A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022

Aisling M Vaughan; Orlando Cenciarelli; Soledad Colombe; Luís Alves de Sousa; Natalie Fischer; Celine M Gossner; Jeff Pires; Giuditta Scardina; Gudrun Aspelund; Margarita Avercenko; Sara Bengtsson; Paula Blomquist; Anna Caraglia; Emilie Chazelle; Orna Cohen; Asuncion Diaz; Christina Dillon; Irina Dontsenko; Katja Kotkavaara; Mario Fafangel; Federica Ferraro; Richard Firth; Jannik Fonager; Christina Frank; Mireia G Carrasco; Kassiani Gkolfinopoulou; Marte Petrikke Grenersen; Bernardo R Guzmán Herrador; Judit Henczkó; Elske Hoornenborg; Derval Igoe; Maja Ilić; Klaus Jansen; Denisa-Georgiana Janță; Tone Bjordal Johansen; Ana Kasradze; Anders Koch; Jan Kyncl; João Vieira Martins; Andrew McAuley; Kassiani Mellou; Zsuzsanna Molnár; Zohar Mor; Joël Mossong; Alina Novacek; Hana Orlikova; Iva Pem Novosel; Maria K Rossi; Malgorzata Sadkowska-Todys; Clare Sawyer; Daniela Schmid; Anca Sîrbu; Klara Sondén; Arnaud Tarantola; Margarida Tavares; Marianna Thordardottir; Veronika Učakar; Catharina Van Ewijk; Juta Varjas; Anne Vergison; Roberto Vivancos; Karolina Zakrzewska; Richard Pebody; Joana M Haussig

doi:10.2807/1560-7917.ES.2022.27.36.2200620

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A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022
Aisling M Vaughan^1,* , Orlando Cenciarelli^2,* , Soledad Colombe^1,3,4 , Luís Alves de Sousa² , Natalie Fischer^1,3 , Celine M Gossner² , Jeff Pires¹ , Giuditta Scardina² , Gudrun Aspelund⁵ , Margarita Avercenko⁶ , Sara Bengtsson⁷ , Paula Blomquist⁸ , Anna Caraglia⁹ , Emilie Chazelle¹⁰ , Orna Cohen¹¹ , Asuncion Diaz¹² , Christina Dillon¹³ , Irina Dontsenko¹⁴ , Katja Kotkavaara¹⁵ , Mario Fafangel¹⁶ , Federica Ferraro⁹ , Richard Firth¹⁷ , Jannik Fonager¹⁸ , Christina Frank¹⁹ , Mireia G Carrasco²⁰ , Kassiani Gkolfinopoulou²¹ , Marte Petrikke Grenersen²² , Bernardo R Guzmán Herrador²³ , Judit Henczkó²⁴ , Elske Hoornenborg²⁵ , Derval Igoe¹³ , Maja Ilić²⁶ , Klaus Jansen¹⁹ , Denisa-Georgiana Janță²⁷ , Tone Bjordal Johansen²² , Ana Kasradze²⁸ , Anders Koch²⁹ , Jan Kyncl³⁰ , João Vieira Martins³¹ , Andrew McAuley³² , Kassiani Mellou³³ , Zsuzsanna Molnár³⁴ , Zohar Mor^35,36 , Joël Mossong³⁷ , Alina Novacek³⁸ , Hana Orlikova³⁰ , Iva Pem Novosel²⁶ , Maria K Rossi³² , Malgorzata Sadkowska-Todys³⁹ , Clare Sawyer⁴⁰ , Daniela Schmid³⁸ , Anca Sîrbu²⁷ , Klara Sondén⁷ , Arnaud Tarantola⁴¹ , Margarida Tavares^42,43,44 , Marianna Thordardottir⁵ , Veronika Učakar¹⁶ , Catharina Van Ewijk^45,47 , Juta Varjas⁴⁶ , Anne Vergison³⁷ , Roberto Vivancos⁸ , Karolina Zakrzewska³⁹ , Richard Pebody^1,** , Joana M Haussig^2,**
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Affiliations: ¹ World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark ² European Centre for Disease Prevention and Control (ECDC), Solna, Sweden ³ Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland ⁴ Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium ⁵ Centre for Health Security and Communicable Disease Control, The Directorate of Health, Reykjavik, Iceland ⁶ Infectious Disease Prevention and Control Unit, Department of Infectious Risks Analysis and Prevention, Centre for Disease Prevention and Control of Latvia, Riga, Latvia ⁷ Unit for Diagnostics Preparedness of Notifiable and High Consequence Pathogens, Public Health Agency of Sweden, Solna, Sweden ⁸ Field Services, United Kingdom Health Security Agency, London, United Kingdom ⁹ Directorate General of Health Prevention, Ministry of Health, Rome, Italy ¹⁰ Santé publique France, the French National Public Health Agency, Saint-Maurice, France ¹¹ Division of Epidemiology, Public Health Services, Ministry of Health, Jerusalem, Israel ¹² National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain ¹³ Health Services Executive, Health Protection Surveillance Centre, Dublin, Ireland ¹⁴ Department of Communicable Diseases, Health Board, Tallinn, Estonia ¹⁵ Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland ¹⁶ Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia ¹⁷ Public Health Wales, Cardiff, United Kingdom ¹⁸ Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark ¹⁹ Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany ²⁰ Ministry of Health, Government of Andorra, Andorra la Vella, Andorra ²¹ Surveillance Coordination Department. Hellenic National Public Health Organization (EODY), Athens, Greece ²² The Norwegian Institute of Public Health, Oslo, Norway ²³ Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain ²⁴ Department of Microbiological Reference Laboratory, National Public Health Center, Budapest, Hungary ²⁵ Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, the Netherlands ²⁶ Croatian Institute of Public Health, Zagreb, Croatia ²⁷ National Centre of Surveillance and Control of Communicable Disease, National Institute of Public Health Romania, Bucharest, Romania ²⁸ Head of Public Health Emergency Preparedness and Response Division, National Center for Disease Control and Public Health, Tbilisi, Georgia ²⁹ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark ³⁰ Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic ³¹ Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal ³² Public Health Scotland, Edinburgh, Scotland, United Kingdom ³³ Directorate of Epidemiological Surveillance and Intervention for Infectious Diseases, Hellenic National Public Health Organization (EODY), Athens, Greece ³⁴ Department of Communicable Disease Epidemiology and Infection Control, National Public Health Center, Budapest, Hungary ³⁵ Public Health Services, Ministry of Health, Jerusalem, Israel ³⁶ School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel ³⁷ Health Directorate, Luxembourg, Luxembourg ³⁸ Austrian Agency for Health and Food Safety (AGES), Vienna, Austria ³⁹ National Institute of Public Health (NIH) - National Research Institute, Warsaw, Poland ⁴⁰ Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom ⁴¹ Santé publique France Regional Office, Saint-Denis, Île-de-France, France ⁴² Emerging Infectious Diseases Unit, Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal ⁴³ Laboratory for Integrative and Translational Research in Population Health (ITR), and EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal ⁴⁴ National Program for Sexually Transmitted Infections and HIV Infection, Directorate-General of Health, Lisbon, Portugal ⁴⁵ National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands ⁴⁶ Department of Communicable Diseases, Health Board, Tallinn, Estonia ⁴⁷ ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden

* These authors contributed equally to this work and share first authorship.

** These authors contributed equally to this work and share last authorship.
Correspondence:
Aisling M Vaughan
vaughana who.int
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Citation style for this article: Vaughan Aisling M, Cenciarelli Orlando, Colombe Soledad, Alves de Sousa Luís, Fischer Natalie, Gossner Celine M, Pires Jeff, Scardina Giuditta, Aspelund Gudrun, Avercenko Margarita, Bengtsson Sara, Blomquist Paula, Caraglia Anna, Chazelle Emilie, Cohen Orna, Diaz Asuncion, Dillon Christina, Dontsenko Irina, Kotkavaara Katja, Fafangel Mario, Ferraro Federica, Firth Richard, Fonager Jannik, Frank Christina, Carrasco Mireia G, Gkolfinopoulou Kassiani, Grenersen Marte Petrikke, Guzmán Herrador Bernardo R, Henczkó Judit, Hoornenborg Elske, Igoe Derval, Ilić Maja, Jansen Klaus, Janță Denisa-Georgiana, Johansen Tone Bjordal, Kasradze Ana, Koch Anders, Kyncl Jan, Martins João Vieira, McAuley Andrew, Mellou Kassiani, Molnár Zsuzsanna, Mor Zohar, Mossong Joël, Novacek Alina, Orlikova Hana, Pem Novosel Iva, Rossi Maria K, Sadkowska-Todys Malgorzata, Sawyer Clare, Schmid Daniela, Sîrbu Anca, Sondén Klara, Tarantola Arnaud, Tavares Margarida, Thordardottir Marianna, Učakar Veronika, Van Ewijk Catharina, Varjas Juta, Vergison Anne, Vivancos Roberto, Zakrzewska Karolina, Pebody Richard, Haussig Joana M. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill. 2022;27(36):pii=2200620. https://doi.org/10.2807/1560-7917.ES.2022.27.36.2200620 Received: 04 Aug 2022; Accepted: 08 Sept 2022

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Abstract

Following the report of a non-travel-associated cluster of monkeypox cases by the United Kingdom in May 2022, 41 countries across the WHO European Region have reported 21,098 cases and two deaths by 23 August 2022. Nowcasting suggests a plateauing in case notifications. Most cases (97%) are MSM, with atypical rash-illness presentation. Spread is mainly through close contact during sexual activities. Few cases are reported among women and children. Targeted interventions of at-risk groups are needed to stop further transmission.

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A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022

Citation style for this article: <a href="/search?value1=Aisling+M+Vaughan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vaughan Aisling M</a>, <a href="/search?value1=Orlando+Cenciarelli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cenciarelli Orlando</a>, <a href="/search?value1=Soledad+Colombe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Colombe Soledad</a>, <a href="/search?value1=Lu%C3%ADs+Alves+de+Sousa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Alves de Sousa Luís</a>, <a href="/search?value1=Natalie+Fischer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fischer Natalie</a>, <a href="/search?value1=Celine+M+Gossner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gossner Celine M</a>, <a href="/search?value1=Jeff+Pires&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pires Jeff</a>, <a href="/search?value1=Giuditta+Scardina&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Scardina Giuditta</a>, <a href="/search?value1=Gudrun+Aspelund&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aspelund Gudrun</a>, <a href="/search?value1=Margarita+Avercenko&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Avercenko Margarita</a>, <a href="/search?value1=Sara+Bengtsson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bengtsson Sara</a>, <a href="/search?value1=Paula+Blomquist&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Blomquist Paula</a>, <a href="/search?value1=Anna+Caraglia&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Caraglia Anna</a>, <a href="/search?value1=Emilie+Chazelle&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chazelle Emilie</a>, <a href="/search?value1=Orna+Cohen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cohen Orna</a>, <a href="/search?value1=Asuncion+Diaz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Diaz Asuncion</a>, <a href="/search?value1=Christina+Dillon&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dillon Christina</a>, <a href="/search?value1=Irina+Dontsenko&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dontsenko Irina</a>, <a href="/search?value1=Katja+Kotkavaara&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kotkavaara Katja</a>, <a href="/search?value1=Mario+Fafangel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fafangel Mario</a>, <a href="/search?value1=Federica+Ferraro&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ferraro Federica</a>, <a href="/search?value1=Richard+Firth&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Firth Richard</a>, <a href="/search?value1=Jannik+Fonager&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fonager Jannik</a>, <a href="/search?value1=Christina+Frank&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Frank Christina</a>, <a href="/search?value1=Mireia+G+Carrasco&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carrasco Mireia G</a>, <a href="/search?value1=Kassiani+Gkolfinopoulou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gkolfinopoulou Kassiani</a>, <a href="/search?value1=Marte+Petrikke+Grenersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Grenersen Marte Petrikke</a>, <a href="/search?value1=Bernardo+R+Guzm%C3%A1n+Herrador&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Guzmán Herrador Bernardo R</a>, <a href="/search?value1=Judit+Henczk%C3%B3&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Henczkó Judit</a>, <a href="/search?value1=Elske+Hoornenborg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hoornenborg Elske</a>, <a href="/search?value1=Derval+Igoe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Igoe Derval</a>, <a href="/search?value1=Maja+Ili%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ilić Maja</a>, <a href="/search?value1=Klaus+Jansen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jansen Klaus</a>, <a href="/search?value1=Denisa-Georgiana+Jan%C8%9B%C4%83&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Janță Denisa-Georgiana</a>, <a href="/search?value1=Tone+Bjordal+Johansen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Johansen Tone Bjordal</a>, <a href="/search?value1=Ana+Kasradze&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kasradze Ana</a>, <a href="/search?value1=Anders+Koch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Koch Anders</a>, <a href="/search?value1=Jan+Kyncl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kyncl Jan</a>, <a href="/search?value1=Jo%C3%A3o+Vieira+Martins&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Martins João Vieira</a>, <a href="/search?value1=Andrew+McAuley&option1=author&noRedirect=true" class="nonDisambigAuthorLink">McAuley Andrew</a>, <a href="/search?value1=Kassiani+Mellou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mellou Kassiani</a>, <a href="/search?value1=Zsuzsanna+Moln%C3%A1r&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Molnár Zsuzsanna</a>, <a href="/search?value1=Zohar+Mor&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mor Zohar</a>, <a href="/search?value1=Jo%C3%ABl+Mossong&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mossong Joël</a>, <a href="/search?value1=Alina+Novacek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Novacek Alina</a>, <a href="/search?value1=Hana+Orlikova&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Orlikova Hana</a>, <a href="/search?value1=Iva+Pem+Novosel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pem Novosel Iva</a>, <a href="/search?value1=Maria+K+Rossi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rossi Maria K</a>, <a href="/search?value1=Malgorzata+Sadkowska-Todys&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sadkowska-Todys Malgorzata</a>, <a href="/search?value1=Clare+Sawyer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sawyer Clare</a>, <a href="/search?value1=Daniela+Schmid&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schmid Daniela</a>, <a href="/search?value1=Anca+S%C3%AErbu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sîrbu Anca</a>, <a href="/search?value1=Klara+Sond%C3%A9n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sondén Klara</a>, <a href="/search?value1=Arnaud+Tarantola&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tarantola Arnaud</a>, <a href="/search?value1=Margarida+Tavares&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tavares Margarida</a>, <a href="/search?value1=Marianna+Thordardottir&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Thordardottir Marianna</a>, <a href="/search?value1=Veronika+U%C4%8Dakar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Učakar Veronika</a>, <a href="/search?value1=Catharina+Van+Ewijk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Van Ewijk Catharina</a>, <a href="/search?value1=Juta+Varjas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Varjas Juta</a>, <a href="/search?value1=Anne+Vergison&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vergison Anne</a>, <a href="/search?value1=Roberto+Vivancos&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vivancos Roberto</a>, <a href="/search?value1=Karolina+Zakrzewska&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zakrzewska Karolina</a>, <a href="/search?value1=Richard+Pebody&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pebody Richard</a>, <a href="/search?value1=Joana+M+Haussig&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haussig Joana M</a>. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(36):pii=2200620. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.36.2200620" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.36.2200620</a> Received: 04 Aug 2022;   Accepted: 08 Sept 2022

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A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022

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