3.1 Reporting coverage

The detailed case dataset was last updated on September 02 2022. As of this date, the total number of detailed confirmed cases reported is 43,974, representing 93.1% 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 (26 August) for data in the Region of the Americas.

2. The most recent Tuesday (30 August) for data in the European Region.

Total cases shown fully as of 01 September are shown in the global trends section.

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 3-9 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:

• 98.2% (26608/27093) 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 77.8% of cases.

• Of all cases with available data, 1.8% (485/27093) are female:

  • The majority of of these cases are reported from the European Region (284/485; 59%) and the Region of the Americas (134/485; 28%)

  • Of the cases where sexual orientation is reported, the majority are Heterosexual (140/145; 97%).

  • The most commonly reported exposure setting is in a party setting with sexual contact (25/75; 33%), and the most common form of transmission is via sexual encounters (82/120; 68%)

• Of the 27,619 cases where age was available, there were 162 (0.6%) cases reported aged 0-17, out of which 43 (0.2%) were aged 0-4:

  • The majority of these cases are reported from the African Region (65 /485; 40%).

  • Of the children reported, 0 have reported exposure in a school setting.

• Among cases with known data on sexual orientation, 95.2% (11683/12277) identified as men who have sex with men. Of those identified as men who have sex with men, 193 / 11683 (1.7%) were identified as bisexual men.

• Among those with known HIV status 44.2% (5,388/12,179) 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.

• 305 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 7,724 of 8,397 (92.0%) 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 2,917 of 4,850 (60.1%) of all likely exposure categories.

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.

• 75.5% (448/593) of cases with available data are male; the median age is 34 years (IQR: 28-42).

• Males between 18-44 years old account for 60.2% of cases.

• Among those with known HIV status 15.9% (79/496) 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.

• 16 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 167 of 203 (82.3%) 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 44 of 144 (30.6%) of all likely exposure categories.

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 fever and is reported in 77% 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.