox virus, historically outbreaks have been driven by that and Clade I.
    Historically, the sexual component of transmission in the countries above has been thought to contribute less to human to human transmission of monkeypox than has been observed in the ongoing global outbreak. It should also be noted that there is limited testing capacity for monkeypox in many of these countries, which has led to underascertainment of monkeypox cases.
    In 2022, as of 13 Sep 2022, there have been 493 confirmed cases of monkeypox reported in these countries and 10 deaths. These represent 1% and 45% of global cases and deaths respectively. In addition, 173 (35% of all cases) detailed cases have been reported to WHO.
    Of those cases with detailed data:
    • 110 male cases (64.3%) and 61 female cases (35.7%) have been reported
    • The median age is 25 (IQR: 11 - 35).
    • Of the 168 cases where age was available, there were 65 (38.7% of total) cases reported aged 0-17, out of which 21 (12.5% of total) were aged 0-4.
    • There are currently no detailed cases for which transmission or exposure setting detail is available
    Trends from these countries are shown below:Epidemic curve shown for cases reported up to 12 Sep 2022 to avoid showing incomplete weeks of data.













    5 Disclaimers


    5.1 Data Overview and Visualizations

    The WHO 2022 monkeypox global trends report aims to provide frequently updated data visualizations. Caution must be taken when interpreting all data presented, and differences between information products published by WHO, national public health authorities, and other sources using different inclusion criteria and different data cut-off times are to be expected. While steps are taken to ensure accuracy and reliability, all data are subject to continuous verification and change. All counts are subject to variations in case detection, definitions, laboratory testing, and reporting strategies between countries, states and territories.
    WHO makes no warranties or representations regarding the contents, appearance, completeness, technical specifications, or accuracy of the report. WHO disclaims all responsibility relating to, and shall not be liable for, any use of the report, the results of such use, or the reliance thereon.
    WHO reserves the right to make updates and changes to the report without notice, and accepts no liability for any errors or omissions in this regard.
    The user of the report is responsible for the interpretation and use of the analysis and outputs performed by the report. The submission of content to the report does not imply WHO’s approval or endorsement of that content, or that the content is appropriate for any purpose or meets any established standard or requirement
    Any designations employed or presentation by the user in its use of the app, including tables and maps, do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries.
    All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).
    A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).


    5.2 Copyright, Permissions, and Referencing

    © World Health Organization 2022, All rights reserved.
    WHO supports open access to the published output of its activities as a fundamental part of its mission and a public benefit to be encouraged wherever possible. Permission from WHO is not required for the use of the WHO coronavirus disease (COVID-19) explorer material or data available for download.
    The user shall not, in connection with use of the app, state or imply that WHO endorses or is affiliated with the user, its use of the app, or any content, output, or analysis resulting from or related to the app, or that WHO endorses any entity, organization, company, or product.
    The use of the WHO emblem / logo by a user of the report in connection with its use is not permitted. For further information, please visit WHO Copyright, Licencing and Permissions.
    Suggested citation: 2022 Monkeypox Outbreak: Global Trends. Geneva: World Health Organization, 2022. Available online: https://worldhealthorg.shinyapps.io/mpx_global/ (last cited: [date]).




    6 Acknowledgements

    We gratefully acknowledge the input of national public health staff involved in surveillance activities and data submission to WHO, the European Centre for Disease Prevention and Control (ECDC) for the provision of surveillance data collected via the TESSy platform, as well as external partners who contributed additional insights and contextual information on the data.



    7 Useful links and documentation


    7.1 Global

    7.2 Region of the Americas

    7.3 Eastern Mediterranean Region

    7.4 European Region



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