Health officials in Spain have confirmed the first documented case of human-to-human transmission of mpox clade 1b outside Africa, raising concerns about wider global spread.
The case, published in the International Journal of Infectious Diseases, involves a 49-year-old man in Madrid with no travel history to endemic regions. Despite having received two doses of the Imvanex smallpox/mpox vaccine, the patient tested positive for the highly transmissible mpox clade 1b strain.
Mpox is a viral disease that spreads through close skin-to-skin contact, causing symptoms such as fever, swollen lymph nodes, and skin lesions.
The patient sought medical care on October 10 after developing a single genital ulcer and painful groin lymph nodes. He reported sexual contact with two local partners, neither of whom had travelled to Africa. After ruling out other sexually transmitted infections, doctors confirmed mpox clade 1b using a PCR test.
“This is the first reported case of mpox clade 1b without any epidemiological link to travel in Africa,” said lead author Jorge-Alfredo Pérez-García of Hospital Clínico San Carlos in Madrid.
Previously, all cases detected outside Africa were linked to recent travel to endemic countries or direct contact with infected travelers. Spain has recorded only one other clade 1b case, involving a traveler returning from Tanzania, with no link to the Madrid patient.
Mpox clade 1b emerged during a 2023 outbreak in the Democratic Republic of the Congo and has since shown sustained human-to-human transmission in several African countries.
Health authorities are urging enhanced surveillance and preventive measures, particularly for vulnerable groups identified in previous outbreaks, including people living with HIV, men who have sex with men, and individuals with multiple sexual partners.
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According to the World Health Organization, 2,501 new mpox cases and 12 deaths were reported across 44 countries in October, highlighting ongoing global transmission.
