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SURVEILLANCE SUMMARY A total of 25,177 cases of monkeypox have been identified through IHR mechanisms and official public sources up to 19 October 2022, 14:00, from 45 countries and areas throughout the European Region. Case-based data were reported for 25,036 cases from 41 countries and areas to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy), up to 19 October 2022, 10:00. Of the 25,036 cases reported in TESSy, 24,863 were laboratory confirmed. Furthermore, where sequencing was available, 464 were confirmed to belong to Clade II, formerly known as the West African clade. The earliest known case has a specimen date of 07 March 2022 and was identified through retrospective testing of a residual sample. The earliest date of symptom onset was reported as 17 April 2022. The majority of cases were between 31 and 40 years-old (9,859/24,992- 39%) and male (24,576/24,977- 98%). Of the 10,802 male cases with known sexual orientation, 96% self-identified as men who have sex with men. Among cases with known HIV status, 38% (3,787/10,064) were HIV-positive. The majority of cases presented with a rash (14,825/15,525- 96%) and systemic symptoms such as fever, fatigue, muscle pain, chills, or headache (10,531/15,52568%). There were 736 cases hospitalised (6%), of which 247 cases required clinical care. Five cases were admitted to ICU, and four cases of monkeypox were reported to have died. To date, WHO and ECDC have been informed of five cases of occupational exposure. In four cases of occupational exposure, health workers were wearing recommended personal protective equipment but were exposed to body fluid while collecting samples. The fifth case was not wearing personal protective equipment. The WHO interim guidance on clinical management and infection prevention and control for monkeypox remains valid and is available at https://apps.who.int/iris/handle/10665/355798.