#19,001
While based on limited reporting, the above graphic provides some valuable insight into how much progress the multiple strains of Mpox have made over the past 13 months in spreading both inside and outside of Africa.
Four years ago, the global Mpox map was far more compact (see below), as Mpox (formerly Monkeypox) was only typically found inside of Africa (note: with a handful of exported cases reported each year).
Geographic Range of Monkeypox - Credit WHO
In the spring of 2022, however, Mpox clade IIb emerged, and began its world tour. According to the CDC; The ongoing global outbreak of clade IIb monkeypox has caused more than 100,000 cases in 122 total countries, including 115 countries where monkeypox was not previously reported.While that outbreak eventually slowed, it never really ended - and in the summer of 2024 the WHO declared a new emerging threat; Clade Ib (see WHO declared the Mpox outbreak in Central Africa to constitute a PHEIC ).
Although clade Ib has taken off slower than did clade IIb, it continues to make inroads around the world, with community transmission now being reported in a number of countries outside of Africa (see WHO DON: Broader Transmission of Mpox Due to clade Ib MPXV – Global situation).
"Based on this, Italy, Malaysia, the Netherlands, Portugal, Spain, and the United States of America are now considered to be experiencing community transmission of clade Ib MPXV. In addition, travel-related cases continue to be reported in many countries."
Earlier this month, the UK also reported a New Recombinant Strain of Mpox Virus in a traveler returning from Asia. Details remain scant, but this continues to validate the concerns expressed eleven years ago - in an EID Journal article Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo - where the authors cautioned:
Small genetic changes could favor adaptation to a human host, and this potential is greatest for pathogens with moderate transmission rates (such as MPXV) (40). The ability to spread rapidly and efficiently from human to human could enhance spread by travelers to new regions.
In the decade since, 2 new clades (Ib and IIb) have emerged, with both (IIb and, to a lesser extent Ib) managing to spread internationally. Given this track record, new emerging variants and/or clades of the mpox virus are not totally unexpected.
While we are in the midst of our annual holiday drought of infectious disease reporting, the WHO published their latest monthly Multi-Country Mpox report on the 22nd, which also includes a brief comment on the UK recombinant finding.
A link, and a few excerpts from this 15-page report, follow.
Mpox
Multi-country external situation report no. 61, published 22 December 2025
Highlights
• All clades of monkeypox virus (MPXV) continue to circulate. Unless mpox outbreaks are rapidly contained and human-to-human transmission is interrupted, there is a risk of sustained community transmission.
• In November 2025, 48 countries across all WHO regions reported a total of 2150 new confirmed mpox cases, including five deaths (case fatality ratio [CFR] 0.2%). About 68% of these cases were reported in the African Region. Four regions observed a decline in confirmed cases in November, compared to October 2025, while the European and Western Pacific regions reported more cases than the previous month.
• Nineteen countries in Africa reported active transmission of mpox in the last six weeks (2 November– 14 December 2025), with 1435 confirmed cases, including seven deaths (CFR 0.5%). Countries reporting the highest number of cases in this period are the Democratic Republic of the Congo, Guinea, Liberia, Kenya and Ghana; while case reports in Liberia still show indications of a rise, weekly case counts in the other countries have been declining in recent weeks.
• Romania has reported detection of clade Ib MPXV for the first time, in a case confirmed in August 2025.
• Outside Africa, community transmission of clade Ib MPXV continues in Spain and in the Netherlands
.• In the Democratic Republic of the Congo, mpox transmission continues across multiple provinces with co-circulation of clades Ia and Ib MPXV, heterogeneous subnational trends and declining access to testing of suspected cases.
• The United Kingdom of Great Britain and Northern Ireland has reported a new travel-linked case of mpox with detection of a recombinant MPXV strain containing genetic elements of both clade Ib and clade IIb MPXV. The extent of circulation of the recombinant strain remains unknown.
• WHO assesses the ongoing public health risk to be moderate for men who have sex with men with new or multiple partners, sex workers and others with multiple partners who may be at risk, and low for the general population with no specific risk factors, continues close monitoring of the situation, and emphases the importance of maintaining surveillance and response capacity, including genomic sequencing notably in locations where multiple MPXV strains co-circulate.
(SNIP)
Recombinant strain of MPXV detected in the United Kingdom of Great Britain and Northern IrelandOn 2 December, WHO was notified by the United Kingdom of a single imported mpox case caused by a recombinant MPXV strain containing both clade Ib and clade IIb MPXV genetic elements in its genome. The case reported recent travel history to Asia, where exposure is likely to have occurred. The individual experienced mild illness and had atypical mpox presentation.
Recombination is a known natural process that can occur when an individual is infected with two related virus strains at the same time. Orthopoxviruses, including MPXV, are capable of recombination when co-infection occurs.Multiple MPXV strains are currently circulating in interconnected sexual networks across many countries and indifferent settings. In this case, the genomic analyses indicate that the virus acquired alternating fragments from both clade Ib and clade IIb MPXV, resulting in a replication-competent recombinant.
The information available for this one case is not sufficient to draw conclusions about the transmissibility or clinical severity of this recombinant strain, or the effectiveness of medical countermeasures against it.
WHO, through its regional and country offices, is continuing to gather more information and closely monitor the situation. The WHO global risk assessment remains unchanged, with the risk considered moderate for men who have sex with men with new or multiple partners, for sex workers and for others with multiple partners who may beat risk, and low for the general population who have no specific risk factors for mpox.
WHO advises Member States to continue implementing the Standing recommendations currently extended to August 2026. Countries should maintain mpox surveillance, case management, infection prevention and control measures, and vaccination strategies, and prioritize genomic sequencing for new and unusual cases, particularly in key populations at risk and in settings where multiple MPXV strains are co-circulating, with timely sharing of sequence data to support close monitoring of viral evolution and transmission patterns.
Since the eradication of smallpox in the 1970s, there is a general feeling that poxviruses are a thing of the past; a near-forgotten relic of the 20th century.
But a 2020 report in the Bulletin of the World Health Organization warned that our waning immunity to smallpox puts society at increasing risk of seeing new poxvirus epidemics (see WHO: Modelling Human-to-Human Transmission of Monkeypox).
We are now on round two of Mpox, and due to its relatively glacial pace, many assume it will fizzle over time.
But the emergence of 2 new clades (Ib & IIb) since 2020 - and a new recombinant in the UK - suggest that Mpox isn't near done reinventing itself, and we ignore its potential do to so at our considerable peril.