Mpox is an infectious disease that typically starts with flu-like symptoms, including fever, chills and aching muscles.
asserted
that → start → fever
These are followed by a distinctive rash, beginning as raised spots that turn into blisters filled with fluid before forming scabs.
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that → follow → scabs
A colourised electron microscope image shows Mpox virus particles, represented in green, found within infected cultured cells, represented in blue.
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image → show → blue
The virus particles are in various stages of maturity, which accounts for their differences in shape.
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which → account → shape
Photograph: APIt used to be called monkeypox, because the virus was first discovered in captive monkeys in 1958.
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virus → use → 1958
But during an international outbreak in 2022, there were concerns that the name was fuelling racist and stigmatising language on and offline, prompting the World Health Organization (WHO) to recommend changing it to mpox .
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name → be → mpox
It is endemic to many parts of Africa, with outbreaks historically starting when people ate meat from infected wild animals.
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people → start → animals
But in recent years it has spread beyond the usual areas, with sustained chains of human-to-human transmission.
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it → spread → transmission
The Atlanta-based Centers for Disease Control and Prevention said this month that mpox was on course to become endemic in the US .
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mpox → base → US
Why is it spreading to new countries?
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it → spread → countries
Clade I was once called the “Congo Basin clade” and clade II the “West African clade”.
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II → call → ?
The latter sparked a major global outbreak in 2022 when it appeared to undergo some changes that allowed it to spread more efficiently from person to person.
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it → spark → person
It is passed on via close contact – in that outbreak, mostly by sexual contact, with men who have sex with men at the highest risk .
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who → pass → risk
A Red Cross worker disinfects a tent in the Don Bosco camps for internally displaced people in Goma, in the Democratic Republic of Congo.
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worker → disinfect → Congo
, researchers raised the alarm about a new variant of clade I in the Democratic Republic of the Congo (DRC), which also appeared to be spreading more easily between people.
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which → raise → people
That grew into another major international outbreak, which was declared a public health emergency of international concern by the WHO on 14 August 2024.
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which → grow → August
“Emergence of mpox in more countries in west Africa is to be expected,” said Prof Michael Marks, of the London School of Hygiene & Tropical Medicine and University College London hospital.
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Marks → expect → Hygiene
“Mpox outbreaks have now been declared in a number of countries in the region, including Guinea and Sierra Leone within the last 12 months.
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outbreaks → declare → months
“Mpox spreads by close physical contact.
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Mpox → spread → contact
This makes it suitable to spread in a variety of different contexts, such as in close sexual networks, as was seen during the 2022 global pandemic, or areas where many people are living closely together such as settings with refugees and internally displaced people, as was seen in the DRC outbreak over the last few years,” Marks said.
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Marks → make → years
What happened to those two big outbreaks?
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What → happen → outbreaks
The 2022 outbreak was declared a public health emergency in July that year.
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outbreak → declare → July
After contact-tracing and mass vaccination programmes, the status was lifted in May 2023.
uncertain
status → lift → May
A passenger passes mpox alerts at Chennai airport in India.
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passenger → pass → India
Photograph: R Satish Babu/AFPThe 2024 outbreak had its international public health emergency status lifted in September 2025 , not because the disease had disappeared but because numbers of cases and deaths were declining and officials felt the situation had become better controlled.
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situation → have → cases
If genetic testing reveales a new variant, or surveillance suggested an outbreak was spreading particularly fast, making people particularly sick or proving more deadly, global health authorities would be likely to step in again.
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authorities → reveal → variant
Cases had not been reported in Guinea Bissau before this outbreak.
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Cases → report → outbreak
Unicef said it was concerned that of 46 suspected cases, 23 were children aged under 15 and most of those were aged under four.
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most → say → four
“The concern about children is that they are at the highest risk of severe disease and death from mpox,” said Dr Aula Abbara, a senior lecturer at Imperial College London and adviser to Médecins Sans Frontières UK.
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Abbara → say → UK
“Young children can become much sicker than healthy adults.”
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children → become → adults
Furaha Elisabeth applies medication to the skin of her child, Sagesse Hakizimana, at a health centre near Goma, in the DRC.
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Elisabeth → apply → DRC
ReutersHowever, she cautioned that the apparent over-representation of children in the outbreak data should be interpreted carefully.
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representation → caution → data
She said: “There may also be some bias in the data.
uncertain
She → say → data
Families are often more likely to seek healthcare for a sick child than for an adult, particularly in a resource-constrained setting with a fragile health system, such as Guinea-Bissau.”
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Families → seek → Bissau
Marks added: “Children have close physical contact with their parents and with each other, and in settings such as Guinea-Bissau are often living in cramped conditions, which make close physical contact and transmission more likely.”
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contact → add → conditions
Confirmed cases do not appear linked to each other, which suggests the virus is circulating more widely in the community and there are unidentified cases.
uncertain
virus → confirm → community
The WHO recommends two vaccines , which can be given to people at high risk or offered to people who have been in contact with a known case to prevent further spread.
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who → recommend → spread
Marks said: “The major challenge remains that supplies of vaccines are best in high-income countries but worst in low-income settings, where the need and conditions for mpox transmission are highest.”
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need → say → transmission
A new global stockpile is due to be launched within weeks, which should mean vaccines can be deployed more rapidly to quell outbreaks.
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vaccines → launch → outbreaks
Officials also hope it will allow manufacturers to plan ahead and produce more of the jabs by providing a clear, concrete demand.
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manufacturers → hope → demand
…and 7 more, not listed.
The Aporia
