82,738 mpox cases in the second emergency — and transmission outlived the PHEIC

Mpox is caused by the monkeypox virus, which exists as two clades — clade I, with subclades Ia and Ib, and clade II, with subclades IIa and IIb [s2]. The global outbreak of 2022–2023 was driven by clade IIb; the emergency that followed was something different [s2]. A surveillance analysis published in PLOS One on 21 October now traces that second emergency from start to finish [s1].

What the study covers

The World Health Organization declared its second Public Health Emergency of International Concern for mpox on 14 August 2024, after clade Ib monkeypox virus emerged in the Democratic Republic of the Congo and spread rapidly across Africa and internationally [s1]. That PHEIC ended on 5 September 2025, and the Africa CDC Public Health Emergency of Continental Security was lifted on 22 January 2026 [s1]. The study characterises global and Africa-specific mpox epidemiology across that full cycle and the immediate aftermath, from January 2024 to February 2026 [s1].

It is a retrospective surveillance analysis built on data exported from the WHO Global Mpox Trends dashboard, supplemented by WHO situation reports S32 through S64 and other national and international surveillance reports [s1]. The authors used negative binomial segmented regression, travel-linked pathway analysis and descriptive statistics, and they are explicit that their models rest on reported case counts: the case-rate ratios they report reflect reported case rates, not true infection incidence [s1].

The numbers

Between January 2024 and February 2026, 82,738 confirmed cases and 306 deaths were reported to WHO globally, a case fatality ratio of 0.37% [s1]. The PHEIC period itself accounted for 74.0% of those cases, and reporting peaked at 7,405 cases in May 2025 [s1].

The international spread was real but, by this count, largely contained at the point of entry. The authors documented 163 clade-specific importation or travel-linked detection events across 41 countries within their primary analytic cutoff [s1]. Documented secondary transmission — onward spread after one of those travel-linked detections — occurred in 25 of them, 15.3%, across 16 countries [s1]. In other words, most importations were caught without seeding sustained chains, while a meaningful minority were not.

The burden stayed concentrated where the emergency began. Within the DRC, 200 health zones recorded 144,035 total reported cases and 2,047 deaths, a case fatality ratio of 1.42% [s1]. Those national figures aggregate suspected, clinically compatible and confirmed cases, which is why the DRC total dwarfs the global confirmed-case count and why its fatality ratio is not directly comparable to the global one [s1]. The concentration was sharp even inside the country: the 20 most-affected health zones accounted for 45.4% of the national burden [s1].

The central finding

Reported transmission declined after the May 2025 peak, but it did not stop when the paperwork did. It persisted beyond the termination of the PHEIC [s1]. The authors' framing is blunt: ending the emergency marked an administrative transition, not the end of mpox transmission [s1].

That distinction is the point of the paper. An emergency declaration is a tool for mobilising attention, funding and coordination, and lifting it is a decision about governance as much as about epidemiology. The surveillance data show a disease that was still circulating — concentrated in a handful of DRC health zones and still generating occasional onward transmission after international detections — at the moment the formal response structures were being stood down [s1].

What to read into it

The caveats are built into the data source. These are reported cases, shaped by how much testing and surveillance each setting could sustain, and the DRC's mixed case definition inflates its totals relative to the confirmed-case counts reported elsewhere [s1]. Undercounting is the likelier direction of error in places where diagnostic capacity is thin, so the true burden is probably higher than the reported figures, not lower.

What the analysis establishes cleanly is the shape of the emergency and its tail. The authors argue the post-emergency period requires sustained surveillance, maintained diagnostic capacity, targeted response in the settings where transmission persists, and equitable access to vaccines and countermeasures [s1]. The mpox virus spreads through close contact with an infected person, contaminated materials or infected animals [s2] — a route that does not respect the end of a declaration.