MPOX - USA (03): (CALIFORNIA) SAN FRANCISCO, CLADE I

T2Wire / Structuredvia promedRetrieved Apr 19, 2026View original source ↗

Grounds assessments

activeAt least one additional EU/G7 country beyond Spain will report a documented Clade Ib mpox sustained transmission cluster (≥5 epidemiologically linked cases over ≥3 weeks) by September 30 2026, driven by the WHO DON587-confirmed multi-mode global Clade Ib spread and cross-border network linkage with Spain's ongoing outbreak.50%activeCalifornia CDPH will issue a formal mpox Clade I cluster alert or public health emergency with ≥10 confirmed cases by 2026-07-19, based on CDPH messaging shift to statewide surge framing within 72h of the Apr 16 SF index case.60%activeAt least one confirmed Clade Ib case in the United States linked to the Mexico-US border corridor (distinct from the San Francisco Clade I case) within 90 days, based on Mexico's confirmed Clade Ib Jan 2026, high-volume cross-border movement, and CDC diagnostic pause creating federal detection gaps.40%activeAt least one MPXV Clade I or Clade Ib case in the California cluster (or a direct epidemiological contact) will demonstrate tecovirimat treatment failure — defined as progressive or non-resolving lesions after ≥14 days of standard-dose therapy — documented by CDC, CDPH, or peer-reviewed source by 2026-07-19. F13L mutation conferring phenotypic resistance is already documented in Clade IIb (Contag et al., EID Dec 2023, PMC10683816); if the SF/California Clade I exposure is reaching immunocompromised hosts (HIV/AIDS, oncology patients) — the highest-risk population for resistance selection — ...30%activeA locally-acquired Clade I mpox transmission chain (≥2 epidemiologically linked cases without African travel history) will be confirmed in North America within 90 days of the San Francisco Clade I detection (Apr 19 2026).40%activePakistan (Khairpur/Sindh) mpox cases will be genomically confirmed as Clade Ib by WHO DON or Pakistan MoH by June 2026, representing the third non-African Clade Ib community transmission geography after Spain (Dec 2025) and Singapore (Apr 2026), based on infant mortality in Khairpur district (7 infants dead/positive, Apr 2026) and demographic severity patterns consistent with Clade Ib rather than Clade IIb.40%activeAt least one confirmed mpox Clade Ib case with travel linkage to Singapore will be detected in Japan, South Korea, or Australia by October 2026, given Singapore's confirmed local Clade Ib transmission (2 cases, CDA Apr 4 2026) and Singapore's role as the primary aviation hub for East Asia–Pacific travel.50%resolvedAt least one confirmed mpox Clade IIb case linked to Singapore will be detected in Japan, South Korea, or Australia by October 2026, given Singapore's confirmation of local Clade IIb transmission (Apr 14 2026) and its role as the primary aviation hub for East Asia–Pacific travel.50%resolvedMpox clade Ib will be confirmed in at least 2 East African countries outside the DRC by April 2026.90%activeCalifornia will confirm at least 2 additional Clade I mpox cases (beyond the San Francisco Apr 16 index) within 60 days of Apr 20 2026, with at least one in Los Angeles County or adjacent counties — indicating multi-focus Clade I circulation rather than isolated importation.60%activeAt least one confirmed mpox Clade Ib case imported to the US will be significantly delayed in diagnosis (>7 days from symptom onset to laboratory confirmation) or go initially undetected due to CDC diagnostic capacity gaps, by October 2026, given that CDC paused mpox and rabies diagnostic testing capability (Apr 1–2 2026) during an active global PHEIC with confirmed Clade Ib community transmission outside Africa.50%activeAt least one confirmed mpox case (clade unspecified) will be detected in India within 90 days of the Pakistan Khairpur Sindh infant deaths cluster (by July 14 2026), given Pakistan-India cross-border movement in the Punjab/Rajasthan/Gujarat corridor and the unprecedented pediatric severity profile suggesting Clade Ib circulation in an adjacent geography.40%resolvedMpox Clade Ib will establish at least one additional documented sustained community transmission chain outside the African continent by July 2026.70%activeA novel recombinant mpox lineage arising from tri-clade co-circulation (Clade Ia, Ib, and Clade IIb) in the Republic of the Congo will be genomically documented by April 2027, based on the first reported co-circulation of all three major mpox clades in a single geography.30%activeMpox Clade IIb C.1 will establish sustained community transmission in at least one additional Southeast Asian country beyond Cambodia by October 2026, based on the documented Phnom Penh outbreak and regional mobility patterns.50%

Evidence content

The California Department of Public Health (CDPH) is urging individuals at high risk for mpox to get vaccinated due to an increase in cases across the state. The CDPH is monitoring the situation and emphasizes that vaccination is the best way to protect against both Clade I and Clade II mpox. The department recommends that people at higher risk get both doses of the vaccine. Diseases: Mpox. Places: San Francisco, California, United States, United States. Species: Humans.

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