The Weekly Epidemiological Record (WER) was first issued in 1926 by the Health Office of the League of Nations. It was entrusted to the World Health Organization (WHO) when it was created in 1948 and has appeared every week since then.
It serves as an essential instrument for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the IHR and on other communicable diseases of public health importance, including emerging or re-emerging infections.
An electronic version of the WER is accessible every Friday and can be downloaded free of charge.
Inside this issue
Highlighted signals and events
During epidemiological week 27 (29 June to 5 July 2026), WHO Public Health Intelligence (PHI) teams conducted digital event based surveillance (DEBS) to support the early detection and assessment of potential public health threats. During the reporting period, approximately 672 000 raw signals were scanned and triangulated through DEBS. From this large pool of signals, fourteen signals and/or events met assessment thresholds and underwent further analysis and categorization. Of the fourteen categorized signals, thirteen represented unique signals. Eight signals and/or events were escalated for operational attention.
In the reporting week, two new events were verified through PHI activities. In addition, two Disease Outbreak News (DON) were published. A summary of identified raw signals, assessed signals, and published outputs is presented in the tables below.
| Screened signals1 | Signals categorized2 | Unique signals3 | Signals escalated4 |
| 672 000 | 14 | 13 | 8 |
1 Signals screened: Total volume of raw signals reviewed from across multiple sources during the reporting period.
2 Signals categorized: Number of signals categorized for further detailed WHO assessment and actions during the reporting period.
3 Unique signals: Count of distinct signals after removing duplicate or repeated entries from different sources within the same epidemiological week.
4 Signals escalated: Subset of categorized signals that triggered escalation actions.
| Region | Hazard |
| Africa | • Cholera • Mpox • Not yet diagnosed disease |
| Americas | • Falsified/substandard medical product |
| Eastern Mediterranean | • Cholera • Crimean-Congo Hemorrhagic fever |
| Europe | • Dengue • Mpox |
| South-East Asia | • Adverse event following immunization • Malaria • Suspected poisoning |
| Western Pacific | • IMpox • Tropical cyclone |
5 The absence of listed signals indicates that no publicly available signals were identified during the reporting period and does not imply absence of signal activity overall.
| Disease Outbreak News (2) | |
| • | Hantavirus outbreak linked to cruise ship travel, Multi-locations |
| • | Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo & Uganda |
Multi-country outbreak of mpox
The global mpox outbreak is classified within the WHO Emergency Response Framework (ERF) as a graded health emergency.
The WHO Director-General has, therefore, issued standing recommendations under the provisions of the International Health Regulations (2005) 6 to support States Parties in addressing the risk posed by mpox. In this context, and in line with the WHO Strategic Framework for enhancing prevention and control of mpox (2024–2027) and the Health emergency prevention, preparedness, response and resilience (HEPR) framework , WHO continues to emphasize five core components — the 5Cs: Coordination, Collaborative surveillance, Community protection, Care, and Countermeasures — underpinned by ongoing research Collaborations to generate data and inform development and effectiveness of interventions.
6 As amended in 2014, 2022, and 2024. ↑
Global situation
From 1 January 2022 to 31 May 2026, 187 117 confirmed cases, including 510 deaths (case fatality ratio [CFR] 0.3%), have been reported by 144 countries. During this period, three main peaks in global case counts are noted: August 2022 (driven largely by the rapidly expanding epidemic in the WHO European Region and Region of the Americas); September 2023 (driven by outbreaks in the WHO Western Pacific and South-East Asia Regions), and May 2025 (reflecting the upsurge of mpox in the WHO African Region) (Figure 2).
In May 20267, 1844 confirmed cases, including three deaths (CFR 0.2%), were reported by 34 countries (Figure 3), a 24% increase from the number of confirmed cases reported in April 20268.
The highest number of cases in May 2026 was in the WHO African Region, which reported 76% (1408 of 1844) of confirmed cases, followed by the regions for Europe (13%, 235 cases), the Western Pacific (9%, 167 cases), the Americas (0.9%, 17 cases), South-East Asia (0.8%, 15 cases), and the Eastern Mediterranean (0.1%, two cases). This might not include some cases reported directly by Member States to WHO under the International Health Regulations (2005).
All clades of the monkeypox virus (MPXV) continue to circulate, causing both localized and extended mpox outbreaks linked to various MPXV clades (Ia, Ib, IIa, and IIb) and diverse modes of transmission in different settings.
The geographic range of clade Ib MPXV, first detected in 2023, continues to expand, with community transmission established in Africa and Europe. The global distribution of clade IIb MPXV, first detected in 2022, continues, with cases reported in all WHO regions. Clade Ia and clade IIa MPXV remain relatively localized to Central and West Africa respectively.
7 Last complete month for which global mpox data are available.
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8 Data may reflect incomplete and delayed reporting and are subject to retrospective adjustments over time.
↑
Focus on selected countries
Madagascar
In the largest ongoing mpox outbreak in the African Region and globally currently reported through global surveillance channels, Madagascar has reported 113 confirmed cases of mpox in the last week alone. With a test positivity of around 80%, this shows ongoing transmission, suboptimal surveillance with under-detection of cases, and challenges with the response. Since December 2025, Madagascar has had sustained community transmission, reported 2408 confirmed cases, including 14 deaths (CFR 0.6%) as of 28 June 2026. Most deaths reported were in individuals with immune suppression.
Response has been scaled up, including vaccination, with 84 174 individuals having received at least one dose of the MVA-BN vaccine. Persons vaccinated were 18 973 health workers, 4699 contacts of cases (timing of administration not provided), 1734 sex workers, 1130 people living with HIV, and 57 638 other individuals not otherwise identified. The country received a second allocation of the MVA-BN vaccine and is expanding access through use of intradermal administration. Case management has been strengthened: 93% of confirmed cases received care in dedicated treatment centers or at home.
The outbreak is not yet under control and the situation remains concerning due to continuing high case counts, high test positivity and inadequate description of outbreak epidemiology to guide interventions; operational challenges and gaps related to logistics; limited healthcare capacity; vaccine stockouts and cold chain challenges; and further needs for ongoing risk communication and community engagement for populations at risk. Madagascar is undertaking an intra-action review during the week of 13 July 2026 to gauge progress and reorient the response as needed.
Groups at risk
Considerations for population groups at risk are based on known transmission dynamics, risk factors for infection and for severe disease, and appropriate public health interventions and programmes for outbreak response and control. Key populations at risk are outlined in Table 1.
| Individuals with multiple sexual partners |
| Individuals engaged in sexual activities characterized by frequent partner change, overlapping partnerships and/or anonymous sexual contacts. This group may include men who have sex with men with multiple partners, transgender individuals with multiple partners, sex workers and their clients, long-distance truck drivers in certain settings, and anyone else who engages in sexual activity with multiple partners.
These populations overlap with groups known to be at increased risk of other sexually transmitted infections (STIs), including HIV, which is relevant both for transmission dynamics and for the risk of severe mpox disease in individuals with untreated or advanced immunosuppression. Transmission in these groups at risk can also lead to household and wider community spread. |
| Persons living with advanced HIV disease |
| Persons living with advanced or poorly controlled HIV, characterised by severe immunosuppression (low CD4 count) and/or high viral load, are at higher risk of severe mpox disease, complications and death, whereas people with well-controlled HIV and preserved CD4 counts generally experience outcomes similar to those without HIV.
These risks reinforce the importance of HIV testing and CD4 staging in persons with mpox, and of prioritising people with HIV and low CD4 counts for preventive vaccination. |
| Individuals living in areas with a history of zoonotic transmission of mpox |
| People in parts of Africa where zoonotic transmission of mpox has occurred or may occur may be at risk through different exposure pathways and health risks. In these settings, infection may result from zoonotic spillover or subsequent human-to-human transmission primarily through close contact following spillover, particularly within the household. In this group, particular groups of interest include animal handlers, those with forest occupations, and people living in and hunting or foraging in forested areas, including children and adolescents.
In these areas, outbreaks of mpox linked to travel from other epidemic areas also occur, often linked to sexual contact. Characterizing outbreaks, persons affected, distinct risk factors, modes of transmission and MPXV clades present can all help to identify appropriate interventions for mpox in areas where zoonotic transmission is an ongoing risk and other exposures may also occur. |
| Infants, children and adolescents |
| Infants and children in any of the contexts listed here, including at home, may be at risk of mpox and at higher risk of severe disease or death. Children in forested areas may have contact with animals carrying MPXV or consume insufficiently cooked wild game or meat products.
Children and adolescents may be at particular risk in specific settings. These may include health facilities with limited capacity for infection prevention and control, humanitarian or conflict-affected settings where conditions may be conducive to crowding or sexual violence, congregate settings or other specific contexts. Adolescents may also be at risk of exposure through sexual contact. |
| Contacts of persons with mpox |
| Individuals who have had known contact with a person with suspected, probable or confirmed mpox during the infectious period are at risk of becoming infected. |
| Health workers at risk of repeated exposure |
| These include clinical laboratory and healthcare personnel performing diagnostic testing for mpox or providing care with inadequate access to or use of personal protective equipment, as well as other health workers and outbreak response team members who may be at risk.
Outbreaks in health care settings may affect health workers and/or patients in, or frequenting, the affected health facility. In these contexts, vulnerable individuals (as above) may be particularly at risk. |
General recommendations
- All countries and health partners are strongly encouraged to sustain surveillance and notification for mpox, along with coordinated preparedness and response activities in all technical areas in line with the International Health Regulations (2005) and WHO guidance.
- All countries are strongly encouraged to continue to engage closely with communities that may be at risk, such as people with multiple sexual partners, to promote the uptake of protective measures, ensuring that all communication and interventions are delivered in a stigma-free, respectful and inclusive manner, avoiding messaging that reinforces negative stereotypes or discrimination.
- All countries are encouraged to identify the location and quantity of mpox vaccines remaining in countries at national and sub-national level and make every effort to ensure people at risk can complete their course of vaccination.
Recent publications of interest
- World Health Organization.
Situation report #67, June 2026.
WHO Situation report #67 - World Health Organization.
Mpox global trends. [Internet]. Geneva: World Health Organization; 2022– 2026 [cited 2026 Jul 6]
Available from: Mpox global trends dashboard - European Centre for Disease Prevention and Control.
Mpox worldwide overview [Internet]. Stockholm: ECDC; 2026 [cited 2026 Jul 6].
Available from: ECDC Mpox worldwide overview - koona EN, Namulemo L, Sinnah MM, Vandi MA, Sahr F. Fourfold or higher mpox mortality in people living with HIV: A national cohort from Sierra Leone’s 2025 outbreak.
Journal of Interventional Epidemiology and Public Health [Internet]. 2026 Jun 17. [cited 2026 Jul 6]. 2026; 9(2):100.
Available from: https://doi.org/10.37432/jieph-d-26-00070 - Mfitundinda E, Migisha R, Kobusingye JO, et al. Assessment of mpox severity and associated factors in Uganda, November 2024-February 2025.
International Journal of Infectious Diseases. 2026;170: (108832).
Available from: https://doi.org/10.1016/j.ijid.2026.108832 - Ogoina, D., Dunning, J., Damon, I., Mbala P, Kuppalli K. Mpox emergence, epidemiology, biology, clinical features and control.
Nature Reviews Microbiology. 2026;24: 463–477.
Available from: https://doi.org/10.1038/s41579-026-01305-y