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Two new cases of variant mpox, clade 1b, detected in the UK are the first locally transmitted cases in Europe and the first outside Africa, the World Health Organization announced on Tuesday.

The UK Health Security Agency (UKHSA) confirmed late on Monday that the two new cases were household contacts of Britain’s first case identified last week, bringing the total number of confirmed cases in the country to three.

The WHO has warned that European states should be prepared for “rapid action” to contain the latest variant of mpox, which spreads through close physical contact, including sex and sharing enclosed spaces.

The two cases are also the first to be transmitted locally outside of Africa since August 2024, when the WHO declared the outbreak of the new variant an international public health emergency – the highest level of alert.

Those affected are under specialist care and the risk to the UK population “remains low”, UKHSA said.

The original case was detected after the person traveled to several African countries on holiday and returned to the UK on October 21.

The patient developed flu-like symptoms over 24 hours and, on October 24, began developing a rash that worsened over the following days.

Mpox, a viral disease related to smallpox, has two types, clade 1 and clade 2. Symptoms include fever, a rash or pus-filled blisters, swollen lymph nodes, and body aches.

The WHO first declared an international public health emergency in 2022 due to the spread of clade 2. This outbreak mostly affected gay and bisexual men in Europe and the United States.

Vaccination and awareness drives in many countries helped reduce the number of cases worldwide, and the WHO lifted the emergency in May 2023 after reporting 140 deaths out of about 87,400 cases.

In 2024, a two-way epidemic of clade 1 and clade 1b, a new strain affecting children, spread widely in the Democratic Republic of Congo.

The new strain has also been reported in neighboring Burundi, Kenya, Rwanda and Uganda, with imported cases in Sweden, India, Thailand, Germany and the UK.

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