Health Security Update
Editor: Alyson Browett, MPH

Contributors: Christina Potter, MSPH, Lane Warmbrod, MS, MPH, and Rachel Vahey, MHS
The Johns Hopkins Center for Health Security will be analyzing and providing updates, as needed, on the confirmed and suspected monkeypox outbreaks that have been identified in the several nations in Europe and North America. If you would like to receive these updates, please sign up here.

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Update on Recent Outbreaks in Europe & North America as of May 20, 2022 at 1:30pm ET

Recent cases have now been identified in the United Kingdom (20 confirmed), Spain (30 confirmed), Portugal (14 confirmed)2, Australia (2 confirmed)2 Belgium (2 confirmed), Canada (2 confirmed)31, France (1 confirmed),32 Germany (1 confirmed), Italy (3 confirmed), Sweden (1 confirmed), and the United States (1 confirmed). To date, no deaths are reported.

Contact tracing is underway, but it is likely that cases may have occurred through community transmission. Additionally, it has been noted that an unusual number of the new cases have arisen among gay, bisexual, or other men who have sex with men (MSM).However, scholars have noted that MSM are not the only community at risk. Sexual transmission has been hypothesized as a potential mode of transmission but has not been reported as a driver of transmission in past monkeypox outbreaks.
Select Readings on Monkeypox

Monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo, giving us decades to learn more about the virus. The following list includes select scientific literature on monkeypox. The articles cover a range of issues, including epidemiology, genomic variability, asymptomatic transmission, and treatment. Additional resources from the Center, the US CDC, and the WHO are listed at the bottom.

Alakunle E, Moens U, Nchinda G, Okeke MI. Monkeypox virus in Nigeria: infection biology, epidemiology, and evolution. Viruses. 2020;12(11):1257. doi:10.3390/v12111257
Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141. doi:10.1371/journal.pntd.0010141
Guagliardo SAJ, Monroe B, Moundjoa C, et al. Asymptomatic Orthopoxvirus Circulation in Humans in the Wake of a Monkeypox Outbreak among Chimpanzees in Cameroon. Am J Trop Med Hyg. 2020;102(1):206-212. doi:10.4269/ajtmh.19-0467
Kugelman JR, Johnston SC, Mulembakani PM, et al. Genomic variability of monkeypox virus among humans, Democratic Republic of the Congo. Emerg Infect Dis. 2014;20(2):232-239. doi:10.3201/eid2002.130118
McCollum AM, Damon IK. Human Monkeypox. Clin Infect Dis. 2014;58(2):260-267. doi:10.1093/cid/cit703
Nolen LD, Osadebe L, Katomba J, et al. Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. Emerg Infect Dis. 2016;22(6):1014-1021. doi:10.3201/eid2206.150579
Patrono LV, Pléh K, Samuni L, et al. Monkeypox virus emergence in wild chimpanzees reveals distinct clinical outcomes and viral diversity. Nat Microbiol. 2020;5(7):955-965. doi:10.1038/s41564-020-0706-0
Petersen E, Kantele A, Koopmans M, et al. Human Monkeypox. Infect Dis Clin North Am. 2019;33(4):1027-1043. doi:10.1016/j.idc.2019.03.001
Russo AT, Berhanu A, Bigger CB, et al. Co-administration of tecovirimat and ACAM2000™ in non-human primates: Effect of tecovirimat treatment on ACAM2000 immunogenicity and efficacy versus lethal monkeypox virus challenge. Vaccine. 2020;38(3):644-654. doi:10.1016/j.vaccine.2019.10.049
Simpson K, Heymann D, Brown CS, et al. Human monkeypox—After 40 years, an unintended consequence of smallpox eradication. Vaccine. 2020;38(33):5077-5081. doi: 10.1016/j.vaccine.2020.04.062
Other Resources