Global mpox outbreak dynamics during and after the 2024–2026 public health emergency

The second WHO Public Health Emergency of International Concern (PHEIC) for mpox was declared on 14 August 2024 after clade Ib monkeypox virus emerged in the Democratic Republic of the Congo (DRC) and spread rapidly across Africa and internationally. The PHEIC ended on 5 September 2025, and the Africa CDC Public Health Emergency of Continental Security was lifted on 22 January 2026. This study characterised global and Africa-specific mpox epidemiology across the full second PHEIC cycle and immediate post-emergency period, from January 2024 to February 2026. A retrospective surveillance analysis was conducted using the WHO Global Mpox Trends dashboard exported data, supplemented by WHO situation reports S32–S64 and international and national surveillance reports. Analyses included negative binomial segmented regression, travel-linked pathway analysis, exploratory analysis of documented secondary transmission after travel-linked detection, and descriptive statistics. Models used reported case counts with log population offsets; reported case-rate ratios therefore reflect reported case rates rather than true infection incidence. Between January 2024 and February 2026, 82,738 confirmed cases and 306 deaths were reported to WHO globally (case fatality ratio 0.37%). The PHEIC period accounted for 74.0% of cases, peaking at 7,405 cases in May 2025. In total, 163 clade-specific importation or travel-linked detection events were documented across 41 countries within the primary analytic cutoff; documented secondary transmission occurred in 25 (15.3%) events across 16 countries. Within DRC, 200 health zones recorded 144,035 total reported cases and 2,047 deaths (case fatality ratio 1.42%); these aggregate suspected/clinically compatible and confirmed cases. The top 20 health zones accounted for 45.4% of national burden. Reported transmission declined after the May 2025 peak but persisted beyond PHEIC termination. Emergency termination marked an administrative transition, not the end of mpox transmission. The post-emergency period requires sustained surveillance, maintained diagnostic capacity, targeted response in persistent transmission settings, and equitable access to vaccines and countermeasures.