Molecular epidemiological surveillance of monkeypox virus in Indonesia from 2023 to 2024.

Monkeypox (mpox) has re-emerged as global public health concern including in several non-endemic countries. This study aims to characterize monkeypox virus (MPXV) genomes in Indonesia, to explore viral evolution and transmission. Genomic analysis was conducted on 53 isolates from Indonesian mpox patients between 2023 and 2024. All sequences belonged to Clade IIb, with identified sub-clades including A.1.1, B.1, B.1.3, and C.1 - of which C.1 became dominant during this period. Out of 87 mpox-confirmed cases, 60.9% (53/87) were successfully sequenced and submitted to the Global Initiative on Sharing All Influenza Data (GISAID). The majority of cases in Indonesia occurred among males (95.4%), men who have sex with men (59.8%), and people living with HIV/AIDS (71.3%). Notably, a large portion of cases had no travel history, suggesting local transmission. Initially, only clade IIb (B.1) was detected in October 2022. By August 2023, lineage diversity had increased, with B.1.3 and C.1 emerging as the predominant sub-clades. A time-calibrated phylogenetic tree revealed genetic relatedness and shared ancestry within clade IIb. Integrating genomic and epidemiological data offers valuable insights to improve mpox surveillance and public health response in Indonesia and the broader region.