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What happened, where and when?
Madagascar is experiencing its first documented Mpox epidemic (clade 1b), which began in epidemiological week 51 of 2025 (endDecember 2025) and continues as an active outbreak. As of the latest situation report dated 12 January 2026, the country has recorded 228 total cases (24 conrmed by laboratory testing and 204 suspected cases) with zero deaths reported among both conrmed and suspected cases, indicating a case fatality rate of 0% to date. The outbreak originated and remains heavily concentrated in Boeny region, specically Mahajanga I district, which accounts for 150 of the 228 cases (66% of national burden) with 17 of the 24 laboratory-conrmed cases. Geographic expansion has occurred progressively since the initial detection, with cases now reported across 16 of Madagascar's 23 regions including the capital region Analamanga (16 cases, 2 conrmed), Vakinankaratra (19 cases, 4 conrmed), Betsiboka (6 cases, 1 conrmed), Diana (7 cases), and Haute Matsiatra (10 cases). The epidemic shows evidence of sustained community transmission with a laboratory positivity rate of 34.8% (24 positive results from 69 completed tests out of 106 specimens collected), and a peak occurred on 31 December 2025 with 23 cases reported in a single day. The outbreak timeline shows rapid escalation from 34 cases on 5 January 2026 to 92 cases on 8 January 2026, and subsequently to 228 cases by 12 January 2026, representing a seven-fold increase within one week. On 12 January 2026 alone, 21 new suspected cases were notied (8 in Mahajanga I, 5 in Antananarivo Renivohitra, 4 in Fianarantsoa, 2 in Atsimondrano, 1 each in Ambalavao and Soalala) with 19 specimens collected for testing, demonstrating ongoing active transmission and geographic spread toward high-population urban centers including the capital Antananarivo. The epidemic has triggered activation of Madagascar's National Emergency Operations Center (COUSP) on 9 January 2026, deployment of treatment and isolation centers across aected regions, establishment of contact tracing systems, and implementation of enhanced surveillance including a green line (910) that has received 273 calls with 9 suspected cases identied through this community reporting mechanism, demonstrating both the severity of the outbreak.