The WHO Counted Sixty-Six Clade Ib Mpox Cases in Portugal in Six Weeks, More Than Germany, France and Britain Together

The World Health Organization published its sixty-ninth situation report on the multi-country mpox outbreak on Monday. Buried in a paragraph about clade Ib, the more recently identified branch of the monkeypox virus, is a line that puts Portugal at the top of a European table: in the last six weeks covered by the report, Portugal notified 66 confirmed clade Ib cases. Germany notified 24, France 20, the United Kingdom 18 and Ireland 12.

Portugal alone therefore accounts for more recent clade Ib cases than those next three countries put together. On the cumulative count since the lineage began spreading, Portugal ranks third in Europe with 162 cases, behind Spain on 241 and France on 173, and ahead of Germany on 140.

The other half of the story is what Portugal has published about this itself, which is nothing. The most recent monthly mpox bulletin on the Direção-Geral da Saúde (Directorate-General for Health) website is dated 31 May 2025. It covers April and May of that year, and its national summary contains the sentence that now reads oddly: "all cases are clade IIb; no clade Ib cases have been reported in Portugal."

What the WHO report actually says

The report classifies a country as having community transmission of clade Ib if at least one case notified in the previous six weeks reported no recent travel and no epidemiological link to a traveller from a country with mpox transmission during the incubation period. The classification applies regardless of how many cases there are.

Nine countries outside Central and East Africa meet that test: Czechia, France, Germany, Ireland, Italy, the Kingdom of the Netherlands, Portugal, Switzerland and the United Kingdom. The WHO adds that transmission in these countries includes sexual networks of men who have sex with men and of sex workers.

The six-week window runs to 26 August 2026, which is the cut-off the report uses for its clade-distribution data. Two countries reported clade Ib for the first time since the previous edition: Chile, which notified the WHO on 31 July of a case in an adult man who had travelled to Italy and Spain, and Hungary, whose first case was a man who had travelled to Estonia and Spain.

The wider numbers are steadier than the Portuguese ones. Globally, between 1 January 2025 and 31 July 2026, 105 countries reported 65,784 confirmed cases and 264 deaths. In July 2026 alone, 32 countries reported 1,370 confirmed cases and seven deaths, a case fatality ratio of 0.5 percent, with about three-quarters of those cases in the WHO African Region. The European Region reported 247 confirmed cases in July, down 22 percent from 315 in June.

The WHO conducted a fresh global rapid risk assessment in August 2026 and left its conclusions where they were. The overall public health risk is moderate. For people with multiple sexual partners the risk is moderate; for children in historically endemic areas it is moderate; for everyone else it is low. The Director-General's standing recommendations under the International Health Regulations have been extended to August 2027, and the WHO continues to treat the outbreak as a graded emergency.

Portugal's own last word on this is fifteen months old

Portugal was the second country in the world to report cases in the 2022 outbreak. The Instituto Nacional de Saúde Doutor Ricardo Jorge (National Institute of Health) confirmed the first five in the laboratory, and the country has been a reference point in the epidemiology of mpox ever since. That makes the gap in national reporting more conspicuous rather than less.

The DGS bulletin of 31 May 2025 is detailed. It counts three distinct outbreaks since May 2022 and 1,236 confirmed cases in total, including two deaths, both in immunocompromised patients during the first wave. The first outbreak ran from 3 May 2022 to 27 March 2023 and produced 956 confirmed cases. The second ran from 1 June 2023 to 31 March 2024 and produced 242. The third began on 1 June 2024 and had produced 38 cases by the end of May 2025, of which 11 arrived in April and May alone.

The bulletin profiles that third outbreak closely. Every case was male, aged between 21 and 56, with a median age of 34. Thirty-four of the 38, or 89 percent, were men who have sex with men. Ten, or 26 percent, had been vaccinated against mpox. Of those for whom HIV status was recorded, 15 had an HIV diagnosis. On exposure in the 21 days before symptoms began, 25 reported sexual contact with multiple partners, 12 reported group or anonymous sex, eight reported travel abroad and three reported sauna attendance. The document also flags EuroPride 2025 in Lisbon as a mass gathering that could raise the risk of person-to-person transmission.

Then it stops. There is no bulletin for June 2025, none for any month since, and none for 2026. Lusa asked the DGS to respond to Monday's WHO figures and had received no answer by the time its report went out.

Why the clade matters

The distinction between clade IIb and clade Ib is the thing the DGS bulletin was tracking and the WHO report is now counting. Clade IIb is the lineage behind the global outbreak that began in May 2022. Clade Ib is the lineage that emerged in the Democratic Republic of the Congo and its neighbours and prompted the WHO's August 2024 declaration of a public health emergency of international concern. Until at least the end of May 2025, on the DGS's own account, Portugal had recorded none of it.

Something changed between then and the six weeks to 26 August 2026, and the only public description of that change is a table in a Geneva situation report. Sixty-six cases in six weeks is not a large number in absolute terms. It is a large number relative to every other country in Western Europe, and it is a very large number relative to a country whose last national update said the lineage was not here.

The symptoms are the ones the DGS has described throughout: fever, severe headache, muscle and back pain, fatigue, swollen lymph nodes, and a rash that progressively affects the skin and mucous membranes. Transmission is through close physical contact, particularly with lesions or bodily fluids, and through contaminated material such as bedding, towels and personal items.

What this means for residents

• Nothing about your daily risk has changed. The WHO's assessment for people who are not in a higher-exposure group remains low, and it reviewed that assessment as recently as last month. This is not a public-transport or a workplace disease.
• If you are in a higher-exposure group, vaccination is the lever. The DGS vaccination rule is Norma n.º 006/2022 of 12 July 2022, updated on 21 November 2024. It sets out who qualifies for pre-exposure and post-exposure vaccination in Portugal. Vaccination is not a guarantee: a quarter of the cases in the third Portuguese outbreak had been vaccinated.
• Route a suspected case through SNS 24 first, not through an emergency room. Mpox needs isolation and contact tracing, and the 808 24 24 24 line exists to direct that. Turning up unannounced at a crowded urgência is the worst version of the same decision.
• Do not read the reporting silence as an all-clear. The absence of a national bulletin is a reporting gap, not an epidemiological finding. The cases in the WHO table were notified by Portugal, which means Portuguese surveillance detected them; what has not happened is publication.
• Expect travel questions rather than travel restrictions. Nothing in the report recommends border measures. The two new clade Ib countries this month both traced their first case to travel within Europe, which is the pattern that makes national surveillance data useful to ordinary travellers, and the reason its absence is worth noticing.

The WHO's next situation report will carry a new six-week window. Whether the Portuguese line in it goes up or down, the more useful document would be the one the DGS used to publish every month, which would say how many of the 162 cases are recent, where they are, how many people have been vaccinated, and whether the third outbreak the bulletin was tracking in May 2025 ever ended. A global situation report is not a substitute for a national one, and at the moment it is the only one there is.