深度报告-2026-02-16-世界卫生组织-WHO_Rapid_Risk_Assessment_-_Mpox,_Global_v.6_36页_1mb

MPOX, MULTI-COUNTRY Summary

Overview

As of 07 February 2026, the monkeypox virus (MPXV) continues to circulate globally, with outbreaks reported in 143 countries and territories from 1 January 2022 to 31 December 2025. A total of 177,848 confirmed cases and 477 deaths have been recorded, with a case fatality ratio (CFR) of 0.3%. The overall public health risk is assessed as moderate, and confidence in available information is moderate. The risk is further categorized into three population groups: individuals with multiple sexual partners, children in historically endemic areas, and all other individuals.

Key Findings

Global Public Health Risk

• Overall Risk: Moderate

• Confidence: Moderate

• The virus has spread across various regions, with sexual contact being a primary driver of transmission, especially in newly affected areas.

• Clade Ib has been the dominant strain in recent outbreaks, with some cases involving recombinant strains of clade Ib/Ilb and Ib/Ib.

• Severe outcomes are more common among immunocompromised individuals, including those with HIV, malignancies, or other chronic conditions.

• Case fatality ratio (CFR) remains below 1% in most settings, but can be as high as 15% among those with CD4 counts <200 cells/mm³.

• Children under 5 years in historically endemic areas, particularly in the Democratic Republic of the Congo (DRC), face higher CFRs (up to 3.2%) compared to older individuals (1.8%).

Individuals with Multiple Sexual Partners

• Risk: Moderate
• Likelihood of infection: High
• Consequences: Minor (in general population), but severe in immunocompromised individuals
• Rationale:
  • Sexual networks with frequent partner change and high turnover are key drivers of MPXV spread.
  • Viral shedding can occur up to 4 days before symptom onset, increasing the risk of pre-symptomatic transmission.
  • Men who have sex with men (MSM), sex workers, and their clients are at higher risk.
  • Immunocompromised individuals, especially those with untreated or poorly controlled HIV, are at increased risk for severe disease.
  • Vaccination efforts have been implemented in some countries, but coverage remains uneven, particularly in low- and middle-income countries.

Children in Historically Endemic Areas

• Risk: Moderate
• Likelihood of infection: Moderate
• Consequences: Severe, especially among those under 5 years
• Rationale:
  • Children in the DRC and other parts of West and Central Africa are disproportionately affected.
  • Syndromic surveillance is limited, making it difficult to accurately assess the burden.
  • High CFR in children is attributed to limited access to healthcare and co-morbidities like malaria and malnutrition.
  • While children are vulnerable to severe disease, their role in geographic spread is minimal compared to adults.

All Other Individuals

• Risk: Low
• Likelihood of infection: Low
• Consequences: Minimal
• Rationale:
  • Most individuals in this group experience mild, self-limiting disease.
  • Severe outcomes are rare, except in those with underlying immunocompromising conditions.
  • Vaccination has been prioritized for high-risk groups, and the general population remains largely immunologically naive.
  • Non-sexual transmission (e.g., household, occupational) is less efficient and contributes minimally to spread.

Risk Questions and Assessments

1. Risk for Human Health (Individuals with Multiple Sexual Partners)

• Likelihood: Likely
• Consequences: Minor
• Risk: Moderate
• Rationale: While most adults experience mild disease, immunocompromised individuals face higher risks of severe disease and death. The presence of recombinant strains and the potential for pre-symptomatic transmission increase the risk of sustained spread within sexual networks.

2. Risk of Geographic Spread (Individuals with Multiple Sexual Partners)

• Likelihood: Highly likely
• Consequences: Minor
• Risk: Moderate
• Rationale: Sexual networks facilitate rapid geographic spread, especially when cases are imported and transmitted within communities. However, the overall impact of spread is considered minor due to the limited number of reported cases and effective control measures in many areas.

3. Risk of Insufficient Control Capacities (Individuals with Multiple Sexual Partners)

• Likelihood: Likely
• Consequences: Minor
• Risk: Moderate
• Rationale: Control efforts are hindered by inadequate recognition of sexual transmission, limited vaccine coverage, and insufficient funding in many low- and middle-income countries. These factors can delay response and increase the likelihood of sustained transmission.

4. Risk for Human Health (Children in Historically Endemic Areas)

• Likelihood: Moderate
• Consequences: Severe
• Risk: Moderate
• Rationale: Children, especially those under 5, are at higher risk of severe disease and death in historically endemic areas due to limited healthcare access and co-morbidities. The CFR in this group is significantly higher than in other regions.

5. Risk of Geographic Spread (Children in Historically Endemic Areas)

• Likelihood: Low
• Consequences: Minor
• Risk: Moderate
• Rationale: Children are not the primary drivers of geographic spread, as their role in transmission is limited. However, the risk of undetected spread remains due to limited surveillance in endemic areas.

6. Risk of Insufficient Control Capacities (Children in Historically Endemic Areas)

• Likelihood: Likely
• Consequences: Moderate
• Risk: Moderate
• Rationale: Limited surveillance, diagnostic capacities, and healthcare access in endemic regions contribute to the risk of insufficient control. The virus continues to circulate in these areas, especially in rural, forested regions.

Conclusion

Mpox remains a moderate public health risk globally, with sexual networks being the main driver of transmission. While most individuals experience mild disease, immunocompromised populations and children in endemic areas face higher risks of severe outcomes. Control efforts are improving, but challenges persist in terms of funding, vaccine coverage, and response capacity, particularly in low- and middle-income countries. Continued genomic surveillance, targeted vaccination, and effective community engagement are essential to manage the ongoing risk and prevent further spread.