2022–2023 mpox outbreak in Europe

2022–2023 mpox outbreak in Europe
DiseaseMpox
Virus strainMonkeypox virus (West African clade)
Index caseLondon, England
Arrival date6 May 2022 (1 year, 6 months and 2 weeks ago)
Confirmed cases22,640
Suspected cases‡82
Deaths
1
Territories
35
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

The 2022–2023 mpox outbreak in Europe is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak reached Europe on 6 May 2022 when the United Kingdom reported their first case of mpox. As of 13 July 2022, 35 European countries and territories have confirmed cases.

Background

These paragraphs are an excerpt from Mpox.[edit]

Mpox (formerly known as monkeypox)[1] is an infectious viral disease that can occur in humans and some other animals.[2] Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes.[2] The illness is usually mild and most of those infected will recover within a few weeks without treatment.[3] The time from exposure to onset of symptoms ranges from five to twenty-one days and symptoms typically last from two to four weeks.[4] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.[5]

The disease is caused by the monkeypox virus,[lower-alpha 1] a zoonotic virus in the genus Orthopoxvirus. The variola virus, the causative agent of the disease smallpox, is also in this genus.[2] Human-to-human transmission can occur through direct contact with infected skin or body fluids, including sexual contact.[2] People remain infectious from the onset of symptoms until all the lesions have scabbed and healed.[5] It may spread from infected animals by handling infected meat or via bites or scratches.[5] Diagnosis can be confirmed by PCR testing a lesion for the virus' DNA.[2]

Transmission

Stages of lesion development.

A large portion of those infected were believed to have not recently traveled to areas of Africa where mpox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.[6]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[7]

Timeline

Arrival

An index case was imported into the United Kingdom in late April 2022, by a man who had travelled to Nigeria, where the disease is endemic. He had already showed symptoms since 29 April, and was admitted to hospital in London on 6 May. On 12 May, the man was confirmed to have contracted mpox. The following day, another mpox case was confirmed, and the United Kingdom reported these cases to the World Health Organization (WHO).[8]

Cases transited through Europe

May

18 May

On 18 May, Spain and Portugal both confirmed their first cases of mpox following the confirmation of mpox in the United Kingdom starting an outbreak in the countries.[9] It is unknown how it was contracted, but most likely via travel or skin-to-skin contact abroad.

19 May

On 19 May, Belgium confirmed its first cases of mpox in two Belgian men, it was later confirmed by Reuters that the men had gone to the same party.[10]

Later, Italy confirmed its first case of mpox in an Italian man in Rome, the man was isolated at the Spallanzani Hospital. The disease was likely contracted from a stay in the Canary Islands.[11] There were 2 suspected cases, which later became confirmed cases.

Sweden then confirmed its first case of mpox in Stockholm, the Swedish Health Agency confirmed it later. The person was not reported to be a woman or a man, but it was most likely a man.[12] It is unknown how it was contracted, but likely via travel or skin-to-skin contact abroad.

20 May

On 20 May, France reported their first case of mpox. The patient had no travel history, meaning he didn't contract the disease abroad.[13]

On the same day, Germany and the Netherlands reported their first cases of mpox.[14][15] It was unknown how it was contracted in both stories, but likely via travel or skin-to-skin contact abroad.

21 May

On 21 May, Switzerland confirmed its first case of mpox. It was in a person of undisclosed gender, contracted through "close physical contact" abroad, according to Reuters.[16]

22 May

On 22 May, Austria confirmed its first case of mpox.[17] It is unknown how it was contracted or who contracted it, but likely via travel or skin-to-skin contact abroad.

23 May

On 23 May, Denmark detected its first mpox infection. It was in an adult male, likely contracted from a trip to Spain, according to Reuters.[18] No cases of mpox were detected in Greenland, a Danish constituent country in North America.

24 May

On 24 May, the Czech Republic registered its first case of mpox in a woman, likely picked up from a festival in Belgium, according to Reuters.[19]

On the same day, Slovenia also registered its first case of mpox. It was in a traveller of undisclosed gender who likely contracted mpox from a trip to the Canary Islands, according to Reuters.[20]

27 May

On 27 May, Ireland confirmed its first case of mpox in the east of the country.[21] The Health Protection Surveillance Centre (HPSC) commenced publication of a weekly report on the epidemiology of human mpox in Ireland on 9 June.

On the same day, Finland also confirmed its first case of mpox. It was in a man who likely had contracted the disease from a trip to another European country, according to Reuters.[22][23]

28 May

On 28 May, Malta registered its first case of mpox. It was in an adult male, who most likely picked up the disease abroad from one of the countries affected by the outbreak, according to the Malta Times.[24]

31 May

On 31 May, Hungary confirmed its first case of mpox, in an adult male. It is still being investigated whether or not he recently travelled, though it is unknown how the man contracted the disease.[25]

On the same day, Norway confirmed its first case of mpox. It was in a person of undisclosed gender who most likely contracted the disease from travelling abroad. The case was linked to the ongoing outbreak in Europe, meaning that the patient may have travelled to a European country that was affected by the outbreak.[26]

June

1 June

On 1 June, Gibraltar, a British Overseas Territory, registered its first case of mpox in a Spanish resident of undisclosed gender working in Gibraltar. The patient likely contracted the disease from close contact with another Spanish national also working in Gibraltar.[27]

3 June

On 3 June, Latvia confirmed its first mpox infection. It was in an elderly person of undisclosed gender who most likely contracted the disease abroad.[28]

8 June

On 8 June, Greece confirmed the country's first mpox case. It was in a person of undisclosed gender who likely contracted the disease from a trip to Portugal.[29]

9 June

On 9 June, Iceland confirmed its first mpox case. It was in two men who most likely contracted the disease from a trip to Europe.[30]

10 June

On 10 June, Poland confirmed its first mpox case. It is unknown who the patient is or how it was contracted, but it is possible it was picked up via travel or skin-to-skin contact.[31]

13 June

On 13 June, Romania confirmed its first monkempoxypox infection. It was in an adult male who most likely contracted the disease from his partner who travelled in several different European countries that have been affected by mpox at the time.[32]

15 June

On 15 June, Luxembourg confirmed its first mpox case. It is unknown how it was contracted, though it is being investigated. The disease was likely picked up via travelling abroad or skin-to-skin contact.[33]

On the same day, Georgia also confirmed its first case of mpox. It was in a patient of undisclosed gender who likely contracted the disease from a trip to Europe.[34]

17 June

On 17 June, Serbia confirmed its first case of mpox. It was in a patient of undisclosed gender. It was revealed that it was an "imported case", meaning that the patient may have contracted the disease abroad.[35]

23 June

On 23 June, Bulgaria confirmed its first mpox case. It was in two men who most likely contracted the disease from a trip to Spain and the United Kingdom but don't reckon any contact with infected persons.[36]

On the same day, Croatia also received its first case of mpox. It was in an adult man who most likely contracted the disease from a stay in Italy and Spain.[37]

28 June

On 28 June, Estonia confirmed its first case of mpox. It was in a middle-aged man who most likely contracted the disease abroad. He had no close contacts with anyone in Estonia.[38]

July

2 July

On 2 July, Andorra registered its first mpox case in a woman of unknown age. It is unknown how it was contracted, but it may likely have been picked up either abroad via travel or via skin-to-skin contact.[39]

7 July

On July 7, Slovakia received its first case of mpox. It was in a person of undisclosed gender in the 20-59 age group who most likely contracted the disease abroad.[40]

12 July

On 12 July, Russia confirmed its first case of mpox. It was in a man probably in his 20-25 age group who likely contracted the disease from a trip to Europe where the outbreak had started. The man then tested positive for the virus and was isolated in a hospital, most likely in Saint Petersburg.[41]

13 July

On 13 July, Bosnia and Herzegovina registered its first mpox case. It is unknown how it was contracted, although the disease was likely picked up abroad via travel or skin-to-skin contact.[42]

22 July

On 22 July, Monaco confirmed its first case of mpox, in a man who most likely had travelled to France where the disease was spreading. The Princess Grace Hospital Centre later reported that the first case of the disease had been confirmed in the residential area of La Colle.

September

15 September

On 15 September, Ukraine's Ministry of Health reported the country's first case of mpox. The Ministry noted that the patient, who did not travel abroad, was experiencing "mild symptoms" and undergoing hospital treatment.[43][44] The region where the case was reported was not disclosed.[43]

Responses

World Health Organization (WHO)

On 20 May, the WHO convened an emergency meeting of independent advisers to discuss the outbreak and assess the threat level.[45] Its European chief, Hans Kluge, expressed concern that infections could accelerate in Europe as people gather for parties and festivals over the summer.[46] On 14 June, the WHO announced plans to rename the disease from monkeypox to mpox in order to combat stigma and racism surrounding the disease.[47] Another meeting convened on 23 June determined that the outbreak does not constitute a Public Health Emergency of International Concern for the time being.[48]

Countries

The majority of European countries responded to the outbreak, and the responses of some are listed below.

  •  Belgium: The Risk Assessment Group (RAG) and health authorities declared that those infected with mpox must self-isolate for 21 days.[49]
  •  Germany: Fabian Leendertz of the Robert Koch Institute described the outbreak as an epidemic that will not last long: "The cases can be well isolated via contact tracing and there are also drugs and effective vaccines that can be used if necessary."[46]
  •  Ireland: The Health Service Executive (HSE) has set up a multidisciplinary incident management team to prepare for the possible arrival of mpox, and infectious diseases experts are on alert for patients with symptoms of the virus.[50]
  •  Kosovo: On 23 May, the Ministry of Health and the National Public Health Institute, have drafted a document of recommendations and measures to help prevent the spread of the disease. In a press statement, healthcare authorities have declared that the situation is being closely monitored.[51]
  •  Luxembourg: On 21 May, the Ministry of Health said that they are monitoring the situation with its Europe.[52] he National Infectious Diseases Department of the HLC and refrain from close contact activities until the infection has resolved.[53]
  •  United Kingdom: On 22 May, Education Secretary Nadhim Zahawi said "we're taking it very, very seriously" and that the UK government had already started purchasing smallpox vaccines.[54] The Terrence Higgins Trust and British Association for Sexual Health and HIV (BASHH) expressed concern about the impact on sexual health services in the United Kingdom.[55][56]

Dependent territories

  •  Gibraltar: On 31 May, a Strategic Coordination Group met to discuss Gibraltar's state of preparedness in the eventuality that a case of mpox was confirmed in the territory amid the rapid rise of cases in the United Kingdom and Spain.[57]

Cases per country and territory

This is a table of confirmed and suspected mpox cases in European countries during the ongoing 2022–2023 mpox outbreak. It does not include countries where suspected cases were reported but later discarded. (As of 13 July 2022)

Cases of mpox by countries of Europe (last updated on as of 8 July 2022)
Country Confirmed Suspected Total Last update First confirmed case Last confirmed case
 Andorra 1 — 1 8 July 2022[39] 2 July 2022[39]
 Austria 83 — 83 14 July 2022[58] 22 May 2022[59]
 Belgium 225 1 226 14 July 2022 19 May 2022[10]
 Bosnia and Herzegovina 1 — 1 13 July 2022[42][60] 13 July 2022[42]
 Bulgaria 3 — 3 5 July 2022[61][60] 23 June 2022[36]
 Croatia 3 — 3 12 July 2022[37][60] 23 June 2022[37]
 Czech Republic 12 — 12 13 July 2022[62][60] 24 May 2022[19]
 Denmark 32 — 32 13 July 2022[60] 23 May 2022[18]
 Estonia 2 — 2 5 July 2022[60] 28 June 2022[38]
 Finland 13 — 13 11 July 2022[63][60][64] 27 May 2022[22][23]
 France 912 — 912 12 July 2022[65] 20 May 2022[66]
 Georgia 2 — 2 28 June 2022[67] 15 June 2022[34]
Germany 1,859 — 1,859 15 July 2022[68] 20 May 2022[14]
 Gibraltar[lower-alpha 2] 5 — 5 14 July 2022[27][60][69] 1 June 2022[27]
 Greece 12 — 12 13 July 2022[70] 8 June 2022[29][71]
 Hungary 28 — 28 13 July 2022[72] 31 May 2022[25]
 Iceland 6 — 6 7 July 2022[73] 9 June 2022[30]
 Ireland 85 — 85 27 July 2022[74] 27 May 2022[75]
 Italy 339 — 339 15 July 2022[76] 19 May 2022[77]
 Latvia 2 — 2 5 July 2022[60] 3 June 2022[28]
 Luxembourg 7 — 7 5 July 2022[60] 15 June 2022[33]
 Malta 9 — 9 13 July 2022[60] 28 May 2022[24]
Netherlands 549 — 549 14 July 2022[78] 20 May 2022[15]
 Norway 35 — 35 14 July 2022[79] 31 May 2022[26]
 Poland 22 — 22 13 July 2022[80] 10 June 2022[31]
Portugal 515 — 515 14 July 2022[81] 18 May 2022[82]
 Romania 16 — 16 14 July 2022[83] 13 June 2022[32]
 Russia 1 — 1 12 July 2022[46] 12 July 2022[41]
 Serbia 5 — 5 14 July 2022[35][60][84] 17 June 2022[35]
 Slovakia 1 — 1 7 July 2022[40] 7 July 2022[40]
 Slovenia 19 — 19 13 July 2022[85] 24 May 2022[20]
Spain 4,371 62 4,433 12 July 2022[86] 18 May 2022[87]
 Sweden 58 — 58 13 July 2022[88] 19 May 2022[89][90]
  Switzerland 181 — 181 13 July 2022[91] 21 May 2022[16]
 Ukraine 3 — 3 22 September 2022[92] 15 September 2022[43]
United Kingdom 2,469 — 2,469 14 July 2022[93] 6 May 2022[94]
 Total 10,005 82 10,087 —

Timeline of first confirmed cases by country or territory

First confirmed mpox cases by country or territory
Date Countries / Territories
6 May 2022 United Kingdom
18 May 2022 Spain • Portugal
19 May 2022  Belgium •  Italy •  Sweden
20 May 2022  France • Germany • Netherlands
21 May 2022   Switzerland
22 May 2022  Austria
23 May 2022  Denmark
24 May 2022  Czech Republic •  Slovenia
27 May 2022  Finland •  Ireland
28 May 2022  Malta
31 May 2022  Hungary •  Norway
1 June 2022  Gibraltar[lower-alpha 2]
3 June 2022  Latvia
8 June 2022  Greece
9 June 2022  Iceland
10 June 2022  Poland
13 June 2022  Romania
15 June 2022  Luxembourg •  Georgia
17 June 2022  Serbia
23 June 2022  Bulgaria •  Croatia
28 June 2022  Estonia
2 July 2022  Andorra
7 July 2022  Slovakia
12 July 2022  Russia
13 July 2022  Bosnia and Herzegovina
15 September 2022  Ukraine

Timeline of suspected cases by country or territory

Countries listed below had only suspected cases at the time of reporting. Some countries reported confirmed cases after reporting suspected cases. Countries listed several times reported suspected cases again after they discarded suspected cases before.

Timeline of suspected mpox cases by country or territory
Date Countries / Territories
20 May 2022  Greece (discounted on 22 May)
5 June 2022  Georgia (confirmed on 15 June)[95]

As of 11 July 2022, 33 European countries and territories have been affected by the pandemic.

See also

Notes

    1. ↑ The World Health Organization (the authority on disease names) announced the new name "mpox" in November 2022. But virus naming is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which is currently reviewing all orthopoxvirus species. As of March 2023, the official name of the virus remains "monkeypox virus".[1]
    2. 1 2 British Overseas Territory.

    References

    1. 1 2 "WHO recommends new name for monkeypox disease" (Press release). World Health Organization (WHO). 28 November 2022. Retrieved 29 November 2022.
    2. 1 2 3 4 5 "WHO Factsheet – Mpox (Monkeypox)". World Health Organization (WHO). 18 April 2023. Archived from the original on 21 April 2022. Retrieved 21 May 2023.
    3. ↑ "Monkeypox". GOV.UK. 24 May 2022. Archived from the original on 18 May 2022. Retrieved 28 May 2022.
    4. ↑ "Mpox Symptoms". U.S. Centers for Disease Control and Prevention (CDC). 2 February 2023. Archived from the original on 21 May 2023. Retrieved 21 May 2023.
    5. 1 2 3 "Mpox (monkeypox)". World Health Organisation. 12 May 2023. Archived from the original on 23 May 2023. Retrieved 24 May 2023.
    6. ↑ Vargas, Ramon Antonio (7 June 2022). "US raises monkeypox alert level but says risk to public remains low". the Guardian. Retrieved 9 June 2022.
    7. ↑ "Monkeypox update: Where the outbreak stands now".
    8. ↑ "Monkeypox - United Kingdom of Great Britain and Northern Ireland". www.who.int. Retrieved 23 June 2022.
    9. ↑ "U.S. monkeypox case reported, as Spain, Portugal report infections in growing outbreak". STAT. 18 May 2022. Retrieved 23 June 2022.
    10. 1 2 "Belgium detects first two monkeypox cases". Reuters. 20 May 2022. Retrieved 23 June 2022.
    11. ↑ "Italy confirms first monkeypox case". Reuters. 19 May 2022. Retrieved 19 May 2022.
    12. ↑ "Sweden reports monkeypox case in Stockholm". Outbreak News Today. 19 May 2022. Retrieved 23 June 2022.
    13. ↑ AA (20 May 2022). "First case of monkeypox in the Paris region of France". AA.
    14. 1 2 "First case of monkeypox in Germany, in the Berlin/Munich region". Reuters. 20 May 2022.
    15. 1 2 "First case of monkeypox in the Netherlands". Reuters. 20 May 2022.
    16. 1 2 "First case of monkeypox in Switzerland". Reuters. 21 May 2022.
    17. ↑ "First case of monkeypox in Austria". Reuters. 22 May 2022.
    18. 1 2 "Denmark registers first case of monkeypox infection". Reuters. 23 May 2022. Archived from the original on 24 May 2022. Retrieved 23 May 2022.
    19. 1 2 "First case of monkeypox in the Czech Republic". Reuters. 24 May 2022.
    20. 1 2 "Slovenia reports its first monkeypox infection". Reuters. 24 May 2022. Retrieved 24 May 2022.
    21. ↑ BBC (28 May 2022). "First case of monkeypox in Republic of Ireland". BBC. Retrieved 5 July 2022.
    22. 1 2 "First case of monkeypox confirmed in Finland". Reuters. 27 May 2022. Archived from the original on 27 May 2022. Retrieved 27 May 2022.
    23. 1 2 "Suomen ensimmäinen apinarokkotapaus vahvistettu". Helsingin Sanomat (in Finnish). 27 May 2022. Archived from the original on 27 May 2022. Retrieved 27 May 2022.
    24. 1 2 "First monkeypox case detected in Malta". Malta Today. Archived from the original on 28 May 2022. Retrieved 28 May 2022.
    25. 1 2 "Hungary reports first case of monkeypox". Reuters. 31 May 2022. Archived from the original on 1 June 2022. Retrieved 31 May 2022.
    26. 1 2 "Norway reports its first case of monkeypox". Reuters. 31 May 2022. Archived from the original on 6 June 2022. Retrieved 31 May 2022.
    27. 1 2 3 "GHA confirms first case of monkeypox in Gibraltar". Gibraltar Chronicle. Archived from the original on 1 June 2022. Retrieved 1 June 2022.
    28. 1 2 "Latvia records first case of monkeypox". Reuters. 3 June 2022. Archived from the original on 3 June 2022. Retrieved 3 June 2022.
    29. 1 2 "Greece detects first case of monkeypox infection". Reuters. 8 June 2022. Archived from the original on 8 June 2022. Retrieved 8 June 2022.
    30. 1 2 "First case of monkeypox reported in Iceland". Grapevine Reykjavik. Retrieved 9 June 2022.
    31. 1 2 "Poland reports first case of monkey pox – PAP news agency". Reuters. 10 June 2022. Archived from the original on 10 June 2022. Retrieved 10 June 2022.
    32. 1 2 "Romania detects its first monkeypox case". Reuters. 13 June 2022. Retrieved 13 June 2022.
    33. 1 2 "First case of monkeypox detected in Luxembourg". Luxembourg Times. 16 June 2022. Retrieved 16 June 2022.
    34. 1 2 "Georgia confirms first case of monkeypox". 15 June 2022. Retrieved 15 June 2022.
    35. 1 2 3 "Serbia reports first case of monkeypox". Reuters. 17 June 2022. Archived from the original on 17 June 2022. Retrieved 17 June 2022.
    36. 1 2 "First case of monkeypox reported and confirmed in Bulgaria". Reuters. Retrieved 23 June 2022.
    37. 1 2 3 "Croatia reports first monkeypox case". Post Online Media. Archived from the original on 24 June 2022. Retrieved 24 June 2022.
    38. 1 2 "First case of monkeypox diagnosed in Estonia". Eesti Rahvusringhääling. Retrieved 30 June 2022.
    39. 1 2 3 "Primer cas de verola del mico" (in Spanish). 2 July 2022. Retrieved 9 July 2022.
    40. 1 2 3 "Slovakia confirms first case of monkeypox -public health authority". Reuters. Retrieved 7 July 2022.
    41. 1 2 "Russia Confirms First Case of Monkeypox". Moscow Times. 12 July 2022. Retrieved 12 July 2022.
    42. 1 2 3 "First monkeypox case confirmed in Bosnia". N1 Bosnia. Retrieved 13 July 2022.
    43. 1 2 3 "First monkeypox case confirmed in Ukraine". Ukrinform. 15 September 2022. Retrieved 30 September 2022.
    44. ↑ "В Україні зареєстрований випадок віспи мавп". Міністерство охорони здоров'я України (in Ukrainian). 15 September 2022. Retrieved 30 September 2022.
    45. ↑ Rigby, Jennifer (20 May 2022). "WHO to hold emergency meeting on monkeypox on Friday -sources". Reuters. Archived from the original on 20 May 2022. Retrieved 20 May 2022.
    46. 1 2 3 Rigby, Jennifer; Grover, Natalie (20 May 2022). "WHO calls emergency meeting as monkeypox cases top 100 in Europe". Reuters. Archived from the original on 20 May 2022. Retrieved 21 May 2022.
    47. ↑ "WHO Will Rename Monkeypox Virus to Minimize Stigma, Racism". Bloomberg.com. 13 June 2022. Retrieved 15 June 2022.
    48. ↑ "Meeting of the International Health Regulations (2005) Emergency Committee regarding the multi-country monkeypox outbreak". who.int. WHO. Archived from the original on 28 June 2022. Retrieved 26 June 2022.
    49. ↑ "Monkeypox patients must spend 21 days in isolation". The Brussels Times. Archived from the original on 24 May 2022. Retrieved 22 May 2022.
    50. ↑ "Ireland on alert for monkeypox as virus spreads across Europe". The Irish Times. 20 May 2022. Archived from the original on 20 May 2022. Retrieved 23 May 2022.
    51. ↑ "Kosovo takes preventive measures against the spread of monkeypox". Euronews. 24 May 2022. Archived from the original on 24 May 2022. Retrieved 1 June 2022.
    52. ↑ "Kosovo takes preventive measures against the spread of monkeypox – Euronews Albania". 24 May 2022. Archived from the original on 24 May 2022. Retrieved 1 June 2022.
    53. ↑ "Ministry of Health: Luxembourg spared from monkeypox so far". RTL Today. 21 May 2022. Archived from the original on 24 May 2022. Retrieved 23 May 2022.
    54. ↑ "UK Confirms Local Transmission of Monkeypox". Eyewitness News (South Africa). Archived from the original on 24 May 2022. Retrieved 22 May 2022.
    55. ↑ "Monkeypox could have 'big detrimental effect' on access to sexual health services, experts warn". inews.co.uk. 21 May 2022. Archived from the original on 24 May 2022. Retrieved 23 May 2022.
    56. ↑ "Monkeypox: Doctors concerned over impact on sexual health". BBC News. 21 May 2022. Archived from the original on 20 May 2022. Retrieved 23 May 2022.
    57. ↑ "Gibraltar Government prepares for Monkeypox, as UK cases rise". Gibraltar Chronicle. Archived from the original on 1 June 2022. Retrieved 1 June 2022.
    58. ↑ "Affenpocken". AGES (in German). Retrieved 15 July 2022.
    59. ↑ "First case in Austria and 2 others". 22 May 2022. Retrieved 22 May 2022.
    60. 1 2 3 4 5 6 7 8 9 10 11 12 "Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin". European Centre for Disease Prevention and Control. Retrieved 7 July 2022.
    61. ↑ "Third Case of Monkeypox Confirmed in Bulgaria". Bulgarian News Agency. Archived from the original on 27 June 2022. Retrieved 27 June 2022.
    62. ↑ "Pražští hygienici evidují šestý laboratorně pozitivně testovaný případ opičích neštovic" (in Czech). Archived from the original on 1 June 2022. Retrieved 3 June 2022.
    63. ↑ "THL: Suomessa todettu yhteensä 10 apinarokkotartuntaa". Ilta-Sanomat (in Finnish). 4 July 2022. Retrieved 4 July 2022.
    64. ↑ "Factbox: Monkeypox cases around the world". Reuters. 11 July 2022. Retrieved 12 July 2022.
    65. ↑ "Cas de variole du singe : point de situation au 7 juillet 2022" (in French). 8 July 2022. Archived from the original on 26 June 2022. Retrieved 8 July 2022.
    66. ↑ "France, Germany, Belgium report first monkeypox cases amid unusual spread in Europe". France 24. 20 May 2022. Archived from the original on 21 May 2022. Retrieved 20 May 2022.
    67. ↑ "В Грузии подтвержден первый случай оспы обезьян" (in Russian). 15 June 2022. Archived from the original on 16 June 2022. Retrieved 15 June 2022.
    68. ↑ "RKI - Affenpocken - Internationaler Affenpocken-Ausbruch: Fallzahlen und Einschätzung der Situation in Deutschland". www.rki.de. Retrieved 15 July 2022.
    69. ↑ "2022 Monkeypox Outbreak Global Map | Monkeypox | Poxvirus | CDC". www.cdc.gov. 21 June 2022. Retrieved 15 July 2022.
    70. ↑ "Eleven Monkeypox Cases Detected so Far in Greece". The National Herald. Retrieved 7 July 2022.
    71. ↑ "Σχετικά με κρούσμα ευλογιάς των πιθήκων στη χώρα μας". 8 June 2022. Archived from the original on 8 June 2022. Retrieved 9 June 2022.
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    73. ↑ "Sex einstaklingar hafa greinst með apabólu á Íslandi". Embætti landlæknis (in Icelandic). Retrieved 7 July 2022.
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    76. ↑ Salute, Ministero della. "Vaiolo delle scimmie". www.salute.gov.it (in Italian). Retrieved 15 July 2022.
    77. ↑ "Italy reports first case of monkeypox infection, two more suspected". 19 May 2022. Archived from the original on 19 May 2022. Retrieved 24 May 2022.
    78. ↑ "Monkeypox (apenpokken) | RIVM". www.rivm.nl. Retrieved 15 July 2022.
    79. ↑ "FHI Statistikkbanker". FHI Statistikkbanker (in Norwegian). Retrieved 15 July 2022.
    80. ↑ "2022 Monkeypox Outbreak Global Map | Monkeypox | Poxvirus | CDC". www.cdc.gov. 21 June 2022. Retrieved 12 July 2022.
    81. ↑ "Informação semanal sobre Infeção Humana por vírus Monkeypox – Nº 002". www.dgs.pt. Retrieved 15 July 2022.
    82. ↑ "Monkeypox. Já há 14 casos de varíola dos macacos em Portugal" [Monkeypox. There are already 14 cases of monkeypox in Portugal]. www.dn.pt (in European Portuguese). Archived from the original on 18 May 2022. Retrieved 18 May 2022.
    83. ↑ "Factbox: Monkeypox cases around the world". Reuters. 15 July 2022. Retrieved 15 July 2022.
    84. ↑ "2022 Monkeypox Outbreak Global Map | Monkeypox | Poxvirus | CDC". www.cdc.gov. 21 June 2022. Retrieved 15 July 2022.
    85. ↑ "Okužbe z virusom opičjih koz v Sloveniji" [Infections with the monkey goat (pox) virus in Slovenia] (in Slovenian). Archived from the original on 24 May 2022. Retrieved 8 July 2022.
    86. ↑ Spain cases can be aggregated from the following sources:
    87. ↑ "Monkeypox cases investigated in Europe, US and Canada". BBC News. 19 May 2022. Archived from the original on 19 May 2022. Retrieved 19 May 2022.
    88. ↑ "Apkoppor (Internationellt maj 2022-) — Folkhälsomyndigheten". www.folkhalsomyndigheten.se (in Swedish). Retrieved 15 July 2022.
    89. ↑ "Ett fall av apkoppor rapporterat i Sverige" [A case of monkeypox reported in Sweden] (in Swedish). Archived from the original on 19 May 2022. Retrieved 24 May 2022.
    90. ↑ "Sweden reports first case of monkeypox". The News International. Archived from the original on 19 May 2022. Retrieved 19 May 2022.
    91. ↑ "Monkeypox". Federal Office of Public Health. Archived from the original on 21 June 2022. Retrieved 8 July 2022.
    92. ↑ "В Україні підтвердився третій випадок віспи мавп". Слово і Діло (in Ukrainian). Retrieved 30 September 2022.
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    94. ↑ "Monkeypox – United Kingdom of Great Britain and Northern Ireland". World Health Organization. Archived from the original on 19 May 2022. Retrieved 19 May 2022.
    95. ↑ "В соседней Грузии выявлены случаи с подозрением на оспу обезьян". 1news.az (in Russian). Retrieved 30 June 2022.
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