2022–2023 mpox outbreak in Europe explained

2022–2023 mpox outbreak in Europe
Disease:Mpox
Virus Strain:Monkeypox virus (West African clade)
Arrival Date:6 May 2022 (ago)
Confirmed Cases:22,640
Suspected Cases:82
Deaths:1
Territories:35
Index Case:London, England

The 2022–2023 mpox outbreak in Europe is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak reached Europe on 6 May 2022 when the United Kingdom reported their first case of mpox. 35 European countries and territories have confirmed cases.

Transmission

A large portion of those infected were believed to have not recently traveled to areas of Africa where mpox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.[1]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[2]

Timeline

Arrival

See main article: 2022–2023 mpox outbreak in Germany, 2022–2023 mpox outbreak in the United Kingdom and 2022–2023 mpox outbreak in the Netherlands.

An index case was imported into the United Kingdom in late April 2022, by a man who had travelled to Nigeria, where the disease is endemic. He had already showed symptoms since 29 April, and was admitted to hospital in London on 6 May. On 12 May, the man was confirmed to have contracted mpox. The following day, another mpox case was confirmed, and the United Kingdom reported these cases to the World Health Organization (WHO).[3]

Cases transited through Europe

May

18 May

See main article: 2022–2023 mpox outbreak in Spain and 2022–2023 mpox outbreak in Portugal.

On 18 May, Spain and Portugal both confirmed their first cases of mpox following the confirmation of mpox in the United Kingdom starting an outbreak in the countries.[4] It is unknown how it was contracted, but most likely via travel or skin-to-skin contact abroad.

19 May

On 19 May, Belgium confirmed its first cases of mpox in two Belgian men, it was later confirmed by Reuters that the men had gone to the same party.[5]

Later, Italy confirmed its first case of mpox in an Italian man in Rome, the man was isolated at the Spallanzani Hospital. The disease was likely contracted from a stay in the Canary Islands.[6] There were 2 suspected cases, which later became confirmed cases.

Sweden then confirmed its first case of mpox in Stockholm, the Swedish Health Agency confirmed it later. The person was not reported to be a woman or a man, but it was most likely a man.[7] It is unknown how it was contracted, but likely via travel or skin-to-skin contact abroad.

20 May

See main article: 2022–2023 mpox outbreak in France, 2022–2023 mpox outbreak in Germany and 2022–2023 mpox outbreak in the Netherlands. On 20 May, France reported their first case of mpox. The patient had no travel history, meaning he didn't contract the disease abroad.[8]

On the same day, Germany and the Netherlands reported their first cases of mpox.[9] [10] It was unknown how it was contracted in both stories, but likely via travel or skin-to-skin contact abroad.

21 May

On 21 May, Switzerland confirmed its first case of mpox. It was in a person of undisclosed gender, contracted through "close physical contact" abroad, according to Reuters.[11]

22 May

On 22 May, Austria confirmed its first case of mpox.[12] It is unknown how it was contracted or who contracted it, but likely via travel or skin-to-skin contact abroad.

23 May

On 23 May, Denmark detected its first mpox infection. It was in an adult male, likely contracted from a trip to Spain, according to Reuters. No cases of mpox were detected in Greenland, a Danish constituent country in North America.

24 May

On 24 May, the Czech Republic registered its first case of mpox in a woman, likely picked up from a festival in Belgium, according to Reuters.

On the same day, Slovenia also registered its first case of mpox. It was in a traveller of undisclosed gender who likely contracted mpox from a trip to the Canary Islands, according to Reuters.

27 May

On 27 May, Ireland confirmed its first case of mpox in the east of the country.[13] The Health Protection Surveillance Centre (HPSC) commenced publication of a weekly report on the epidemiology of human mpox in Ireland on 9 June.

On the same day, Finland also confirmed its first case of mpox. It was in a man who likely had contracted the disease from a trip to another European country, according to Reuters.

28 May

On 28 May, Malta registered its first case of mpox. It was in an adult male, who most likely picked up the disease abroad from one of the countries affected by the outbreak, according to the Malta Times.

31 May

On 31 May, Hungary confirmed its first case of mpox, in an adult male. It is still being investigated whether or not he recently travelled, though it is unknown how the man contracted the disease.

On the same day, Norway confirmed its first case of mpox. It was in a person of undisclosed gender who most likely contracted the disease from travelling abroad. The case was linked to the ongoing outbreak in Europe, meaning that the patient may have travelled to a European country that was affected by the outbreak.

June

1 June

On 1 June, Gibraltar, a British Overseas Territory, registered its first case of mpox in a Spanish resident of undisclosed gender working in Gibraltar. The patient likely contracted the disease from close contact with another Spanish national also working in Gibraltar.

3 June

On 3 June, Latvia confirmed its first mpox infection. It was in an elderly person of undisclosed gender who most likely contracted the disease abroad.

8 June

On 8 June, Greece confirmed the country's first mpox case. It was in a person of undisclosed gender who likely contracted the disease from a trip to Portugal.

9 June

On 9 June, Iceland confirmed its first mpox case. It was in two men who most likely contracted the disease from a trip to Europe.

10 June

On 10 June, Poland confirmed its first mpox case. It is unknown who the patient is or how it was contracted, but it is possible it was picked up via travel or skin-to-skin contact.

13 June

On 13 June, Romania confirmed its first monkempoxypox infection. It was in an adult male who most likely contracted the disease from his partner who travelled in several different European countries that have been affected by mpox at the time.

15 June

On 15 June, Luxembourg confirmed its first mpox case. It is unknown how it was contracted, though it is being investigated. The disease was likely picked up via travelling abroad or skin-to-skin contact.

On the same day, Georgia also confirmed its first case of mpox. It was in a patient of undisclosed gender who likely contracted the disease from a trip to Europe.

17 June

On 17 June, Serbia confirmed its first case of mpox. It was in a patient of undisclosed gender. It was revealed that it was an "imported case", meaning that the patient may have contracted the disease abroad.

23 June

On 23 June, Bulgaria confirmed its first mpox case. It was in two men who most likely contracted the disease from a trip to Spain and the United Kingdom but don't reckon any contact with infected persons.

On the same day, Croatia also received its first case of mpox. It was in an adult man who most likely contracted the disease from a stay in Italy and Spain.

28 June

On 28 June, Estonia confirmed its first case of mpox. It was in a middle-aged man who most likely contracted the disease abroad. He had no close contacts with anyone in Estonia.

July

2 July

On 2 July, Andorra registered its first mpox case in a woman of unknown age. It is unknown how it was contracted, but it may likely have been picked up either abroad via travel or via skin-to-skin contact.

7 July

On July 7, Slovakia received its first case of mpox. It was in a person of undisclosed gender in the 20-59 age group who most likely contracted the disease abroad.

12 July

On 12 July, Russia confirmed its first case of mpox. It was in a man probably in his 20-25 age group who likely contracted the disease from a trip to Europe where the outbreak had started. The man then tested positive for the virus and was isolated in a hospital, most likely in Saint Petersburg.

13 July

On 13 July, Bosnia and Herzegovina registered its first mpox case. It is unknown how it was contracted, although the disease was likely picked up abroad via travel or skin-to-skin contact.

22 July

September

15 September

On 15 September, Ukraine's Ministry of Health reported the country's first case of mpox. The Ministry noted that the patient, who did not travel abroad, was experiencing "mild symptoms" and undergoing hospital treatment.[14] [15] The region where the case was reported was not disclosed.

Responses

World Health Organization (WHO)

On 20 May, the WHO convened an emergency meeting of independent advisers to discuss the outbreak and assess the threat level.[16] Its European chief, Hans Kluge, expressed concern that infections could accelerate in Europe as people gather for parties and festivals over the summer.[17] On 14 June, the WHO announced plans to rename the disease from monkeypox to mpox in order to combat stigma and racism surrounding the disease.[18] Another meeting convened on 23 June determined that the outbreak does not constitute a Public Health Emergency of International Concern for the time being.[19]

Countries

The majority of European countries responded to the outbreak, and the responses of some are listed below.

The Risk Assessment Group (RAG) and health authorities declared that those infected with mpox must self-isolate for 21 days.[20]

Fabian Leendertz of the Robert Koch Institute described the outbreak as an epidemic that will not last long: "The cases can be well isolated via contact tracing and there are also drugs and effective vaccines that can be used if necessary."[17]

The Health Service Executive (HSE) has set up a multidisciplinary incident management team to prepare for the possible arrival of mpox, and infectious diseases experts are on alert for patients with symptoms of the virus.[21]

On 23 May, the Ministry of Health and the National Public Health Institute, have drafted a document of recommendations and measures to help prevent the spread of the disease. In a press statement, healthcare authorities have declared that the situation is being closely monitored.[22]

On 21 May, the Ministry of Health said that they are monitoring the situation with its Europe.[23] he National Infectious Diseases Department of the HLC and refrain from close contact activities until the infection has resolved.[24]

On 22 May, Education Secretary Nadhim Zahawi said "we're taking it very, very seriously" and that the UK government had already started purchasing smallpox vaccines.[25] The Terrence Higgins Trust and British Association for Sexual Health and HIV (BASHH) expressed concern about the impact on sexual health services in the United Kingdom.[26] [27]

Dependent territories

On 31 May, a Strategic Coordination Group met to discuss Gibraltar's state of preparedness in the eventuality that a case of mpox was confirmed in the territory amid the rapid rise of cases in the United Kingdom and Spain.[28]

Cases per country and territory

This is a table of confirmed and suspected mpox cases in European countries during the ongoing 2022–2023 mpox outbreak. It does not include countries where suspected cases were reported but later discarded.

Country!scope="col" data-sort-type=number
ConfirmedSuspectedTotalLast updateFirst confirmed caseLast confirmed case
11[29]
838314 July 2022[30] [31]
Belgium225122614 July 2022
Bosnia and Herzegovina11[32] [33]
Bulgaria33[34] [35]
Croatia33[36]
Czech Republic1212[37] [38]
Denmark3232[39]
Estonia22[40]
Finland131311 July 2022[41] [42] [43] [44]
France912912[45] [46]
Georgia22[47] [48]
Germany1,8591,85915 July 2022[49]
Gibraltar55[50] [51]
Greece1212[52] [53] [54]
Hungary2828[55] [56]
Iceland66[57] [58]
Ireland8585[59] [60]
Italy339339[61] [62]
Latvia22[63]
Luxembourg77[64]
Malta99[65]
Netherlands54954914 July 2022[66]
Norway3535[67] [68]
Poland222213 July 2022[69] [70]
Portugal515515[71] [72]
Romania1616[73] [74]
11[75]
Serbia55[76] [77]
Slovakia11[78]
Slovenia1919[79] [80]
Spain4,371624,433[81] [82]
Sweden5858[83] [84] [85]
Switzerland181181[86]
Ukraine3322 September 2022[87] 15 September 2022
United Kingdom2,4692,46914 July 2022[88] [89]
Total10,0058210,087

Timeline of first confirmed cases by country or territory

Date! scope="col"
Countries / Territories
United Kingdom
Spain • Portugal
Belgium • Italy • Sweden
France • Germany • Netherlands
Switzerland
Austria
Denmark
Czech Republic • Slovenia
Finland • Ireland
Malta
Hungary • Norway
Gibraltar
Latvia
Greece
Iceland
Poland
Romania
Luxembourg • Georgia
Serbia
Bulgaria • Croatia
Estonia
Andorra
Slovakia
Bosnia and Herzegovina
15 September 2022 Ukraine

Timeline of suspected cases by country or territory

Countries listed below had only suspected cases at the time of reporting. Some countries reported confirmed cases after reporting suspected cases. Countries listed several times reported suspected cases again after they discarded suspected cases before.

Timeline of suspected mpox cases by country or territory
DateCountries / Territories
Greece (discounted on 22 May)
Georgia (confirmed on 15 June)[90]

33 European countries and territories have been affected by the pandemic.

See also

Notes and References

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  2. Web site: Monkeypox update: Where the outbreak stands now .
  3. Web site: Monkeypox - United Kingdom of Great Britain and Northern Ireland . 2022-06-23 . www.who.int . en.
  4. Web site: 2022-05-18 . U.S. monkeypox case reported, as Spain, Portugal report infections in growing outbreak . 2022-06-23 . STAT . en-US.
  5. News: 2022-05-20 . Belgium detects first two monkeypox cases . en . Reuters . 2022-06-23.
  6. News: 2022-05-19 . Italy confirms first monkeypox case. en . Reuters . 2022-05-19.
  7. Web site: 2022-05-19 . Sweden reports monkeypox case in Stockholm . 2022-06-23 . Outbreak News Today . en-US.
  8. News: AA . 2022-05-20 . First case of monkeypox in the Paris region of France . en . AA .
  9. News: 2022-05-20 . First case of monkeypox in Germany, in the Berlin/Munich region . en . Reuters .
  10. News: 2022-05-20 . First case of monkeypox in the Netherlands . en . Reuters .
  11. News: 2022-05-21 . First case of monkeypox in Switzerland . en . Reuters .
  12. News: 2022-05-22 . First case of monkeypox in Austria . en . Reuters .
  13. News: BBC . 2022-05-28 . First case of monkeypox in Republic of Ireland . en . BBC . 2022-07-05.
  14. Web site: 2022-09-15 . First monkeypox case confirmed in Ukraine . 2022-09-30 . Ukrinform.
  15. Web site: 2022-09-15 . В Україні зареєстрований випадок віспи мавп . 2022-09-30 . Міністерство охорони здоров'я України . uk.
  16. News: Rigby . Jennifer . 20 May 2022 . WHO to hold emergency meeting on monkeypox on Friday -sources . en . Reuters . live . 20 May 2022 . https://web.archive.org/web/20220520215707/https://www.reuters.com/business/healthcare-pharmaceuticals/who-hold-emergency-meeting-monkeypox-friday-sources-2022-05-20/ . 20 May 2022.
  17. News: Rigby . Jennifer . Grover . Natalie . 20 May 2022 . WHO calls emergency meeting as monkeypox cases top 100 in Europe . Reuters . live . 21 May 2022 . https://web.archive.org/web/20220520212102/https://www.reuters.com/world/europe/monkeypox-outbreak-europe-largest-ever-region-cases-cross-100-2022-05-20/ . 20 May 2022.
  18. News: 2022-06-13 . WHO Will Rename Monkeypox Virus to Minimize Stigma, Racism . en . Bloomberg.com . 2022-06-15 .
  19. Web site: Meeting of the International Health Regulations (2005) Emergency Committee regarding the multi-country monkeypox outbreak . 2022-06-26 . who.int . WHO . en . 28 June 2022 . https://web.archive.org/web/20220628012204/https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak . live .
  20. Web site: Monkeypox patients must spend 21 days in isolation . . 22 May 2022 . 24 May 2022 . https://web.archive.org/web/20220524192714/https://www.brusselstimes.com/226540/monkeypox-patients-must-spend-21-days-in-isolation . live .
  21. News: 20 May 2022 . Ireland on alert for monkeypox as virus spreads across Europe . en . . 23 May 2022 . 20 May 2022 . https://web.archive.org/web/20220520143721/https://www.irishtimes.com/news/world/europe/ireland-on-alert-for-monkeypox-as-virus-spreads-across-europe-1.4883747 . live .
  22. Web site: 2022-05-24 . Kosovo takes preventive measures against the spread of monkeypox . 2022-06-01 . . en-US . 24 May 2022 . https://web.archive.org/web/20220524113950/https://euronews.al/en/kosovo/2022/05/24/kosovo-takes-preventive-measures-against-the-spread-of-monkeypox/ . live .
  23. Web site: 2022-05-24 . Kosovo takes preventive measures against the spread of monkeypox – Euronews Albania . 2022-06-01 . en-US . 24 May 2022 . https://web.archive.org/web/20220524113950/https://euronews.al/en/kosovo/2022/05/24/kosovo-takes-preventive-measures-against-the-spread-of-monkeypox/ . live .
  24. News: 21 May 2022 . Ministry of Health: Luxembourg spared from monkeypox so far . en . . 23 May 2022 . 24 May 2022 . https://web.archive.org/web/20220524192722/https://today.rtl.lu/news/luxembourg/a/1916605.html . live .
  25. Web site: UK Confirms Local Transmission of Monkeypox . . 22 May 2022 . 24 May 2022 . https://web.archive.org/web/20220524192725/https://ewn.co.za/2022/05/22/uk-confirms-local-transmission-of-monkeypox . live .
  26. Web site: 2022-05-21 . Monkeypox could have 'big detrimental effect' on access to sexual health services, experts warn . 2022-05-23 . inews.co.uk . en . 24 May 2022 . https://web.archive.org/web/20220524193914/https://inews.co.uk/news/health/monkeypox-could-detrimental-effect-access-sexual-health-services-experts-warn-1643210 . live .
  27. News: 2022-05-21 . Monkeypox: Doctors concerned over impact on sexual health . en-GB . BBC News . 2022-05-23 . 20 May 2022 . https://web.archive.org/web/20220520230245/https://www.bbc.com/news/health-61527835 . live .
  28. Web site: Gibraltar Government prepares for Monkeypox, as UK cases rise . 2022-06-01 . . en . 1 June 2022 . https://web.archive.org/web/20220601160257/https://www.chronicle.gi/gibraltar-government-prepares-for-monkeypox-as-uk-cases-rise/ . live .
  29. News: Primer cas de verola del mico. 9 July 2022. 2 July 2022. es.
  30. Web site: Affenpocken . 2022-07-15 . AGES . de . 23 July 2022 . https://web.archive.org/web/20220723145857/https://www.ages.at/mensch/krankheit/krankheitserreger-von-a-bis-z/affenpocken . dead .
  31. Web site: 22 May 2022. First case in Austria and 2 others. 22 May 2022.
  32. Web site: First monkeypox case confirmed in Bosnia . N1 Bosnia . 13 July 2022 .
  33. Web site: Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin . 7 July 2022 . European Centre for Disease Prevention and Control.
  34. Web site: Third Case of Monkeypox Confirmed in Bulgaria . . 27 June 2022 . 27 June 2022 . https://web.archive.org/web/20220627164040/https://www.bta.bg/en/news/bulgaria/287976--third-case-of-monkeypox-confirmed-in-bulgaria . live .
  35. Web site: First case of monkeypox reported and confirmed in Bulgaria. . 23 June 2022 . en.
  36. Web site: Croatia reports first monkeypox case . Post Online Media . 24 June 2022 . 24 June 2022 . https://web.archive.org/web/20220624073615/https://www.poandpo.com/in-sickness-and-health/croatia-reports-first-monkeypox-case/ . live .
  37. Web site: Pražští hygienici evidují šestý laboratorně pozitivně testovaný případ opičích neštovic. 3 June 2022. cs. 1 June 2022. https://web.archive.org/web/20220601230426/https://www.hygpraha.cz/prazsti-hygienici-eviduji-sesty-laboratorne-pozitivne-testovany-pripad-opicich-nestovic/. live.
  38. News: 2022-05-24 . First case of monkeypox in the Czech Republic. en . Reuters .
  39. News: Denmark registers first case of monkeypox infection . . 23 May 2022 . 23 May 2022. 24 May 2022 . https://web.archive.org/web/20220524145139/https://www.reuters.com/world/europe/denmark-registers-first-case-monkeypox-infection-health-ministry-2022-05-23/ . live .
  40. Web site: First case of monkeypox diagnosed in Estonia . . 30 June 2022.
  41. Web site: 2022-07-04 . THL: Suomessa todettu yhteensä 10 apinarokkotartuntaa . 2022-07-04 . Ilta-Sanomat . fi.
  42. News: 2022-07-11 . Factbox: Monkeypox cases around the world . en . Reuters . 2022-07-12.
  43. News: First case of monkeypox confirmed in Finland. Reuters. 27 May 2022. 27 May 2022. 27 May 2022. https://web.archive.org/web/20220527071709/https://www.reuters.com/world/europe/first-case-monkeypox-confirmed-finland-2022-05-27/. live.
  44. Web site: Suomen ensimmäinen apinarokkotapaus vahvistettu . 27 May 2022 . . 27 May 2022 . fi . 27 May 2022 . https://web.archive.org/web/20220527060709/https://www.hs.fi/kaupunki/art-2000008845103.html . live .
  45. Web site: Cas de variole du singe : point de situation au 7 juillet 2022. 8 July 2022. fr. 8 July 2022. 26 June 2022. https://web.archive.org/web/20220626181307/https://www.santepubliquefrance.fr/les-actualites/2022/cas-de-variole-du-singe-point-de-situation-au-23-juin-2022. live.
  46. Web site: 20 May 2022 . France, Germany, Belgium report first monkeypox cases amid unusual spread in Europe . 20 May 2022 . . en . 21 May 2022 . https://web.archive.org/web/20220521020725/https://www.france24.com/en/europe/20220520-france-germany-belgium-report-first-monkeypox-cases-amid-unusual-spread-in-europe . live .
  47. News: В Грузии подтвержден первый случай оспы обезьян. 15 June 2022. russian. 15 June 2022. 16 June 2022. https://web.archive.org/web/20220616022915/https://www.gazeta.ru/social/news/2022/06/15/17938676.shtml. live.
  48. News: Georgia confirms first case of monkeypox . 15 June 2022 . en . 15 June 2022.
  49. Web site: RKI - Affenpocken - Internationaler Affenpocken-Ausbruch: Fallzahlen und Einschätzung der Situation in Deutschland . 2022-07-15 . www.rki.de.
  50. Web site: GHA confirms first case of monkeypox in Gibraltar . . 1 June 2022 . 1 June 2022 . https://web.archive.org/web/20220601124032/https://www.chronicle.gi/gha-confirms-first-case-of-monkeypox-in-gibraltar/ . live .
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  52. Web site: Eleven Monkeypox Cases Detected so Far in Greece . . 7 July 2022.
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  70. News: Poland reports first case of monkey pox – PAP news agency . . 10 June 2022 . 10 June 2022 . 10 June 2022 . https://web.archive.org/web/20220610104238/https://www.reuters.com/world/europe/poland-reports-first-case-monkey-pox-pap-news-agency-2022-06-10/ . live .
  71. Web site: Informação semanal sobre Infeção Humana por vírus Monkeypox – Nº 002 . 2022-07-15 . www.dgs.pt.
  72. Web site: Monkeypox. Já há 14 casos de varíola dos macacos em Portugal . Monkeypox. There are already 14 cases of monkeypox in Portugal . live . https://web.archive.org/web/20220518213313/https://www.dn.pt/sociedade/ja-ha-14-casos-de-variola-dos-macacos-em-portugal-14869281.html . 18 May 2022 . 18 May 2022 . www.dn.pt . pt-PT.
  73. News: 2022-07-15 . Factbox: Monkeypox cases around the world . en . Reuters . 2022-07-15.
  74. News: 2022-06-13 . Romania detects its first monkeypox case . en . Reuters . 2022-06-13.
  75. News: Russia Confirms First Case of Monkeypox. . 12 July 2022 . 12 July 2022 . en.
  76. News: Serbia reports first case of monkeypox . . 17 June 2022 . 17 June 2022 . 17 June 2022 . https://web.archive.org/web/20220617134647/https://www.reuters.com/business/healthcare-pharmaceuticals/serbia-reports-first-case-monkeypox-2022-06-17/ . live .
  77. Web site: 2022-06-21 . 2022 Monkeypox Outbreak Global Map Monkeypox Poxvirus CDC . 2022-07-15 . www.cdc.gov . en-us.
  78. Web site: Slovakia confirms first case of monkeypox -public health authority . . 7 July 2022.
  79. Web site: Okužbe z virusom opičjih koz v Sloveniji . Infections with the monkey goat (pox) virus in Slovenia . 8 July 2022 . sl . 24 May 2022 . https://web.archive.org/web/20220524193349/https://www.nijz.si/sl/okuzbe-z-virusom-opicjih-koz-v-sloveniji . live .
  80. News: 2022-05-24 . Slovenia reports its first monkeypox infection . en . Reuters . 2022-05-24.
  81. Spain cases can be aggregated from the following sources:
  82. News: 19 May 2022. Monkeypox cases investigated in Europe, US and Canada. BBC News . live . 19 May 2022. https://web.archive.org/web/20220519102925/https://www.bbc.co.uk/news/health-61506562. 19 May 2022.
  83. Web site: Apkoppor (Internationellt maj 2022-) — Folkhälsomyndigheten . 2022-07-15 . www.folkhalsomyndigheten.se . sv.
  84. Web site: Ett fall av apkoppor rapporterat i Sverige . A case of monkeypox reported in Sweden . 24 May 2022. 19 May 2022. https://web.archive.org/web/20220519110819/https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2022/maj/ett-fall-av-apkoppor-rapporterat-i-sverige/. live . sv.
  85. Web site: Sweden reports first case of monkeypox . live . https://web.archive.org/web/20220519132229/https://www.thenews.com.pk/latest/959055-sweden-reports-first-case-of-monkeypox . 19 May 2022 . 19 May 2022 . The News International.
  86. Web site: Monkeypox . . 8 July 2022 . 21 June 2022 . https://web.archive.org/web/20220621005640/https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/affenpocken.html#573159143 . live .
  87. News: В Україні підтвердився третій випадок віспи мавп . uk . Слово і Діло . 2022-09-30.
  88. Web site: Monkeypox outbreak: epidemiological overview, 15 July 2022 . 2022-07-15 . GOV.UK . en.
  89. Web site: Monkeypox – United Kingdom of Great Britain and Northern Ireland . live . https://web.archive.org/web/20220519004851/https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381 . 19 May 2022 . 19 May 2022 . World Health Organization.
  90. Web site: В соседней Грузии выявлены случаи с подозрением на оспу обезьян . 2022-06-30 . 1news.az . ru.

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