2022–2023 mpox outbreak 2022–2023 mpox outbreak an outbreak of mpox, a viral disease then commonly known as "monkeypox", was confirmed in may 2022. the initial cluster of cases was found in the united kingdom, where the first case was detected in london on 6 may 2022 in a patient with a recent travel history from nigeria (where the disease is endemic). on 16 may, the uk health security agency (ukhsa) confirmed four new cases with no link to travel to a country where mpox is endemic. all four cases appeared to have been infected in london. from 18 may 2022 until may 2023, cases were reported from several countries and regions, predominantly in europe and in the americas but also in asia, in africa, and in oceania. the outbreak marked the first time mpox had spread widely outside central and west africa. 2022 mpox outbreakspread of disease as of 14 october 2022 endemic clade i(formerly congo basin or central african clade) endemic clade ii(formerly west african clade) both clades recorded clade ii outbreak in 2022 suspected cases diseasempoxvirus strainmonkeypox virus (mpv), clade ii, 2017–2019 outbreak subcladesourcetravel from nigeria (presumed/hypothesis)location113 countries and territories(111 with confirmed cases,2 with suspected cases only)first outbreaklondon, united kingdom(first outside of historically-endemic african countries)datefirst international outbreak: 6 may 2022 public health emergency of international concern: 23 july 2022 – 11 may 2023 (9 months, 2 weeks and 4 days)confirmed cases86,956 (since january 2022)deaths119 (since january 2022) on 23 july, the director-general of the world health organization (who), tedros adhanom ghebreyesus, declared the outbreak a public health emergency of international concern (pheic). as of 18 march 2023, there had been a total of 86,516 confirmed cases in over 113 countries.in may 2023, the world health organization declared an end to the global health emergency declared in response to the worldwide outbreak of mpox virus. mpox is a viral infection that manifests a week or two after exposure with fever and other non-specific symptoms, and then produces a rash with lesions that usually last for 2–4 weeks before drying up, crusting and falling off. while mpox can cause large numbers of lesions, in the current outbreak, some patients experience only a single lesion in the mouth or on the genitals, making it more difficult to differentiate from other infections. in infections before the current outbreak, 1–3 percent of people with known infections have died (without treatment). cases in children and immunocompromised people are more likely to be severe. mpox spreads through close, personal, often skin-to-skin contact. the disease can spread through direct contact with rashes, or body fluids from an infected person, by touching objects and fabrics that have been used by someone with mpox or through respiratory secretions. given the unexpected and vast geographical spread of the disease, the actual number of cases is likely to be underestimated. while anyone can get mpox, to date the majority of confirmed cases outside of the endemic regions in africa occurred in young or middle-aged men who have sex with men (msm) who had recent sexual contact with new or multiple partners. on 28 july, the who director-general advised msm to limit exposure by reducing the number of sexual partners, reconsidering sex with new partners, and maintaining contact details to allow for epidemiological follow-up. the centers for disease control and prevention has emphasized the importance of reducing stigma in communicating about the demographic aspects of mpox, specifically with regards to gay and bisexual men. background these paragraphs are an excerpt from mpox. mpox (pronounced /ˈɛmpɒks/ em-poks, formerly known as monkeypox) is an infectious viral disease that can occur in humans and some other animals. symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. the time from exposure to onset of symptoms ranges from five to twenty-one days and symptoms typically last from two to four weeks. there may be mild symptoms, and it may occur without any symptoms being apparent. cases may be severe, especially in children, pregnant women or people with suppressed immune systems. the disease is caused by the monkeypox virus, a zoonotic virus in the genus orthopoxvirus. the variola virus, the causative agent of smallpox, is also in this genus. of the two types (called "clades") in humans, clade ii (formerly west african clade) causes a less severe disease than the central african (congo basin) type. it may spread from infected animals by handling infected meat or via bites or scratches. human-to-human transmission can occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route. people can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off; with some evidence of spread for more than a week after lesions have crusted. diagnosis can be confirmed by testing a lesion for the virus's dna. there is no known cure. a study in 1988 found that the smallpox vaccine was around 85% protective in preventing infection in close contacts and in lessening the severity of the disease. a newer smallpox and mpox vaccine based on modified vaccinia ankara has been approved, but with limited availability. other measures include regular hand washing and avoiding sick people and animals. antiviral drugs, cidofovir and tecovirimat, vaccinia immune globulin and the smallpox vaccine may be used during outbreaks. the illness is usually mild and most of those infected will recover within a few weeks without treatment. estimates of the risk of death vary from 1% to 10%, although few deaths as a consequence of mpox have been recorded since 2017. emergency preparedness on 17 march 2021, the nuclear threat initiative led a tabletop exercise at the munich security conference simulating hypothetical public health responses to the intentional release of a genetically manipulated strain of monkeypox virus. on 23 july 2022, the world health organization director-general tedros adhanom ghebreyesus declared the 2022 outbreak a public health emergency of international concern.in may 2023, the emergency was declared over. mpox in endemic africa the africa centres for disease control and prevention had alerted several members of the african union in may 2022 about cases of mpox. the director of the africa cdc, ahmed ogwell, said that cameroon, central african republic, the democratic republic of congo and nigeria have reported 1,405 endemic cases with 62 deaths during the first five months of 2022. the case fatality rate in these four african countries combined was 4.4%. in an article in the conversation, oyewale tomori pointed out that the number of mpox infections in nigeria through 2021 is likely to be under-reported because much of the nigerian population has been avoiding healthcare facilities due to fear of contracting covid-19. nigeria's surveillance of various diseases, including mpox, had to focus on the global covid-19 pandemic in 2020 and 2021, missing many cases and resulting in a drop in official statistics. as british health authorities reported the first case of mpox in the uk in may 2022, the nigerian government has released to the public information and statistics on reported cases and deaths in the country. in the report of 9 may 2022, the ncdc stated that 230 cases were confirmed across 20 states and the federal capital territory between 2017 and 2022. rivers state was the most affected, followed by bayelsa and lagos. in the span from 2017 to 2022, the ncdc reported six deaths in six different states, making for a 3.3% case fatality ratio. on 30 may, the first death from mpox was reported in nigeria during 2022; the last time a death was reported in the country from this disease was in 2019. outbreak characteristics