Mpox Is Back, in New Countries, and Children Appear Worst Affected

A fresh outbreak of mpox in Guinea-Bissau — the country's first — has returned the virus to the headlines. The question is what has changed.

The scale so far

Since 2022 there have been almost 190,000 laboratory-confirmed cases reported worldwide across 145 countries. Before that, outbreaks were relatively small and confined to a handful of African countries where the infection is endemic.

Mpox typically begins with flu-like symptoms — fever, chills, aching muscles — followed by a distinctive rash that starts as raised spots, turns into fluid-filled blisters and then forms scabs.

The name changed during the 2022 international outbreak. It had been called monkeypox since the virus was first identified in captive monkeys in 1958, but concerns that the name was fuelling racist and stigmatising language led the World Health Organization to recommend the shorter term.

What is different this time

Two things. The geography keeps extending into countries with no previous experience of the disease, meaning no clinical familiarity and no established response protocol.

And the demographic has shifted. Children appear particularly affected in the new cases — a change from the transmission patterns that characterised the 2022 emergency, and one that alters both the clinical picture and the public health response required.

Two global emergencies have already been declared, in 2022 and 2024. The pattern of the past four years suggests the pauses between them are not the disease receding so much as the attention doing so.