Monkeypox epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Bassel Almarie M.D.[2]


Precise prevalence and incidence are difficult to establish due to paucity of reporting in previous outbreaks. The median age of patients infected with monkeypox in the 1970s and 1980s was 4 and 5 years, respectively. In the 2000s and 2010s, the median age of persons infected with monkeypox increased to 10 and 21 years. In May 2022, the average median age of monkeypox infections was 37 years.

Epidemiology and Demographics

Incidence and Attack Rate

In the Democratic Republic of the Congo, the incidence rate of monkeypox was 0.64 per 100,000 persons in 2001. Between 2005 and 2007, the average annual cumulative incidence of confirmed monkeypox was 0.53 per 100,000 persons[1]. This rate has increased to 2.82 in 100,000 persons in 2013[2][3].

In the Central African Republic, the attack rate of suspected or confirmed monkeypox was 20 per 100,000 persons in a 2015 outbreak[4], and 500 per 100,000 persons in the 2016 outbreak[5].

Case Fatality Rate

The annual case fatality rate of monkeypox disease is approximately 8.7 %[6].

The case fatality rate for the Central African clade is (10.6%) significantly higher than that of the West African clade (3.6%), according to pooled data from 28 peer-reviewed articles and 10 reports[6][7].

  • Cases detected in the 2022 outbreak in the US and Europe have been associated with the West African clade of monkeypox virus[8].


  • United States
    • In 2003, the median age for the 82 patients for whom age data were available was 28 years[9].
    • In May 2022, the mean age for 17 reported cases of monkeypox was 40 years [10].
    • In September 2022, median age for the 21,008 reported cases was 34 years (range: <1 year to 89 years)[11].
  • Africa:
    • In the 1970s and 1980s, the median age of monkeypox infection was 4 and 5 years.
    • In the 2000s and 2010s, the median age of monkeypox infection was 10 and 21 years.
  • Portugal: In May 2022, the median age of monkeypox infection was 33 years[12].
  • Ireland: In May 2022, the median age of monkeypox infection was 37 years [13].
  • United Kingdon: In May 2022, the median age of monkeypox infection was 38 years old[14].


Men are more commonly affected with monkeypox than women. In previous outbreaks, men represented more than 50% of cases[6]. In the 2022 outbreak, men accounted for the majority of the cases[15].


  1. Rimoin AW, Mulembakani PM, Johnston SC, Lloyd Smith JO, Kisalu NK, Kinkela TL; et al. (2010). "Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo". Proc Natl Acad Sci U S A. 107 (37): 16262–7. doi:10.1073/pnas.1005769107. PMC 2941342. PMID 20805472.
  2. Hoff NA, Doshi RH, Colwell B, Kebela-Illunga B, Mukadi P, Mossoko M; et al. (2017). "Evolution of a Disease Surveillance System: An Increase in Reporting of Human Monkeypox Disease in the Democratic Republic of the Congo, 2001-2013". Int J Trop Dis Health. 25 (2). doi:10.9734/IJTDH/2017/35885. PMC 6095679. PMID 30123790.
  3. "The changing epidemiology of human monkeypox—A potential threat? A systematic review | PLOS Neglected Tropical Diseases".
  4. Kalthan E, Dondo-Fongbia JP, Yambele S, Dieu-Creer LR, Zepio R, Pamatika CM (2016). "[Twelve cases of monkeypox virus outbreak in Bangassou District (Central African Republic) in December 2015]". Bull Soc Pathol Exot. 109 (5): 358–363. doi:10.1007/s13149-016-0516-z. PMID 27783372.
  5. Kalthan E, Tenguere J, Ndjapou SG, Koyazengbe TA, Mbomba J, Marada RM; et al. (2018). "Investigation of an outbreak of monkeypox in an area occupied by armed groups, Central African Republic". Med Mal Infect. 48 (4): 263–268. doi:10.1016/j.medmal.2018.02.010. PMID 29573840.
  6. 6.0 6.1 6.2 Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR; et al. (2022). "The changing epidemiology of human monkeypox-A potential threat? A systematic review". PLoS Negl Trop Dis. 16 (2): e0010141. doi:10.1371/journal.pntd.0010141. PMC 8870502 Check |pmc= value (help). PMID 35148313 Check |pmid= value (help).
  7. "".
  8. "Multi-country monkeypox outbreak in non-endemic countries".
  9. "Update: Multistate Outbreak of Monkeypox --- Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003".
  10. "Monkeypox Outbreak — Nine States, May 2022 | MMWR".
  11. "Technical Report 3: Multi-National Monkeypox Outbreak, United States, 2022 | Monkeypox | Poxvirus | CDC". Retrieved 2022-10-20.
  12. "Eurosurveillance | Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022".
  13. "News: Monkeypox in Ireland - latest update - Health Protection Surveillance Centre".
  14. "Monkeypox cases confirmed in England – latest updates - GOV.UK".
  15. Harris E (2022). "What to Know About Monkeypox". JAMA. doi:10.1001/jama.2022.9499. PMID 35622356 Check |pmid= value (help).