WHO: global mpox clade I cases declining since May 2025, with Madagascar now leading Africa ahead of DRC
As of June 14, 2026, Madagascar reported 689 confirmed clade I mpox cases in the preceding six weeks, more than any other country, while the Democratic Republic of Congo and all other African nations each fell below 100 cases in the same window, continuing a downward trend in Africa-wide clade I transmission that began in May 2025
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Summary
The WHO's multi-country mpox situation report as of June 14, 2026 confirmed that Africa-wide clade I transmission has been declining since May 2025 and that the geographic leadership within Africa has shifted: Madagascar reported 689 confirmed clade I cases in the preceding six weeks, more than any other country, while the DRC and all other African nations each fell below 100 cases in the same window. The five countries that have reported the most clade I cases since the outbreak expanded in 2025 are DRC, Uganda, Madagascar, Burundi, and Kenya. The DRC continues to see mpox transmission across multiple provinces with co-circulation of clades Ia and Ib and heterogeneous provincial trends, but the volume has fallen sharply. Globally, clade I cases have been confirmed in 24 countries outside Africa since August 2024, including the United States, United Kingdom, India, Thailand, China, Brazil, and Australia.
The split
African public health authorities and Africa CDC framed the declining DRC numbers as a result of intensified community-level surveillance and vaccination in the DRC's eastern provinces, though they cautioned that limited laboratory capacity meant case counts in several countries likely understated true infection rates. WHO and ECDC stressed the significance of Madagascar's emergence as the leading clade I country, noting that Madagascar's health system has less experience with mpox containment than the DRC and that the island's geographic isolation creates distinct logistical challenges for outbreak response. European and North American health authorities used the June situation report to maintain, but not escalate, travel advisories for affected regions.
By the numbers
- 689 confirmed clade I cases in Madagascar in the six weeks to June 14, 2026 (most of any country)
- Less than 100 clade I cases in each of DRC and all other African countries in the same six-week window
- 5 countries with the most clade I cases since 2025: DRC, Uganda, Madagascar, Burundi, Kenya
- 24+ countries outside Africa confirmed clade I cases since August 2024
- Declining clade I trend in Africa ongoing since May 2025
Why it matters
The shift from DRC-dominant transmission to Madagascar-led counts marks a geographic realignment of the Mpox outbreak within Africa. Madagascar's lower baseline health infrastructure for viral hemorrhagic disease containment, combined with its limited prior mpox caseload, raises the risk of sustained community transmission if the outbreak is not contained quickly. The continuing decline in DRC, where clade I was initially identified and where the most intensive response effort has been deployed, suggests that concentrated surveillance and vaccination can suppress the virus, providing a model for Madagascar's response. The global spread to 24+ non-African countries remains a lower-volume but persistent public health concern.
What to watch
- Whether Madagascar's clade I case counts continue to rise or stabilise in subsequent WHO situation reports
- Madagascar's vaccine procurement and deployment in affected regions
- Whether any non-African country reports a sustained clade I transmission cluster rather than isolated imported cases
- Africa CDC's quarterly assessment of outbreak trajectory and revised case projections