Children have historically gotten mpox in endemic areas in Western and Central Africa, and in this outbreak the high number of children with mpox reported in likely reflects spread within households. Based on what we know right now, we don't expect to see the same sort of risk in children if mpox were introduced in the United States for reasons including different household makeup and size, access to disinfecting products, and improved access to medical care.
CDC assessed the risk to the United States overall population and specific populations within the United States posed by the clade I mpox outbreak as low.
In Central Africa, people have gotten clade Ia mpox through contact with infected dead or live wild animals, household transmission, or patient care; a high proportion of cases have been reported in children younger than 15 years of age.
Subclade Ib was recently identified in eastern DRC and has been spread through intimate and adult sexual contact between different demographics, including heterosexual spread with sex trade workers. So, far clade Ib has a lower case-fatality rate than clade Ia mpox.
The ongoing global outbreak of clade II mpox has caused more than 100,000 cases in 122 total countries, including 115 countries where mpox was not previously reported. The outbreak is caused by the subclade IIb.
Historically, only Cameroon in West Africa had cases of both clade I and clade II mpox, but they were seen in different parts of the country. To date, no other country has reported cases due to both clades, with the exception of the recent travel-associated clade I cases in Belgium, Canada, Germany, India, Sweden, Thailand, the United Kingdom, the United States, Zambia, and Zimbabwe.
