need to understand and contain the global outbreak by raising awareness about monkeypox (e.g., to support health care seeking, and early case detection) and undertaking comprehensive case and contact tracing and management. Methods · A rapid, focused scan of relevant background information and recently updated monkeypox publications from selected public health organizations available as of May 27, 2022 (e.g., the United States Centers for Disease Control and Prevention [CDC]; the United Kingdom Health Security Agency [UK HAS]; World Health Organization [WHO]; the European Centre for Disease Prevention and Control [ECDC]) informed the content outlined below, with review from PHO medical and scientific staff. Epidemiology · Sporadic monkeypox cases and outbreaks outside of endemic areas have been reported. Travel-related cases have been reported in the US in 2021, Singapore in 2019, Israel in 2018 and Benin in 1978.3 For outbreaks in non-endemic areas, the source could be traced to travel to endemic areas, contact with infected animal or person, or contact with objects contaminated by an infected person. · In 2003, 47 confirmed and probable cases were reported from six states in the US, attributed to having had contact with pet prairie dogs which in turn acquired the infection after being housed near imported mammals from Ghana, including two African giant pouched rats, nine dormice, and three rope squirrels that later tested positive for monkeypox virus by the Centers for Disease Prevention and Control.10 A case control study by Reynolds et al. after the outbreak found that cases were more likely than controls to have had daily exposure to a sick animal (odds ratio [OR] = 4.0; 95% CI: 1.2– 13.4), cleaned cages and bedding of a sick animal (OR = 5.3; 95% CI: 1.4–20.7), or touched a sick animal (OR = 4.0; 95% CI: 1.2–13.4).11 None of the cases in the outbreak were attributed exclusively to person-to-person contact.10 · In September 2018, 3 cases were identified in the UK, including two who had a recent travel history to Nigeria but otherwise epidemiologically unconnected, and a health care worker involved in the care of one of the two cases and likely acquired the infection from contact with contaminated bed linen.3,12 · In May 2021 and June 2021, 3 cases were reported in a family in the United Kingdom (UK), with the index case reporting recent travel history to Nigeria.13,14 Multi-Jurisdictional Monkeypox Outbreak 2022 – What We Know So Far 4 · On May 15, 2022, WHO was notified of four confirmed monkeypox from the UK.15 By May 27, 2022, 500 cases (403 confirmed and 97 suspect) have been reported from 28 countries across four WHO regions: European, the Americas (including Canada), Western Pacific and Eastern Mediterranean. · Among the 84 confirmed cases from different regions of the world with hospitalization data, 38 (45.2%) were hospitalized.9 · No deaths associated with these monkeypox infections have been reported to date.1 · All cases confirmed by polymerase chain reaction (PCR) have been identified as being infected with the West African clade.1 · The extent and chains of transmission has yet to be determined as surveillance systems are being put in place. Given the number of countries across multiple WHO regions reporting cases of monkeypox, it is highly likely that cases will be detected in other countries.1 · Reported cases thus far have no established travel links to endemic areas. Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men seeking care in primary care and sexual health clinics.1 While transmission through sexual contact has not been documented previously,16 the ECDC noted that transmission between sexual partners, due to unprotected intimate contact with an infectious person during sex with infectious skin lesions, seems the likely mode of transmission.17 · Genome sequence from a skin lesion swab from a confirmed case in Portugal indicated a close match with exported cases from Nigeria to the United Kingdom, Israel and Singapore in 2018 and 2019.18 · Preliminary phylogenetic analysis of specimens collected in May 2022 from some European countries showed close relation to each other, providing further evidence of substantial community spread in Europe: · A specimen from an individual in Belgium showed close relation to the recently uploaded genome from the outbreak in Portugal.19 · A specimen from an individual in Spain showed close relation to sequences reported by Portugal and Germany.20 · a specimen from an individual in Italy (who arrived from Portugal a week prior to specimen collection) showed close relation to the sequences from Portugal.21 · Phylogenetic inference of the sequence from a skin lesion of a German case also reveals close relation to a 2022 isolate from Portugal.22 Subsequent analysis of genome sequences from nine additional cases with specimens collected between May 15 and 17, 2022 showed close relation to the 2022 sequences from the UK, Portugal and the US. In addition, these sequences suggest that the 2022 worldwide outbreak most likely has a single origin that is associated with the exportation of monkeypox virus from Nigeria to non-endemic countries (the UK, Israel