The Democratic Republic of the Congo (DRC), Burundi, and Uganda remain at the center of a growing mpox outbreak, with over 21,000 confirmed cases reported across Africa in the past year, according to the latest situation report from the World Health Organization (WHO). As the outbreak continues to spread, public health officials warn that ongoing armed conflict, limited testing capacity, and undetected community transmission could further complicate containment efforts.
Between January 2024 and February 2025, DRC recorded the highest number of cases on the continent, with more than 14,500 confirmed infections and 43 deaths. Uganda, which reported the second-highest number of cases in the past six weeks, has seen a steady rise in weekly incidence, with 1,226 cases and seven deaths recorded during that period. Burundi, where the outbreak is largely concentrated in the capital Bujumbura and the city of Gitega, has documented over 3,300 confirmed cases.
The outbreak in DRC is particularly concerning due to the co-circulation of two different mpox virus subclades, clade Ia and clade Ib, raising questions about transmission patterns and the potential for further spread. While clade Ia infections have historically been linked to zoonotic transmission, clade Ib appears to be spreading exclusively through human-to-human contact, often in sexual networks. WHO officials note that more data is needed to determine the full scope of transmission.
The continued spread of mpox in the DRC comes against the backdrop of escalating violence in the eastern part of the country, where attacks by armed groups have displaced thousands and severely disrupted healthcare services. WHO officials warn that conflict is hampering mpox surveillance and response efforts, leading to an undercounting of cases in some areas.
“The humanitarian situation in eastern DRC is exacerbating health crises on multiple fronts, including the spread of mpox,” said a WHO spokesperson. “Access to care is limited, and disease surveillance is significantly hindered by insecurity.”
While WHO has been working with national governments to bolster laboratory testing capacity, gaps remain. In some areas, suspected mpox cases that undergo testing are not removed from overall counts, raising concerns about potential overestimation of case numbers.
Beyond Africa: International Spread and Travel-Linked Cases
Outside of Africa, clade Ib mpox cases have been reported in 13 countries, including the United Kingdom, the United States, Germany, and China. Many of these cases have been linked to international travel, raising concerns about cross-border transmission. Notably, the United Arab Emirates (UAE) reported its first confirmed case of mpox in early February, a development that suggests possible undetected transmission within the country.
“Although the UAE has officially reported only one case, at least seven cases have been detected in other countries among travelers from the UAE,” the WHO report states. “This suggests potential community transmission within the country.”
Several European and Asian countries, including Belgium, Thailand, and Sweden, have reported secondary transmission from imported cases, indicating that the outbreak is no longer confined to Africa.
Public Health Response and Vaccine Challenges
The WHO has been working with governments and public health agencies to implement vaccination campaigns targeting high-risk populations. However, vaccine access remains a challenge. While a total of 516,480 vaccine doses have been delivered to six African countries, uptake has been slow, and some nations have yet to launch large-scale vaccination programs.
In January 2025, the DRC became the first country to expand its emergency use authorization for mpox vaccines to include children as young as one year old, reflecting concerns about rising infections among younger populations. In Burundi, which has seen a shift in the age distribution of cases, children under five years old were initially the most affected group, but recent data suggest that young adults aged 20-29 now represent the highest number of infections.
Meanwhile, WHO is working to address supply shortages by coordinating the global allocation of vaccines, with additional doses expected to be distributed in the coming months. In the latest round of allocations, Angola, Guinea, Sierra Leone, and Uganda were approved to receive an additional 238,300 doses.
As cases continue to rise in multiple regions, the WHO has renewed calls for increased surveillance, expanded testing capacity, and strengthened community engagement efforts. Public health experts warn that without a coordinated international response, the outbreak could further escalate, particularly in conflict-affected areas where access to healthcare is already severely constrained.
In Uganda, where cases have steadily increased in recent weeks, the government has stepped up public awareness campaigns and mobilized community health workers to improve early detection. However, experts caution that many challenges remain, including logistical barriers to vaccine distribution and the need for sustained funding to support outbreak response efforts.