The Director-General of the World Health Organisation (WHO)is issuing a revised set of temporary recommendations on mpox. This follows the fourth meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the 2024 upsurge of mpox, held on June 5, 2025.

The WHO Director-General expressed his most sincere gratitude to the Chair, Members, and Advisors of the Committee. The proceedings of the fourth meeting of the Committee will be shared with States Parties to the IHR and published.

 Temporary Recommendations

These temporary recommendations are issued to States Parties experiencing the transmission of the monkeypox virus (MPXV), including, but not limited to, those with sustained community transmission and clusters of cases or sporadic travel-related cases of MPXV clade Ib.

They are intended to be implemented by those States Parties in addition to the current standing recommendations for mpox, valid until 20 August 2025.

In the context of the global efforts to prevent and control the spread of mpox disease, outlined in the WHO Strategic Framework for Enhancing Prevention and Control of mpox: 2024–2027, the aforementioned standing recommendations apply to all States Parties.

All current WHO interim technical guidance can be accessed on the WHO website. Its evidence-based guidance has been and will continue to be updated in line with the evolving situation, new scientific evidence, and the WHO risk assessment to support States Parties in implementing the Strategic Framework for enhancing mpox prevention and control.

According to Article 3 of the IHR (2005), the implementation of these temporary recommendations, as well as the standing recommendations for mpox, by States Parties shall be with full respect for the dignity, human rights, and fundamental freedoms of persons.

Note: The text in brackets next to each temporary recommendation below indicates the status for the set of temporary recommendations issued on 27 November 2024.

Emergency Coordination

Secure political commitment and engagement to intensify mpox prevention and response efforts. This includes resource allocation for the lowest administrative and operational level reporting mpox cases (hotspots) in the prior 4 weeks. (EXTENDED)

Establish or enhance national and local emergency prevention and response coordination arrangements as recommended in the WHO Mpox Global Strategic Preparedness and Response Plan (2025). This will also include its upcoming iteration, in line with the WHO Strategic Framework for Enhancing Prevention and Control of Mpox: 2024–2027. (EXTENDED, with updated reference)

Establish or enhance coordination among all partners and stakeholders engaged in or supporting mpox prevention and response activities through cooperation, including the introduction of accountability mechanisms. (EXTENDED)

Establish a mechanism to monitor the effectiveness of mpox prevention and response measures implemented at lower administrative levels, so that such measures can be adjusted as needed. (EXTENDED)

Engage with and strengthen partner organisations for collaboration and support for the mpox response. This should include humanitarian actors in the context of insecurity, such as humanitarian corridors or areas with internal or refugee population displacements, as well as in hosting communities in insecure areas. (EXTENDED, with re-phrasing)

Collaborative Surveillance

Enhance mpox surveillance by increasing the sensitivity of the approaches adopted and ensuring comprehensive geographic coverage. (EXTENDED)

 Expand access to accurate, affordable and available diagnostics to test for mpox. This should be achieved through strengthening arrangements for the transport of samples, decentralising testing, and establishing arrangements to differentiate MPXV clades and conduct genomic sequencing. (EXTENDED)

Identify, monitor, and support contacts of persons with suspected, clinically diagnosed, or laboratory-confirmed mpox to prevent onward transmission. (EXTENDED)

Scale up efforts to thoroughly investigate cases and outbreaks of mpox to understand the modes of transmission and transmission risk, and prevent its onward transmission to contacts and communities. (EXTENDED)

Report suspected, probable, and confirmed cases of mpox to the WHO in a timely and weekly manner. (EXTENDED)

Safe and Scalable Clinical Care

Provide clinical, nutritional and psychosocial support for patients with mpox, including, where appropriate and possible, isolation in care centres and/or access to materials and guidance for home-based care. (EXTENDED)

Develop and implement a plan to expand access to optimised supportive clinical care for all patients with mpox, including children, pregnant women, and persons living with HIV. This is in recognition of the association of mpox-related morbidity and mortality in persons living with HIV with untreated or advanced HIV. This includes prompt identification and effective management of endemic co-infections, such as malaria, chickenpox or measles. This also includes offering HIV tests to adult patients who do not know their HIV status and to children, as appropriate testing and treatment for other sexually transmitted infections (STIs) among cases linked to sexual contact, and referral to HIV/STIs treatment and care services when indicated. (EXTENDED, with re-phrasing)

Strengthen health and care workers’ capacity, knowledge and skills in clinical and infection prevention and control pathways – screening, diagnosis, isolation, environmental cleaning, discharge of patients, including post-discharge follow-up for suspected and confirmed mpox – and provide health and care workers with personal protective equipment (PPE). (EXTENDED)

Strengthen adherence to infection prevention and control (IPC) measures and availability of water, sanitation, hygiene (WASH) and waste management services and infrastructure in healthcare facilities and treatment and care centres. This is to ensure the delivery of quality healthcare services and the protection of health and care workers, caregivers, and patients. (EXTENDED, with re-phrasing)

International Traffic

Establish or strengthen cross-border collaboration arrangements for the surveillance, management, and support of suspected mpox cases and contacts. This is in addition to providing information to travellers and conveyance operators, without resorting to travel and trade restrictions that unnecessarily impact local, regional, or national economies. (EXTENDED)

 Vaccination

Continue to prepare for and implement targeted use of vaccine for “Phase 1-Stop the outbreak” (as defined in the WHO Mpox Global Strategic Preparedness and Response Plan (2025)). This should be achieved by identifying the lowest administrative level reporting cases (hotspots) and targeting those groups at high risk of mpox exposure to interrupt sustained community transmission. (EXTENDED, with rephrasing and updated reference)

Develop and implement plans for vaccination in the context of an integrated response at the lowest administrative level reporting cases for people at high risk of exposure (e.g., contacts of cases of all ages, health and frontline workers, and other groups at risk such as those with multiple sexual partners and sex workers in endemic and non-endemic areas). 

This entails a targeted, integrated response, including active surveillance and contact tracing, as well as the agile adaptation of immunisation strategies and plans to the local context. This includes dose-sparing options (single dose/fractional dosing) in the context of limited availability of vaccines; proactive community engagement to generate and sustain demand for and trust in vaccination; close monitoring of mpox vaccination activities, coverage and adverse events following immunisation (AEFI); assessment of vaccine effectiveness, and documenting lessons learned and their implementation. (MODIFIED)

Community Protection

Strengthen risk communication and community engagement in affected communities and local workforces to support outbreak prevention, response, and vaccination strategies. This should be particularly at the lowest administrative levels, with reporting of cases. Key actions include training, mapping high-risk and vulnerable populations to inform tailored interventions, implementing data-driven approaches for social listening, community feedback, and dialogue, as well as managing misinformation. This entails, inter alia, communicating effectively the uncertainties and new information regarding the natural history of mpox and modes of transmission, the effectiveness of mpox vaccines and the duration of protection following vaccination, as well as any clinical trials to which the local population may have access, as appropriate. (EXTENDED, with re-phrasing)

Address stigma and discrimination of any kind via meaningful community engagement, particularly in health services and during risk communication activities. This should involve engagement with civil society groups, such as HIV networks, as well. (EXTENDED, with re-phrasing)

Promote and implement IPC measures, as well as basic WASH and waste management services in household settings, congregate settings (e.g., prisons, internally displaced persons and refugee camps), schools, points of entry, and cross-border transit areas. (EXTENDED)

Governance and Financing

Galvanise and scale up national funding, exploring external opportunities for targeted funding of mpox prevention, readiness, and response activities. Advocate for the release of available funds and take steps to identify potential new funding partners for emergency response. (EXTENDED)

Optimise the use of resources in the context of global and local external funding shortfalls. This should be achieved by allocating available resources to the implementation of core mpox response interventions needed in the medium term; maximising their cost-efficiency through cross-programmatic synergetic approaches; and by engaging partners in resource-sharing arrangements to maintain the delivery of essential health services. (NEW)

Integrate mpox prevention and response measures, including enhanced surveillance, in existing programmes for prevention, control and treatment of other endemic diseases – especially HIV, as well as STIs, malaria, tuberculosis and other vaccine-preventable diseases, and/or non-communicable diseases – striving to identify activities which will benefit the programmes involved and lead to better health outcomes overall. (EXTENDED)

Addressing Research Gaps

Invest in addressing outstanding knowledge gaps and generating evidence during and after outbreaks, as defined in “A Coordinated Research Roadmap – Mpox Virus: Immediate Research Next Steps to Contribute to Controlling the Outbreak” (2024), including vaccine effectiveness in different contexts. (EXTENDED, with re-phrasing)

Invest in field studies to better understand animal hosts and zoonotic spillover in the areas where MPXV is circulating, in coordination with the animal health sector and One Health partners. (EXTENDED)

Strengthen and expand the use of genomic sequencing to characterise the epidemiology and chains of transmission of MPXV, thereby better informing control measures, particularly regarding the emergence and circulation of new virus strains. (EXTENDED, with re-phrasing)

Reporting on the Implementation of Temporary Recommendations

 Report quarterly to WHO on the status of, and challenges related to, the implementation of these temporary recommendations, using a revised standardised tool and channels that will be made available by WHO, also allowing for the monitoring of progress and the identification of gaps in the national response. (EXTENDED, with re-phrasing)

 (Source: WHO)