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Epidemiological Alert Monkeypox in non-endemic countries - 20 May 2022

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Given the occurrence of cases of monkeypox in countries within and outside of the Region of the Americas, the Pan American Health Organization / World Health Organization (PAHO/WHO) shares with its Member States a series of considerations in relation to the identification of cases, the isolation, identification, and follow-up of contacts, the clinical management, and the prevention and control of healthcare-associated infections. Guidance regarding available treatment and vaccines is also provided.

Situation Summary

On 15 May 2022, the World Health Organization (WHO) was notified of 4 confirmed cases of monkeypox from the United Kingdom. Two days later, two other countries reported cases: Portugal and Sweden. All of the cases had no reported history of travel to an area endemic for monkeypox and there was no epidemiological link between the cases reported in different countries. As of 20 May 2022, 11 countries have reported cases: Australia, Belgium, Canada, France, Germany, Italy, Portugal, Spain, Sweden, the United Kingdom, and the United States of America. (1, 2, 3)

In the Region of the Americas, 3 cases of monkeypox have been reported, in Canada (2 cases) and the United States of America (1 case) (4, 5, 6).

These cases have no recent history of travel to an endemic area in West Africa or Central Africa, and most of the initial cases have been detected in sexual health clinics. The geographical scope of the cases in Europe suggests that transmission may have been ongoing for some time, so the occurrence of additional cases in other countries cannot be ruled out.


Monkeypox has traditionally been transmitted mainly through direct or indirect contact with blood, body fluids, or skin or mucosal lesions of infected animals. Secondary or person-toperson transmission can occur through close contact with infected respiratory secretions or skin lesions of an infected person, or with objects recently contaminated with fluids from the patient or materials from the lesion. Transmission occurs primarily through respiratory droplets. Infections are also transmitted by inoculation or transplacentally (congenital monkeypox). There is currently no evidence that monkeypox virus is sexually transmitted. The incubation period is usually 6 to 16 days but has been reported as ranging from 5 to 21 days.

WHO and health authorities from the Member States that have reported cases are conducting intensive case finding, laboratory investigation, clinical management, case isolation, and retrospective and prospective contact tracing.