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Unnoticed Entry, Noticed Transmission: Epidemiological Insights into China's First clade Ib MPXV cluster
Xin Ye1, Peng He2,3,4, Baiyun Yu1
1Guangzhou Tianhe District Center for Disease Control and Prevention, Guangzhou 510655, Guangdong province, China.
The Journal of Infectious Diseases
|March 15, 2026
Summary
Clade Ib mpox can spread from asymptomatic travelers despite negative screening. Enhanced surveillance and diagnostics are crucial for controlling mpox transmission.
Area of Science:
- Epidemiology
- Virology
- Public Health
Background:
- The mpox outbreak caused by clade Ib monkeypox virus (MPXV) was declared a Public Health Emergency of International Concern (PHEIC).
- China implemented enhanced surveillance measures in response to the global mpox outbreak.
- An asymptomatic traveler with negative screening tests initiated China's first clade Ib mpox transmission cluster.
Purpose of the Study:
- To investigate the transmission patterns of clade Ib mpox in China.
- To characterize the clinical, epidemiological, environmental, and genomic features of the mpox cluster.
- To inform public health response strategies for mpox.
Main Methods:
- Conducted comprehensive epidemiological, clinical, environmental, and genomic investigations.
- Utilized quantitative PCR, serological testing, and whole-genome sequencing on human and environmental samples.
- Assessed viral contamination and confirmed mpox infection.
Main Results:
- Identified four epidemiologically linked cases, including an imported index case and suspected second-generation transmission.
- Observed limited symptomatic presentation; two cases had rash, one had lymphadenopathy, and no fever was documented.
- Confirmed clade Ib MPXV infection via whole-genome sequencing; MPXV was detected in 25 of 62 residential environmental samples but not in public settings.
Conclusions:
- Clade Ib mpox transmission can occur from asymptomatic individuals despite negative entry screening.
- Symptom-based or entry-point screening alone is insufficient for detecting mpox.
- Enhanced, risk-based surveillance, diagnostic testing, and targeted prevention are necessary for mpox control.
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