Mpox (Monkeypox) Epidemiology Forecast 2026-2035

Parameter

Insight

Largest Patient Pool

United States

Fastest Growing Country

Germany

High-Risk Population

People with close physical or sexual exposure to an infected person, particularly MSM with new or multiple partners; people with advanced HIV or other immunocompromising conditions; pregnant women; children; and people with repeated occupational or household exposure.

Key Diagnostic Method

Real-time PCR of lesion, vesicular, pustular, scab or other appropriate clinical specimens, with clade-specific PCR and whole-genome sequencing increasingly used to characterize clade I/II and detect recombinant viruses.

Major Risk Factor

Close skin-to-skin or mucosal contact with an infectious person, particularly sexual contact in the current international clade IIb and emerging clade Ib outbreaks.

Major gap in the market

Uneven vaccination coverage, delayed diagnosis and incomplete genomic surveillance remain important gaps, particularly because clade Ib and clade IIb may circulate simultaneously and routine clade-differentiation PCR can fail to identify recombinant viruses.

Epidemiology Segment

Key Insights

Diagnosed Prevalent Cases of the Disease

A conventional prevalence estimate is not appropriate for mpox because infection is generally acute and surveillance captures incident diagnosed cases. WHO reported 190,683 confirmed cases globally from 1 January 2022 through 31 July 2026. Japan had 397 domestically reported cases by 18 September 2026, while the UK had 4,946 total confirmed cases across 2022-August 2026.

Gender-Specific Cases of the Disease

Contemporary international surveillance is strongly male-predominant outside the historically endemic African settings. In France, 283 of 320 cases reported January-July 2026 were male (88%). In the EU/EEA, 90% of clade I cases with complete sexual-behaviour information during September 2025-August 2026 occurred among MSM.

Age-Specific Cases of the Disease

Mpox affects multiple age groups, but the current international clade IIb and emerging clade Ib outbreaks outside Africa are concentrated predominantly in adults. France reported a median age of 34 years among its January-July 2026 cases; only two of 320 reported cases were children younger than 15 years. Children remain an important severe-disease population in clade I settings.

Ethnicity-Wise Cases of the Disease

Ethnicity is not a biological determinant of mpox susceptibility and comparable 8MM ethnicity-specific surveillance is unavailable. U.S. surveillance identifies substantial racial and ethnic variation in diagnosed cases, reflecting geographic, social, behavioural and healthcare-access factors; therefore ethnicity-specific case distributions should not be interpreted as intrinsic susceptibility differences.

Mortality and Survival Analysis of the Disease

WHO reported 529 confirmed deaths among 190,683 confirmed cases globally through 31 July 2026. Severity varies markedly by clade and host. EU/EEA surveillance recorded no clade I deaths during September 2025-August 2026, while two clade II deaths were reported. Severe and fatal disease remains disproportionately associated with immunocompromise, pregnancy and young age, particularly in clade I-affected African populations.

Disease Type

Prevalence

Uncomplicated Cutaneous Mpox

Acute disease dominated by localized or limited skin and mucosal lesions, often accompanied by fever, lymphadenopathy, fatigue or other systemic symptoms.

Anogenital/Mucosal-Predominant Mpox

Disease concentrated around the genital, perianal, oral or other mucosal surfaces, frequently associated with sexual transmission in the contemporary international outbreak.

Mpox with Proctitis

Rectal or anorectal inflammation causing severe anorectal pain, tenesmus, bleeding or painful defecation; an important clinical presentation in clade IIb outbreaks.

Disseminated/Severe Mpox

Extensive lesions or systemic disease with complications such as bacterial superinfection, sepsis, dehydration, respiratory involvement or multi-organ disease.

Country

Key Insights

United States

CDC reported 2,803 mpox cases in 2024 and 2,519 in 2025. One clade Ib case was identified in 2024 and 10 in 2025. By September 2026, more than 60 clade I cases had been reported across at least 20 states, and an increasing proportion had no recent international travel or known links to travelers, indicating emerging domestic clade Ib transmission. Persistent clade IIb transmission disproportionately affects MSM.

Germany

ECDC recorded 212 clade I cases and 136 clade II cases in Germany during September 2025-August 2026, with 56 clade I cases reported in August 2026 alone. Germany was among the first European countries to document clade Ib infections and household secondary transmission.

France

France reported 320 mpox cases from January-July 2026, including 305 laboratory-confirmed cases. Among 246 cases with clade information, 187 (76%) were clade Ib and 59 (24%) clade IIb. Eighty-eight percent were male, median age was 34 years, and 10% of cases with available information were hospitalized.

Italy

During September 2025-August 2026, ECDC recorded 83 clade I cases and eight clade II cases in Italy. Italy had documented locally acquired clade Ib cases by October 2025 after earlier travel-associated introductions, indicating that clade I transmission was no longer limited to imported infections.

Spain

Spain reported 446 clade I and 436 clade II cases during September 2025-August 2026, among the largest national totals in the EU/EEA during this period. In August 2026 alone, Spain reported 38 clade I and one clade II case. Spain was also among the first EU countries to identify locally acquired clade Ib infection in October 2025.

United Kingdom

By 31 August 2026, the UK had reported 168 confirmed clade Ib cases, 969 clade IIb cases during 2023-2026, 76 recombinant-clade cases and one case with clade not yet known, in addition to 3,732 clade IIb cases reported in 2022. The total across all clades from 2022-2026 was 4,946 confirmed cases. Clade Ib cases exceeded clade IIb cases in July 2026.

Japan

Japan's Ministry of Health reported 397 domestic mpox cases by 18 September 2026, excluding one separately publicized case not captured in the notification system. Mpox transmission has continued since the first domestic case in July 2022. Japan has also reported a clade Ib infection following travel to Africa.

India

India had reported 16 mpox cases by May 2025, comprising 10 clade Ib and six clade IIb cases; eight of the 10 clade Ib patients were male and nine had recent international travel. A 2026 Indian clinical-genomic study characterized 10 clade Ib cases identified in Kerala between September 2024 and March 2025; eight were male and seven had travelled to the UAE. India subsequently identified an inter-clade Ib/IIb recombinant virus in a man whose symptoms began in September 2025 after travel from the Arabian Peninsula. He recovered fully and no secondary cases were identified.