Editing Mpox (section)

===Deaths===
Historically, the [[case fatality rate]] (CFR) of past outbreaks was estimated at between 1% and 10%, with clade I considered to be more severe than clade II.<ref name="Death_Rates">{{cite journal |vauthors=Vogel L |date=August 2022 |title=Making sense of monkeypox death rates |journal=CMAJ |volume=194 |issue=31 |pages=E1097 |doi=10.1503/cmaj.1096012 |pmc=9377567 |pmid=35970550 | doi-access = free | title-link = doi }}</ref><ref name="Gessain 2022">{{cite journal |vauthors=Gessain A, Nakoune E, Yazdanpanah Y |date=November 2022 |title=Monkeypox |journal=The New England Journal of Medicine |volume=387 |issue=19 |pages=1783–1793 |doi=10.1056/NEJMra2208860 |pmid=36286263 | doi-access = free | title-link = doi }}</ref>

The case fatality rate of the [[2022–2023 mpox outbreak|2022–2023 global outbreak]] caused by clade IIb was very low, estimated at 0.16%, with the majority of deaths in individuals who were already [[Immunodeficiency|immunocompromized]].<ref>{{cite web |title=Mpox (monkeypox) – Prognosis |url=https://bestpractice.bmj.com/topics/en-gb/1611/prognosis |url-status=live |archive-url=https://web.archive.org/web/20230531173630/https://bestpractice.bmj.com/topics/en-gb/1611/prognosis |archive-date=31 May 2023 |access-date=31 May 2023 |website=BMJ Best Practice}}</ref> In contrast, {{As of|2024|April|lc=y}}, the outbreak of clade I in Democratic Republic of the Congo has a CFR of 4.9%.<ref name="pmid 38753567">{{cite journal |vauthors=McQuiston JH, Luce R, Kazadi DM, Bwangandu CN, Mbala-Kingebeni P, Anderson M, Prasher JM, Williams IT, Phan A, Shelus V, Bratcher A, Soke GN, Fonjungo PN, Kabamba J, McCollum AM, Perry R, Rao AK, Doty J, Christensen B, Fuller JA, Baird N, Chaitram J, Brown CK, Kirby AE, Fitter D, Folster JM, Dualeh M, Hartman R, Bart SM, Hughes CM, Nakazawa Y, Sims E, Christie A, Hutson CL |date=May 2024 |title=U.S. Preparedness and Response to Increasing Clade I Mpox Cases in the Democratic Republic of the Congo – United States, 2024 |journal=MMWR. Morbidity and Mortality Weekly Report | url=https://www.cdc.gov/mmwr/volumes/73/wr/pdfs/mm7319a3-H.pdf |volume=73 |issue=19 |pages=435–440 |doi=10.15585/mmwr.mm7319a3 |pmc=11115432 |pmid=38753567}}</ref>

The difference between these estimates is attributed to:
* differences in the [[virulence]] of clade I versus clade II.<ref name="pmid 38753567" />
* under-reporting of mild or [[asymptomatic]] cases in the endemic areas of Africa, which generally have poor healthcare infrastructure.<ref name="Death_Rates" />
* [[Optimal virulence|evolution]] of the virus to cause milder disease in humans.<ref>{{cite journal |vauthors=Dumonteil E, Herrera C, Sabino-Santos G |date=February 2023 |title=Monkeypox Virus Evolution before 2022 Outbreak |journal=Emerging Infectious Diseases |volume=29 |issue=2 |pages=451–453 |doi=10.3201/eid2902.220962 |pmc=9881786 |pmid=36692511}}</ref>
* better general health, and better health care, in the populations most affected by the 2022–2023 global outbreak.<ref name="Death_Rates" />