Global Mpox spread due to increased air travel

Submitted: 3 January 2024
Accepted: 4 March 2024
Published: 11 June 2024
Abstract Views: 416
PDF: 152
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Mpox is an emerging, infectious disease that has caused outbreaks in at least 91 countries from May to August 2022. We assessed the link between international air travel patterns and Mpox transmission risk, and the relationship between the translocation of Mpox and human mobility dynamics after travel restrictions due to the COVID-19 pandemic had been lifted. Our three novel observations were that: i) more people traveled internationally after the removal of travel restrictions in the summer of 2022 compared to pre-pandemic levels; ii) countries with a high concentration of global air travel have the most recorded Mpox cases; and iii) Mpox transmission includes a number of previously nonendemic regions. These results suggest that international airports should be a primary location for monitoring the risk of emerging communicable diseases. Findings highlight the need for global collaboration concerning proactive measures emphasizing realtime surveillance.



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Baker RE, Mahmud AS, Miller IF, Rajeev M, Rasambainarivo F, Rice BL, Takahashi S, Tatem AJ, Wagner CE, Wang LF, Wesolowski A, 2022. Infectious disease in an era of global change. Nat Rev Microbiol 20:193-205. DOI:
Betancort-Plata C, Lopez-Delgado L, Jaén-Sanchez N, Tosco-Nuñez T, Suarez-Hormiga L, Lavilla-Salgado C, Pisos-Álamo E, Hernández-Betancor A, Hernández-Cabrera M, Carranza-Rodríguez C, Briega-Molina M, Pérez-Arellano JL, 2022. Monkeypox and HIV in the Canary islands: A different pattern in a mobile population. Trop Med Infect Dis 7:318. DOI:
Bhatia S, Lassmann B, Cohn E, Desai AN, Carrion M, Kraemer MUG, Herringer M, Brownstein J, Madoff L, Cori A, Nouvellet P, 2021. Using digital surveillance tools for near real-time mapping of the risk of infectious disease spread. NPJ Digit Med 4:73. DOI:
Brockmann D, Helbing D, 2013. The hidden geometry of complex, network-driven contagion phenomena. Science 342:1337-42. DOI:
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R, 2022. The changing epidemiology of human monkeypox - a potential threat? A systematic review. PLoS Negl Trop Dis 16:e0010141. DOI:
Burki T, 2022. Investigating monkeypox. Lancet 399:2254-5. DOI:
Chang MC, Kahn R, Li YA, Lee CS, Buckee CO, Chang HH, 2021. Variation in human mobility and its impact on the risk of future COVID-19 outbreaks in Taiwan. BMC Public Health 21:226. DOI:
Chevallier R, Shapiro M, Engberg Z, Soler M, Delahaye D, 2023. Linear contrails detection, tracking and matching with aircraft using geostationary satellite and air traffic data. Aerospace 10:578. DOI:
Cui X, Du B, Feng J, Feng Y, Cui J, Yan C, Zhao H, Gan L, Fan Z, Fu T, Xu Z, Zhang R, Du S, Zhou Y, Tian Z, Zhang Q, Fu H, Xue G, Yuan J, 2023. Rapid detection of Mpox virus using recombinase aided amplification assay. Front Cell Infect Microbiol 13:1008783. DOI:
Damaso CR, 2023. Phasing out monkeypox: Mpox is the new name for an old disease. Lancet Reg Health Am 17:100424. DOI:
Del Valle SY, McMahon BH, Asher J, Hatchett R, Lega JC, Brown HE, Leany ME, Pantazis Y, Roberts DJ, Moore S, Peterson AT, 2018. Summary results of the 2014-2015 DARPA Chikungunya challenge. BMC Infect Dis 18:245. DOI:
Escobar LE, Qiao H, Peterson AT, 2016. Forecasting Chikungunya spread in the Americas via data-driven empirical approaches. Parasit Vectors 9:112. DOI:
European Center for Disease Control and Prevention, 2018. Rapid risk assessment: monkeypox cases in the UK imported by travellers returning from Nigeria. Available from: Accessed on: 22/08/2023.
Falendysz EA, Lopera JG, Doty JB, Nakazawa Y, Crill C, Lorenzsonn F, Kalemba LN, Ronderos MD, Mejia A, Malekani JM, Karem K, Carroll DS, Osorio JE, Rocke TE, 2017. Characterization of Monkeypox virus infection in African rope squirrels (Funisciurus sp.). PLoS Negl Trop Dis 11:e0005809. DOI:
Glidden CK, Nova N, Kain MP, Lagerstrom KM, Skinner EB, Mandle L, Sokolow SH, Plowright RK, Dirzo R, De Leo GA, Mordecai EA, 2021. Human-mediated impacts on biodiversity and the consequences for zoonotic disease spillover. Curr Biol 31:R1342-61. DOI:
González-Val R, Marcén M, 2022. Mass gathering events and the spread of infectious diseases: evidence from the early growth phase of COVID-19. Econ Hum Biol 46:101140. DOI:
Grépin KA, Ho TL, Liu Z, Marion S, Piper J, Worsnop CZ, Lee K, 2021. Evidence of the effectiveness of travel-related measures during the early phase of the COVID-19 pandemic: a rapid systematic review. BMJ Glob Health 6:e004537. DOI:
Guarner J, Rio C del, Malani PN, 2022. Monkeypox in 2022 - what clinicians need to know. JAMA 328:139-40. DOI:
Han BA, O’Regan SM, Schmidt JP, Drake JM, 2020. Integrating data mining and transmission theory in the ecology of infectious diseases. Ecol Lett 23:1178-88. DOI:
Henderson DA, Moss B. Smallpox and Vaccinia. In: Plotkin SA, Orenstein WA, editors. Vaccines. 3rd edition. Philadelphia: Saunders; 1999. Chapter 6. Available from:
Hijmans R, Van Etten J, 2021. Raster: geographic analysis and modeling with raster data, R package version 2.3-0 ed. Available from: Accessed on: 1/08/2023.
Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, Daszak P, 2008. Global trends in emerging infectious diseases. Nature 451:990-3. DOI:
Kading RC, Golnar AJ, Hamer SA, Hamer GL, 2018. Advanced surveillance and preparedness to meet a new era of invasive vectors and emerging vector-borne diseases. PLoS Negl Trop Dis 12:e0006761. DOI:
Kazda A, Badanik B, Serrano F, 2022. Pandemic vs. post-pandemic airport operations: hard impact, slow recovery. Aerospace 9:810. DOI:
Kinoshita R, Sassa M, Otake S, Yoshimatsu F, Shi S, Ueno R, Suzuki M, Yoneoka D, 2023. Impact of airline network on the global importation risk of Mpox, 2022. Epidemiol Infect 151:e60. DOI:
Kozlov M, 2022. Monkeypox outbreaks: 4 key questions researchers have. Nature 606:238-9. DOI:
Kraemer MUG, Tegally H, Pigott DM, Dasgupta A, Sheldon J, Wilkinson E, Schultheiss M, Han A, Oglia M, Marks S, Kanner J, O’Brien K, Dandamudi S, Rader B, Sewalk K, Bento AI, Scarpino SV, Oliveira T de, Bogoch II, Katz R, Brownstein JS, 2022. Tracking the 2022 monkeypox outbreak with epidemiological data in real-time. Lancet Infect Dis 22:941-2. DOI:
Li K, Yuan Y, Jiang L, Liu Y, Liu Y, Zhang L, 2023. Animal host range of mpox virus. J Med Virol 95:e28513. DOI:
Luques MN, Oliveira RL, Hir S, dos Santos Nunes D, Higa LM, Mendonça AF, Pereira LA,Sousa F, Castiñeiras TM, Tanuri A, Damaso CR, 2023. Co-circulation of vaccinia and monkeypox viruses in rural areas of Brazil: importance of differential molecular diagnosis. Travel Med Infect Dis 53:102578. DOI:
Meier BM, Bueno de Mesquita J, Burci GL, Chirwa D, Dagron S, Eccleston-Turner M, Forman L, Gostin LO, Habibi R, Negri S, Phelan A, Sekalala S, Taylor A, Villarreal PA, Yamin AE, Hoffman SJ, 2022. Travel restrictions and variants of concern: global health laws need to reflect evidence. Bull World Health Organ 100:178-178A. DOI:
Pebesma E, 2018. Simple features for R: standardized support for spatial vector data. R J 10:439-46. DOI:
Pliakos EE, Andreatos N, Shehadeh F, Ziakas PD, Mylonakis E, 2018. The cost-effectiveness of rapid diagnostic testing for the diagnosis of bloodstream infections with or without antimicrobial stewardship. Clin Microbiol Rev 31:e00095-17. DOI:
R Core Team, 2021. R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. Available from:
Schafer M, Strohmeier M, Lenders V, Martinovic I, Wilhelm M, 2014. Bringing up OpenSky: a large-scale ADS-B sensor network for research. In: Proceedings of the 13th International Symposium on Information Processing in Sensor Networks, Berlin, Germany, 2014, pp. 83-94. DOI:
Seang S, Burrel S, Todesco E, Leducq V, Monsel G, Le Pluart D, Cordevant C, Pourcher V, Palich R, 2022. Evidence of human-to-dog transmission of monkeypox virus. Lancet 400:658-9. DOI:
Shi S, Tanaka S, Ueno R, Gilmour S, Tanoue Y, Kawashima T, Nomura S, Eguchi A, Miyata H, Yoneoka D, 2020. Travel restrictions and SARS-CoV-2 transmission: an effective distance approach to estimate impact. Bull World Health Organ 98:518-29. DOI:
Simpson K, Heymann D, Brown CS, Edmunds WJ, Elsgaard J, Fine P, Hochrein H, Hoff NA, Green A, Ihekweazu C, Jones TC, Lule S, Maclennan J, McCollum A, Mühlemann B, Nightingale E, Ogoina D, Ogunleye A, Petersen B, Powell J, Quantick O, Rimoin A, Ulaeato D, Wapling A, 2020. Human monkeypox - after 40 years, an unintended consequence of smallpox eradication. Vaccine 38:5077-81. DOI:
Sott MK, Bender MS, da Silva Baum K, 2022. COVID-19 outbreak in Brazil: health, social, political, and economic implications. Int J Health Serv 52:442-54. DOI:
Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, Palich R, Nori A, Reeves I, Habibi MS, Apea V, Boesecke C, Vandekerckhove L, Yakubovsky M, Sendagorta E, Blanco JL, Florence E, Moschese D, Maltez FM, Goorhuis A, Pourcher V, Migaud P, Noe S, Pintado C, Maggi F, Hansen A-BE, Hoffmann C, Lezama JI, Mussini C, Cattelan AM, Makofane K, Tan D, Nozza S, Nemeth J, Klein MB,Orkin CM, 2022. Monkeypox virus infection in humans across 16 countries - April-June 2022. N Engl J Med 387:679-91. DOI:
Vaughan A, Aarons E, Astbury J, Brooks T, Chand M, Flegg P, Hardman A, Harper N, Jarvis R, Mawdsley S, McGivern M, Morgan D, Morris G, Nixon G, O’Connor C, Palmer R, Phin N, Price DA, Russell K, Said B, Schmid ML, Vivancos R, Walsh A, Welfare W, Wilburn J, Dunning J, 2020. Human-to-human transmission of monkeypox virus, United Kingdom, October 2018. Emerg Infect Dis 26:782-5. DOI:
UNDESA, 2022. World population prospects. Available from: Accessed on: 16/05/2023.
World Health Organization, 2022. Monkeypox - United Kingdom of Great Britain and Northern Ireland. Available from: Accessed on: 1/08/2023.

How to Cite

Qiao, H., Paansri, P., & Escobar, L. E. (2024). Global Mpox spread due to increased air travel. Geospatial Health, 19(1).