Historically endemic to parts of South America, Oropouche virus (OROV) has caused an estimated 500,000 infections since its discovery, with a marked geographic expansion beyond the Amazon basin into other regions of South America and the Caribbean since late 2023. This Review synthesises current evidence on OROV epidemiology, transmission dynamics, clinical manifestations, diagnostics, viral diversity, and public health impact, with the primary objective of identifying critical knowledge gaps and outlining priorities for surveillance, research, and control. Human transmission occurs primarily via Culicoides paraensis midges, while the competence of other vectors, the role of animal reservoirs in sustaining sylvatic transmission, and the contribution of vertical and sexual transmission remain incompletely understood. Although most infections are self-limiting, reports of neurological disease, Guillain-Barré syndrome, adverse pregnancy outcomes, and rare fatalities highlight uncertainties regarding pathogenicity, risk factors for severe disease, and long-term sequelae. The known teratogenicity of related Simbu serogroup orthobunyaviruses in animals further raises concerns about foetal risk in humans. Environmental change, expanding vector ranges, and viral evolution are likely contributing to outbreak emergence and geographic spread. Based on the available evidence, this review highlights priority gaps in epidemiological surveillance, diagnostics and genomic monitoring, vector competence and ecology, transmission pathways, and countermeasure development. Addressing these gaps through coordinated surveillance, improved laboratory capacity, targeted vector control, and focused research will be essential to mitigate the public health impact of OROV and reduce the risk of further spread.

In October-November 2025, eight autochthonous cases of monkeypox (MPXV) clade Ib virus infection were reported in the Netherlands. All cases were men who have sex with men aged 25-65; none required hospital admission or antiviral treatment. Phylogenetic analysis combined with contact tracing suggest multiple introductions or cryptic circulation with onwards transmission within the community. Highly related international sequences were identified dating back to August 2025, indicating sustained global community transmission of clade Ib outside the African continent.

Several studies have documented reverse zoonotic transmission of SARS-CoV-2, including in farmed mink which are susceptible to human respiratory viruses and are known for serving as a reservoir capable of generating new virus variants in densely populated farms. Here, we present the genomic investigation launched in response to detection of human infections with mink-origin SARS-CoV-2 lineages, and show evidence of at least 14 high-confidence introductions of SARS-CoV-2 from humans into farmed mink in Lithuania where sustained transmission in farmed mink lasted up to a year. We estimated the most likely timeframes for these introductions encompassing at least six SARS-CoV-2 lineages, some of which were already extinct in humans, with Bayesian phylogenetic and molecular clock analyses. This study highlights the public health risks posed by fur farms and underscores that passive genomic surveillance systems are ineffective without the active involvement and expertise of responsible institutions.

Genomic surveillance has become an indispensable tool for the identification of pathogens and tracking of transmission chains. Building upon the global sequencing and surveillance infrastructure developed and expanded during the COVID-19 pandemic, these capacities are now being adapted to track other pathogens in low- and middle-income countries which remain disproportionately affected by infectious diseases. This is evident in the recent and unprecedented spread of mpox virus in regions experiencing multiple concurrent infectious disease outbreaks, highlighting the need for broad, adaptable diagnostic detection and sequencing capacity. In this Perspective, we describe the applications, insights, and challenges encountered during ongoing capacity building efforts for the characterization of the mpox outbreak and other emerging pathogens in the African Great Lakes Region.

The outbreak of hantavirus disease caused by Andes virus aboard a cruise ship is a reminder of the challenges posed by emerging diseases in the modern era. While Andes virus-associated disease can be particularly severe, it is unlikely to spread extensively beyond the current number of cases or emerge as a large epidemic, especially if public health measures are followed. Nonetheless, the outbreak exemplifies the complexity of international outbreak response with differences in national preparedness frameworks and the rapid spread of mis-/disinformation. We discuss this outbreak in the context of global epidemic and pandemic preparedness and emphasize the importance of sustained, inclusive global collaborative One Health approaches to preparedness and response. We stress the urgent need for global coordination, discuss specific challenges, and provide recommendations for further strengthening of global preparedness.

Despite remarkable progress towards measles elimination in Burundi, the country has seen a resurge in cases since 2019. Epidemiological investigations have been performed; however, it remained unclear if all measles cases involved in recent outbreaks were linked or caused by multiple independent events including introductions from other countries. Therefore, the objective of this study is to investigate the genetic diversity and evolution of measles virus (MeV) during the last large MeV outbreak in Burundi in 2024. The study was carried out on oropharyngeal swab samples collected from four neighboring health districts. Amplicon-based MeV sequencing was performed on the MinION Mk1D. Consensus sequences were generated from 18 isolates and phylogenetic and Bayesian evolution analysis including 152 closely related public genomes were performed. Results showed that all 18 newly generated whole-genome sequences belonged to the genotype B3. Phylogenetic analysis revealed a diverse population of MeV circulating in Burundi, with sequences divided into two separate clusters. The first cluster consisted of two sequences and was most closely related to Italian sequences, while the second cluster was more related to local transmission in the Great-Lakes region based on the N450 region. Based on whole-genome sequences, the remaining 16 whole-genome sequences from Burundi clustered with one sequence from the Netherlands. The most recent common ancestor of the sequences in the second cluster was estimated to be around the beginning of 2023 (between the end of 2022 and the end of 2023 using the 95% confidence intervals) by using Bayesian evolutionary analysis. Here, we provide the first batch of MeV whole-genome sequences generated on the African continent of the ongoing MeV outbreak in the Great Lakes region of Africa. Using these whole genome sequences, we demonstrated that measles viruses genotype B3 were already circulating in Burundi since the beginning of 2023 well before the outbreak in 2024 was noted. We also showed that the recurrent measles outbreaks in Burundi are ignited from different sources, showing that measles in Burundi is sustained by multiple introductions and emphasizing the importance of ongoing molecular surveillance for elimination efforts.

Rabies is a zoonotic disease known to humankind for millennia. Despite being preventable, rabies is still neglected and causes human fatalities, predominantly in resource-limited areas in Africa and Asia. In South Africa, rabies is maintained in both domestic and wildlife reservoir hosts, with frequent cross-species transmission. This study utilized retrospective epidemiological data from the Eastern Cape (EC) province of South Africa from November 2020 until December 2024, which included a prominent dog rabies outbreak. The majority of the rabies cases were reported in the Nelson Mandela Bay Municipality (NMBM). Subsequently, the study aimed to establish the origin of the outbreak and track its spread within the NMBM and the EC province, using descriptive summaries on epidemiological data gathered from 2596 cases, as well as partial glycoprotein gene sequence analyses generated from a panel of rabies viruses (RABVs), originating from rabies-infected dog brain tissues (n = 102), human samples (n = 4), domestic cats (n = 3), and livestock (n = 5). Throughout the outbreak in the EC, dogs (n = 705) were the most commonly infected host species, highlighting the central role this domestic carnivore plays in rabies epizootiology in this country. The RABVs analyzed from this outbreak shared significant sequence homology of 99% mean sequence identity, suggesting a common progenitor and supporting the historical introduction of rabies into South Africa. Based on the sequence data, the RABVs from this outbreak were delineated into three distinct clusters, with the majority of the samples grouping within the recently described DD-I and DD-II clusters and a single sample cluster with wildlife samples in cluster BEF-II. Cumulatively, our data suggest at least three independent introductions of the RABV infection into the dog populations of the NMBM between 2021 and 2024, with DD-II subgroup C being the most dominant. The introduction of rabies into the study area may suggest a more complicated explanation linked to lapsed dog vaccinations during the outbreak period.

Abstract In September 2023, the first infections with a novel lineage of mpox were detected in South Kivu. Since then, the virus has spread regionally, nationally and internationally. As part of continued efforts to understand the mpox ecology and epidemiology, the South Kivu district of public health and partners have set up systematic case finding and follow-up, including strain characterisation through PCR and sequencing. Samples were collected from 595 hospitalized patients with a confirmed mpox virus infection. A clade differentiating RT-PCR showed that 545 (92%) of samples were positive for clade Ib but also - remarkably- that Clade Ia infections were diagnosed for the first time in South Kivu. First detected in cases in week 7 in Kamituga, 50 cases were identified over the whole study period (8,40% of all cases). Phylogenetic analysis of initial cases revealed introductions of clade Ia into the South Kivu province alongside the continuation of the clade Ib mpox virus outbreak. These findings underscore the increasing complexity of clade I mpox virus outbreaks in the DRC.

Birds are primary reservoirs and amplifying hosts for flaviviruses like West Nile virus (WNV) and Usutu virus (USUV). Wild mammals are also susceptible, although their role remains poorly characterised due to limited studies investigating wild mammal infections. In the Netherlands, WNV and USUV circulate among birds and mosquitoes, with evidence for infections in domestic avian species, horses (WNV) and humans. Wild carnivores may also be exposed through mosquito bites or by ingestion of infected prey. To better understand the ecology and epidemiology of both viruses in wild mammals, we investigated the extent of WNV and USUV exposure in free-ranging wild carnivores in the Netherlands. Samples from wild carnivores, collected across the Netherlands from 2020 to 2023, were tested for viral RNA using RT-PCR, and for antibodies using a protein microarray (PMA) alongside focus reduction neutralisation test (FRNT90). USUV-RNA was detected in nine (1.1%) of 818 carnivores. Positives included a weasel (Mustela nivalis), a Eurasian badger (Meles meles), a red fox (Vulpes vulpes), and six stone martens (Martes foina), sampled between 2020 and 2022. Partial USUV-sequences were obtained from the weasel, Eurasian badger, and red fox. These sequences cluster with sequences from Dutch wild birds and mosquitoes. WNV- and/or USUV-antibodies were detected in 1.5% (6/413) and 1.9% (8/413) of the carnivores, respectively. WNV- and USUV- antibodies were found in red foxes and stone martens. The detections of antibodies to both viruses and USUV RNA in several species suggest that wild carnivores in the Netherlands are indeed exposed and may serve as sentinel hosts.

Rwanda has experienced recurrent Rift Valley fever virus outbreaks in the last decade. In this study, we investigated whether these outbreaks resulted from repeated introductions or sustained local circulation. We generated RVFV whole-genome sequences from livestock samples collected between 2022 and 2025 using Nanopore sequencing. Genomic analyses indicated the outbreaks resulted from sustained local circulation of lineage C rather than repeated introductions, suggesting ongoing transmission likely driven by sporadic spillover. This study underscores the importance of continuous genomic One Health surveillance in endemic settings.

BACKGROUND:Rabies causes over 59,000 human deaths each year, primarily in endemic regions where surveillance is challenging. We report a prospective observational cohort study evaluating rabies virus (RABV) RNA detection from wound swabs of individuals bitten by dogs as a tool to strengthen surveillance and assess human exposure. METHODS:We enrolled 100 individuals with unwashed, less than 24 hours-old, WHO-defined category III bite wounds at the Rabies Prevention Center, Indus Hospital, Karachi, Pakistan. Swabs were collected from wounds before and after washing. Serum samples were obtained before and 14 days after initiation of the three-visit intradermal IPC post-exposure prophylaxis (PEP) regimen. Demographic and clinical data were recorded. RABV RNA was detected using genotype-1 and pan-lyssavirus PCR assays; detection of RABV neutralising antibodies was evaluated by rabies fluorescent antibody virus neutralisation test (rFAVN). Primary outcome was RABV RNA detection; secondary outcomes included bite characteristics and virus-neutralising antibody (VNA) titres. FINDINGS:Among 100 participants (mean age 18.9 years; 82% male), bites occurred mainly on the lower limb (34%), head (21%) and arm (15%). RABV RNA was detected in 64% of swabs by genotype-1 and 44% by pan-lyssavirus PCR; from 40/64 positive samples the RABV-N gene was sequenced and used for downstream phylogenetic analysis. Wound washing slightly decreased RNA levels. At day 14, RABV neutralising antibodies were detected in 93.8% (75/80) of the individuals (mean titre 5.8 IU/mL). INTERPRETATION:Wound swab-based RABV RNA detection is a feasible, scalable method for rabies surveillance and exposure assessment in endemic settings. Combined with serology, it informs both viral exposure and PEP efficacy, supporting broader application in high-volume clinical care. FUNDING:Supported by a VENI Grant (NWO-VENI 09150162010181, to CWEE) and Off Road grant (ZonMw 04510252520092, to CWEE).

Usutu virus (USUV) is a zoonotic arbovirus causing systemic and neuroinvasive diseases in birds and flu-like or sporadic neuroinvasive disease in humans. USUV-associated encephalitis is morphologically well-characterized in birds, while the mechanisms of cell-damage in spontaneously infected birds remain poorly understood. For the closely related West Nile virus, apoptosis significantly contributes to the pathogenesis of othoflavivirus-induced neuropathology. This study investigates the involvement of apoptosis in USUV-associated encephalitis in Eurasian blackbirds (Turdus merula). To determine the apoptosis involvement, immunohistochemistry for cleaved-caspase-3 (CC3), TUNEL-assay, and RT-qPCR to compare mRNA expression levels of caspase 8 (extrinsic pathway) and caspase 9 (intrinsic pathway) were performed on brains of USUV-infected (n = 26) and USUV-uninfected (n = 16) blackbirds, as well as Africa 3 and Europe 3 USUV-lineages. The results showed a higher CC3 expression in USUV-infected (m = 231,96 ± 117,033) compared to uninfected blackbirds (m = 22,00 ± 13,31) (p < 0.001). Similarly, higher TUNEL-positive cell counts were detected in USUV-infected (m = 197,00 ± 83,56) compared to uninfected blackbirds (m = 19,00 ± 16,08) (p < 0.01). No significant differences were detected comparing Africa 3 and Europe 3 lineages. Additionally, both caspases were upregulated in USUV-infected blackbirds. Caspase 8 was in average 4,37 ± 0,89 (CI α = 0,05) times higher in USUV-infected blackbirds (p < 0.0001), while caspase 9 expression was in average 1,82 ± 0,89 (CI α = 0,05) times higher in USUV-infected blackbirds (p < 0.01). Although both apoptotic pathways are involved, the extrinsic pathway is notably more active in USUV-infected blackbirds, highlighting its role in USUV-associated brain damage.

Enterovirus D68 (EV-D68) is an emerging respiratory virus associated with extra-respiratory complications, especially acute flaccid myelitis. However, the pathogenesis of acute flaccid myelitis is not fully understood. It is hypothesised that through infection of skeletal muscles, the virus further infects motor neurons via the neuromuscular junction. We hypothesise that EV-D68 infection of human skeletal muscles can impair muscle function directly, thereby contributing to the development of EV-D68-associated muscle weakness. Here, we inoculated human induced pluripotent stem cell-derived skeletal muscle myotubes grown in 2D and 3D with different EV-D68 isolates, which resulted in a productive infection and cell death. We showed through neuraminidase treatment that sialic acids facilitate infection of these cells. EV-D68 infection of the 3D model led to tissue damage, reduction of contractile force, and hampered muscle regeneration. Altogether, we showed that human skeletal muscle can act as an extra-respiratory replication site and infection of skeletal muscles may contribute to EV-D68-associated muscle weakness.

Usutu virus (USUV) is a zoonotic neurotropic arbovirus related to the West Nile virus that causes mortality in birds and sporadic neurologic human disease. Current research on natural USUV-associated disease lacks data on ocular involvement. This study investigated ocular and periocular tissue involvement in natural USUV infections and associated disease in Eurasian blackbirds (Turdus merula). Twenty-two found-dead Eurasian blackbirds were examined. USUV reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) detected 12/22 infected blackbirds. Histology and immunohistochemistry for virus antigen, inflammation (anti-CD3 for T-lymphocytes), and apoptosis (anti-cleaved caspase-3 (CC3)) assessed the virus tropism and associated damage. In the eye of USUV-infected blackbirds, choroiditis was the main finding (9/12), while the pecten oculi (4/12) and optic nerves (4/12) were occasionally affected. Virus antigen was detected in the lesions. The cornea and retina lacked virus antigens and lesions. Periocular soft tissues (12/12) and eyelids (9/12) were also affected. Lesions in the choroid (P < .001), ciliary bodies (P < .01), and sclera (P < .05) were significantly associated with USUV infection. In the choroid, CD3 and CC3 strongly correlated with the virus antigen scores (P < .0001), suggesting a T-cell response and apoptosis involvement in the ocular damage. A negative correlation was identified for the virus antigen score in choroid and eyelids with USUV RT-qPCR Ct values (P < .05). This study reports for USUV features consistent with ocular and periocular tropism and disease with a major involvement of the choroid, suggesting a primary ocular vascular spread.

Norovirus is a leading cause of gastroenteritis globally. Understanding the emergence, evolution, and trends in norovirus genotype/strain diversity is essential to develop sustainable strategies to guide the development of interventions. Here, we used urban wastewater samples to assess and compare the diversity of noroviruses worldwide. By using a metagenomics approach, we analyzed 327 sewage samples, collected from 62 cities across 6 continents, collected over the course of two years between 2017 and 2019. Norovirus sequences were found in >80 % of the samples, yielding 7609 contigs. We identified a total of 34 capsid genotypes and 44 polymerase P-types, predominantly belonging to genogroups known to infect humans, including: GI, GII, GIV, GVIII and GIX. Changes in diversity over time were detected, along with seasonal variations in wastewater. Some rarely reported genotypes/P-types were found to be widespread, showing the potential of wastewater surveillance to complement traditional surveillance. Phylogenetic analyses revealed that in several instances, wastewater sequences were closely related to sequences reported in outbreaks of the same region. However, novel clusters were also found in locations where fewer or no sequences from outbreaks are available (e.g., African regions). The use of metagenomic sequencing for wastewater-based epidemiology has the potential to uncover the diversity of norovirus circulating in the population, being especially helpful for those regions where classical surveillance programs are not well established.

Mpox is an emerging zoonotic disease that caused two public health emergencies of international concern within two years. Less is known about the interplay of microbial organisms in mpox lesions which could result in superinfections that exacerbate outcomes or delay recovery. We utilized a unified metagenomic sequencing approach involving slow-speed centrifugation and differential lysis on 19 mpox lesion swabs of hospitalized patients in South Kivu province (eastern DRC) to characterize bacteria, antimicrobial resistance genes, mpox virus (MPXV), and viral co-infections. High-quality MPXV whole-genome sequences were obtained until a Ct value of 27. Furthermore, co-infections with other clinically relevant viruses, such as varicella zoster virus and herpes simplex virus-2, were detected and confirmed by real-time PCR. In addition, metagenomic sequence analysis of the bacterial content showed the presence of bacteria associated with skin and soft tissue infection in 10 of the 19 samples analyzed. These bacteria had a high abundance of resistance genes, with possible implications for antimicrobial treatment based on the predicted antimicrobial resistance. In conclusion, we report the presence of bacterial and viral pathogens in mpox lesions and detection of widespread resistance genes to the standard antibiotic treatment. The possibility of a co-infection, including antimicrobial resistance, should be considered when discussing treatment options, along with the determination of the case-fatality ratio.IMPORTANCEThe mpox virus clade Ib lineage emerged in the eastern Democratic Republic of the Congo owing to continuous human-to-human transmission in a vulnerable patient population. A major challenge of this ongoing outbreak is its occurrence in regions with severely limited healthcare infrastructure. As a result, less is known about co-infections in affected patients. Identifying and characterizing pathogens, including their antimicrobial resistance, is crucial for reducing infection-related complications and improving antimicrobial stewardship. In this study, we applied a unified metagenomics approach to detect and characterize bacterial and viral co-infections in mpox lesions of hospitalized mpox patients in the eastern DRC.

Understanding secondary attack rates is a key knowledge gap in the ongoing clade Ib mpox virus (MPXV) outbreak in the Democratic Republic of the Congo. Here, we report the first cross-sectional serological study to investigate local MPXV clade Ib transmission in South Kivu, DRC. Seropositivity was defined as a detectable titer in a cell lysate-based screening ELISA and confirmation by virus neutralization test. Sera were collected in November and December 2023 (n = 120), and in May 2024 (n = 48) from professional sex workers (PSW) and visitors of 25 bars with reports of mpox cases. We detected serological evidence for MPXV infection in 18% and 17% of these sera, respectively, indicating that PSW played an important role in MPXV clade Ib transmission in this region. Additionally, sera from 108 direct contacts of mpox cases from 34 households were collected between September 2023 and May 2024. Serological evidence for MPXV infection was found in at least one serum sample in 50% of households, including in nine households with seropositive minors, providing evidence for close-contact household transmission. Serological studies are needed to comprehend the extent and severity of the ongoing MPXV outbreak, and may be used to guide targeted vaccination strategies, particularly for high-risk groups.

Vibrio cholerae is responsible for outbreaks in Africa, but the cause of the outbreaks remains poorly understood. Here, we report the draft genomes of four Vibrio cholerae strains isolated from individuals affected by an outbreak in Kamituga, South Kivu, the Democratic Republic of the Congo, between January and May 2024.

Understanding secondary attack rates is a key knowledge gap in the ongoing clade Ib mpox virus (MPXV) outbreak in the Democratic Republic of the Congo. Here, we report the first serological study to investigate the extent of local MPXV clade Ib transmission, performed in South Kivu, DRC. Sera were collected in November and December 2023 (n=120), and May 2024 (n=48) from professional sex workers (PSW) and visitors of 25 bars with reports of mpox cases. In 18% and 17% of these sera, respectively, serological evidence for MPXV infection was detected, indicating that PSW played an important role in MPXV clade Ib transmission in this region. Additionally, sera from 108 direct contacts of mpox cases from 34 households were collected between September 2023 and May 2024. At least one serum sample tested seropositive in 50% of households. Serological studies are needed to comprehend the extent and severity of the ongoing MPXV outbreak, and may be used to guide targeted vaccination strategies, particularly for high-risk groups. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study received partial funding from the EDCTP funded projects GREAT-LIFE (grant numbers 101103059, laboratory training) and JUA KIVU (grant number 101195116, study design and execution). Assay development at Erasmus MC was supported through the HERA project DURABLE (grant number 101102733) and the Netherlands Organization for Health Research and Development (ZonMw, grant agreement 10150022310035). We gratefully acknowledge the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO) for their research support under the MRC-UKRI grant MC\_PC\_24001, which was awarded to local investigators, Kamituga Hospital, and the Division Provinciale de la Sante (DPS, Provincial Division of Health) in South Kivu, Bukavu. We also acknowledge the Wildlife Conservation Network (WCN) and Conservation Action Research Network (CARN) for the scholarship and research support they awarded to LMM. We would like to thank the DPS of South Kivu and Kamituga Health Zone for their collaboration during the study. Finally, the DPS acknowledges the support of the Bill & Melinda Gates Foundation [INV-078955 AIMS-NEI]. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: For the samples obtained in DRC, ethical clearance was obtained from the ethical review committee of the Catholic University of Bukavu (UCB/CIES/NC/022/2023) and a tripartite Memorandum of Understanding signed between the Provincial Health Division (Division Provinciale de la Sante, DPS), Stansile and the Erasmus MC. All participants provided informed consent. In case the participant was a minor, parental consent was obtained. The 10 validation sera were collected from laboratory workers in the Netherlands who received MVA-BN vaccination for safety reasons as employees of a Biosafety Level 3 (BSL-3) laboratory under the Erasmus Medical Center vaccination cohort (COVA) biobanking study protocol (MEC-2014-398). The protocol was approved by the Erasmus MC Medical Ethics Review Committee. Written informed consent was obtained from all study participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data from the present study are not part of public databases but are available upon reasonable request from the corresponding author. Patient-related data may be subject to patient confidentiality, or unavailable due to the use of pseudonymized data. This study used unique materials, which were custom-made for specific analyses (ELISA antigens and virus stocks). Materials are available upon reasonable request, will be released via a material transfer agreement and can otherwise be obtained via the included experimental protocols in the Methods. The consensus sequence of the clade Ib MPXV isolate is available on GISAID under the accession number EPI\_ISL\_19621388.