First case of mpox due to monkeypox virus clade Ia infection detected outside Africa

  1. Cian Dowling-Cullen
  2. Laura Fahey
  3. Michael Carr
  4. Brian Keogan
  5. Josephine Hebert
  6. Siti Mardhiah Muhamad Fauz
  7. Jane Stapleton
  8. Allison Deane
  9. Elizabeth O'Donoghue
  10. Colette Reilly
  11. Christine Kelly
  12. Eavan G Muldoon
  13. Margaret O'Sullivan
  14. Anne Sheahan
  15. Suzanne Cotter
  16. Mary O'Meara
  17. Eoghan de Barra
  18. Éamonn O'Moore
  19. Keith Ian Quintyne
  20. Cillian de Gascun
  21. Áine O'Toole
  22. Daniel Hare
  23. Derval Igoe
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Abstract

In February 2025, the first confirmed case of monkeypox virus (MPXV) clade Ia infection outside Africa was identified in a traveller returning to Ireland from the Democratic Republic of the Congo (DRC). We report the clinical, laboratory, and epidemiologic features of this case, including the stable disease course and absence of secondary transmission. We also present phylogenetic analysis and APOBEC3-associated mutation profiling that placed the virus obtained from this patient in an evolving cluster of MPXV clade Ia infections in Kinshasa, DRC, likely driven by sustained human-to-human transmission. This case highlights the evolving epidemiology of MPXV clade Ia and its potential for further international spread, reinforcing the need for vigilance and coordinated global surveillance.

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